Liposuction - LifeSculpt
In theory, liposuction is pretty simple. Tiny incisions are made in the skin around an area of undesirable fat. Thin metal cannulas with small holes at the end are introduced into the fat, and the fat is then suctioned out. The procedure leaves tiny, nearly invisible scars. For liposuction to deliver on its potential as a cosmetic procedure, several conditions must be met.
Patients must be in good health. There must be available fat to be suctioned from areas accessible to liposuction. Areas treated by this procudre in women are typically the hips and thighs, abdomen, buttocks. Arms, calves, and neck can sometimes be treated. In men, typical areas are the abdomen and flanks (love handles). Some men have excess fat in the breast area, and liposuction can remove this.
The skin must have sufficient elasticity so that when the fat is removed, it will retract and not hang loosely. This, more than a patient's age, determines the likelihood of a good outcome. Older patients with good skin elasticity will do better than younger patients with poor elasticity.
Given the above conditions, most patients will do well so long as expectations are realistic. Most patients will not achieve the smooth, blemish-free, firm skin contours seen in professional models unless they have this type of skin, to begin with. Patients with some skin irregularities, dimpling, creases, etc. will likely have these after liposuction. Liposuction is not a treatment for the dimpled skin condition which is called cellulite. This is not a type of tissue but simply describes the puckered skin contour some women have on their thighs and buttocks. The procudre will not make this go away but should not worsen it either.
The procedure is done as an outpatient, and local, regional, or general anesthesia can be used according to the areas and extent of work to be done. Postoperatively, patients will be put into a firm, elastic compression garment which will be worn 24 hours a day for the first week or so. This helps reduce any bruising and swelling of the tissues and speeds up the recovery process. Pain is usually mild and much like a bruise. Most patients can return to routine daily activities, including work, in a few days; sometimes even the next day or so.
Much has been made of the tumescent technique for liposuction. This technique involves nothing more than the injection of fluid into the fat before the suctioning is done. The fluid used is sterile saline mixed some local anesthetic and some epinephrine, to aid in postoperative pain control and to reduce bleeding. This fluid puffs out the fat and stabilizes it, making it easier to remove. In some cases, tumescent technique is used to perform liposuction using purely local anesthesia. This allows virtually any doctor to perform this procedure in their office but sometimes results in massive doses of local anesthesia being given, and this can be toxic. We use a variant of this technique because it does improve results but we limit our amount of solution to quantities that are well below any toxic levels. Because we have the capability to provide any anesthesia in our surgical suite, we can offer numerous options for our patients to make the procedure safer and more comfortable.
As with all surgical techniques, someone is always seeking to improve on it. The newest form of liposuction is laser assisted. In this technique, the area is first pre-treated using a laser. The purpose of the laser is to melt the fat and enhance skin tightening to yield better results in a wider variety of patients. It is also used in areas notoriously resistant to liposuction, such as the arms.
We are pleased to offer laser-assisted liposuction with the Palomar Lifesculpt laser system. Unlike other platforms (CoolLipo, Smartlipo) for laser assisted liposuction, which use one laser wavelength for both fat removal and skin tightening, the Lifesculpt system uses two patented lasers. One is the ideal for fat, and the other is the ideal for skin tightening. Devices with only one laser must use a compromise wavelength between those two ideals. We feel that our unit is the most advanced and effective device on the market at this time.
Some surgeons perform large volume liposuction, removing thousands of cubic centimeters of fat at a time. This is sometimes done as a weight reduction technique. Large volume liposuction carries some real risks, and most of the serious complications have occurred with large volume techniques. These should be done in a hospital and patients very carefully monitored for 24 hours postoperatively. At this time we are not convinced that the benefits of large volume techniques outweigh the risks and do not offer this particular variant of the procedure.
The ideal candidate is the patient who is at or near their ideal body weight, or at least at a weight that they are comfortable with; who have discrete accumulations of fat in areas accessible to the procedure, and who have a reasonably good skin tone that will allow for retraction after the fat is removed.
Properly done, and on carefully selected patients, this is an excellent addition to plastic surgery and is here to stay.