Liposuction

Lipoplasty, Suction-assisted lipectomy, or as it is more widely known, liposuction, is still one of the best techniques for spot body contouring. This is not a weight-loss procedure since evidence has not shown a significant change in patients’ weights or improvement in co-morbidities. However, it does affect shape greatly. It is also worth remembering that only subcutaneous fat that is removed and not any visceral fat, thus any abdominal protrusion caused by thickened visceral fat will remain despite thinning out of the subcutaneous fat.

Liposuction Techniques

Standard liposuction consists of tumescent fluid, different sized cannulas, a suction machine, and the surgeon’s competence. Over the years, there have been other additions to this basic procedure. Newer technologies include Ultrasound-assisted liposuction, Power-assisted liposuction, Vaser-assisted liposuction, and Laser-assisted liposuction. These additives are said to aid with loosening and/or melting the adipose tissues prior to suctioning, toning and improving skin retraction/tightening after liposuction, decreasing operative complications, and improving the ease of the procedure for the surgeon.

Ideal Candidates

Patients are divided depending on the severity of lipodystrophy and the amount of skin redundancy.

• TYPE 1 Patients
  Have mild lipodystrophy, with normal skin tone and minimal irregularities. They are typically younger and are generally in good health.
• TYPE 2 Patients
  Have circumferential lipodystrophy throughout the trunk and extremities and have slightly diminished skin tone and some skin irregularities.
• TYPE 3 Patients
  Found to have more pronounced circumferential lipodystrophy and significant skin redundancy. These patients would benefit more from skin excision techniques to deal with the skin redundancy along with liposuction.

Based on this classification, it becomes apparent that for liposuction to be successful, patient selection is key. Ideal patients are healthy people who are not morbidly obese and are currently at a stable weight. They have realistic goals and are able and willing to undergo long term lifestyle changes particularly with exercise and diet.

Anatomically, there are several things that should be remembered about fats. First, fat cells are stable cells. They do not regenerate like skin cells or liver cells. The number is constant throughout one’s lifetime. However, when people gain weight, fat cells hypertrophy (they enlarge). They also shrink when you lose weight, but the number stays the same. In liposuction, fat cells that are removed are gone forever and do not regenerate. Since there are fewer fat cells in lipoed areas, when you gain weight, the layer of fat does not get as thick as those areas that did not undergo lipo. This is why people think that after lipo, their fat had “moved”.

Secondly, there are 3 layers of fats in the subcutaneous area. Knowing these layers is important for the surgeon in terms of targeting the proper layer for liposuction in order to maximize results and minimize complications like dents and skin necrosis. Finally, the Zones of Adherence must be identified and respected. These are areas of dense fibrous attachments that help define the body’s natural shape. Whether or not a surgeon should enter into these zones will depend on the ultimate contour goals set by the patient and the doctor.

Your Consultation with Dr. Joel Nicdao

Not all patients are candidates for liposuction. During the initial consultation, it should be determined whether the patient should undergo some weight loss methods and come back for a consultation after several months. Patients who may undergo liposuction are advised to undergo a pre-operative risk assessment.

Liposuction may be staged in order to avoid complications of large volume liposuction. Risks and complications must be discussed. Among the common complications are postoperative pain, dehydration, infection, and bleeding. More serious complications include deep vein thrombosis, pulmonary embolism, and inadvertent perforation into the abdominal or thoracic cavity which may lead to death.

The Liposuction Procedure

Surgical markings are placed with the patient standing in front of a mirror so that they may have a common understanding as to the target areas for liposuction. Zones of adherence and any skin irregularities (cellulite, dimpling, or any asymmetry) are also marked and discussed so that they may not be mistaken for the effects of the surgery. Points of entry are also determined at this point so that they may be placed in areas covered by underwear or concealed in natural creases and folds. It is preferred that entry points be small and placed asymmetrically so as not to call attention to their locations.

The type of anesthesia will depend on the preference of the surgeon. There have been no studies showing the superiority of one type of anesthesia over another in liposuction. However, regional anesthesia (epidural or spinal) is generally avoided due to the potential hypotension and possibility of volume overload. Apart from the anesthesia used, tumescent fluid (Klein’s Solution) also has lidocaine and epinephrine which may add to pain control and decrease blood loss. After infiltration, surgeons wait around 7 to 30 minutes in order to benefit from the full effects of epinephrine for lessening blood loss.

Depending on the target areas, patients are positioned in order to maximize the number of fats suctioned and to minimize the risk of entering any major cavity. During positioning, bolsters, pillows and arm boards are used to prop the patient with particular attention to the patient’s airway.

Recovery & Results

Postoperatively, appropriate compression garments are placed which are used 24 hours a day for the first month. Some surgeons allow their patients to use compression for only 2 weeks instead of an entire month. Ambulation is advised as early as possible, however, patients are monitored for signs of dehydration which may cause them to feel dizzy or even faint while they are in the upright position. Patients are advised that over the next few days, they should expect some weight gain after the procedure due to edema. Initial contour changes may be appreciated on the 2nd week from surgery. Best results are anywhere from 6 to 8 months after surgery.

Frequently Ask Questions