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Frequently
Asked Questions - Liposuction
Introduction - Liposuction:
Liposuction, also called suction assisted lipectomy, is one of
the most common cosmetic procedures performed in the United
States. The procedure is done to remove or minimize pockets of
fat throughout the body. It is not a procedure to be used for
weight loss. The areas that are typically treated are the
abdomen, hips, waist, back, inner thighs, outer thighs, inner
knees, upper arms, and neck. Both male and female's breasts can
also be suctioned if they are larger than desired. The technique
involves making very small incisions, injecting the area with a
fluid that contains anesthetic and epinephrine (to minimize
bleeding), and then introducing a metal cannula for the
suctioning. The cannula has one or more holes at the end of it
and is attached at the other end to a vacuum that literally
sucks out the fat after it has been broken up by the tip of the
cannula. The goal of the procedure is not to remove all the fat,
but to contour the body to give it a more aesthetic shape.
Who is a candidate for liposuction?
Liposuction is performed on adults of all ages. The typical
patient is a male or female between the ages of 20 and 50.
Patients who have areas on their body with an excess of fat,
somewhat out of proportion to the rest of the body, are good
candidates. People who are significantly overweight are not good
candidates for liposuction. Most patients are healthy and
exercise regularly but cannot lose fat in certain areas of their
body regardless of how much they exercise. In men, the most
common areas are the abdomen and "love handles". In women, the
inner and outer thighs, including the "saddlebags", are very
common areas to have treated.
Are there any people who should not have liposuction?
Patients who are obese or require a large amount of weight loss
are not good candidates. Those with significant medical problems
and heavy smokers are also not good candidates. Smokers should
stop smoking at least 2 to 4 weeks before this or any other
surgery.
Can liposuction be done on the same area later, if the results
aren't perfect?
Liposuction can be redone in areas if not enough fat was
removed, or if there is a significant weight gain and the
remaining fat cells have grown significantly.
Can liposuction be done on male breasts?
Liposuction is an excellent treatment method for gynecomastia, a
condition where a male's breasts grows out of proportion to the
remainder of the body. Excellent results can be achieved.
Ultrasound liposuction is often used because the male breast
tissue can be rather fibrous and hard. Using the ultrasound,
makes it easier to break up the tissue to remove it.
When will I see the final results?
It generally takes one to three months for all of the swelling
to be gone to be able to see the final contour.
How long do the results last?
As long is your diet is maintained, the results will last
forever. Obviously, your body will still go through the normal
changes with age.
Will the fat come back worse somewhere else?
The fat cells that are removed are gone forever and will not be
replaced. Areas that are not liposuctioned will have the same
number of cells as always. Any remaining fat cells in the body,
whether in the areas that where liposuctioned or in other areas,
can and will get bigger only if a significant amount of weight
is gained. The body does not make new fat cells somewhere else
to make up for the ones that were removed.
What are the potential risks with this type of surgery?
The most common complications of liposuction include contour
deformities from taking out too much or too little fat,
asymmetry, rippling of the skin, developing a fluid collection (seroma),
and noticeable scars. Liposuction is real surgery and serious
complications like fluid overload and even death can result. A
risk of ultrasound liposuction is burns on the skin.
Does it matter what kind of doctor I go to for this type of
surgery?
It is very important to go to a plastic surgeon who has
experience with liposuction and who trained at a reputable
medical center. There are physicians of many different
specialties who have started to do liposuction in the last few
years even though they were not formally trained in the
technique. This includes some dermatologists, gynecologists,
general surgeons, and even internal medicine doctors. The
potential dangers of liposuction are very real and the procedure
should not be taken lightly simply because it is so common. A
weekend training course does not provide enough training for a
physician to be competent in the technique.
What type of anesthesia is used?
The procedure can be performed either under general anesthesia
or local anesthesia with sedation. Which one is used depends on
surgeon and patient preference. If a large volume of fat is to
be removed, general anesthesia is the safer way to go.
What are the different techniques used for liposuction?
Generally speaking, the actual technique of moving the cannula
back and forth is not very different from one doctor to another.
What does vary is the judgment and experience of the surgeon,
who has to decide how much fat to remove and where to remove it.
There are different machines that can be used. Some surgeons use
standard liposuction equipment while others use either external
or internal ultrasound to help break up the fat before it is
suctioned. Dr Wigoda typically used ultrasonic liposuction.
Are there advantages to using ultrasound?
Ultrasound is particularly useful in areas that are more
fibrous, like the back or in male breasts, or in patients who
are having liposuction done a second time, who will have more
scarring on the inside. Generally speaking, the surgery is less
labor intensive for the surgeon because the ultrasound breaks up
the fat, whereas with standard liposuction, the tip of the
cannula has to cut the fat. Dr Wigoda feels that he can often
remove more fat with the ultrasound than with standard
liposuction.
Why is fluid injected into the fat area before doing the
liposuction?
The fluid that is injected contains lidocaine, an anesthetic,
and epinephrine, a vasoconstrictor. Use of this solution
decreases the amount of blood loss from the procedure to the
point that it is minimal. The lidocaine is needed if the
procedure is done under local anesthesia with sedation. It also
will help to reduce the pain after surgery to some degree.
Where are the incisions made?
The location of the incisions will vary depending on what area
is to be liposuctioned. Generally, for each area, one or two
incisions are made and they are placed in a spot where they will
not be very noticeable.
What does tumescent mean?
Tumescent is a term used to describe a technique used where a
large amount of fluid is injected into the area to be suctioned
and minimal sedation is required or used. The anesthesia comes
from the lidocaine in the solution.
How long is the incision? Will it be noticeable?
Incisions for standard liposuction measure about 5 millimeters.
Those for internal ultrasound are closer to 8 to 10 millimeters.
They are generally placed in spots where they will be hidden but
occasionally they will be visible, particularly in areas like
the back.
How long does the surgery take?
The procedure can take anywhere from 30 minutes to 6 hours
depending on how much fat is taken and how many areas are
suctioned.
How much fat can be removed?
The volume of fat to be removed can vary significantly from one
patient to another. It can range from only a few hundred cc's (a
can of coke is about 450 cc) to many liters (even up to 10
liters or 10,000 cc). The average amount removed is in the range
of 1500 to 3000 cc. Very large liposuction procedures should be
done in a hospital with an overnight stay for monitoring.
Can the removed fat be injected into other areas of the body?
Fat can be used as a filler and injected either into contour
defects (like in the legs) or more commonly, injected into the
face. This is done to rejuvenate the face where the fat in the
cheek has atrophied or descended. It can also be injected into
the lips to "plump" up the lips. Any fat that is to be
reinjected needs to be suctioned manually with a special cannula
and treated gently by the surgeon if it is to survive.
How much fat that is re-injected actually survives in the long
run?
Generally much more fat is injected than is needed to fill a
defect because only a small portion will survive. This will
range from none to 50% of what is injected.
Can the fat be injected into a female's breasts to make them
larger?
While it is technically possible and is done on occasion in
other countries, injecting fat into a woman's breasts is not a
good idea. In the vast majority of cases, it will not last. It
can also become calcified (hard) and cause changes in a
mammogram that would make it difficult to tell whether a cancer
was growing or if it was just necrotic and calcified fat.
What happens before I have the surgery?
You will first have a consultation with Dr. Wigoda to discuss
your particular case. Once you have decided to proceed with the
surgery and have scheduled a date, you will return for a second
visit at which time Dr. Wigoda will review the surgery with you,
photos will be taken, consent forms will be signed, and further
instructions and prescriptions will be provided. Full payment is
made prior to surgery (or financing is arranged). You will have
lab tests drawn and an electrocardiogram done by your primary
care physician (or we will recommend where to do this) one to
two weeks prior to the surgery.
What happens on the day of surgery?
You will arrive at the office surgery center. You will not have
eaten or drank anything since midnight the night before. You
will be checked in and your vital signs will be taken. You will
put on a gown. An intravenous line will be started. Dr Wigoda
will mark the areas to be treated with a marker. You may be
given a sedative in your I.V. to help you relax before you are
taken back to the operating room.
What happens after surgery?
Dressings and a garment or binder is applied. You will recover
for 1 to 2 hours in the recovery room. You will then be driven
home by a friend or family member. Your activities will be
slightly limited for the first few days. It is possible to have
some fluid leak out of the incisions for the first 48 hours. It
is advisable that you not drive for at least 1 to 2 days after
surgery. As the pain and swelling decreases you will be able to
resume normal activities. Dr Wigoda will allow you to resume
strenuous exercise after 3 to 4 weeks.
How much bruising, swelling, and pain is there?
After surgery, it is expected that the areas treated will have a
moderate amount of swelling. Most of the swelling will resolve
over 2 to 4 weeks. There is typically some bruising that
resolves over 1 to 3 weeks. The amount of pain post-operatively
is very patient dependent. Some patients will experience mild
discomfort. It is unusual to have significant pain. The vast
majority of patients report the pain as tolerable. For the most
part, all of the pain and discomfort resolves completely with
time, generally 2 to 4 weeks.
When can I get back to work? When can I drive a car?
For sedentary work with minimal physical activity you can expect
to go back after 1 to 3 days. For moderate activity, it will
take about 3 to 5 days to be comfortable. It will take 1 to 3
days to be able to drive safely, depending on your pain
tolerance and how much pain medication you are taking (if any).
Will there be stitches that have to come out?
Dr Wigoda will remove the sutures after approximately 7 days.
When can I resume sexual relations?
You may want to wait at least one to two weeks until the
soreness diminishes sufficiently. Early sexual activity may
prolong your soreness and discomfort.
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