Liposuction is one of the most frequently performed aesthetic surgery procedures in the world. The procedure that is performed today is far different from that originally developed in France in the 1980s. Many refinements in both the technique and the equipment used for liposuction have occurred during that time which have made body contouring safer and the ability to extract and contour even relatively large amounts of fat possible with fewer side effects, better results, and less risk. Having said this, it is important that liposuction be done by board-certified plastic surgeons. There is no substitute for proper training, experience, and good judgment, particularly with regard to this procedure.
Liposuction involves the removal of fat by small tubes, or cannulas, attached to a vacuum aspiration device. Only fat in the subcutaneous layers of the body are accessible for liposuction. Patients with fat inside their abdomen, for example, are not helped by liposuction, but instead must resort to dieting and exercise for this visceral fat loss. Liposuction is not a substitute for proper diet and exercise. Although liposuction, per se, is not a reliable way of losing weight; it is a very reliable means of contouring.
Once the fat cells are removed, your net fat cell number is reduced permanently, thus making it theoretically more difficult for you to regain the fullness in the treated area. Liposuction is essentially a redistribution operation in that the fat in the areas treated is reduced in proportion to the rest of the body. Without a reduction in caloric intakeand without exercise, it is predictable that fat would still accumulate as a means of storing energy. If the depots of fat that were once present have been significantly reduced in capacity, then it follows that those fat depots remaining untreated may tend to accumulate more fat if energy intake exceeds energy expenditure.
It is therefore very important that patients considering liposuction understand the importance of diet and exercise in maintaining their weight, and realize that liposuction is not an alternative to a healthy lifestyle.
A comprehensive assessment of each patient on an individual basis is essential to the development of a specific treatment plan directed at identifying those specific areas that may be responsive to liposuction. In many instances, patients seek consultation for what amounts to a desire to lose weight. A stable Body Mass Index of less than 27 is necessary to be considered a candidate for liposuction. You should be aware of your Body Mass Index (BMI) and Dr. Creasman’s guidelines for what constitutes a good body weight to be a candidate for liposuction. In our experience, patients with a BMI above 27 are usually too overweight to derive a good result with liposuction. Their problem is more generalized, and liposuction would not typically be able to access areas of fat accumulation, such as the fat within the abdominal cavity. The ideal candidates have very specific areas of their bodies, which cause them concern and seem to be unresponsive to dieting and/or exercise. Liposuction affords us the ability to sculpt those specific areas with very small incisions (and thus very inconspicuous scars), thus bringing the patient into proportion with the rest of his or her features.
Dr. Creasman offers a complimentary consultation during which he gathers a medical history, including the patient’s weight gain and loss pattern, diet and exercise regimen, and goals for the procedure. Any previous medical conditions need to be identified prior to assessing the patient for surgical candidacy. Height and weight measurements are taken and a physical examination is done to assess the skin tone and texture, skeletal abnormalities such as scoliosis, and muscle bulk and tone.
Risks of Liposuction
Serious medical complications from liposuction are infrequent, but include bleeding, infection, skin irregularities, numbness, asymmetry, lumpiness, looseness or darkening of the pigmentation of the skin, blood clots that block blood flow, excessive fluid loss that can lead to shock, excessive fluid accumulation that must be drained (seroma), perforation injury to the skin or other organs, and adverse reactions to anesthesia. In addition, specific complications of UAL include thermal skin injury or burn from the ultrasonic device, and a more common occurrence of seromas. Scars from liposuction are small, but can sometimes be prominent, particularly in patients with dark pigmentation.
Some cosmetic problems may require additional surgery for correction. These complications, though infrequent, may result in additional expense to you.
Before Your Procedure
It is imperative that patients refrain from ingesting any medications or other substances which could potentially be the cause of surgical complications. A list of medications should be reviewed and discontinued at least two weeks prior to operation. Patients are seen two weeks prior to their surgery date for a general physical examination to ensure that no underlying medical problems exist which may interfere with the safety of their surgery. Specifically, any infections which arise prior to operation, however seemingly trivial, should be reported to our office.
Prophylactic antibiotics are administered intravenously just prior to operation. A prescription for pain medication is written at the preop visit, so that you have your pain pills when you return home from the operation.
Pre-operative photographs are taken so that you can see the improvement from your surgery afterwards. We generally take post-operative photographs at 3 months after your procedure.
You will be asked to sign a surgical consent that enumerates the risks of the procedure in detail. These risks will be explained herein and also at the consultation.
Most liposuction procedures are performed under a combination of local and general anesthesia, with some small volume procedures being done under local anesthesia with sedation. The anesthesia requirements for your procedure will be discussed with you by Dr. Creasman at the time of your consultation.
Skin markings are made to outline the sites to be treated. The anesthesia is then administered, and in every instance the fat is infused with a very dilute local anesthetic (tumescent technique) to distend the fat cells, which makes it easier to extract them and improves the ability to contour the areas smoothly. Dr. Creasman uses a technique known as ULTRASONIC LIPOPLASTY (UAL) to treat many areas of the body. This involves the use of a cannula which has ultrasound waves emanating from the tip. These sound waves break apart the fat cells, releasing their contents and making it less traumatic to sculpt the tissue. Rather than just suctioning the whole fat cell out, often in clumps, this technique removes the free contents of the cells and the ruptured membranes of the cells separately. The rationale is that smoother results can be obtained with this technology. One of the problems with liposuction in the past has been visible irregularities in the skin of treated areas. UAL has made this less of a problem, in general. Another advantage is the ability to remove much more fat without any appreciable blood loss. Yet another advantage is the ability to remove fat from very fibrous areas, such as the back and the upper abdomen, which is much more difficult with conventional suction-assisted lipectomy (SAL). Dr. Creasman has been using UAL since its introduction in 1996, and has experience in over 2500 patients. Results with UAL appear to be superior to those with SAL alone, especially in the flanks, hips, male breast, back, and upper abdomen.
At the conclusion of the UAL portion of the procedure, traditional liposuction is used to evacuate any residual emulsified fat, and to further sculpt the contour. The small incisions are not stitched, but left open to drain, and an elastic compression garment and stick-on foam sheeting is applied to control swelling and to reduce the risk of fluid build up beneath the skin.
After a period of at least an hour to monitor you in our recovery room, you will be discharged into the company of an adult escort.
After Your Surgery
You will almost certainly experience fluid drainage from the incisions, which can be dramatic and needs to be anticipated in terms of protecting clothing, car seats, and mattresses. We will provide you with some barrier drapes for your drive home, but you will need to protect your bed sheets for a couple of days. Dr. Creasman wants you to be up walking on the day of surgery to facilitate as much drainage as possible; “the more you ooze, the less you’ll bruise”. This drainage usually stops within 48 hours. At 2 days, we ask you to remove your garments, gently peel off the sticky foam and then shower. You will be seen in the office and all incisions checked. You will then be able to shower, but you will be asked to wear your compressive garment for approximately a month. This helps to control swelling and to assist in contouring the skin back down to the underlying muscle. The garment can be laundered after the first follow-up visit.
Certain side effects of liposuction, whether UAL or SAL, include pain, burning, swelling, bruising, oozing (blood-tinged fluid), and temporary numbness. The pain is usually well controlled with the prescribed medication, but a feeling of soreness persists for several days to several weeks. It takes at least six weeks to begin to feel normal again. The skin is usually quite numb and may feel very hard to the touch. It may even take as long as six months for the tissues to feel absolutely normal, depending on the extent of the procedure. At one week, we recommend beginning a 2-3 times/week massage regimen. We can refer you to a massage therapist or physical therapist for this treatment, which you will need for 3-4 weeks.
Most patients return to sedentary type work in a few days to a week, to physical work in one to two weeks. Though moderate exercise (e.g. walking) is encouraged in the early post-operative period, vigorous exercise such as swimming, jogging, aerobics, and weight training should generally be avoided for about a month. Dr. Creasman will be following you on a regular basis to give you specific feedback about your activity level.