Liposuction, or simply lipo, is a type of cosmetic surgery that removes fat from the human body in an attempt to change its shape. Evidence does not support an effect on weight beyond a couple of months and it does not appear to affect obesity related problems.
Serious complications include deep vein thrombosis, organ perforation, bleeding, and infection. Death occurs in about one per ten thousand cases. The safety of the technique relates not only to the amount of tissue removed, but to the choice of anesthetic and the person's overall health. Several factors limit the amount of fat that can be removed in one session. Negative aspects to removing too much fat include "lumpiness" in the skin.
Areas operated on can include the abdomen, thighs, buttocks, and backs of the arms. The procedure may be performed under general, regional, or local anesthesia. It then involves using a cannula and negative pressure to suck out fat. It is believed to work best on people with a normal weight and good skin elasticity.
While the suctioned fat cells are permanently gone, after a few months overall body fat generally returned to the same level as before treatment. This is despite maintaining the previous diet and exercise regimen. While the fat returned somewhat to the treated area, most of the increased fat occurred in the abdominal area. Visceral fat - the fat surrounding the internal organs - increased, and this condition has been linked to life-shortening diseases such as diabetes, stroke, and heart attack.
In the United States it is the most commonly done cosmetic surgery.
Video Liposuction
Uses
Liposuction is generally used in an attempt to change the body's shape. Weight loss from liposuction appears to be of a short term nature with little long term effect. After a few months fat typically returns and redistributes. Liposuction does not help obesity related metabolic disorders like insulin resistance.
Maps Liposuction
Side effects
- Bruising: can be painful in the short term, and should fade after a few weeks.
- Swelling (medical): should subside gradually over a month or two.
- Scars: will vary in size depending on the particular procedure, and should fade over the weeks. Scarring is an individual thing, partly dependent on heredity. For some, scar healing may take as long as a year.
- Pain: should be temporary and controlled by either over-the-counter medication or by a prescription, but may last forever.
- Numbness: sometimes persists for a few weeks or be permanent.
- Post-operative weight gain
- Limited mobility: will depend on the exact procedure.
There could be various factors limiting movement for a short while, such as:
- Wearing a compression garment
- Keeping the head elevated
- Temporary swelling or pain
Complications
There is a spectrum of complications that may occur due to liposuction -- risk is increased when treated areas cover a greater percentage of the body, incisions are numerous, a large amount of tissue is removed, and concurrent surgeries are done at the same time.
When done using local anesthesia the risk of side effects appear less than with general anesthesia. In Europe between 1998 and 2002, 23 deaths mostly from infection occurred.
The more serious possible complications include:
- Death
- Allergic reaction to medications or material used during surgery.
- Infection: any time the body is incised or punctured, bacteria can get in and cause an infection. During liposuction, multiple small puncture wounds are made for inserting the cannula that can vary in size depending on the technique.
- Seroma: Sometimes the entrapped liquified fat may get accumulated beneath the subcutaneous plain as a seroma. Small seromas get absorbed spontaneously, but larger seromas need aspiration to avoid secondary infection.
- Damage to the skin: most surgeons work on the deeper levels of fat, so as to avoid wounding the skin any more than they must for the insertion of the cannula.
- Sometimes the cannula can damage tissue beneath the skin, which may show up as a spotted appearance on the skin surface.
- Skin necrosis (dead skin) is a rare complication, in which the skin falls off in the necrotic area. The problem can vary in degree. The resulting wound then needs to heal typically requiring extended wound care.
- Puncture of an internal organ: since the surgeon cannot see the cannula, sometimes it damages an internal organ, such as the intestines during abdominal liposuction. Such damage can be corrected surgically, although in rare cases it can be fatal.
- Contour irregularities: sometimes the skin may look bumpy and/or withered, because of uneven fat removal, or poor skin elasticity. Not all patients heal in the same way, and with older patients the healing may be slower and a bit imperfect.
- Thromboembolism and fat embolism: although liposuction is a low-risk procedure for thromboembolism including pulmonary embolism, the risk cannot be ignored.
- Burns: sometimes the cannula movement can cause friction burns to skin or nerves. Also, in UAL, the heat from the ultrasound device can cause injury to the skin or deeper tissue.
- Lidocaine toxicity: when the super-wet or tumescent methods are used, too much saline fluid may be injected, or the fluid may contain too high a concentration of lidocaine. Then the lidocaine may become too much for that particular person's system. Lidocaine poisoning at first causes tingling and numbness and eventually seizures, followed by unconsciousness and respiratory or cardiac arrest.
- Fluid imbalance: since fat contains a lot of fluid and is removed in liposuction, and since the surgeon injects fluid for the procedure, even a very large amount of it for tumescent liposuction, there is a danger of the body's fluid balance being disturbed. This could happen afterwards, after the patient is at home. If too much fluid remains in the body, the heart, lungs and kidneys could be badly affected.
Candidacy
Not everyone is a good candidate for liposuction. One might question who is a good candidate for increased visceral fat, which the procedure causes. It is not a good alternative to dieting or exercising. To be a good candidate, one must usually be over 18 and in good general health, have an ongoing diet and exercise regimen, and have fatty pockets of tissue available in certain body areas. Significant disease limiting risk (e.g. diabetes, any infection, heart or circulation problems) weigh against the eligibility of a person for the procedure. In older people, the skin is usually less elastic, limiting the ability of the skin to readily tighten around the new shape. Liposuction of the abdominal fat should not be combined with simultaneous tummy tuck procedures due to higher risk of complications and mortality. Laws in Florida prevent practitioners combining liposuction of the upper abdomen and simultaneous abdominoplasty because of higher risks.
Techniques
In general, fat is removed via a cannula (a hollow tube) and aspirator (a suction device). Liposuction techniques can be categorized by the amount of fluid injection and by the mechanism in which the cannula works.
In all liposuction methods, there are certain things that should be done when having the procedure:
- The candidate and the surgeon will agree ahead of time on exactly which area(s) will be treated and both will discuss what outcome to expect
- A consent form is signed on the day of surgery
- An antibiotic will be given about an hour beforehand, or afterwards
- The targeted areas are marked on the body while the candidate is in a standing position
- Sometimes photos will be taken of the area to be treated, so the patient will have before and after photos
- In the operating room, a sterilizing solution, such as Betadine, is applied to the relevant areas
- Local anesthetic is injected and the patient may be given a sedative, either orally or through an IV injection
- Incisions are small, about a quarter to a third of an inch
- The patient will probably have an IV fluid line, since he or she will be losing fluid with the fat and the fluid balance must be kept intact
- There will be some monitoring devices attached to the body to keep track of the blood pressure, heart rate, and blood oxygen level
- Usually the patient can get up, walk around, and go home the same day if he or she did not receive general anesthesia, although they would need someone else to drive them
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Ultrasound-assisted liposuction
Ultrasound-assisted liposuction techniques used in the 1980s and 1990s were associated with cases of tissue damage, usually from excessive exposure to ultrasound energy. Third-generation UAL devices address this problem by using pulsed energy delivery and a specialized probe that allows physicians to safely remove excess fat.Surgeons found that in some cases, the UAL method caused skin necrosis (death) and seromas, which are pockets of a pale yellowish fluid from the body, analogous to hematomas (pockets of red blood cells).
Tumescent technique
Tumescent liposuction is a technique that provides local anesthesia to large volumes of subcutaneous fat and thus permits liposuction totally by local anesthesia. In the past, liposuction surgery required blood transfusions because of significant blood loss in the liposuction aspirate. The tumescent liposuction technique eliminates both the need for general anesthesia and intravenous narcotics and sedatives while minimizing blood loss.
Sutures
Doctors disagree on the issues of scarring with not suturing versus resolution of the swelling allowed by leaving the wounds open to drain fluid. Since the incisions are small, and the amount of fluid that must drain out is large, some surgeons opt to leave the incisions open, the better to clear the patient's body of excess fluid. They find that the unimpeded departure of that fluid allows the incisions to heal more quickly. Others suture them only partially, leaving space for the fluid to drain out. Others delay suturing until most of the fluid has drained out, about 1 or 2 days. In any case, while the fluid is draining, dressings need to be changed often. After one to three days, small self-adhesive bandages are sufficient.
Liposuction and tightening / lifting skin
The removal of quantities of fat from under the skin allows the elastic skin to potentially retract after SAL. The level of skin retraction following liposuction is affected by the age of the patient, quality of skin, presence of underlying disease or smoking and the presence of previous skin damage such as caused by childbirth and surgery. Liposuction techniques such as subdermal undermining using fine cannulas can stimulate further skin retraction but are more frequently associated with contour irregularity. While subdermal undermining may help the skin contract, patients with severe elasticity loss and heavy stretch marks prior to liposculpture may require removal of redundant skin by surgical means after liposculpture. Usually this can be performed after 6 months.
Surgical lifts such as a rhytidectomy (facelift), mastopexy (breast lift), abdominoplasty (tummy tuck), Lipotuck (combination abdominoplasty and liposuction), or lower body lift, thigh lift, or buttock lift can be utilized when sagging skin alone is the issue or after massive weight loss when the combination of large amounts of skin and shrunken fat cause significant skin droop.
Large volume Liposuction (SAL) in combination with other surgery is common but may have higher complication rates. When done simultaneously, SAL is done minimally in the areas of the undermined tissues to minimize further insult to the blood supply, however a new technique in tummytuck surgery involves vigorous liposuction first before excising the redundant skin.
Preparation
Before receiving any of the procedures, no anticoagulants should be taken for two weeks before the surgery. If general anesthesia or sedation will be used, and the surgery will be in the morning, fasting from midnight the night before is required. If only local anesthesia will be used, fasting is not required. Smoking of tobacco must be avoided for about two months prior to surgery, as nicotine interferes with circulation and can result in loss of tissue. Bruising can be seen in people who smoke post surgery.
Recovery
Depending on the extent of the liposuction, patients are generally able to return to work between two days and two weeks. A compression garment which can easily be removed by the patient is worn for two to four weeks, this garment must have elasticity and allow for use of bandages. If non-absorbable sutures are placed, they will be removed after five to ten days.
Usage
Removal of very large volumes of fat is a complex and potentially life-threatening procedure. The American Society of Plastic Surgeons defines "large" in this context as being more than 5 liters (around 10½ pints). Most often, liposuction is performed on the arms, abdomen, buttocks, and thighs in women, and the chest, abdomen, and flanks in men. Liposuction was the most common plastic surgery procedure performed in 2006 with 403,684 patients and in the year 2011 with 1,268,287 patients.
History
Relatively modern techniques for body contouring and removal of fat were first performed by a French surgeon, Charles Dujarier. A 1926 case that resulted in gangrene in the leg of a French model in a procedure performed by Dr. Dujarier set back interest in body contouring for decades.
Liposuction evolved from work in the late 1960s from surgeons in Europe using primitive curettage techniques which were largely ignored, as they achieved irregular results with significant morbidity and bleeding. The invention of modern liposuction procedure is linked to the name of two Italian gynecologists, Arpad and Giorgio Fischer, who created the blunt tunneling method in 1974. Then, liposuction first burst on the scene in a presentation by the French surgeon, Dr Yves-Gerard Illouz, in 1982.
Another French surgeon, Pierre Fournier used lidocaine as local anesthetic, modified the incision technique, and began to use compression after the operation. During the 1980s, many United States surgeons experimented with liposuction, developing some variation sedation rather than general anesthesia. Concerns over the high volume of fluid and potential toxicity of lidocaine with tumescent techniques eventually led to the concept of lower volume "super wet" tumescence.
Practitioners often report that many of the modern technologies touted to improve liposuction are simply advertising hooks.
See also
- Abdominal etching
- Bariatrics - branch of medicine that deals with the causes, prevention, and treatment of obesity
- Gastric bypass surgery
- Lipotomy
- Spot reduction
Notes
External links
- Liposuction at DMOZ
- FDA liposuction information
Source of the article : Wikipedia
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