Liposuction
Liposuction,
also known as liposculpture or simply lipo, re-contours your body outline by removing pockets of fat from under the skin. First introduced in Europe in
the 1970s, liposuction has become one of the most popular cosmetic surgical procedures performed. Since its introduction, liposuction has undergone
significant improvements in terms of technique, instrumentation and the expected results.
The procedure should primarily be used to help redefine body contours in those "troublesome" areas resistant to a healthy diet and exercise regimen.
Liposuction is used to treat everything from the neck by the removal of a tiny amount of fat, through to reshaping larger contours like the outer thighs
and abdomen.
Before and after photographs
The New Zealand Medical Council has banned New Zealand doctors from using "Before and After" photographs in any form of public communication, including websites. The only permissible use of such photographs under the New Zealand Medical Council rules is during a medical consultation.
Dr Masters will show you examples of previous patient's "Before and After" photographs during your consultation.
Best Patients/Indications for Liposuction
Almost every patient with discreet areas of fatty
accumulation under the skin that are resistant to a healthy lifestyle, an appropriate diet and a regular exercise plan, is indicated for liposuction.
The best candidates are patients who have achieved a "steady state" with regard to their body size. These patients who have balanced their dietary
intake, their lifestyle and exercise output, will see a sustained benefit from liposuction.
LIPOSUCTION SURGERY IS NOT A PROCEDURE DESIGNED FOR GENERALISED WEIGHT LOSS. The purpose of liposuction is to improve a patient's contour in one or more
areas by the removal of localised pockets of fat. It cannot be used as a general system for weight loss or to globally reduce the number of fat cells
throughout the body. People who are progressively gaining weight, that is, their lifestyle and exercise patterns are not in balance with their dietary
intake, are poor candidates for liposuction. Such people will see only a temporary improvement from liposuction, but in the meantime will have exposed
themselves to both a surgical risk and a fruitless financial burden.
If stretch marks, excessive skin or poor skin quality are significant components of your concerns, liposuction alone is unlikely to successfully address
them. In such situations, excisional surgery is usually required (e.g. a tummy tuck for the abdomen) with or without liposuction.
Who Isn't Suitable for Liposuction?
Liposuction is not appropriate for patients who are gaining weight,
significantly overweight or who have poor quality skin that will not retract well following the procedure. A consultation with Dr Masters is the best
method to establish your suitability for liposuction surgery.
Relevant Anatomy
Fat located beneath the skin but above the first muscle layer is suitable for liposuction. Fat deep to
the muscle layer (e.g. around the internal organs) cannot be removed by liposuction. In most areas of the body there are relatively few important
structures running through the superficial fat and as such liposuction can be considered a relatively safe procedure.
Anaesthesia
Having used both local anaesthetic and general anaesthetic modalities, Dr Masters now chooses to almost
exclusively use general anaesthesia. A specialist anaesthetist will provide the general anaesthetic and continuously monitor you for the entire duration
of the procedure.
Less frequently, when a small area of liposuction is being treated, local anaesthetic with or without intravenous sedation is used and a tumescent
liposuction technique is used.
Where is the Surgery Performed
The majority of cases are done at Southern Cross Hospital in Wellington. Smaller cases
not requiring general anaesthesia are usually performed in Dr Masters' own operating room. He only operates in Wellington.
Pre-operative Preparation for Liposuction
Dr Masters will provide you with precise instructions well in advance of your
surgery to allow you a smooth and stress-free preparation for the procedure. Take the time to read your consent form thoroughly, along with any other
information Dr Masters gives you. This will allow you to have all of your questions answered prior to the procedure, and ensure there are no unexpected
surprises during the post-operative period.
If you are the main domestic executive in your home, or you live alone, you should plan ahead with regard to housework and meal preparation. Do your
grocery shopping, cleaning, etc the day before your surgery and plan to have meals that require minimal preparation and/or cooking time.
If you are a smoker, STOP SMOKING at least one month pre-operatively (see the "Policies" page). Do not take any aspirin or aspirin-containing products
for at least 10 days prior to your surgery. If you are on any other medications, ensure that Dr Masters is aware of the medications (including
homoeopathic remedies) so that any requiring cessation during the peri-operative period can be discontinued.
Liposuction Surgery
The entire surgery is performed through punctures in the skin 5 mm long or less. Each incision is
carefully planned to minimise the visibility of the resulting small scar (e.g. in a natural skin crease). A dilute adrenaline containing solution is
infiltrated into the fatty deposits to be treated. A liposuction tube, or cannula, is passed through the unwanted fatty deposits whilst connected to
high vacuum. Initially the deeper layers are treated and then progressively smaller cannulae are used as the skin surface is approached. The dilute
(tumescent) fluid contains adrenaline to constrict the blood vessels, decreasing bleeding and post-operative bruising. The fluid also swells the fatty
compartment, thereby allowing the surgeon to pass the small cannula through more times. As each of these passes does not go down exactly the same track,
the net result is to remove the fat in a sheet like manner, yielding a smoother final result. This is SAL liposuction (suction assisted
lipectomy).
During the 1990s ultrasound-assisted lipoplasty (UAL) became popular. This system is similar in many respects to SAL (described above) except the
incisions required are larger and the cannula vibrates millions of times per second, liquefying the fat prior to it being removed by suction. UAL has
the advantage of being better suited to more fibrous areas (e.g. the back and the male breast), but comes with the disadvantage that the heat that the
system generates is associated with a higher risk of complications.
More recently PAL (power assisted lipectomy) was introduced to New Zealand. This system combines traditional SAL with a mechanical device to move the
cannula approximately 2 mm backwards and forwards up to 4000 times per minute. With this mechanical advantage, fibrous areas that were traditionally
difficult to treat with SAL are now readily treated without the disadvantage of the potential complications of UAL. This system reduces the physical
pressure Dr Masters must apply during liposuction and allows him to spend more time concentrating on shaping the region rather than forcing instruments
through the tissues.
Once the fat removal is complete, dissolving stitches are used to close each small incisions. A custom-made post-operative pressure garment is fitted
and will be worn for approximately three weeks.
Post-operative Period and Recovery
For general safety reasons you will need a responsible adult to be with you for the
first 24 hours post-operatively. Dr Masters will prescribe oral pain-relief. There is no way to predict how a certain individual will respond to the
post-operative discomfort. As a rule, the smaller the area of liposuction performed, the less discomfort the patient has.
Not infrequently, the small puncture sites ooze fluid for up to 24 hours. Although some patients find this alarming as it is usually bloodstained, it is
completely normal following this kind of procedure.
Altered skin sensation, like pins and needles, will be present wherever liposuction has been performed. Full return of normal sensation is expected and
can take a number of months.
During the procedure the cannula tip often bumps into the underlying muscle layer. This causes some bruising of the muscle, which is reflected in a
feeling of muscular discomfort for a number of days after the procedure.
For the first 3 weeks a post-operative compression suit is worn over all of the areas that were treated. This is designed to limit swelling, increase
safety, increase comfort and improve the final result. The suit can be worn under clothing and is worn at all times except when showering.
Most patients are able to return to gentle cardiovascular exercise after one week. Higher impact exercise (eg aerobics classes, running, etc) should not
be resumed until at least 4 weeks after the procedure. Your body needs this time to help reform the fibrous tissue joining your skin to the deeper
layers. Swimming is an excellent post-operative exercise; however, it should not be commenced until the punctures are absolutely sealed (approximately
12 days).
Liposuction Results
An initial change is obvious at the completion of surgery. The final result however, depending on
the number and size of areas treated, may not be seen for 3 to 6 months. Your body needs time to clear the residual surgical debris, remove the
swelling and eliminate bruising, and for your skin to fully retract as much as it is going to.
You can expect to see a significant change in the contour of the areas treated, limited only by the fact that only fat can be removed - muscle, bone and
skin are not re-fashioned as part of this procedure. Remember, liposuction is not weight loss surgery, and there will not necessarily be a dramatic
change in your weight. Similarly, liposuction is not designed to improve skin quality (e.g. cellulite). After the operation you can expect to have
approximately the same degree of skin waviness and dimpling as what you had before the operation. Like any other cut, the small stab-like incisions
will initially be red and will pass through a series of stages before becoming pale and inconspicuous. This process may take several months and mirrors
the internal changes your body is undergoing.
Complications of Surgery in General
Before deciding to proceed with surgery, every patient must thoroughly consider the
risks involved, not just the benefits. During your pre-operative consultation(s), Dr Masters will openly discuss the risks with you so that you can
consider them. There are two broad groupings of surgical risks: those that pertain to surgery in general; and those specific to the procedure being
performed. A full listing of all the potential complications and risks of this procedure is beyond the scope of this website. But they include;
Generalised surgical risks:
- Bleeding - usually occurs within the first 24-48 hours of the procedure and may require a return to the operating room. A quiet, restful
post-operative period will help to avoid this problem.
- Bruising - whenever possible, Dr Masters uses medications and techniques that help to avoid post-operative bruising.
- Infection - surgical incisions, even though created in ideal circumstances, can become infected. When appropriate, antibiotics are prescribed to
lower this risk.
- Unfavourable scarring - every surgical incision results in a scar. It is Dr Masters' role to maximise the quality of your scars and, whenever
possible, to hide them in natural skin creases.
- Allergic reactions - although unlikely to occur, some patients do have allergies to the medications used. If you are aware of any drug allergies
you may have please notify Dr Masters.
Risks and Complications Specific to Liposuction
Liposuction, when performed using modern techniques by a fully qualified
surgeon who has undergone comprehensive training in their field, should not result in significant complications. Surgery however, even liposuction,
should not to be undertaken lightly; complications can and do occur from time to time. These include:
- Asymmetry - any right versus left asymmetry is usually within the normal levels present in people who have never had an operation.
- Skin death - this is a rare complication usually associated with the inappropriate use of UAL technology. Dr Masters has never had a case of skin
loss from liposuction.
- Dimpling, rippling, ridges and divots - once again, with modern techniques using tumescent fluid and small cannula, these occurrences should be
rare. Dr Masters aims to leave the skin no wavier than what it was pre-operatively.
- Sagging of skin post-operatively - this complication can occur, but is much less frequent than one would expect. If Dr Masters believes your skin
will not shrink to match the post-liposuction volume of the area concerned, then he will recommend an alternative surgical technique.
- Sensory changes - As discussed above, there can be a period of time where the skin loses sensation. Complete recovery of sensation after
liposuction is expected with time.
- Scarring - as the punctures are so small, troublesome scarring from liposuction cannulae is rare.
- Fluid overload - with careful monitoring of fluid input and output during the operative procedure, this should not be an issue. One of the
important roles of your anaesthetist is to precisely monitor fluid input and output during the case.
Liposuction Cost
A written quote will be provided after your consultation. Liposuction usually costs $7,000 to $16,000.
The cost of the procedure is dependent upon a number of variables including:
- The sites being treated.
- The number of sites being treated.
- The size of the sites being treated.
- The anaesthetic used.
- If an overnight stay is required.
- Your medical history, etc.
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