100 plastic surgery

How is a liposuction procedure performed?

• Tumescent liposuction describes a “wetting solution” with a local anesthetic, such as lidocaine and another medication in IV fluids, which is injected before surgery, causing blood vessels to shrink down or constrict. This allows liposuction to be performed with the patient under local anesthesia, minimizes blood loss and reduces postsurgical pain and bleeding.
• Suction-assisted liposuction (SAL), the most traditional form of liposuction, draws fat out with a vacuum.
• Power-assisted liposuction (PAL) is traditional SAL with the addition of a tool to increase the motion of the cannula, which speeds up fat removal.
• Ultrasound-assisted liposuction (UAL) transmits energy through a special hand piece that helps to loosen and melt fat, enabling a greater volume of fat to be removed. This is best for larger areas, dense fat and male patients.
• VASER, a variation of UAL, is an ultrasonic cannula with several grooves that evenly disperse the energy, improving fat disruption and removal.
• Laser-assisted liposuction (LAL), such as Smartlipo and Slimlipo, is a relatively new technology. The theory is that the laser will work like ultrasound-assisted lipoplasty to disrupt the fat cells and make fat removal more efficient and less traumatic.

• Separation - loosens, emulsifies and separates out the unwanted fat cells without generating heat, so essential blood vessels, skin and other tissues are unharmed
• Aspiration - fat cells are gently removed through suction, without damaging supporting structures such as nerves, blood vessels, skin
• Fat Equalization – smooths out the remaining thin fat layer, leaving behind a uniform layer of ‘local fat grafts’ that prevents contour deformities from forming

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1. The surgeon will diagram treatment areas like the hips, abdomen, thighs and flanks.
2. A cannula is inserted through a small incision and fat carried away with suction.
3. Liposuction helps eliminate unsightly bulges by removing localized fat deposits.
4. It is important to maintain a healthy lifestyle with diet and exercise to prolong results.

What are my options?

What will my liposuction incisions and scars be like?

• Because liposuction incisions are small, the scars are also small.
• The amount or degree of scarring depends on the surgeon’s technique and your genetic tendencies.
• Most lipoplasty scars fade and are barely perceptible over time. Visible scars are more likely when large liposuction cannulas are used and in patients who have darkly pigmented skin.
• There are two types of marks that can remain on the skin after liposuction. One is a true scar and the other is known as dyschromia, which is a dark (hyperpigmented) or light (hypopigmented) spot on the skin.
• Generally, the incisions are very small and placed in hidden areas. Sometimes, depending on the area, the incisions cannot be hidden.

Select a surgeon you can trust

• Education, training and certification
• Experience with liposuction surgery
• Your comfort level with him or her

Your initial consultation appointment

• Ask you to look in a mirror and point out exactly what you would like to see improved.
• Take pictures of you, including 3D photos, especially if the areas to be treated are on your rear side (back, buttocks, or other areas). This will help your surgeon understand your expectations and determine if liposuction can achieve them.
• Evaluate the elasticity of your skin and perform specific measurements to determine skin laxity. The ideal candidate for liposuction surgery has excellent skin tone/tissue elasticity with isolated areas of excess fat.
• Discuss your ideal weight, realistic weight and current weight. He or she may suggest a weight loss program before surgery.
• Ask you about your plans regarding future pregnancies.

• Previous surgeries
• Past and present medical conditions, including any history of high blood pressure, thyroid problems or diabetes
• Allergies and current medications

Your treatment plan

• An approach to your surgery, including the type of procedure of combination of procedures.
• The outcomes that you can anticipate.
• Your financial investment in the procedure.
• Associated risks and complications.
• Options for anesthesia and surgery location.
• What you need to prepare for your surgery.
• What you can expect to experience after surgery.
• Share before-and-after photos of cases similar to yours and answer any questions.

Questions to ask your aesthetic plastic surgeon

• Am I a good candidate for liposuction?
• Are the results I am seeking reasonable and realistic?
• Do you have before-and-after photos I can look at for the procedure I am undergoing?
• Will my scars be visible? Where will my scars be located?
• What kind of anesthesia do you recommend for me?
• What will be the costs associated with my surgery?
• What will you expect of me to get the best results?
• What kind of recovery period can I expect and when can I resume normal activities?
• What are the risks and complications associated with my procedure?
• How are complications handled?
• What are my options if the cosmetic outcome of my surgery does not meet the goals we agreed on?

How do I prepare for a liposuction procedure?

• Stop smoking before undergoing surgery to better promote healing.
• Avoid taking aspirin, certain anti-inflammatory drugs and some herbal medications that can cause increased bleeding.
• Regardless of the type of surgery to be performed, hydration is very important before and after surgery for safe recovery.
• If your surgeon recommends weight benchmarks or lifestyle changes, do your best to achieve them to ensure the best results and minimize the chance of complications.

• You will receive medications to make you as comfortable as possible during the surgical procedure. Frequently, local anesthesia and intravenous sedation are used for patients undergoing liposuction, although general anesthesia is sometimes desirable.
• For your safety during the operation, various monitors are used to check your heart, blood pressure, pulse and the amount of oxygen circulating in your blood.
• Your plastic surgeon will follow the surgical plan discussed with you before surgery. Once the operation has begun, he or she may decide to combine various techniques or change a technique to ensure the best result. It is important that you feel comfortable and trust your doctor to make these decisions.
• After surgery, you will be taken into a recovery area where you will continue to be closely monitored. You will most likely be wearing a compression garment to help “shrink” the skin. Many patients state that the area feels sore, as if they underwent a vigorous workout.
• You will probably be permitted to go home after a short observation period unless you and your plastic surgery have made other plans for your immediate post-operative recovery.

• Drains, if they have been placed
• Normal symptoms you will experience
• Any potential signs of complications

• The first few days after surgery, you should rest quietly. Elevate the affected body part if possible. Remember, you must not take aspirin or certain anti-inflammatory medications. You will most likely wear a postsurgical garment; if it is too tight, notify your surgeon.
• The first 48 hours after surgery, you will experience varying degrees of swelling and bruising. The swelling is maximal at 48 hours after surgery and mostly disappears within two to three weeks, but there may be slight residual swelling for up to four months. Bruising is normal and typically disappears within seven to ten days.
• Sutures, if placed, are usually removed seven to ten days after liposuction.
• Do not smoke after your liposuction surgery to prevent coughing and bleeding. Do not drink alcohol for five days after surgery or while you are taking pain medication.
• Avoid straining, bending over and lifting during the early post-operative period. In many cases, you will be able to resume most of your normal activities within ten days or less.
• Discomfort after liposuction is generally limited to soreness rather than pain. Pain medications are prescribed to lessen any discomfort during the first few days.
• Patients usually return to work within a few days following a liposuction procedure.

• It is important to ambulate (walk) as soon as possible after liposuction to discourage swelling and prevent blood clots in the legs. However, avoid strenuous exercise for four to six weeks because it can trigger unnecessary fluid retention in the treated areas.
• You should wait a minimum of six weeks before exposure to sun and heat, including sunbathing, because of the possibility of swelling.
• You will wear a compression garment over the treated areas for four to six weeks to control swelling and promote skin contraction.

• Adverse reaction to anesthesia
• Hematoma or seroma (an accumulation of blood or fluid under the skin that may require removal)
• Infection and bleeding
• Changes in sensation
• Scarring
• Allergic reactions
• Damage to underlying structures
• Unsatisfactory results that may necessitate additional procedures

• Indentations
• Contour irregularities

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