Liposuction
Liposuction, also known as liposculpture, re-contours your body outline by removing discreet pockets of fat from under the skin. The procedure was first introduced in Europe in the 1970s and has become one of the most popular cosmetic surgical procedures performed today. Since its introduction, liposuction has undergone significant improvements in terms of the technique, the 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 sharpening the angle between the chin and neck by the removal of a tiny amount of fat, through to reshaping larger contours like the outer thigh.
Sample Procedure
Before | After | Comments | 
|  | Case 5 - 21 year old female before and 4 months after 2100 ml liposuction to the upper inner and upper outer thighs. | | | More Images Back to Top |
Indications
Almost every patient who has discreet areas of fatty accumulation under the skin that are resistant to a healthy lifestyle, an appropriate diet and exercise, 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 their dietary intake in balance with their lifestyle and exercise output, will see a sustained benefit from liposuction.
LIPOSUCTION 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 a significant component of your concerns are stretch marks, excessive skin or poor quality skin, then liposuction alone is unlikely to address your concerns. In such situations, excisional surgery is usually required (e.g. a tummy tuck for the abdomen) with or without liposuction.
Relevant Anatomy
The fat located beneath the skin and above the first muscle layer is suitable for liposuction. Fat deep to the muscle layer (eg. around the internal organs) cannot be removed by liposuction. In most areas of the body there are few other important structures running through the superficial fat and as such liposuction can be considered a relatively safe procedure.
Anaesthesia
Depending on the size and the number of fatty deposits, there are various choices for the type of anaesthesia used. Typically a specialist anaesthetist will be asked to provide a general anaesthetic
Less frequently, when smaller areas of liposuction are being performed local anaesthetic, with or without intravenous sedation is used. These cases are usually having only 1 or 2 small areas treated.
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.
Pre-operative Preparation
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 gave 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 “Disclaimer� 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 Mr Masters is aware of the medications (including homoeopathic remedies) so that any that require cessation during the peri-operative period can be discontinued.
The Surgery
Through small punctures in the skin (ideally in a natural skin folds to help disguise it post-operatively) a dilute local anaesthetic 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 cannulas are used as the skin surface is approached.
The dilute fluid, or tumescent fluid, has many effects. Firstly, it numbs the area being treated. Secondly, it contains adrenaline to constrict the blood vessels to decrease 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, which in turn, means the final result is smoother with less grooves and ridges.
During the 1990s, a new method of performing liposuction was popularised, ultrasound-assisted lipoplasty (UAL). This system is similar in many respects to that described above (SAL or suction-assisted lipoplasty) 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 (eg the back and the male breast) but comes with the disadvantage that the system generates enough heat that the skin can easily be burnt or the blood supply damaged.
The most recent innovation in liposuction technology to be introduced to New Zealand is power-assisted lipoplasty (PAL). 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.
Once the fat removal is complete, dissolving stitches are placed under the skin to help close each of the small incisions. The patient is then placed in a custom-made post-operative pressure garment that they will wear for approximately three weeks.
Post-operative Period and Recovery
You will need a responsible adult to be with you for the first 24 hours. The residual effects of the local anaesthetic are still in effect when the patient goes home and, as such, surgical discomfort is minimal. As the local anaesthetic wears off, the use of oral pain-relieving medications that Dr Masters will prescribe becomes necessary. Some patients literally take no additional pain relief; others find themselves in considerable discomfort for a number of days, requiring strong oral pain relief. There is no way to predict how a certain individual will respond to the post-operative discomfort. Although, as a rule of thumb, the smaller the area of liposuction performed, the less discomfort the patient has.
Not infrequently, the small puncture sites ooze fluid for 24 hours. Although some patients find this alarming as it can frequently be bloodstained, it is completely normal following this kind of procedure.
Usually there are areas of altered skin sensation wherever liposuction has been performed. Full return of sensation is the norm, however this may 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 muscular discomfort for a number of days after the procedure.
Most patients are able to return to gentle cardiovascular exercise by Day 3. Higher impact exercise (eg aerobics classes, running, etc) should not be resumed until at least 3 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 healed (approximately 12 days).
Results
An initial result is obvious at the completion of surgery, the final result however is not seen for at least 10 weeks. As efficient as the fat removal systems are, there are always damaged to fat cells left behind at the completion of the surgery. Once your body clears the post-liposuction cellular debris, the inflammation can subside and the final result becomes more evident. Meanwhile, the skin is shrinking and there is an increase in fibrous tissue under the skin caused by the surgery, both of which add to the final result.
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 months.
Complications (general)
Before deciding to proceed with surgery, every patient needs to thoroughly consider the risks, as well as the benefits, of the proposed procedure. During your pre-operative consultation(s), Dr Masters will openly discuss the risks with you so that you can consider them. A full listing of all the potential complications and risks of this procedure is beyond the scope of this website. There are two broad groupings of surgical risks: those that pertain to surgery in general; and those specific to the procedure being performed.
Generalised surgical risks include:
- 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-liposuctional 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. The norm is to have complete recovery of sensation after liposuction.
- Scarring – as the punctures are so small, troublesome scarring from liposuction cannulas 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.
- Local anaesthetic overdose – performing this surgery under local anaesthetic does mean that significant amounts are used. International experience of tens of thousands of cases using these high volumes of local anaesthetic has shown it to be a safe procedure when performed by an appropriately trained specialist in appropriately equipped environments. Nevertheless, the doses being used are high and deaths from local anaesthetic overdose have been reported in the overseas literature.
Approximate Costs
A written quote will be provided after your consultation. Liposuction usually costs $6,000 to $13,000. 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.
Back to Top
|
|
|
|
|
Printer Friendly