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Liposuction

If you have been eating right and exercising consistently but can't get rid of the "problem areas," liposuction may be the choice for you. Some areas of localized fat do not respond to diet and exercise, or they may be the result of heredity. With liposuction Dr. de Ramon is able to offer patients in Harrisburg, PA and the Central PA region the ability to sculpt the areas of their bodies that are a concern to them, allowing them to achieve better proportions and contour and improved self-image.

 

There are many things to consider before having liposuction by Dr. de Ramon:

 

A liposuction consultation lasts between 30 and 60 minutes. Dr. de Ramon does a complete history & physical, discusses your concerns/goals and evaluates your appropriateness for the procedure. A candidate then returns for a second consultation to answer final questions and choose a surgery date. Liposuction surgery is normally done as an outpatient at either PinnacleHealth Harrisburg area hospitals or at the Cumberland Surgery Center in Mechanicsburg. Post-operative recovery usually requires 3-5 days of rest and one week without driving. A post-operative compression garment is also worn to reduce swelling.

 

Liposuction can be performed in many areas of the body including neck, chest, arms, abdomen, flanks, thighs, and buttocks. In some cases, more than one area can be treated at a single surgical setting. In others, a staged approach may be the best for optimal results and patient safety.

 

Other body plastic surgery procedures:

 

More Information:



If You're Considering UAL...

Ultrasound-assisted lipoplasty, commonly known as "UAL," is a relatively new liposuction technique that uses sound waves to "liquefy" unwanted fat. Although it is not a substitute for traditional Harrisburg PA liposuction, UAL can be an effective tool for removing fat from fibrous body areas, such as the male breasts or the back, or for removing larger volumes of fat in a single procedure.

 

Often, traditional liposuction is performed with UAL to help shape UAL-treated areas or to treat areas of the body not suited for UAL, such as the neck and inner thighs.

 

If you are considering UAL, this brochure will provide an overview of the technique: when it can help, how it is performed and what results you can expect. It can't answer all of your questions, since a lot depends on your individual circumstances. Ultimately, you and your plastic surgeon will determine whether UAL or traditional liposuction is best suited for you.

 

Please ask your physician if there is anything about the procedure you don't understand.

 

The Best Candidates for UAL

Liposuction can enhance your appearance and your self confidence, but it won't necessarily change your looks to match your ideal, or cause other people to treat you differently. Before you decide to have UAL or liposuction of any type, think carefully about your expectations and discuss them with your surgeon.

 

The best candidates for UAL are generally no different than candidates for the traditional liposuction procedure: normal-weight people with firm, elastic skin who have pockets of excess fat in particular areas. UAL candidates should be physically healthy, psychologically stable and realistic in their expectations. Age is usually not a criterion for liposuction, but older patients may have diminished skin elasticity and may not achieve the same results as a younger patient.

 

All Surgery Carries Some Uncertainty and Risk
Since it was first described in the medical literature in 1991, UAL has been performed on several thousand patients worldwide. However, long-term effects of ultrasound energy are not known and extensive research and clinical trials are need to establish fully the safety and efficacy of UAL. So far, clinical investigators have reported good results from the technique.

 

UAL is normally safe when patients are carefully selected, the operating facility is properly equipped and the physician has completed an appropriate, hands-on UAL training course.

As with traditional liposuction, serious medical complications from UAL are infrequent. However, possible complications include clots that block blood flow, infection, excessive fluid loss that can lead to shock, excessive fluid accumulation that must be drained, skin injury, perforation injury to the skin or other organs and adverse reactions to anesthesia.

 

One potential complication specifically related to the UAL technique is thermal skin injury or burn caused by the heat from the ultrasound device. Also, temporary collections of fluid beneath the skin surface (seromas) are more common with UAL.

 

Also, you should be aware that at present, the tube-like instruments or cannulas used to perform UAL are slightly larger than the cannulas used for traditional liposuction. The longer incisions that are needed for UAL require that they be placed carefully in hidden areas. For this reason, some surgeons prefer to use the traditional liposuction technique in areas where an obvious scar may result.

 

Cosmetic complications from all types of liposuction include: irregularities of the skin's surface, areas of uneven pigmentation, and asymmetry. Some cosmetic problems can be treated with additional surgery.

Planning Your Surgery
In your initial consultation, your surgeon will evaluate your health, determine where your fat deposits lie and assess the condition of your skin. Your surgeon will explain the body contouring methods that may be most appropriate for you. For example, you may learn that an abdominoplasty or "tummy tuck" may more effectively meet your goals; or that a combination of traditional liposuction and UAL would be the best choice for you.

 

Be frank in discussing your expectations with your surgeon. Also, be sure to tell your physician about any significant weight losses or gains you have had at any time. You should inform your surgeon if you smoke, and if you're taking any medications, vitamins or other drugs.

 

Preparing for Your Surgery
Your surgeon will give you specific instructions on how to prepare for surgery, including guidelines on eating and drinking, smoking, and taking or avoiding vitamins, iron tablets and certain medications. If you develop a cold or an infection of any kind, especially a skin infection, your procedure may have to be postponed.

While you are making preparations, be sure to arrange for someone to drive you home after your surgery and, if needed, to help you out for a day or two.

 

Where Your Surgery Will Be Performed
UAL may be performed in a surgeon's office-based facility, an outpatient surgery center, or a hospital. It is usually done on an outpatient basis. If a large volume of fat will be removed, a stay in a hospital or overnight nursing facility may be required.

 

Anesthesia for UAL
If you are having only a small amount of fat removed, UAL may be performed under local anesthesia combined with a sedative to make you drowsy. You will be awake but relaxed and feel only minimal discomfort. Some surgeons may prefer to use an epidural block, similar to the anesthesia commonly used in childbirth.

 

General anesthesia may be used if you prefer it, or if your doctor so advises. In that case, you will sleep through the procedure.

 

The Surgery

The time required to perform UAL may vary considerably, depending on the amount of work you are having done. However, UAL generally takes longer than traditional liposuction because of the extra "fat-liquefying" step involved.

 

To begin the procedure, salt water containing local anesthesia and adrenaline is injected into the area to be treated. Then, a metal cannula connected to an ultrasound generator is inserted beneath the skin through a small incision. The ultrasonic energy causes the walls of the fat cells to break down, allowing the fat to flow out of each cell. The "liquified" fat combines with the injected fluid to create an emulsion, which is removed from the body by vacuum pressure.

 

If you are awake, you may feel some warmth and vibration during the procedure. You will probably be given some fluid through an IV (intravenous) tube to keep your fluid level balanced. Typically, only a small amount of blood is lost during UAL. However, if your surgeon determines that a blood transfusion may be needed, you can donate your own blood in advance of the procedure.

 

After Your Surgery
After surgery, you will likely experience some fluid drainage from the incisions. A drainage tube may be inserted beneath the skin to prevent fluid build-up. To help control swelling, you may be fitted with a snug elastic bandage or compression garment to wear over the treated area. The bandage or garment is typically worn for up to four weeks, to help your skin shrink to fit its new contour.

 

The side-effects of traditional liposuction surgery - pain, burning, swelling, bleeding and temporary numbness — can be expected from UAL as well. The pain can be controlled with medications prescribed by your surgeon, though you may still feel stiff and sore for a few days.

 

It is normal to feel a bit depressed in the days or weeks following surgery. This feeling will subside as you begin to look and feel better.

 

Getting Back to Normal
Healing is a gradual process. Your surgeon will probably tell you to start walking around as soon as possible. You will begin to feel better after about a week and you should be back to work within two weeks following your surgery. Any stitches are usually removed within the first week.

 

Activity that is more strenuous should be avoided for about three weeks as your body continues to heal. Although most of the bruising and swelling usually disappears within six weeks, some swelling may remain for six months or more.

 

Your surgeon will schedule follow-up visits to monitor your progress and to see if any additional procedures are needed.

 

Your New Look
You will see a noticeable difference in the shape of your body quite soon after surgery. However, improvement will become even more apparent after about six weeks, when most of the swelling has subsided.

 

If your expectations are realistic, you will probably be very pleased with the results of your surgery. You may find that you are more comfortable in a wide variety of clothes and more at ease with your body. And, by eating a healthy diet and getting regular exercise, you can help to maintain your new shape permanently.

 


What Is Liposuction?
Liposuction is the surgical vacuuming of fat from beneath the surface of the skin. It is used to reduce fullness in any area of the body. It is an excellent method of spot reduction but is not an effective method of weight loss.

 

What Is the Tumescent Technique?
The tumescent technique involves injection beneath the skin of large volumes of salt water containing lidocaine, a local anesthetic, and small amounts of adrenaline, a naturally occurring hormone that shrinks blood vessels. By injecting this solution to the fat prior to performing liposuction the plastic surgeon numbs the tissues and shrinks the blood vessels thereby eliminating pain and reducing and minimizing bleeding, bruising and swelling. The tumescent technique permits some patients who were previously treated under general anesthesia to be treated under local anesthesia with sedation.

 

Who Is a Candidate for Liposuction?
Generally people who have localized areas of protruding fat achieve the most dramatic results. Patients who are slightly overweight can benefit from liposuction. It is best to be at or near your normal weight. Good skin elasticity permits the skin to shrink easily to the reduced contour. There are no absolute age limits for liposuction.

 

What Areas Are Most Frequently Treated?
In women, the single most frequently treated areas are the outer thighs, followed by the stomach. In men, the flank area or "love handles" are treated most frequently.

 

Can Liposuction Tighten Up a Loose Neck?
If there is excess fat in the area under the chin and the skin is taut, liposuction alone can produce a more sculpted, angular and youthful jaw line. If, however, the skin of the neck is loose, hanging or crepey, even if there is excess fat, liposuction alone will not produce the desired result. Patients with loose skin usually require a face and neck lift in addition to or instead of liposuction. In general, most patients who benefit from liposuction of the neck are under 40. Most patients over 40 will require some surgical skin tightening.

 

Liposuction Seems Very Simple and Safe. Are There any Dangers?
Although liposuction is very safe and effective, it is a surgical procedure and can cause complications such as infection, bleeding and nerve damage. In addition, aesthetic complications such as skin irregularity or waviness can occur if too much fat has been removed. Fortunately, complications are uncommon and most patients are satisfied with their results.

 


If you're considering liposuction...
Liposuction is a procedure that can help sculpt the body by removing unwanted fat from specific areas, including the abdomen, hips, buttocks, thighs, knees, upper arms, chin, cheeks and neck. During the past decade, liposuction, which is also known as "lipoplasty" or "suction lipectomy," has benefited from several new refinements. Today, a number of new techniques, including ultrasound-assisted lipoplasty (UAL), the tumescent technique, and the super-wet technique, are helping many plastic surgeons to provide selected patients with more precise results and quicker recovery times. Although no type of liposuction is a substitute for dieting and exercise, liposuction can remove stubborn areas of fat that don't respond to traditional weight-loss methods.

 

If you're considering liposuction, this brochure will give you a basic understanding of the procedure - when it can help, how it is performed and how you might look and feel after surgery. It won't answer all of your questions, since much depends on your individual circumstances. Please ask your doctor if there is anything about the procedure you don't understand.

 

The best candidates for liposuction
To be a good candidate for liposuction, you must have realistic expectations about what the procedure can do for you. It's important to understand that liposuction can enhance your appearance and self confidence, but it won't necessarily change your looks to match your ideal or cause other people to treat you differently. Before you decide to have surgery, think carefully about your expectations and discuss them with your surgeon.

The best candidates for liposuction are normal-weight people with firm, elastic skin who have pockets of excess fat in certain areas. You should be physically healthy, psychologically stable and realistic in your expectations. Your age is not a major consideration; however, older patients may have diminished skin elasticity and may not achieve the same results as a younger patient with tighter skin.

 

Liposuction carries greater risk for individuals with medical problems such as diabetes, significant heart or lung disease, poor blood circulation, or those who have recently had surgery near the area to be contoured.

 

Planning your surgery
In your initial consultation, your surgeon will evaluate your health, determine where your fat deposits lie and assess the condition of your skin. Your surgeon will explain the body-contouring methods that may be most appropriate for you. For example, if you believe you want liposuction in the abdominal area, you may learn that an abdominoplasty or "tummy tuck" may more effectively meet your goals; or that a combination of traditional liposuction and UAL would be the best choice for you.

 

Be frank in discussing your expectations with your surgeon. He or she should be equally frank with you, describing the procedure in detail and explaining its risks and limitations.

 

Getting the answers you need
Individuals considering liposuction often feel a bit overwhelmed by the number of options and techniques being promoted today. However, your plastic surgeon can help. In deciding which is the right treatment approach for you, your doctor will consider effectiveness, safety, cost and appropriateness for your needs. This is called surgical judgment, a skill that is developed through surgical training and experience. Your doctor also uses this judgement to prevent complications; to handle unexpected occurrences during surgery; and to treat complications when they occur.

Your surgeon's education and training have helped to form his or her surgical judgement, so take the time to do some background checking. Patients are encouraged to consider a doctor certified by the American Board of Plastic Surgery ("ABPS"). By choosing a plastic surgeon who is certified by the ABPS, a patient can be assured that the doctor has graduated from an accredited medical school and completed at least five years of additional residency - usually three years of general surgery (or its equivalent) and two years of plastic surgery. To be certified by the ABPS, a doctor must also practice surgery for two years and pass comprehensive written and oral exams.

 

Preparing for your surgery
Your surgeon will give you specific instructions on how to prepare for surgery, including guidelines on eating and drinking, smoking, and taking or avoiding vitamins, iron tablets and certain medications. If you develop a cold or an infection of any kind, especially a skin infection, your surgery may have to be postponed.

 

Though it is rarely necessary, your doctor may recommend that you have blood drawn ahead of time in case it is needed during surgery.

 

Also, while you are making preparations, be sure to arrange for someone to drive you home after the procedure and, if needed, to help you at home for a day or two.

 

Where your surgery will be performed
Liposuction may be performed in a surgeon's office-based facility, in an outpatient surgery center, or in a hospital. Smaller-volume liposuction is usually done on an outpatient basis for reasons of cost and convenience. However, if a large volume of fat will be removed, or if the liposuction is being performed in conjunction with other procedures, a stay in a hospital or overnight nursing facility may be required.

 

Anesthesia for liposuction
Various types of anesthesia can be used for liposuction procedures. Together, you and your surgeon will select the type of anesthesia that provides the most safe and effective level of comfort for your surgery.

If only a small amount of fat and a limited number of body sites are involved, liposuction can be performed under local anesthesia, which numbs only the affected areas. However, if you prefer, the local is usually used along with intravenous sedation to keep you more relaxed during the procedure. Regional anesthesia can be a good choice for more extensive procedures. One type of regional anesthesia is the epidural block, the same type of anesthesia commonly used in childbirth.

However, some patients prefer general anesthesia, particularly if a large volume of fat is being removed. If this is the case, a nurse anesthetist or anesthesiologist will be called in to make sure you are completely asleep during the procedure.

 

The surgery
The time required to perform liposuction may vary considerably, depending on the size of the area, the amount of fat being removed, the type of anesthesia and the technique used.

 

There are several liposuction techniques that can be used to improve the ease of the procedure and to enhance outcome.

 

Liposuction is a procedure in which localized deposits of fat are removed to recontour one or more areas of the body. Through a tiny incision, a narrow tube or cannula is inserted and used to vacuum the fat layer that lies deep beneath the skin. The cannula is pushed then pulled through the fat layer, breaking up the fat cells and suctioning them out. The suction action is provided by a vacuum pump or a large syringe, depending on the surgeon's preference. If many sites are being treated, your surgeon will then move on to the next area, working to keep the incisions as inconspicuous as possible.

Fluid is lost along with the fat, and it's crucial that this fluid be replaced during the procedure to prevent shock. For this reason, patients need to be carefully monitored and receive intravenous fluids during and immediately after surgery.

 

Technique variations
The basic technique of liposuction, as described above, is used in all patients undergoing this procedure. However, as the procedure has been developed and refined, several variations have been introduced.

 

Fluid Injection, a technique in which a medicated solution is injected into fatty areas before the fat is removed, is commonly used by plastic surgeons today. The fluid - a mixture of intravenous salt solution, lidocaine (a local anesthetic) and epinephrine (a drug that contracts blood vessels) - helps the fat be removed more easily, reduces blood loss and provides anesthesia during and after surgery. Fluid injection also helps to reduce the amount of bruising after surgery.

 

The amount of fluid that is injected varies depending on the preference of the surgeon.

 

Large volumes of fluid - sometimes as much as three times the amount of fat to be removed - are injected in the tumescent technique. Tumescent liposuction, typically performed on patients who need only a local anesthetic, usually takes significantly longer than traditional liposuction (sometimes as long as 4 to 5 hours). However, because the injected fluid contains an adequate amount of anesthetic, additional anesthesia may not be necessary. The name of this technique refers to the swollen and firm or "tumesced" state of the fatty tissues when they are filled with solution.

 

The super-wet techniqueis similar to the tumescent technique, except that lesser amounts of fluid are used. Usually the amount of fluid injected is equal to the amount of fat to be removed. This technique often requires IV sedation or general anesthesia and typically takes one to two hours of surgery time.

 

Ultrasound-Assisted Lipoplasty (UAL). This technique requires the use of a special cannula that produces ultrasonic energy. As it passes through the areas of fat, the energy explodes the walls of the fat cells, liquefying the fat. The fat is then removed with the traditional liposuction technique.

 

UAL has been shown to improve the ease and effectiveness of liposuction in fibrous areas of the body, such as the upper back or the enlarged male breast. It is also commonly used in secondary procedures, when enhanced precision is needed. In general, UAL takes longer to perform than traditional liposuction.

 

All surgery carries some uncertainty and risk
Liposuction is normally safe, as long as patients are carefully selected, the operating facility is properly equipped and the physician is adequately trained.

 

As a minimum, your surgeon should have basic (core) accredited surgical training with special training in body contouring. Also, even though many body-contouring procedures are performed outside the hospital setting, be certain that your surgeon has been granted privileges to perform liposuction at an accredited hospital.

 

Your doctor must have advanced surgical skills to perform procedures that involve the removal of a large amount of fat (more than 5 liters or 5,000 ccs); ask your doctor about his or her other patients who have had similar procedures and what their results were. Also, more extensive liposuction procedures require attentive after-care. Find out how your surgeon plans to monitor your condition closely after the procedure.

However, it's important to keep in mind that even though a well-trained surgeon and a state-of-the art facility can improve your chance of having a good result, there are no guarantees. Though they are rare, complications can and do occur. Risks increase if a greater number of areas are treated at the same time, or if the operative sites are larger in size. Removal of a large amount of fat and fluid may require longer operating times than may be required for smaller operations.

 

The combination of these factors can create greater hazards for infection; delays in healing; the formation of fat clots or blood clots, which may migrate to the lungs and cause death; excessive fluid loss, which can lead to shock or fluid accumulation that must be drained; friction burns or other damage to the skin or nerves or perforation injury to the vital organs; and unfavorable drug reactions.

 

There are also points to consider with the newer techniques. For example, in UAL, the heat from the ultrasound device used to liquefy the fat cells may cause injury to the skin or deeper tissues. Also, you should be aware that even though UAL has been performed successfully on several thousand people worldwide, the long-term effects of ultrasound energy on the body are not yet known.

 

In the tumescent and super-wet techniques, the anesthetic fluid that is injected may cause lidocaine toxicity (if the solution's lidocaine content is too high), or the collection of fluid in the lungs (if too much fluid is administered).

 

The scars from liposuction are small and strategically placed to be hidden from view. However, imperfections in the final appearance are not uncommon after lipoplasty. The skin surface may be irregular, asymmetric or even "baggy," especially in the older patient. Numbness and pigmentation changes may occur. Sometimes, additional surgery may be recommended.

After your surgery
After surgery, you will likely experience some fluid drainage from the incisions. Occasionally, a small drainage tube may be inserted beneath the skin for a couple of days to prevent fluid build-up. To control swelling and to help your skin better fit its new contours, you may be fitted with a snug elastic garment to wear over the treated area for a few weeks. Your doctor may also prescribe antibiotics to prevent infection.

Don't expect to look or feel great right after surgery. Even though the newer techniques are believed to reduce some post-operative discomforts, you may still experience some pain, burning, swelling, bleeding and temporary numbness. Pain can be controlled with medications prescribed by your surgeon, though you may still feel stiff and sore for a few days.

 

It is normal to feel a bit anxious or depressed in the days or weeks following surgery. However, this feeling will subside as you begin to look and feel better.

 

Getting back to normal

Healing is a gradual process. Your surgeon will probably tell you to start walking around as soon as possible to reduce swelling and to help prevent blood clots from forming in your legs. You will begin to feel better after about a week or two and you should be back at work within a few days following your surgery. The stitches are removed or dissolve on their own within the first week to 10 days.

 

Activity that is more strenuous should be avoided for about a month as your body continues to heal. Although most of the bruising and swelling usually disappears within three weeks, some swelling may remain for six months or more.

 

Your surgeon will schedule follow-up visits to monitor your progress and to see if any additional procedures are needed.

If you have any unusual symptoms between visits - for example, heavy bleeding or a sudden increase in pain - or any questions about what you can and can't do, call your doctor.

 

Your new look
You will see a noticeable difference in the shape of your body quite soon after surgery. However, improvement will become even more apparent after about four to six weeks, when most of the swelling has subsided. After about three months, any persistent mild swelling usually disappears and the final contour will be visible.

 

If your expectations are realistic, you will probably be very pleased with the results of your surgery. You may find that you are more comfortable in a wide variety of clothes and more at ease with your body. And, by eating a healthy diet and getting regular exercise, you can help to maintain your new shape.

 


Procedure Status
Liposuction is a surgical technique used to contour the body by removing unwanted areas of fat. During the procedure, a hollow suction tube, or "cannula," is passed through small skin incisions and manipulated in such a way that the unwanted fat is broken up and transferred through the tube by the attached vacuum machine. Patients may be given general anesthesia or merely sedated to undergo liposuction and generally do not need to remain hospitalized overnight. Improvements in body contour are usually permanent with this procedure.

 

From its introduction into the United States in 1982, liposuction has grown to become the nation's most frequently performed cosmetic plastic surgery procedure. In addition, its techniques have been adapted for such noncosmetic purposes as tumor surgery, breast reduction and flap contouring. A recent modification of the technique, ultrasound-assisted liposuction (UAL), substitutes high-frequency ultrasonic energy for mechanical energy, to remove localized areas of fat.

 

The tumescent technique allows surgeons to inject large amounts of fluid into the areas of fat before performing liposuction. The fluid, containing local anesthetic(s) and blood vessel constricting drugs, can reduce blood loss, alleviate pain and lessen the need for general anesthesia. The local anesthesia is usually supplemented with intravenous sedation or general anesthesia when liposuction is performed by plastic surgeons.

 

With the "super-wet" technique, lesser amounts of fluid and local anesthetic are injected and blood loss is similarly reduced. The procedure is usually done under general or spinal anesthetic.

 

Position Statement
The American Society of Plastic Surgeons (ASPS) believes that liposuction is generally safe, provided that patients are carefully selected, the operating facility is properly equipped, and the physician has basic (core) accredited surgical training with special training in body contouring. Patients should be aware that lipoplasty to remove more than five liters (5000cc's) of fat and fluid requires a high level of surgical skill and a provision for prolonged monitoring after the procedure.

 

ASPS believes that ultrasound-assisted liposuction (UAL) is an acceptable alternative to traditional liposuction in some circumstances because it offers the potential of easier removal of fat in more fibrous areas. However, because the heat generated by ultrasonic energy creates a risk for burns to treated areas, plastic surgeons should complete a CME category 1 approved training program in UAL before using the technique clinically.

 

ASPS believes that pre-injection methods (including "tumescent" and "super-wet" techniques) usually decrease blood loss and reduce the need for transfusion. Surgeons who use these techniques to remove large volumes of fat and fluid must have a background of surgical education in the principles of fluid management.

ASPS does not recommend liposuction for individuals with complicated diabetes, poor circulation, significant heart or lung disease, or those with recent surgery in the region to be treated.

 

Surgeon Selection
Because there are no federal or state laws governing the scope or quality of specialty education a physician must attain to designate him/herself a specialist, patients should exercise care in selecting a surgeon. In particular, ASPS recommends that individuals seeking liposuction inquire whether privileges to perform liposuction have been granted to a particular surgeon at an accredited hospital because hospitals must examine credentials carefully before granting specialty privileges to staff physicians.

 

If the procedure is to be performed outside a hospital, patients may inquire whether the surgical facility is accredited by an organization such as the American Association for Accreditation of Ambulatory Surgical Facilities. This organization (847-949-6058) requires maintenance of strict quality standards for facilities that achieve its accreditation.

 

Patient Profile
The ideal candidate for liposuction is a healthy adult man or woman with localized areas of unwanted fat beneath firm, elastic skin. Although patients of all ages may benefit from liposuction, the loss of skin elasticity with advancing age may limit the degree of improvement in older patients. Women usually seek liposuction to improve contour in the hips, thighs, abdomen, legs, buttocks and face-neck area. Men most frequently seek improvement in the waist and abdomen.

Limitations, Risks and Complications
Liposuction cannot compensate for deficiencies in diet and exercise. It is generally not a suitable method for weight loss, nor will it tighten loose skin or eliminate the shallow surface irregularities popularly termed "cellulite."

 

Imperfections in final appearance are not uncommon after liposuction. The skin surface may be irregular, asymmetric or even "baggy," especially in the older patient. Numbness and pigmentation may occur. Sometimes additional surgery may bring further improvement.

 

As noted, ultrasound-assisted liposuction carries the risk for burns to the skin and deeper tissues. In addition, the long-term biological effects, if any, of ultrasound energy are not known.

 

Though serious medical complications from liposuction are rare, the risks increase if a greater number and size of areas are treated at one time. Removal of large volumes of fat and fluid may require sizable volumes of pre-injection fluid and longer operating times than in smaller operations. The combination of these factors can create greater hazards for infection, delays in healing, improper fluid balance, injury (especially perforation) to vital organs, shock and unfavorable drug reactions. As with any surgical procedure, blood clots may form in the veins with risk of migration to the lungs, which can be fatal.

 

Recovery
All patients experience some degree of discomfort after liposuction, though most begin to feel better during the first week. Pain, swelling, discoloration and numbness should be expected, and a drain tube may occasionally be placed beneath the skin for a day or more. Ordinarily, patients are instructed to wear a snug elastic garment over the treated area for a few weeks. With the garment in place, many are able to return to work within a few days and to resume strenuous activity within the first month. Although most of the discoloration and swelling usually disappear by six weeks, some may persist for six months or longer.

Statistics
A nationwide survey of ASPS member plastic surgeons in 1996 has disclosed the following facts:

 

This briefing paper on liposuction for plastic surgery patients and consumers was developed by ASPS, which formed a task force to review the history and physiology of liposuction. The task force includes representatives from ASPS, the American Society for Aesthetic Plastic Surgery and the Lipoplasty Society, Inc.

 

This document is designed to provide accurate and authoritative information in regard to the topic covered as of the date of publication and is subject to change as scientific knowledge and technology advances and as practice patterns evolve. The views expressed herein represent the collective, but not necessarily the individual, views of members of the American Society of Plastic Surgeons.

 


What Exactly Is Ultrasound-Assisted Lipoplasty?
Ultrasound-assisted lipoplasty (UAL) is a method of liposuction that has been practiced in Europe and South America for a number of years but has only recently begun to attract attention in the United States. It is similar to traditional liposuction techniques in that fatty tissue is removed from the body through small (less than one centimeter) incisions for the purpose of improving body contour. However, with UAL the fat is first fractionated by the application of ultrasonic energy. The ultrasonic energy is delivered to the fat via a long narrow probe, which is inserted through the same small incisions used for traditional liposuction. The ultrasonic energy targets the fat cells leaving the surrounding structures, such as blood vessels and connective tissues, apparently undamaged. The fractionated fat can then be removed using low-volume suction.

 

How Does Ultrasound Fractionate Fat?
Ultrasonic energy is transmitted to the fat via a long narrow probe, which is connected to a handpiece held by the surgeon. The handpiece is connected to an ultrasonic generator, which converts electrical energy to ultrasonic energy. When the ultrasonic energy comes in contact with the fat, the high frequency vibration effectively bursts the fat cells allowing release of fractionated fat from the cell. This fractionated fat mixes with the body fluid and the wetting solution infused by the surgeon to form a stable fatty emulsion, which is a creamy light yellow color. This can then be removed from the body with relatively low-volume suction. This results in less trauma to tissues and therefore less bleeding, bruising and discomfort, leading to shorter periods of convalescence.

 

What Are the Advantages of UAL?
Early data indicates that, while UAL is not a substitute for traditional liposuction, there may be benefits, including decreased post-operative swelling and bruising. Some physicians believe UAL allows better control of contour or shape of the body in the areas treated with liposuction and early experience has shown minimal problems with post-operative contour irregularity. It allows relatively large volumes of fat removal per operation with relatively little blood loss and minimal post-operative bruising. UAL is also physically less demanding from a surgical standpoint. Certain anatomic regions, such as the hip, posterior back and central body regions, may respond preferentially to UAL. However, at present, traditional liposuction remains the best method of removing fat from certain body areas such as the face, neck, knees and inner thighs. In fact, traditional liposuction may be required in addition to UAL in many cases.

 

Are There any Possible Complications Associated With UAL?
As with any surgical procedure there are possible risks and complications. The risks and possible complications of UAL are essentially the same as with traditional liposuction techniques. Bleeding and infection are very rare with either technique (a good estimate would be less than 1 percent of cases have either of these problems.) Contour irregularity (or unevenness of the body contour) is possible with either technique. With any large amount of liposuction there is the possibility of accumulation of fluid in an area that was suctioned. This is called a seroma and is easily treated by drawing off the fluid in an office setting. Overaggressive liposuction by any technique, especially when carried out very close to the skin, can compromise the blood supply to the overlying skin. This could lead to loss or scarring of the skin. There is also the potential for burns at the entry site or along the path of the probe. This problem should be extremely rare.

 

What Kind of Anesthesia Is Used for UAL?
UAL can be performed using a number of different kinds of anesthesia, just the same as with traditional liposuction techniques. It can be done under a general anesthetic in which the patient is completely asleep. It can also be done under an epidural anesthesia, which is commonly used when a baby is delivered. Or it can be done under local anesthesia. With local and epidural anesthesia the patient is awake but is usually given some sort of sedative to keep him or her comfortable and relaxed. The question of what kind of anesthesia is appropriate for you should be discussed with your surgeon or anesthesiologist.

 

How Much Does This Procedure Cost?
The cost of the procedure will vary depending on the surgeon and in some cases the geographical area. In general, the more areas of your body that you have suctioned the more it costs. This question also must be discussed with your surgeon. Once you and your plastic surgeon have discussed which areas you might like addressed and which areas he/she feels are appropriate for this procedure, the cost can be accurately estimated.

 

What Can I Expect During the Post-Operative Period?
The answer to this question depends largely on what areas and how much fat you have suctioned. In general, the more aggressive the removal and the more areas you have suctioned, the more "strict" the post-operative regimen. In general, you can expect some discomfort during the first week or so. Most people describe it as discomfort rather than actual pain. Many say it feels like a deep bruise. The skin over the areas suctioned is often numb for a variable length of time. Most surgeons require you to wear some kind of post-operative compression garment such as a girdle or an abdominal binder. This is used to compress the tissues to lessen swelling and bleeding. The type of garment you will wear will depend on your surgeon's personal protocol and which areas you have suctioned. Most surgeons have you wear this for anywhere from two to six weeks after surgery.

 

Can I Gain the Weight Back?
Yes, you can regain weight after any kind of liposuction. You have a set number of fat cells as an adult and liposuction simply removes a certain number of them. If you gain weight, the remaining fat cells can grow bigger, which is how we gain weight. The good news is that there are fewer fat cells remaining in the area of the body that was suctioned and the "weight" tends to distribute itself more evenly in harmony with your new body contour. All in all, liposuction is not the answer to weight control, rather it is a surgical method of contouring the body. It is always best to be at a stable and realistic weight when you undergo this procedure.

 

How Do I Select a Plastic Surgeon for UAL?
Since UAL is a new technique in this country, it is important to select a surgeon with appropriate training and experience with UAL.

 


If your surgeon recommends the Tumescent Technique...
The tumescent technique is a relatively new liposuction method that can reduce post operative bruising, swelling and pain. Because blood loss is minimized during tumescent liposuction, use of the technique reduces the chance that a blood transfusion will be needed.

 

In the tumescent technique, areas of excess fat are injected with a large amount of anesthetic liquid before liposuction is performed. The liquid causes the compartments of fat to become swollen and firm or "tumesced." The expanded fat compartments allow the liposuction cannula to travel smoothly beneath the skin as the fat is removed.

 

Candidates for Tumescent Liposuction
Any person who is a candidate for traditional liposuction is also a good candidate for the tumescent technique. Although the technique can be used on any area of the body, it is commonly used on areas that require enhanced precision, such as the face, neck, arms, calves and ankles.

 

Individuals who have large areas of excess fat may also be good candidates for tumescent liposuction.

 

Understanding the Risk
Although the anesthesia requirements are lessened and blood loss is minimized with tumescent liposuction, patients undergoing the procedure still face the same risks and cosmetic complications associated with traditional liposuction surgery.

 

There are also risks specifically associated with the tumescent technique. These rare complications include pulmonary edema (the collection of fluid in the lungs), which may occur if too much fluid is administered; and lidocaine toxicity, which occurs if the solution's lidocaine content is too high.

 

You can reduce your risks by choosing a board-certified plastic surgeon who has adequate experience with the technique.

 

Anesthesia
For many patients, general anesthesia is the best option. For others, the anesthetic contained in the solution combined with sedation may provide sufficient comfort during the procedure. Or, if your doctor feels it's appropriate, the tumescent solution itself may serve as the sole means of anesthesia.

 

The Surgery
In tumescent liposuction, the warmed tumescent liquid — a dilute solution containing lidocaine, epinephrine and intravenous fluid — is injected into the area to be treated. As the liquid enters the fat, it becomes swollen, firm and blanched. Liposuction is then performed on the tumesced areas.

 

After Surgery
The long-acting effects of the anesthetic solution help to provide pain relief after the procedure and decrease the need for additional pain medication.

 

For the first day or two after surgery, most patients experience swelling in the treated areas, as well as some fluid drainage from the incision sites.

 

Light activity is usually resumed within the first few days after tumescent liposuction; normal activity can be resumed within a few weeks.

 

Your New Look
Patients are usually able to see a noticeable difference almost immediately after surgery. However, more improvement can be seen after three weeks, when most of the swelling has subsided. After about three months, any persistent mild swelling will disappear and the final contour will be visible.

 

Patients are usually very pleased with the results of the procedure. By eating a healthy diet and getting regular exercise, you can help to maintain your slimmer figure or leaner physique.