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TREATMENT
Many liposuction procedures can be done in the physician's office-based operating room, or an outpatient hospital operating room. Liposuction is a surgical procedure that vacuums out fat from beneath the skin's surface to reduce fullness in certain areas. Patients having large amounts of fat removed or cosmetic procedures in addition to liposuction spend the night in the hospital after surgery.
The technique used for your liposuction surgery depends on you and your particular problem area, your surgeon's preference, the location and number of areas to be treated and the amount of fat to be removed. The most commonly used techniques today include:
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Tumescent and super-wet.
Basic liposuction involves infusing the area to be treated with a solution of saline; lidocaine, an anesthetic; and epinephrine, a drug that constricts blood vessels to curb bleeding. The difference between techniques is the total amount of fluid used. In the tumescent technique, the solution used is two to three times the amount of fat to be removed. In the super-wet technique, the amount of fluid infused is same as the amount of fat slated for removal. Which version of these two techniques is used depends on your surgeon's preference and judgment regarding which is best for you.
What kind of anesthesia is used for these techniques also depends on the amount fat to be removed, and your surgeon's preferences and medical judgment pertaining to what is best for you. Because the large volume of fluid used in the tumescent technique includes an anesthetic, your surgeon may not administer additional anesthesia before the procedure, especially when a small amount of fat is to be removed, such as 1.5 liters or less from one or two areas on the body. In such cases, a sedative in pill form may be given to relax you before surgery begins. Because the super-wet technique uses less anesthesia-containing fluid, additional anesthesia, such as an intravenous sedation, an epidural block or general anesthesia may is used. General anesthesia is more common when large amounts of fat, such as more than 1.5 liters, are to be removed, and/or multiple areas on the body, such as thighs and hips, are to be treated.
In these fluid infiltration techniques, a thin metal tube is inserted into the fat layer beneath the skin in the area to be treated. This tube is attached to an infusion pump, which pumps the solution into the area. This tube is removed and, after waiting for the anesthesia in the solution to take effect, an incision is made into the skin to accommodate a hollow tube that ranges in size from 2 to 6 millimeters (mm) in diameter. This tube, called a cannula, is attached to a vacuum. The cannula is inserted through the incision into the fat layer beneath the skin. It is moved through the fat layer in a push-and-pull motion to break up the fat and suck it out of the body.
The surgeon may make two to more incisions in each area for insertion of the cannula in different locations in the treatment area to suction out fat from different directions. Using a crisscross technique helps avoid creating tunnels in the fat that would result in wavy-looking skin irregularities after surgery.
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Ultrasound-assisted.
This technique uses the same basic preparation as tumescent and super-wet liposuction, but employs a different type of cannula that emits ultrasound waves at its tip to liquefy the fat, and then suctions it out of the body. The cannula may be larger in diameter, 4 mm to 5 mm.
When the ultrasonic energy hits the fat, the high-frequency vibrations explode the fat cells. The fat mixes with body fluids and the infused solution, and is sucked out of the body using suction. Some surgeons say this technique results in less trauma to surrounding tissue and, therefore, less bleeding, bruising and postoperative discomfort. Surgeons favoring this technique also say they have better control.
According to the American Society for Dermatologic Surgery, disadvantages to the ultrasound-assisted liposuction procedure may include a more obvious scar due to a larger opening required for insertion, and a higher incidence of complications, such as skin burns and seromas (a collection of body fluid causing swelling).
Like other liposuction techniques, anesthesia for ultrasound-assisted liposuction varies from local to general, depending on the individual patient, how much fat is to be removed and the surgeon's preference.
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Power.
Using the same basic techniques as tumescent and super-wet liposuction, power liposuction, also called power-assisted liposuction, involves use of a motorized cannula. In addition, the surgeon physically moving the cannula back and forth through the fat to help break it up while suctioning, the cannula moves or vibrates itself under electrical or nitrogen power, moving short stroke distances of 2 mm to 3 mm. Meanwhile, the surgeon manipulates the direction of the cannula. Surgeons favoring this new technique say it permits them to perform the procedure faster and with more precision, resulting in less trauma to surrounding tissues, and therefore, less bruising and discomfort and quicker recovery times. Power liposuction often is performed under a sedative and anesthesia in the infused fluid or general anesthesia.
Because liposuction vacuums out body fluids along with fat, patients should have intravenous fluid replacement while undergoing liposuction to prevent dehydration and shock.
After the procedure is complete, the incisions may be closed either with butterfly bandages or stitches, or left open to permit drainage, depending on the size of the cannula used. A compression garment is then placed over the body area treated. For a hip and thigh treatment, for example, a girdle-type garment is used. The purpose of the garment is to smooth the treated area to help healing so the skin appears flat and to help control swelling. Patients must wear the garment 24 hours a day for one to six weeks after surgery. Your health care professional also may give you a prescription for postoperative pain, such as acetaminophen with codeine. An antibiotic also may be prescribed.
Patients usually are told to rest for at least two days after surgery. Many patients have their surgery on a Friday morning, return home in that afternoon, rest over the weekend, and resume work on Monday. Normal exercise and activities can be resumed in about two weeks. A follow-up visit to check on progress and remove any stitches is usually required five days to a week after surgery.
Common temporary postoperative side effects of liposuction are bruising, swelling and numbness of the skin in the area treated. They usually are temporary and subside in six weeks or less. Swelling, however, may take as long a six months to disappear.
Although it is usually done on an outpatient basis, and may be performed in your health care professional's office surgical suite, you must recognize that liposuction is still surgery, and all surgeries carry risks, including death.
Among the extremely rare, potentially life-threatening complications are:
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anesthesia-related problems, such as breathing difficulties and fluid in the lungs
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blood clots or fat clots that can migrate to the lungs
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perforation of organs with the cannula
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burning of tissues in ultrasound-assisted liposuction
Uncommon complications, occurring in less than one percent of patients, are:
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bleeding
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excessive bruising
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infection
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seromas, or pockets of fluid collection under the skin, also can occur when large amounts fat are removed, but usually can be treated in an office setting by draining with a needle and syringe (seromas tend occur more often with ultrasound-assisted liposuction)
More common complications include:
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irregularities in contour, such as lumps or divots where too little or too much fat was removed
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asymmetry, where the contour differs on each side of the body
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skin irregularities, such as loose, baggy or wavy skin
Many of the complications can be the result of poor surgical technique, lack of experience in the procedure or poor patient selection. Contour and symmetry problems can require additional, touch-up liposuction surgery, know as revision surgery. Various studies in the medical literature have reported revision rates ranging from five percent to 20 percent, depending on the type of patient, the number of areas treated at one time and how much fat was removed. Most experienced liposuction surgeons today report revision rates of about two percent for fit patients having a small amount of fat removed from a single area. The revision rate may rise to six percent for patients who are 20 to 30 pounds overweight having multiple body areas treated and a large amount of fat removed. A small amount of fat is considered less than 1.5 liters, while a large amount is 4 to 5 liters. Removing more than 5 liters of fat in a single liposuction treatment is considered too risky by most surgeons as an office procedure.
