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| Liposuction: What's New in Body Sculpting? |
by Harlan Pollock, MD
Todd Pollock, MD |
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Cosmetic Surgery: Promises and Pitfalls
It is difficult, if not impossible, to separate hype from fact. The following statements are intended to provide current factual information and North Dallas Plastic Surgery's personal opinion of controversial aspects of cosmetic surgery.
Liposuction has become the most frequently performed cosmetic procedure since its introduction some fifteen years ago. All body sculpting procedures are based on liposuction, which is the technique of fat removal using small gauge cannulas (tubes) introduced through small incisions to vacuum (aspirate) excess fat.
Liposuction is best for localized fat deposits that are resistant to diet and exercise. It is not a weight loss operation. It has little effect on skin quality or cellulite. Results are permanent and usually quite natural in appearance. Complications are uncommon, but can include; bleeding, infection, and contour irregularities. The best way to find out the facts is in a consultation with one or more surgeons certified by the American Board of Plastic Surgery.
Tumescent liposuction refers to a liposuction technique in which a large volume of fluid is injected into the area to be suctioned. This fluid is saline (salt water) containing a dilute solution of adrenalin and local anesthetic. The preparation of the tissues with this solution facilitates the fat removal, reduces bleeding, and provides profound local anesthesia, eliminating the need for general anesthesia. Tumescent liposuction requires three times as much fluid being injected as what is aspirated (the fat and fluid removed). Though relatively safe, fluid overloading - which can result in congestive heart failure - has been reported as well as toxic effects of the local anesthesia.
Superwet liposuction is similar to tumescent liposuction but introduces less fluid into the area to be treated: usually a 1:1 proportion of the fluid to inject to the fat/fluid aspirated. This is generally safer than tumescent liposuction due to the lower risk of fluid overload. Yet is is effective enough to permit liposuction with IV sedation (twilight sleep).
Ultrasonic liposuction is a relatively new technique which involves the use of ultrasound high frequency waves to break up the fat prior to its removal. This high tech method of liposuction is presently under investigation and shows promise for removal of male breast tissue and the more fibrous fatty tissue in some areas of the back. It appears to have little, if any, advantage over conventional liposuction in the usual liposuction patient. It does have certain added disadvantages; increased expense and operating time, requires general anesthesia, and increased complications, which include skin burns, fluid accumulation (seromas) and burning pain.
Power assisted liposuction is similar to ultrasonic liposuction in that it permits liposuction in fibrous areas (such as the breast), in the back and in previously treated areas. It has the advantage of being less expensive with no added risk and no increase in operation time. It is a very effective method of body contouring which has been found to make the procedure easier for the surgeon. That is its main advantage, and because it's better for the surgeon it leads to a better result for the patient.
What's the best procedure? Who's the best candidate? Here are some additional points to remember:
- It's important that the patient has realistic expectations. Liposuction will not cure obesity. The procedure is generally recommended for patients of normal weight who have localized fat deposits that have been resistant to exercise and diet. Good candidates for liposuction are the patients who are within 30 percent of their ideal body weight and have adequate skin elasticity to ensure good cosmetic results.
- It's valuable to thoroughly discuss the procedure. Above, we talked about tumescent and superwet techniques (these both involve monitoring the ratio of injected fluid to the liquid, including fat, removed during liposuction). Proper fluid management is one of the fundamentals of a board-certified plastic surgeon’s training in caring for their patients.
- Some patients (and their doctors) may prefer local anesthesia, or epidural anesthesia (with or without conscious sedation), many patients want to sleep throughout the procedure. We believe that general anesthesia should be administered by a board-certified/board-eligible anesthesiologist or a certified registered nurse anesthetist.
- The value of discussing risks and postoperative care. Liposuction is serious surgery and it should only be done when a patient understands the risks. There is more risk of complications with multiple procedures and with longer surgical sessions. Liposuction is often performed as an outpatient procedure but if more than five liters (5000 ccs) of fat and fluid are removed, the patient should have an overnight hospital stay.
Remember, the best way to find out the facts is in a consultation with one or several surgeons certified by the American Board of Plastic Surgery.
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Learn more about liposuction now.
Learn about other plastic surgery procedures to consider in addition to liposuction.
To search for information about other ways to enhance your appearance, visit the eBody home page now.
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