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Fat Contouring
(Liposuction)
Background
This section covers the topic liposuction, which includes suction-assisted lipectomy, ultrasonic-assisted liposuction, and tumescent liposuction.
Now one of the most frequently performed
aesthetic surgery procedures in the world, liposuction
is a relatively new procedure which has only been in existence since
the early 1980’s. The procedure that is performed today is far different
from that originally developed in France. 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 stated this, it is important that liposuction
be done by surgeons trained as Plastic Surgeons, and certified
by the American Board of Plastic Surgery. 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. We are frequently
asked if the fat "goes somewhere else", or if one tends to
put on weight in other areas of the body. One explanation for this perception
may be that without a change in caloric intake, in the setting of stable
or declining basal metabolic rate (which occurs as we age), it is predictable
that fat would 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.
The Consultation
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 good candidacy 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. Digital images are obtained
and using sophisticated morphing software, Dr. Creasman can demonstrate
a realistic estimate of the result you might obtain with liposuction.
This provides you with an image of yourself which is enormously useful
to your decision-making about whether this is a procedure which would
satisfy your goals.
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
(see below, The Operation)
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. Even an
otherwise innocent infection can result in a disastrous surgical wound
infection, and must be treated prior to surgery.
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. Dr. Creasman also suggests you take a surgical vitamin/homeopathic regimen to aid in healing and to reduce swelling and bruising in the post-operative period. These are available for purchase in our office.
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.
What follows is a preoperative checklist for you to follow in preparation for your liposuction:
- Please pick up liquid Ivory hand soap and cleanse the skin of the areas being treated with liposuction for the three days prior to your operation.
- Report any signs or symptoms of infection, such as fever, inflamed body parts, burning with urination, cough, diarrhea, or flu symptoms.
- Avoid shaving the body part being treated prior to surgery. We will shave the area in the preop area.
- Wear a non-pullover shirt to your operation. We suggest a zipper front sweatshirt. Your clothes should be loose-fitting, and may get soiled with blood, so wear nothing of any significant value. Wear slip on shoes with smooth soles for ease of ambulation. Wear cotton underwear and clean white socks.
- Do not wear makeup. Please remove any artificial nail material from both of your index fingers. We monitor your oxygen levels through your nail beds, and artificial nail products interfere with this.
- Do not wear jewelry or bring other valuables to the office on the day of your surgery. Pierced body parts, including navels, nipples, and tongues, need to be free of jewelry for your safety.
- Take any prescribed medications as directed.
- DO NOT EAT OR DRINK ANYTHING FOR SIX HOURS PRIOR TO YOUR ARRIVAL.
- Avoid smoking for six hours prior to surgery.
- Avoid alcohol for 48 hours prior to surgery. It can lead to dehydration and can interfere with clearance of your anesthetic medications.
- Stock up on Coke Classic, Gatorade, and water. You need to maintain your hydration and Coke will reduce any nausea you might have after anesthesia.
- You may have a significant amount of drainage after your procedure, so be prepared to protect your car seats and furniture/bedding at home. Purchase a couple of rubber sheets or “chux” disposable barrier drapes for this purpose.
- You need reliable transportation to and from the office for the day of surgery and on the first postoperative visit, which is typically 2-3 days after operation. You need to have someone with you for the first 48 hours. If you cannot find transportation from a friend or family member, we can arrange medical transportation, but you will still need someone in the home for 48 hours as a support system.
You will be asked to pay your surgical
fee at your pre-operative visit. The fee is determined at the time of
the consultation, and is different for every scenario or combination
of areas treated, and so cannot be specifically provided here.
The Operation
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). UAL
is relatively new technology in the United States, but Dr. Creasman
has been using it since its introduction in 1996, and has experience
in over 500 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. It is wise to obtain an impermeable or rubber sheet for aftercare for this reason. 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.
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