Liposuction

Adam David Lowenstein, MD, FACS
Article by
Santa Barbara Plastic Surgeon

Liposuction is one of the most common aesthetic operations performed in the United States and involves surgical removal of fat from the body.  Since fat is eliminated from the body with liposuction, it is not expected that the fat in these areas will return, nor is it expected that the fat will return in other areas of the body.  If you maintain a healthy diet and exercise regimen following your liposuction procedure in Santa Barbara, you should expect to maintain your new “reset point” of a slimmer, more attractive body contour for many years to come.

Who is a candidate for liposuction?

The ideal liposuction candidate is at or near their ideal body weight, and has a mild to moderate amount of fat that they are looking to have removed.  It is critical to remember that liposuction is not a means of weight loss, but liposuction is a great way to get rid of regions of fatty tissue that are unsightly.  Liposuction is commonly performed in the following areas:

upper abdomen

lower abdomen

flanks or love handles

hips

thighs

knees

chest

male breast

back

neck

While liposuction is extraordinarily effective at removal of fat, the ideal candidate has healthy skin with good elasticity overlying the area of fatty bulge.  This enables the skin to retract over the new, flatter contour following surgery.

How is liposuction performed?

The liposuction procedure begins in the consultation room on the morning of surgery.  You will again confirm with the Doctor the areas that you wish to be treated.  Preoperative markings will be placed by the Doctor, around the areas of concern, and multiple circles may be used to delineate peaks or bulges of the most fat, not unlike a topographic map that shows mountains and valleys.  Your incision sites will also be determined at this point and marked accordingly.

The Doctor performs most of their liposuction under general anesthesia, although local anesthesia is an option in healthy patients with small areas of fat.  In the AAAASF certified surgery center, you will be brought to the operating room and made comfortable while the appropriate anesthesia is administered.  You may need to be rolled on your side to get the best access to the fatty areas, and since you are asleep during the procedure, this happens without your awareness and with the utmost gentle attention.  Some surgeons prefer the shortcut of twisting your body into un-natural contours in order to shorten the procedure, but the Doctor feels that actually repositioning you in order to completely expose the area to be treated reduces distortion of the fat and therefore reduces distortion in the outcome.

After cleaning your skin with a special beta-dyne solution to remove bacteria, sterile drapes are placed around the areas to be treated with liposuction.  Small incisions are made in the pre-marked areas, and efforts are made to allow approach to the fat from at least 2 directions, preferentially near 90 degrees.  This allows for the crosshatch technique which reduces postoperative irregularity and wave deformities.  Through these incisions, narrow cannulas shaped like tubes with holes at the end are used to administer a solution to prepare the fat.

The administered solution contains saline as well as a small amount of epinephrine which helps your blood vessels in the area to constrict and be much less likely to bleed.  Although some bruising is occasionally seen, the Doctor has not seen postoperative bleeding complications in his liposuction patients with the use of epinephrine. Another additive to the solution is Lidocaine, which acts as a short acting anesthetic.  In patient who are not having general anesthesia, lidocaine is an important additive for the purposes of comfort.  For those liposuction patients who are asleep and under general anesthesia, a minimal amount of lidocaine is needed and used, as too much lidocaine can cause serious problems.  Unfortunate cases of death following liposuction have been seen in the news, and this is most often due to excess use of lidocaine by inexperienced physician.   By limiting the lidocaine exposure to his patients, the Doctor creates another level of safety for his patients not often seen in the plastic surgery community.

Following administration of the preparatory solution, a period of about 10 minutes is allowed to pass to maximize the effect of the epinephrine in the solution.  Your fat is now ready for liposuction.  The deep fat is first addressed with larger diameter cannulas to create the overall shape to the new contour of the area treated.  Liposuction from two directions allows a uniform evacuation of fat from the deep layer and reduces the chance for deep fat irregularities.  After deep liposuction, the superficial layers are addressed, again in the crosshatch technique, from the same small incisions made in the beginning of the case.  Smaller diameter cannulas in the more superficial region reduces the chance of waviness that could result from the use of large tubes too close to the skin.  Crosshatch technique in the superficial tissue allows for a uniform removal of fat in this layer, again increasing the likelihood for a smooth and natural result.  It is the following extra step, however, which the Doctor finds most helpful in creating a smooth and natural post liposuction contour.  Using the most narrow cannulas,  the Doctor uses a crosshatch technique right under the skin to release the small strands of connective tissue that can lead to dimpling after liposuction.  This step additionally allows for redistribution of any remaining fat, creating an effective “auto grafting” which smooths out any remaining peaks and valleys leaving a smooth, natural you.

Following evacuation of the fat, the small incisions are closed with absorbable sutures and surgical tape.  A compression garment is then placed to allow the skin to adhere to the underlying new contour during healing.  You will then be gently woken from anesthesia and brought to the recovery area where you will find yourself in a comfortable recliner chair being cared for by the Doctor’s experienced and caring nursing staff.

Expectations after liposuction…

Following your liposuction, you will need to wear the postoperative compression garment for several weeks.  This is important in that the skin needs to stay tightly against the underlying tissue to allow optimal healing and prevent fluid from collecting in areas that are not compressed.  For similar reasons, it will be important to moderate your activity as excessive motion can cause the healing layers to move against each other and this again can lead to fluid collections.  The Doctor will ask that you avoid excessive activity for 2-3 weeks following your liposuction while the healing process progresses.

After 3-4 weeks, you will be able to gradually increase your activity, and begin to decrease your need for the compression garment.  After 4 weeks your compression garment will only need to be worn at night and during physical activity, and after 6 weeks, you will be released to do any activity you wish without the need for the compression garment during activity or at night.

Severe pain is very unusual following liposuction, and you can expect to be relatively comfortable even immediately after surgery.  Commonly, patients mention a burning type of sensation in the areas of liposuction treatment, though this has never been noted to be excessive.