Overview of Liposuction
Liposuction — also known as suction-assisted lipectomy — is one of the most common cosmetic surgeries carried out around the world. It’s a procedure that modifies the shape of the body, using a vacuum to remove fat that lies just beneath the skin in specific areas of the body. However, it’s important to note that liposuction is not meant to be a method for losing weight.
Since it was first introduced in the early 1980s, liposuction has seen a range of improvements in both technology and procedure. This includes the use of lasers and ultrasound. Some of these advancements will be explained below.
Anatomy and Physiology of Liposuction
Understanding how fat is organized beneath the skin is essential for safely and effectively performing liposuction procedures. When we look at the body, there are two primary areas where fat is stored: the “shallow” or superficial layer, and the “deep” layer. These layers are usually separated by a thin layer of connective tissue, which can be different depending on the body part.
However, it’s crucial to know that the superficial layer, although often targeted for fat removal, is also the most at risk for complications from liposuction. These include uneven skin texture or disturbances in blood flow to the area. To avoid these complications, it’s necessary to avoid overly aggressive liposuction in this area and ensure that the surgical tools don’t touch the skin directly.
The composition of the fat in these areas can also differ. For example:
* Fibrous fat tissue, usually found in the superficial layers, is harder to break up for liposuction because it’s denser and more structured.
* Areolar fat, which is deeper and looser with less tough material between the fat cells, is more suitable for liposuction.
There are specific areas where the fat layer sticks more closely to the muscle beneath, which are known as zones of adherence (ZOAs). During liposuction, it’s important to avoid these areas to reduce the risk of leaving the skin with an uneven appearance. ZOAs include: the side of the buttocks, the crease of the buttocks, the back and side of the thigh close to the knee, the middle of the inner thigh and the side of the hip and thigh.
Why do People Need Liposuction
Liposuction is mostly considered a cosmetic procedure that is decided on by choice, rather than being medically necessary. This means it’s important that the doctor is certain that the person getting the procedure will benefit from it.
So, there are a few things that indicate if someone is suitable for liposuction. These are known as indications. Here’s what they typically look like:
Firstly, the person should have extra fat that’s causing noticeable changes in the shape of their body. This extra fat is typically in specific regions of the body.
Secondly, the person should ideally be within 30% of their normal Body Mass Index (BMI). BMI is just a way of measuring whether a person’s weight is healthy for their height.
Thirdly, the best candidates for liposuction often have a somewhat normal weight. They should also have minimal to moderate amounts of extra fat tissue, and their skin should be somewhat tight, not loose.
Finally, it’s also important that the person’s weight hasn’t fluctuated too much in the last six to twelve months. This means their weight should have been generally the same for at least half a year leading up to the surgery.
When a Person Should Avoid Liposuction
Doctors should always get detailed information about a patient’s medical and social background, including checking if they use alcohol or tobacco products.
For the best results, patients planning on having a procedure should quit smoking at least four weeks before. This not only helps with the healing process but also minimizes the chances of complications.
One serious complication that can result from liposuction is a condition known as a deep vein thrombosis (DVT). This is a blood clot that could potentially move to the lungs and cause a life-threatening condition known as a pulmonary embolism (PE). Therefore, doctors make efforts to figure out if a patient is at risk of a DVT/PE before the procedure, by using a risk assessment tool called the Caprini score.
What’s more, studies have shown that up to 15% of patients seeking cosmetic surgery may have body dysmorphic disorder (BDD). This is a mental health condition where a person is excessively concerned about a perceived flaw in their appearance, even when there’s nothing really wrong. If a doctor suspects a patient has BDD, based on certain signs or findings during the initial interview, or they think they have unrealistic expectations, the patient should not have surgery until they have been assessed by a mental health expert like a psychiatrist.
Equipment used for Liposuction
Since the discovery of fat removal surgery, also known as liposuction, there have been several changes to the tools (cannulas) used. In the past, these cannulas were sharp with only one opening but nowadays, they are dull and have multiple openings near their ends. This means that they pose a lower risk of accidentally puncturing into important parts of the body such as the layer lining the inside of the abdomen (pleura), deep throat spaces, or the layers lining the abdominal cavity (peritoneum). They also help to reduce blood loss during the operation.
The function of the cannula is to separate fat cells from the fibrous connective tissue (stroma) holding them, allowing the fat to be sucked out. A larger cannula is capable of removing more fat, but it also causes more indirect damage and blood loss compared to a smaller one. The type and size of the cannula used may differ based on the surgeon’s preferred method and the area being targeted for liposuction. Body liposuction, submental (under the chin) liposuction, face liposuction, and liposuction for fat grafting (relocating fat to another area) will have different cannulas.
The type of fat extraction device used for liposuction depends on how much fat needs to be removed and what it will be used for. For example, if it’s intended for fat grafting (moving fat to a different part of the body), high-pressure suction devices are usually avoided to prevent damaging the fat. If only a small amount of fat needs to be removed, say, for adding fat to the face, a manual syringe might be used. The process of removing fat involves a delicate balance of physical forces, with the cannula providing the most resistance to the flow of fat being suctioned out.
A technique often used in liposuction is the application of a wetting solution (also called tumescent solution) made of diluted lidocaine and epinephrine. This solution is inserted under the skin before liposuction occurs. For example, if 50 cc of fat are planned to be removed from the abdomen, then 50 cc of the tumescent solution is administered prior to the operation.
Who is needed to perform Liposuction?
When you get liposuction, which is a procedure to remove excess fat, the doctor who puts you to sleep (anesthesiologist) has to pay close attention to your body’s fluid levels. This is because liposuction causes changes to these levels. The solution used during liposuction to help break down fat cells may end up finding its way into your bloodstream after the procedure. It has been shown that only about 30% of this solution is removed during the procedure itself.
There are guidelines for managing body fluids during liposuction which can be helpful for your anesthesiologist. These guidelines state that if the total volume of fat and fluid removed (lipoaspirate) during the surgery is less than 4 liters, then normal fluid management routines can be continued. However, if the amount removed exceeds 4 liters, additional fluids have to be given. This involves giving 0.25 mL of a special type of fluid (crystalloid) for every 1 mL of fat and fluid removed beyond the initial 4 liters.
This is especially important for surgeries where large amounts of fat are removed and large volumes of the fat-dissolving solution are used. Even though the areas below the head and neck can handle large volume liposuction procedures, there is a need for the surgeon and the anesthesiologist to be watchful for any signs of instability in your heart rate and blood pressure or signs of an allergic reaction to the local anesthetic used.
Preparing for Liposuction
Before any cosmetic procedure, taking photographs is very important. These photos help doctors plan the surgery and can also help if any patient is not happy with the results of the operation. It’s also important for the doctor to use a marker to indicate on the patient’s body where they will be removing excess fat during the surgery.
Before the surgery starts, the doctor needs to double-check all the equipment is there and that everything is working as it should. If the patient has any concerns, it’s important they discuss these concerns with the doctor. This should happen before the operation begins, regardless of whether the patient will be asleep (using general anesthesia) or awake but numb (using local anesthesia) for the surgery.
Next, a wetting solution is applied to the areas where the fat will be removed. This has to be left to work for about 15 to 30 minutes. This allows the blood vessels to shrink (vasoconstriction) and the area to become numb (anesthesia). After this, the patient is covered with sterile cloths that only show the specific operation area.
In operations where a large amount of fat is being removed, the patient will need to be put in different positions at different stages of the surgery. For example, they might need to lie on their back (supine), on their front (prone), or on their side (lateral decubitus). When removing fat from the trunk area, some surgeons put the patient in a gentle jack-knife position. This helps to avoid any accidental tissue damage during the surgery.
How is Liposuction performed
Liposuction is a type of surgery that removes fat from the body. There are several methods a surgeon might use to do this operation, but they all generally follow the same steps:
The surgeon makes small openings in your skin using a surgical knife. They will then insert a thin tube, known as a cannula, into these openings. The surgeon controls the cannula with one hand while using their other hand to feel your skin and make sure the cannula is at the right depth. It should be just underneath the top layer of fat. If you see your skin dimpling, it means the tube is too close to the surface, which could cause lumps or bumps in your skin after the surgery.
Sometimes, the surgeon uses traditional suction-assisted liposuction (SAL) to help vacuum out the fat. This is the most common method. However, there are new, more modern techniques they might use, too.
Power-assisted liposuction (PAL) is one such modern technique. It uses a cannula attached to a motor that moves the cannula back and forth. This makes removing the fat easier and quicker.
Another new method is ultrasound-assisted liposuction (UAL). This technique uses ultrasound waves from the cannula to break down the fat cells, which can then be suctioned out. It’s designed to help the surgeon remove the fat more efficiently.
Alternatively, the surgeon might use laser-assisted liposuction (LAL). This employs a laser from the cannula to break down the fat. This method also tends to be very efficient at reducing fat.
No matter which method is used, the surgeon will continue the procedure until they can’t feel any more significant fat deposits in the target area.
Doctors are still debating which of these techniques is best. Current research suggests that the newer methods, like UAL and LAL, may not be significantly better than the traditional SAL method. However, there may be specific situations where UAL and LAL are more advantageous. For example, UAL may be more effective than SAL for treating enlarged male breasts. LAL and UAL can also be better at reducing blood loss during large-volume liposuction. Moreover, LAL might be the best option for tightening skin in the area under the chin.
Remember that every person’s body is different, so the effectiveness of these techniques can vary. Your doctor will work with you to determine the best option for your body and your health.
Possible Complications of Liposuction
Before going through a procedure like liposuction, it’s important to understand that complications can happen. Here are some of the common ones:
1. Bruising and changes in body shape: After the procedure, you might notice some bruising around the area where the fat was removed. This is normal and might take a week or two to go away. You could also have swelling, which can take a bit longer to get better – even several weeks. Your final body shape might not be apparent until the swelling has gone.
2. Seroma (fluid accumulation): Sometimes, pockets of fluid can form under the skin after surgery.
3. Temporary weight gain: After the procedure, you may notice a bit of weight gain. This is temporary.
4. Numbness or tingling: This is a feeling of “pins and needles” around the surgical area and is fairly common.
In rare cases, liposuction can cause more serious issues like fat clots in the lungs (fat emboli), which can make it hard for you to breathe, blood clots in the leg (deep vein thrombosis or DVT) that cause leg swelling and pain, and blood clots that travel to your lungs (pulmonary embolism). These serious complications can be life-threatening and need immediate medical attention.
Doctors take steps to prevent complications – for example, they may prescribe medications to prevent blood clots and advise you to start moving around as soon as you can after the procedure.
In liposuction, a local anesthetic called lidocaine is used to numb the area. Even though the dosage can be safely pushed to high amounts, there’s still a chance of too much lidocaine causing problems. If you’re fully asleep under general anesthesia, early indications of lidocaine overdose (such as mouth numbness and ringing in the ears) might not be noticeable until it starts to affect your heart.
If lidocaine overdose does happen, doctors will stop giving the anesthetic immediately, give you oxygen, medicines to prevent or control seizures, and a lipid emulsion infusion, which is a type of fat-based treatment that can help your body to handle the overdose.
What Else Should I Know About Liposuction?
Liposuction is a widely sought-after cosmetic surgery that removes excess fat from certain parts of the body. It’s important for everyone in the healthcare team to have a strong understanding of the basic principles behind this procedure. A solid grasp of how it works not only helps in taking care of patients who undergo this surgery, but also in enhancing the visual results and dealing with any complications that might arise during their treatment and recovery.
