Liposuction

Definition:  Liposuction is a technique whereby fat is broken down & sucked out of the body. It has become one of the most popular cosmetic procedures in the United Kingdom. It can be performed on its own or it can be an conjunction with other procedures.

What is it used for?

Main function is to sculpt:  It is used for removal of localised excessive deposits of fat. Most of these patients have tried exercise & dieting & found that fat in these areas did still persist. The most common areas are the thighs, hips, the abdomen, arms, buttocks.  It can be used for the treatment of gynaecomastia (fatty enlargement of male breasts) or it can be used in conjunction with surgical excision of the excessive fat & breast tissue.  It can also be used in reducing the size & shape of breasts during reduction mammoplasty or after reconstructive surgery.  It can also be used to refine the waistline following a tummy tuck operation (abdominoplasty).

Anaesthesia:  Usually under a general anaesthetic. It can also be performed under local anaesthetic but only for very small areas of the body & even then it is still uncommon. In certain cases of liposuction to the lower limbs, it is possible for this to be performed under epidural anaesthetic in which case an injection in the back makes the lower limbs & legs go numb & the patient is awake during the procedure but does not feel the pain. Duration of stay in hospital depends on the extent of area liposuctioned. For small areas patients can go home the same day (day case) or for large & extensive areas may require a couple of nights stay in hospital.

Duration of operation:  This again depends on the number of areas that have been treated. It can range from anything from half an hour to a few hours.

Technique:  Small stab incisions are made close to the area to be liposuction & a rigid tube is passed underneath the skin which is attached to a suction device. By to & fro movements the rigid tube is used to break down the fat which is sucked out by the vacuum. There are other ways of breaking the fat including the use of ultrasound. Various volumes of fluids containing a mixture of local anaesthetic agent with some adrenalin is injected into the area to prevent excessive bleeding so the material that is sucked out also includes partly this fluid & the fat that has been broken down.

Do the fat cells come back?:  Liposuction removes the fat cells permanently but the remaining fat cells can hypertrophy (increase in size) so there still is a need for a healthy lifestyle following liposuction in order not to lose its benefit.

Post-Op Care:  Usually before the operation measurements are taken of the body part that requires liposuction. This enables the surgeon to order an adequate supportive corset or pressure garment to be used around the area that has been treated. This can either be put on immediately following the treatment in theatre or shortly afterwards on the ward before discharge. The pressure garment is normally worn for a period of 4 - 6 weeks. This helps reduce excessive swelling of the area.

Usually painkillers are given as well to help reduce discomfort. A few stitches used over the stab incisions are usually removed in about 10 days. Sometimes no stitches are used & simple adhesive tapes are used to hold the edges of the very small incisions.

Time off work:  For most people 7 - 10 days off work is usually adequate. As far as going to the gymnasium this is better avoided in the first 4 weeks.

Risks/Complications:

General:  There are general complications that can occur with a general anaesthetic or any stay in hospital, which include chest infection, blood clots in the legs which can dislodge & travel to the lungs. This latter complication is potentially fatal. For this reason patients are usually fitted with firm stockings &, if going to stay more than one night in hospital, may be given an injection to thin the blood.

Specific:  In the early period there might be significant bruising & swelling which can take a few weeks to resolve.

Bruising can also occur leading to an accumulation of blood (haematoma). If this happens this requires a trip back to theatre & with a slightly larger incision to drain the blood.

Infection of the wounds can occur. This may be prevented by the administration of antibiotics. However, if this occurs & there is an associated abscess this may require drainage in theatre as well. This will require a slightly larger incision.

Irregularities of the skin can also occur. Scars from the stab incisions can become raised & lumpy in some patients. The chances of this happening can be reduced by early application of silicone gel.

Pulmonary oedema (water logging of the lungs). This can be occur from the volume of local anaesthetic that has been injected to reduce bleeding. If this water logging occurs it requires immediate treatment to clear the lungs.