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Liposuction


What is liposuction?

Liposuction, also called lipoplasty or suction lipectomy, is a procedure that slims and reshapes specific areas of the body by removing excess fat deposits. This can result in an improved body contour and proportion, and ultimately, an enhanced self-image. Despite good health and a reasonable level of fitness, some people have a body with disproportionate contours due to isolated or localized fatty deposits. These areas may be due to family traits rather than a lack of weight control or physical conditioning. Liposuction can offer a solution for patients who feel that the goal of improving their body shape is out of reach.

Liposuction was the most popular cosmetic procedure performed in the United States last year with over 325,000 cases reported to the American Society of Plastic Surgeons. The procedure was first used in the early 1970s, however complications such as excessive bleeding and undesirable rippling of the skin led to many unsatisfactory results and bad publicity. The procedure was revolutionized in the 1980s with the implementation of the “tumescent” technique which dramatically cut down on blood loss and patient discomfort. This technique of liposuction involves infusion of fluid or “tumescent” into the tissues using thin blunt cannulas prior to fat removal. Combined with high-vacuum suction, this method produced good results and low morbidity. It also allowed patients to have liposuction performed totally by local anesthesia in some cases. Further refinements over the last two decades now allow for much greater fat removal with less blood loss, less discomfort, and less risk to patients. Technological advancements in liposuction cannulas and aspiration equipment, combined with a better understanding of relevant physiology (how the body responds to the procedure) have resulted in both reproducible good results and low morbidity.

Many different liposuction technologies are currently available to patients. These include ultrasonic liposuction which uses ultrasound energy to liquefy the fat prior to removal. This has proven to be effective in areas where the tissues are very dense, such as the male breast in patients with gynecomastia. Laser liposuction has also gained popularity in recent years. This technology involves the use of laser tipped probes (which induce a thermal lipolysis) to liquefy the fat prior to removal. Based on personal experience with these other technologies, Dr. Miles has found that superior results can be achieved with the MicroAire’s PAL® LipoSculptor which has become the mainstay of his liposuction practice. This sophisticated device is the only US-patented liposuction instrument using a reciprocating motion (rather than rotating) to facilitate the movement of the cannula within tissue. This innovation reduces the amount of manual force and physical effort required to perform lipoplasty, especially in areas with fibrous tissue. The result is a more comfortable experience for both the surgeon and the patient. Unlike ultrasonic and laser lipoplasty devices, the PAL® LipoSculptor does not use heat, so there are no concerns for the accidental burning that can occur with other systems. This device has proven its effectiveness and has been purchased by the largest hospitals in the Charlotte area for use in liposuction cases. Companies will continue to capitalize on the big business of liposuction by marketing their new technologies as the “latest and greatest,” but patients need to beware of these advertising hooks and do their homework. The choice of a quality surgeon is the primary determinant of a quality result. Dr. Miles is an experienced board certified plastic surgeon who uses surgical techniques and equipment that have provided consistently excellent results.

Is liposuction safe?

Liposuction surgery is extremely safe if performed by a qualified surgeon such as Dr. Miles. Incisions are very small and, because the surgery addresses the fatty deposits directly under the skin, it is not necessary to operate invasively near vital structures during the procedure. One very important safety aspect of liposuction is the accurate determination of medication dosing in the tumescent fluid that is injected prior to the procedure. Dr. Miles meticulously calculates these values prior to every surgery and keeps the dosing within well accepted safe limits. Most patients undergo the procedure on an outpatient basis, either under local anesthesia in an office setting or under general anesthesia in a hospital. When Dr. Miles performs the surgery in the hospital setting under general anesthesia, he always uses board certified anesthesiologists and works with an experienced team of assistants that have assisted with these procedures for many years. Monitoring devices are always used to keep track of vital signs during the procedure with anesthesia. When large volumes of fat (greater than 5 liters) are removed, Dr. Miles will perform the procedure in a hospital and patients will be admitted overnight for observation as an extra safety precaution.

Safety is the foremost priority with any surgical procedure at North Charlotte Plastic and Reconstructive Surgery. Prior to any surgery, all patients undergo a thorough medical history screening during the consultation process. Medical testing and clearance for surgery from other providers is sometimes necessary. Dr. Miles has extensive experience with liposuction surgery and will discuss any relevant medical conditions. He is a double board certified plastic surgeon who has been performing this procedure for several years. Although complications can occur with any procedure, they are very rare with liposuction surgery. If complications occur, they are usually minor and can be managed effectively in the office based setting without a return to the operating room. However it is important to emphasize that the vast majority of patients who undergo liposuction surgery do not experience any major complications.

How long does liposuction usually take to perform?

Liposuction procedure times are dependent on the number of body areas treated and the amount of fat to be removed. The time range is generally between 1-4 hours. Patients who have small areas treated in the office under local anesthesia are typically in and out in a few hours. Larger procedures will of course take longer, with additional time spent for patient repositioning and reprepping of the various areas to maintain sterility. Because each patient is unique and has an individual goal, the time required to complete the surgery will vary. Dr. Miles places a high priority on attaining an aesthetically pleasing result and will take the necessary time to accomplish this goal.

How do you perform liposuction?

The first step is a consultation with Dr. Miles. During the consultation a great deal of time will be spent addressing patient concerns, treatment areas, and expected outcomes. On the day of the procedure, antibiotics are given prior to surgery to help prevent infection. The area(s) to be liposuctioned are marked on the body while the patient is in a standing position. Patients can participate in this step to ensure that their concerns are addressed.

The procedure starts with sterilization of the skin using various antiseptic solutions. Sedation or anesthesia is then given in a controlled manner. Small incisions (about a quarter inch) are placed in discrete areas. Next, a tumescent solution is injected into the areas prior to fat removal. This solution is important because it contains medication that helps to minimize blood loss and makes patients more comfortable after surgery. The fat is then removed using a series of hollow metal tubes called cannulas that are attached to a vacuum pump. The motion of these cannulas mechanically breaks down and loosens the fat cells to facilitate their removal. Dr. Miles uses a power assisted liposuction (PAL) device that can accomplish this task very efficiently with minimal effect on other structures such as nerves and blood vessels. Care is taken to evenly remove fat from the appropriate layers and to avoid over resection which can cause contour irregularities. The small incisions are then closed with a single stitch and covered with gauze. A compression garment is then applied to the treated areas to help “shrink” the skin. After the procedure, patients are observed for a short period of time and then permitted to go home. In rare cases, if the volume of fat removed is very large, some patients may stay overnight in the hospital or surgical facility. Many areas can often be treated during the same procedure using these techniques.

Who is a good candidate for liposuction?

People choose to undergo liposuction for a variety of personal reasons. Patients should be in generally good health and come to the consultation prepared to discuss their medical history, including information about any medical conditions, drug allergies, and surgeries that they have had. Both women and men can achieve great results with liposuction procedures. Areas that can be effectively treated with liposuction include the thighs, hips and buttocks, abdomen and waist, upper arms, back, inner knees, chest, cheeks, chin and neck, the calves and ankles. Male and female breasts can also be treated with liposuction. There are some limitations to the volume of fat that can be removed at one time, however many different areas can usually be treated during a single operation. . In some cases, liposuction is performed alone, in other cases it is used in combination with other plastic surgery procedures such as a facelift, breast reduction, or a tummy tuck.

Liposuction should be considered a body contouring procedure, not a weight loss procedure. Because liposuction removes fat and not skin, it is most effective in areas with good skin elasticity and minimal amounts of excess or loose skin. Liposuction procedures are not an effective treatment for obesity or a substitute for proper diet and exercise. Although fat removal will result in some weight reduction, the maximum benefits of liposuction are achieved by its ability to provide patients with a shapely contour. The procedure is an excellent way to remove “resistant” fat deposits that are out of proportion with the rest of the body and do not go away with diet and exercise. Liposuction is also not an effective treatment for cellulite, the dimpled skin that typically appears on the thighs, hips and buttocks, or loose saggy skin. It is designed to help those who are near their normal body weight, but still possess bulging areas of fat. After undergoing liposuction, most patients feel more fit and confident about their slimmer appearance.

What are realistic expectations for a patient having liposuction?

Liposuction is consistently one of the most commonly performed cosmetic procedures in the United States due to its excellent results and safety record. During the initial consultation, Dr. Miles will ask patients to point out exactly what areas they would like to see improved. Pictures will often be taken to enhance the discussion and give patients different views of their bodies. This is especially helpful for treatment areas on the back or buttocks. A determination of the elasticity of the skin will also occur. This helps Dr. Miles to understand every patient’s expectations and determine whether or not they can realistically be achieved.

Liposuction surgery can be used to treat stubborn fat pockets in most parts of the body. Patients at or near a healthy body weight will usually achieve the most satisfactory results. The maximum benefits of liposuction are attained by addressing specific areas of lipodystrophy (fat deposits). It is not an effective treatment for obesity. Patients with better skin elasticity also have a more pleasing outcome. Patients who have lost a significant amount of weight will often need excess skin excised in addition to liposuction to get the best results. Liposuction does not effectively treat cellulite or wrinkles. The final results of liposuction can take several months to become evident. In fact, many patients temporarily weigh more immediately after the procedure due to swelling and edema. However, after final results are achieved, patients commonly feel much better about their appearance and how their clothing fits. Complications are rare and generally minor when they do occur. Occasionally small revisions are performed in the office based setting. Other risks more specific to liposuction may include indentations and irregularities. Healthy patients who are good candidates for liposuction can expect excellent results and improvements to their body contour. By maintaining a healthy diet and exercising regularly, the loss of excess fat should be permanently maintained. However, significant weight gain can alter otherwise long-lasting results.

What are the common reasons why a patient wants liposuction?

Women and men are often bothered by certain areas of stubborn fat that seem to be resistant to diet and exercise. This can cause self-esteem issues related to a negative body image. Sometimes patients who are self-conscious about their appearance will avoid wearing clothing such as swimsuits or form-fitting outfits. Liposuction is an excellent way to restore self-confidence and self-esteem. Many areas of the body can be effectively treated with liposuction. These areas include the thighs, hips, abdomen, flanks, upper arms, back, knees, chest, and neck. Incisions are very small and usually heal to be almost imperceptible. The fact that small areas can be safely addressed in the office setting is appealing to many patients who want to avoid the higher costs associated with a hospital and general anesthesia. Some patients will opt to undergo multiple smaller procedures to address their concerns. Liposuction is also a very effective complimentary procedure to other procedures such as a facelift, breast reduction, or a tummy tuck. It is designed to help those who are near their normal body weight, but still possess bulging areas of fat. After undergoing liposuction, most patients feel more fit and confident about their slimmer appearance.

How long does it take for a patient to recover from a liposuction?

Recovery from liposuction surgery is very well tolerated. Dr. Miles follows patients very closely after any surgical procedure and he is always available to answer any questions or address any concerns. After surgery, patients will have surgical compression garments to wear for several weeks. All sutures are removed after one week. Patients are given specific written instructions for liposuction recovery during their preoperative appointment. These instructions will cover how to care for the surgical areas and incisions, medications to take orally to aid healing and reduce the risk of infection, and specific concerns to look for at the surgical site or in your general health. Patients are followed very closely after surgery. Dr. Miles will answer any questions about what you can expect during your individual recovery period.

Patients generally take 1-2 weeks off from their regular activities. Soon after the procedure, there will be swelling and possibly some visible bruising. Postoperative discomfort is usually mild and managed well with pain medication. Most patients are off of their pain medication within the first week. As the weeks pass, the swelling and fluid retention will subside, and an improved body contour will become more apparent. It is important to emphasize that the healing process after liposuction varies greatly among individuals but can takes several months.

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