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Patient I fig 1
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Patient I fig 1
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Body Sculpture (Liposuction)
Liposuction is the most common operation performed
in the United States today. This of course reflects our society Is preoccupation
with appearance, conditioning and our national obsession with food. It
is common knowledge that more than half of the adult population is overweight
and an increasingly high percentage of children are seen in this category.
Interestingly, however, the vast majority of liposuction patients fall
into the normal to moderately overweight group.
Liposuction is not a procedure designed to help
one loose weight. Its best use is to remove collections of fat which are
simply abnormal in Shape as opposed to abnormal in quantity. The following
photo illustrates two patients. One with an abnormal distribution of fat
in the hip area (Patient I, Figure 1 and 2) and the second with an abnormal
distribution of fat in the outer thigh area (so called saddlebags) (Patient
II, Figure I and 2).
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Patient II
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Patient II
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This is a condition known as lipodysmorphia and it
is extremely common. In women the hips and saddlebags are common area of
concern (Patient III, Figure 1 and 2). While in men the flanks (love handles)
and abdomen are more frequently involved (Patient IV, Figure 1 and 2).
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Patient III fig 1
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Patient III fig 2
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Patient IV fig 1
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Patient IV fig 2
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Patient V fig 1 
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Patient V fig 2
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Abnormal fatty accumulations may be removed wherever they lie as in this
unusual presentation of lipodysmorphia involving the premaxillary area
in a young girl Patient V, Figure 1 and 2). WRONG
PIC ? Dowager humps, fat ankles, knees and even discreet lipomas
can all be reduced with the liposuction technique. Judicial and careful
liposuction in the face is also applied but frequently combined with other
facial restoration procedures. If Platysma laxity is absent and no subplatysmal
fat exist, then liposuction is very effectually applied to accumulations
of fat in the neck (Patient VI, Figure 1 and 2).
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Patient VI 
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Numerous techniques of liposuction have been advocated
but the tried and true method is that of the Tumnesent technique. In this
technique a solution containing saline, local anesthetic, adrenaline and
Sodium bicarbonate is infused through a 1/8 inch incision made near the
area of interest into the subcutaneous fatty collection. This allows performance
of the liposuction under local anesthesia and with relatively small amounts
of blood loss. A blunt tipped metal tube (canula) Some 2 - 3 mm in diameter
with 1 to 3 opening on the side near the tip is inserted through the incision
into the Tumnesent infused fatty tissue. The canula is connected to a reservoir
which in turn is connected to suction pump. With each stroke of the canula
a small bit of fatty tissue is extracted. The amount of fat being removed
is carefully monitored and compared to the preoperative estimate while
direct observation for even distribution is assessed. When the proper amount
and the correct distribution has been attained the canula is remove, a
single Stitch closes the incision and a compression garment is fitted to
the patient.
Post operative course is characterized by absences
of pain in the initial phase followed by onset of moderate to intense pain
as the local anesthetic wears off. Strong pain relief medications are made
available for as needed use.
The amount of time required for post operative
recovery varies Somewhat proportionally to the amount of liposuction performed.
In most cased the ideal recovery is attained, that is having surgery on
Thursday or Friday and returning to work on Monday morning. The usual course
of recovery consists of rapid resolution of residual swelling over the
first two weeks followed by slow resolution of swelling over the next 6
weeks followed by final resolution of swelling over the next 6 months.
A very appreciable and nice improvement in appearance will be apparent
immediately after surgery. This is somewhat over 50% of the final result.
AB the rapid resolution phase concludes approximately 75% of final results
will have been obtained but the final results requires 6 to 8 months and
in some cases up to a year.
Patient satisfaction with liposuction on average
is quite high. The best candidates (those of normal weight, with small
to moderate areas of lipodysmorphia) are of course more likely to get the
best results. Those candidates who are moderately overweight or who have
large areas of lipodysmorphia have less chance of obtaining a perfect result
and overweight patients, while frequently very pleased, are the least likely
to have total satisfaction. For these reasons a weight management program
is always offered and is frequently instituted before and is continued
after liposuction surgery. The following photographs show an over weight
patient who underwent a 14 pound liposuction with no loss of time from
work, very little discomfort and whose dress size dropped from 24 to 18
with in two weeks. She was very, very pleased.
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Patient VII 
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 Patient VII
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Photos of the lipo-aspirant illustrate
that large amount of fat can be removed with very little blood loss. In
this case probably less than 100 cc's (Patient VII, Figure 1, 2, and 3). |
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The risks of liposuction surgery is quite low, it
is the most commonly performed operation in the United States. However,
any operative procedure carries some risk and tragedies certainly have
occurred. When death occurs - and there have been approximately 18 over
the course of some 30 years among the millions of liposuction patients
- news collectors are very attentive. Widespread announcement of the event
occurs but never has there been follow up announcement as to the actual
cause, whether it be negligence on the part of the operator or some unrelated
co-morbid event such as concomitant heart attack, anesthetic reaction or
stroke. Certainly serious complications do occur though they are very rare.
Bleeding, pulmonary complications and heart problems cause the vast majority
of peri-operative complications while infection, volume contraction, kidney
failure, blood clots in the legs, pulmonary emboli and stroke comprise
the vast majority of serious late post-operative complications. Personally,
I have never had a serious complication in any of my liposuction patients
but you should be aware that though rare, serious, life threateningly complications
are associated with any major operative procedure. While uncommon, some
complications of a less serious nature do occur. Collections of fluid under
the skin which require aspiration, worsening of a "cellulite"
appearance and contour deformities, whether as depression or retained bulge
are all possible. Where a depression is present, fat may be transferred
back into the area and where a retained bulge is present, additional liposuction
can be accomplished. These usually can be performed under local anesthesia
with practically no disability. Most surgeon do not charge for these "touch
up" procedures.
If there are questions relative to whether you
might or might not be a good candidate for liposuction surgery, I suggest
you first review the weight management section our web page and thereafter,
perhaps, make a consultation for an analysis at which time we can review
various options to achieve your goals.
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