What is Liposuction?
Liposuction is the removal of excess fat with a small, straw-like instrument called a cannula that is attached to a liposuction machine. The fat layer under the skin is converted to a network of tunnels and the cannula is manipulated within the layers to remove unwanted fatty deposits. An elastic garment is then worn for compression and healing. The result is a resculpting of bulging areas into more attractive contours.
When is Liposuction indicated?
Liposuction is most effective for removing localized fat deposits in body areas that do not respond to dieting or exercising. Liposuction is not intended as a substitute for weight loss, but rather is a contouring procedure. It is best utilized in a program of exercise and optimal weight maintenance.
Liposuction also has many valuable therapeutic applications and has been used effectively to treat medical conditions like excessive sweating and non-cosmetic fat accumulation, such as lipomas (benign fatty tumors) and gynecolastia (enlarged, male breasts.)
What Happens Prior to Surgery?
Before surgery, a complete medical history is taken and a careful examination is conducted in order to evaluate your condition. During the consultation, your dermatologic surgeon describes the procedure and what results might realistically be expected. Your doctor also will review alternative treatment options and explain the possible risks and complications that may occur. Photographs are frequently taken before and after surgery to help evaluate the amount of improvement.
How is the Tumescent Technique of Liposuction Performed?
Liposuction can be performed on the dermatologic surgeon’s office facility, in an outpatient surgical suite or in a hospital. If general anesthesia is not otherwise indicated, its potential complications can be avoided by the use of local anesthesia (often used with light sedation) via the tumescent technique. This breakthrough technique refers to filling the skin with local anesthetic in order to remove unwanted fat more efficiently.
With tumescent liposuction, large volumes of a solution containing dilute lidocaine (a local anesthetic) and dilute epinephrine (a drug to shrink capillaries and prevent blood loss) are injected with minimal discomfort directly into areas of excessive fatty deposits. Once the liquid is injected, a small incision is made in the skin, and a tube connected to a vacuum is inserted into the fatty layer. Using to and fro movements the fat is drawn through the tube into a collection system. The tumescent method enables the dermatologic surgeon to remove large amounts of fat more uniformly with fewer skin irregularities and less bleeding and bruising.
What Happens After Surgery?
The local anesthesia injected into the tissue remains for 13 to 24 hours following liposuction surgery greatly minimizing postoperative pain. After tumescent liposuction,, patients are usually alert and able to function without nausea, grogginess and the “washed out” feeling associated with general anesthesia. With the tumescent technique, there is minimal bruising, and many patients do not require postoperative reduction for pain. You can usually return to a desk-type job within 48 hours, physical exercise generally can be resumed three to seven days after liposuction.
Are there any possible complications?
The tumescent technique of liposuction is a remarkable safe procedure with few significant side effects. A recent study in Dermatologic Surgery Journal reported that 112 patients who underwent the tumescent procedure had an average of two quarts of fat removed with no significant complications. Clinical studies by other specialists have also demonstrated the safety and efficacy of tumescent liposuction.
What are the limitations of Liposuction?
Liposuction is not intended as a method for weight loss. It is used as a shaping procedure for areas where hereditary fat deposits resistant to diet and exercise have accumulated. The best results from liposuction occur in body areas where there is reasonable muscle tone, where skin has good elastic quality, and where fat is not excessive. In cases where there is a significant loss of tone and elasticity superior cosmetic results may require a combination of both liposuction and surgical skin tightening to remove the excessive loose tissue.
Your dermatologic surgeon can advise you of the likelihood of the need for additional treatments, depending on the specific condition of your skin.
Who is a good liposuction candidate?
Dr. Amron’s philosophy is that a good candidate is someone who has disproportionate “stubborn” areas of fat storage that cannot be lost with diet or exercise.
Who is not a good candidate?
Someone who is simply overweight but proportionate. If the patient can achieve a perfectly balanced physique with diet and exercise it is a mistake to do liposuction.
How much fat is typically removed?
The correct answer is the amount that makes a person proportionate and achieves a natural result. The goal is not to remove as much fat as possible but to remove the right amount in the right way from the right areas. It may be 200cc (1/2Lb.) or 4 ½ Liters (10Lbs.). Typically the average person has about one to two liters removed (2 ½ - 5 Lbs.). But remember this is pure fat! It is much more that a 2 ½ - 5 Lb weight loss would accomplish.
What is the most that can be removed?
The safe limit for one surgery is five liters (about 11 Lbs.). But more typically it is not the amount of fat that limits the surgery but how many areas that can be safely done at one time.
How long is the surgery?
Most surgeries are between 45 minutes and 2 ½ hours.
How many areas can be done?
Usually between three to four areas can safely be done with one procedure. More than 90% of Dr Amron’s patients only need one surgery for all areas. If additional areas are needed they can be done as soon as 48 hours later.
At what age can a patient have liposuction performed?
Provided they meet the criteria for a good candidate liposuction can safely and effectively be done on someone age 15-28 years. However with advancing age skin elasticity decreases. When elasticity decreases dr. Amron will choose to be less aggressive in his fat removal to achieve a smooth result. However, if Dr. Amron feels the elasticity in a particular area has decreased too much to achieve a smooth result he may suggest liposuction is not a good option.
Is liposuction better before pregnancy?
Because it is always easier to liposuction areas of good skin tone it is better to have it done before pregnancy. However, even after pregnancy if the skin tone is too poor Dr. Amron may refer the patient for an Abdominoplasty procedure (tummy-tuck).
Does the fat come back?
NO. This is a misperception. The fat tissue removed is permanently removed. If it comes back that means that it was either not done sufficiently in the first place or the area is full of another reasons (i.e. loose muscle tone or aging skin tone).
Does the fat go to other areas?
This is also a misperception. That the fat always goes to other areas. This will happen if the surgeon does not pay attention to body proportion (please see doctor's philosophy). If the surgeon pays attention to body proportion and does not make the patient disproportionate the fat will not “go to other areas.”
Does it hurt?
Besides the good “eye of the surgeon” as well as the artistry of the procedure there is an art to doing liposuction under local anesthesia. During the numbing process, which takes form 15-30 minutes the local anesthesia, fluid is slowly seeping into the fat. Most patients feel very little and describe this as an occasional pinch. After the local anesthesia is done the areas are “numb” and one feels only pressure or nothing at all. Almost all patients say the procedure was so much easier then they had imagined.
What about touch-ups?
The natural rate for touch-ups or revision liposuction is around 25%. Dr. Amron strongly feels it is important to do everything to prevent having to “touch-up” as it is much harder to make an area perfect the 2nd or 3rd time around. Dr. Amron’s rate for “touch-ups” is far less than 1%. In the rare instance a touch-up is necessary, the patient usually only covers the operating room time.
What are the chances of irregularities, dimples, or asymmetry occurring?
Very low. Dr. Amron does everything to achieve a smooth natural result and a happy patient. If he feels the chances of irregularities is higher due to a patients poor skin tone or if he has done a revision liposuction he will extensively discuss this with you and may recommend that liposuction is not the best option.
Will I have “loose skin”?
No. When liposuction is done properly the skin “re-drapes” and retracts to conform to the underlying tissue. Most times the skin becomes “tighter” because it has retracted (“pulled back”) and this tends to prevent further loosening of the skin. But all again if Dr. Amron feels the skin tone is already too loose he may not recommend liposuction.
What about scars?
Dr. Amron makes as few incisions as possible to achieve a good result. These incisions are 2-3 mm in length and usually heal very well without needing a stitch. He can usually hide many incisions in most areas of the body but because they usually heal well. It is important to not make too few incisions this might affect a perfect liposuction result. In the rare instance the incisions discolor or thicken. There are ways to lighten or flatten them.
How long do I need to wear the garment?
Usually 10 days full time and an additional 10 days part time (12 hours either day or night).
Do I go home that night?
Yes, it is not necessary in most instances to stay in an aftercare facility. You may return home or to a hotel the day of the surgery, but it is required that a friend or family member be with you.
When can I fly?
In most instances you may fly 2 days after the surgery as long as you are able to walk around every hour.
When can I exercise?
Dr. Amron wants every patient to take a 2-mile walk the day after surgery. This promotes healing. Most patients return to their regular exercise routine between one to two weeks.
When do I see the results?
Final results usually take between 6-12 months. But most of the results are usually seen at about 6 weeks. Usually by 3 weeks much of the swelling is down and most patients are looking better than before the surgery and are able to wear a swimsuit and go on vacation.
Can I combine this with other procedures?
For many of the reasons previously stated, Dr. Amron prefers to focus on liposuction and not combine it with other major procedures. If very few areas are done and the other procedure can be done under IV sedation he may agree to combine it with another minor procedure such as eyelid surgery if he feels it is safe and will not affect results.
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