Liposuction
What is Liposuction/Lipocontouring?
Liposuction/lipocontouring is referred to the operative procedure in which fatty areas around the body are assessed and then infiltrated with local anesthetic solution combined with saline and are then serially suctioned off. This, of course, is done in a sterile setting. Most often we encourage patients to go through and look at their bodies very closely. Then we ask them to choose areas with which they have a particular problem. In patients in whom the weight is static or has been rather stable, we then look at these areas closely. Particular areas are commonly chosen for lipocontouring. These include the flanks, the lower abdomen, the lateral thighs, medial thighs, and the medial knees. All of these areas are then marked prior to surgery and then in symmetric fashion infiltrated with local anesthetic solution combined with saline. The local anesthetic fluid is complemented with very low concentration epinephrine that will help prevent bleeding. Once the anesthetic solution and the epinephrine have had time to work, the local fatty tissue is suctioned off in serial fashion with careful attention to make the areas symmetric with no evidence of any contour defects. Please note that the appropriate name for this procedure is in fact lipocontouring. The emphasis of the procedure is to contour the fatty tissue. Liposuction is not a fat reduction procedure. It should be used to contour the overall body habitus to make it more smooth. Aggressive liposuction should be avoided because it places the patient at risk for operative injury and morbidity.
What Are the Possible Complications?
Like any surgery, there are risks and complications. With liposuction, the most common risks and complications are bleeding, infection, seroma, hematoma, perforation, and contour irregularity. Bleeding can happen if the local epinephrine solution has not had time to work. A seroma is a fluid collection that can develop in the space created by the liposuction. To help prevent this complication, patients are given contour garments that apply pressure to the operative area, to allow collapse and closure of these opened spaces. Contour garments are worn religiously for about 4 to 8 weeks depending on the area suctioned.
Perforation is a possible complication of the procedure when the suction catheter inadvertently invades one of the body cavities. This may cause injury to the chest organs or the abdominal organs, depending on which area the liposuction is being done. In all of my years as a plastic surgeon and in my years’ training as a plastic surgeon, I have never seen this occur.
However, it can occur. To prevent it from happening, we simply choose to be meticulous and overtly careful about the extent of liposuction and the catheters used. Again I have never had this complication and do not expect to ever see it.
Contour irregularity occurs when liposuction/lipocontouring is done and there is an asymmetry. This means that the two sides liposuctioned do not appear to be even. This may happen and needs to be addressed carefully. Most often we are very careful to inject the same amount of anesthetic solution and saline into each area prior to suctioning off the excess fat. We are also very careful to extract the same amount of fat from each side. In this way, we try to keep everything symmetric. However, sometimes this does not give us the symmetric look we hope for. If there is an area that is uneven, we then wait for a few months to allow the tissue and the swelling to subside. At that point, if the tissue is still irregular in shape, we then go back to surgery and address both sides and make them even.
How Painful Is the Procedure?
Like any surgical procedure, there is pain involved. Most patients comment that they have a mild to moderate amount of pain. Most of the pain seen with liposuction/lipocontouring is due to the bruising and the swelling involved. In fact, most complain more about the soreness and aching sensation than actual pain. To help with the pain, we regularly give patients oral and intravenous pain medicines in the post-operative period. Upon their discharge from the hospital, we supplement this with oral pain medication. It must be noted here that at the time of the surgery, the incisions are infiltrated with local anesthetic medication that lasts six hours, in an effort to help with post-operative pain.
How Long Do I Have to Take Off From Work?
Great question. Most often I suggest to patients that they consider taking about 2 to 3 weeks from work. Let me elaborate. Once liposuction/lipocontouring, the area involved becomes swollen and in many cases becomes extremely bruised. This area then slowly goes through healing. We have patients wear contour pressure garments to help with the swelling. This also helps with the postoperative pain as the swelling is controlled. We have patients start walking on post-operative day #1. They are usually walking comfortably by day#3. Most patients note that they are comfortable walking regularly by day#7. Additional time is taken off to help patients heal from all the bruising. However, in some cases, the patients are comfortable to return to their work or activities by week#2. We advise against patients going back to their workout routine until week#6. The logic here is to prevent patients from doing so much exercise as to cause additional swelling. If and when additional swelling develops, the tissues and the body parts are more apt to become more asymmetric in contour. If the patient waits until week#6, the chance of having contour asymmetry is much less because the underlying tissues have had time to settle and the spaces where fluid can collect have closed off.
Can I Combine This Procedure With Any Other Procedure?
Yes and no. Like any surgical procedure, there are limits to what can be done and what is safe. As for the yes, it can be combined with some other procedures. For example, I routinely do this procedure with an abdominoplasty. In fact, liposuction and lipocontouring can help make an abdominoplasty much more smooth. In this way, the overall result is much more improved than with an abdominoplasty alone. Other procedures that are routinely done along with liposuction are breast augmentation or breast lifts. Any procedure that may be too long or too arduous and place the patient at risk for significant bleeding or significant anesthetic exposure would have to be deferred and done in two stages. Please understand I say this without knowing exactly what you, the patient, may have in mind. I can only speak from my experience.
Am I a Good Candidate?
Plastic surgery is not for everyone. It involves certain risks like any operative procedure. As long as you are aware of this fact, you can be considered for the procedure. However, in every case, the patient is best served by a thorough evaluation of their history, their body, and their overall expectations. You as the patient have to be realistic and cognizant of what is possible and what is reasonable. Trust me I am from Beverly Hills and I have had the privilege of working with many of the famous groups of plastic surgeons in LA. I can simply tell you there is no magic. We offer an opportunity to help you with surgical procedures in correcting what you may think is abnormal about your body. Also please understand that for many patients no surgery is needed; just a friendly word of encouragement and confidence from the local Texas Panhandle Plastic Surgeon.