Liposuction

What Is Liposuction?

Liposuction is a surgical procedure that is done to suction out the fat from different areas of the body. Liposuction may be done on the abdomen (tummy tuck), hips, thighs, calves, ankles, upper arms, neck, and back. It is mostly done as a cosmetic procedure to improve the skin and body contour and as well as for the management of certain conditions of obesity.

Alternate names

• Lipo
• Lipoplasty
• Suction assisted lipectomy

Is this procedure an elective or an emergency procedure?

Liposuction surgery is done as an elective procedure.

Types of procedure

Liposuction may be of the following types based on the depth of the procedure

• Deep Liposuction: Traditional liposuction where the deeper layers of fat are removed
• Superficial Liposuction: The superficial layers of fat are removed to help with skin contouring

Liposuction surgery may also be of the following types based on the infiltration technique of operation and the wetting solutions used

• Dry Lipo Surgery: The procedure does not use the infusion of a liquid into the tissues and is associated with more blood loss
• Wet Lipo Surgery: About 100-300ml of fluid with or without epinephrine is infused into the tissues and results in lesser blood loss
• Super wet Lipo Surgery: The infusion of fluid with epinephrine in equal ratios to the amount of fat removed. The blood loss is extremely less
• Tumescent Lipo Surgery: A very large volume of fluid which includes ringer lactate and epinephrine is used

Liposuction may also be of the following types based on the equipment that is used

• Power-assisted Lipo Surgery
• Ultrasound-Assisted Lipo Surgery

Indications

The indications for liposuction surgery could be aesthetic or therapeutic and may include the following

• Obesity
  • Obesity-induced lower limb arthritis
  • Obesity metabolic syndrome
• Lipedema
• Lipodystrophy syndromes
• Madelung disease
• Dercum Disease
• Lipoma
• Lymphedema
• Lymphangioma and cystic lymphangioma
• Limb gigantism
• Insulin-induced lipohypertrophy
• Scar revision
• Extraction of permanent fillers
• Axillary Hyperhidrosis
• Gynecomastia, macromastia, gigantomastia
• HIV associated dorsocervical fat pad

Contraindications and risk factors

Some contraindications for lipo surgery include the following

• Severe cardiovascular disease
• Coagulation disorders
• Pregnancy
• Allergy to lidocaine
• Major surgery within the last 6 months
• Stroke within the last 6 months
• Uncontrolled diabetes
• Unrealistic expectations
• Psychiatric illness and eating disorders
• Uncontrolled drug or alcohol addictions
• Immunosuppressant therapy

Investigations before a lipo surgery

Some investigations that need to be done before a lipo surgery include

• Laboratory tests
  • CBP & ESR
  • Coagulation Profile & Blood typing
  • Basic Metabolic Profile
  • Liver and Renal function tests
  • Pregnancy test – if required
  • Alcohol and tox screen
• Electrocardiography (ECG)

Preoperative advice

Before a liposuction surgery, the following may be done

• Risks and benefits of the procedure are explained
• Anticoagulant medication may be stopped before the liposuction operation
• Antibiotic Prophylaxis may be started a few days before the liposuction surgery

Intraoperative details

Duration: A lipo surgery may last from 30 minutes to 3 hours Anaesthesia: A liposuction operation may be done under local anesthesia for most cosmetic surgery liposuction procedures, or general anesthesia may be used when liposuction surgery is being done for other conditions.

Description of the procedure:

A wide area of skin where the liposuction operation will be performed is thoroughly cleaned with povidone-iodine. An IV line may be put in place. After the anesthetic (local or general) has taken effect, a series of tiny incisions are made and the area is flooded with local anaesthetic and epinephrine (which prevents bleeding) and the fat is then extracted via suction using an instrument called a cannula. The cannula is used for fat removal as well as to contour or shape the skin. Other instruments such as liposhavers may be used, or ultrasound may be used to break up the fat deposits to help with easier suction of the fat cells from below the skin. The incisions are usually not sutured and are closed with tight pressure bandages. In some instances, the incisions may be stapled.

Postoperative details

After liposuction surgery, the following is usually done

• For major procedures done under general anesthesia
  • The individual is shifted to a recovery room and placed under observation until they awaken from the anesthesia
  • Cardiovascular functions are monitored
• For minor cosmetic surgery liposuction involving small areas done under local anesthetic, the individual is usually discharged after the procedure is complete.

Discharge: Usually after the procedure for minor cosmetic surgery liposuction procedures, and the 1st – 2nd postoperative day for major procedures. Instructions are given on the use of compression bandages and post-liposuction care. Common post-procedure occurrences

• Minor bleeding or seepage at the site of surgery
• Mild soreness and pain at the site of surgery may persist for a few days
• Swelling at the site of surgery: which usually subsides by the 2ndweek after the procedure
• Bruising at the site of surgery: which usually subsides by the 2ndweek after the procedure

Medication: Mild pain relievers and antibiotics may be prescribed.

Review: Usually on the 1st postoperative day; sutures if any may be removed and the surgical site is inspected. The results of body contour will be seen usually after 3-6 months.

Resumption of normal activity: Usually after 1 week after the procedure.

Role of diet/exercise/lifestyle changes

Some measures that need to be taken after a liposuction surgery include the following

• To continue wearing the support garments for 24 hours after the surgery
• To shower 2-3 days the procedure
• To move about and indulge in minimal physical activity to avoid the formation of blood clots
• Special elastic or compression garments are to be worn for 4-8 weeks to prevent swelling at the site of surgery
• Eat a healthy diet and exercise as advised by the attending specialists
• Avoid smoking

Complications

Some complications that may be seen after a Lipoplasty operation include

• Bleeding at the surgical site
• Infection at the surgical site
• Loss of sensation
• Formation of blood clots
• Fat or thromboembolism
• Shock
• Perforation of internal organs
• Stroke
• Heart attack

Prognosis

The prognosis of lipoplasty surgery is generally very good with complications rarely being seen. However, the outcome of the procedures is better in individuals with localized fat deposits and good skin texture.

Indications for hospitalization if required

Most lipo operations are done on an outpatient basis, although brief hospitalization may be required for certain procedures.

Suggested clinical specialist/department to consult for the procedure

Liposuction surgery will be performed by specialists from the Department of Cosmetology, Plastic Surgery.