Suction-Assisted Lipectomy (Liposuction) & Liposculpting

Procedure

Suction-assisted lipectomy is performed in a certified fully-equipped surgery facility under a general anesthetic by an anesthesiologist. Before the liposuction begins: salt water containing local anesthesia and adrenaline is injected into the area to be treated. This is called the tumescent technique. A long-acting local anesthetic is also used so you feel, at most, minimal discomfort following surgery.

The procedure is performed through inconspicuous 1/4" incisions which are often hidden in crease lines. A long thin tube, approximately half the width and twice the length of a pencil with specially shaped holes along the tip, is introduced under the skin. This tube is attached to a specialized suction machine through which multiple, long, pipe-like sections of fat are suctioned. Deep inside, the area looks like a block of Swiss cheese with "pipe holes" when the procedure is complete. Because these "pipe holes" fill with serum fluid, compression stockings, and pressure massage will be used to enhance the absorption process.

Ultimately the serum fluid is absorbed over several days to weeks. These "pipe holes" collapse, and like a shrunken sponge, the area becomes smaller. It is this absorption or waiting stage that is most bothersome to the patient who, naturally, desires immediate results. Normal healing, however, takes its course over four to six weeks. You may even note improvement for up to a year as swelling resolves.

The traditional method is used to help shape the UAL treated areas or to treat areas of the body not suited for UAL. The metal cannula is connected to an ultrasound generator and is inserted beneath the skin through a small incision. The ultrasonic energy causes the walls of the fat cells to break down and allows the fat to flow out of each cell.

The tumescent technique is also used and the injected fluid combines with the liquefied fat creating an emulsion, which is removed from the body by suctioning. The tube like instruments or cannulas used to perform UAL are slightly larger than the cannulas used for traditional liposuction. The longer incisions needed for UAL require they be placed carefully in creases of the skin or hidden areas. Some surgeons prefer to use the traditional liposuction technique in areas where an obvious scar may result. The postoperative care is the same for both suctioning techniques.

Liposuction is not an alternative to proper diet and exercise. Best results are obtained with patients who are 20 to 35 years old with isolated collections of fat covered by smooth skin. Ideally, patients should be within 20 pounds of their desired weight, although large variances can be taken into account.

Cellulite, which resembles fatty skin pushed against a tennis racket, is due to fibrous attachments between the skin and muscle surrounded by a firm type of fat called "fibro-fat". Older, looser skin and firmer fibro-fat contribute to cellulite. With certain techniques it can be improved, but suctioning too vigorously can make it worse.

In cases where the patient is older or heavier with more generalized fat distribution, or the skin is less elastic, or if cellulite is present, results are not as good. However some improvement can be achieved if the patient has realistic expectations and the liposuction is performed safely.

Suctioning too much of the upper layer of storage fat or the metabolic fat can form furrows, depressions, dimples, or worsened cellulite. It may be necessary to limit the amount of fat removed in order to avoid these problems. Meticulous surgical judgment and patience in waiting for a final result is very important.

The most commonly suctioned areas are the folds to the side of the lips and nose, the neck, tummy, waist, "love handles," hips, saddle bags, inner thighs, knees and infrequently, the ankles. Normally it is safe to suction up to 2000 cc's or two liters of fat. Amounts in excess of this may require hospitalization and/or transfusion. Stitches are used to close incisions when the suctioning is completed. For best results, and to concentrate fat cells, we recommend that a low salt, low sugar, low fat diet be instituted along with daily walking for two weeks prior to surgery.

Because of fluid retention, you may not see much difference for the first few weeks following surgery, and you may notice bruising due to deeper suctioning. The change in your appearance, however, will become increasingly evident over the next few months. Usually most bruising and swelling disappears within six weeks, while some swelling may remain for six months or more. Compression to the suction sites is necessary to eliminate fluid build-up. Although some leg or ankle swelling beginning a few days after surgery is not unusual, any pain or tenderness in the calves should be immediately reported to the office.

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