For generations, people have used various techniques to improve their physical appearance. Although diet, exercise and flattering clothing styles help many look better, others remain dissatisfied because of stubborn, unsightly bulges. In women, those fat deposits occur most frequently from the waist down, on hips, buttocks and outer thighs (saddlebags). Fat deposits on men tend to accumulate above the waist, on the abdomen and sides of the waist (love handles).

Now with a procedure called liposuction surgery, both men and women can improve the contours of their bodies through a relatively simple and safe technique. Liposuction surgery involves the removal of fat cells from the body and may be used alone or in conjunction with other procedures, such as facelift or "tummy tuck." It is designed for those who have specific areas of localized fat deposits and who have tried unsuccessfully to eliminate them through diet, exercise and weight loss.

While the procedure is not designed to correct general obesity, any area where excess fat deposits have accumulated can be treated. These include the chin, neck, jowls, cheeks, arms, inner and outer thighs, buttocks, knees, hips and abdomen. (Fig. A) Men with enlarged breasts called gynecomastia can also benefit from this technique.

Men and women in good physical condition with good skin elasticity are the best candidates for this surgery. When the procedure was first introduced, only younger people were considered to be good candidates; however, recent improvements in the technique have made it possible to treat patients of all ages. Each person seeking this treatment, regardless of age, must be personally assessed by the physician to determine if he or she is a suitable for liposuction surgery.

Before Liposuction
Fig. A		 After Liposuction


Before Surgery

Prior to surgery a complete medical history is taken in order to evaluate the general health of the patient. A thorough examination is also conducted. The physician describes the type of anesthesia to be used, the procedure, what results might realistically be expected, and possible risks and complications.

Preoperative directions may include the elimination of certain drugs which contain aspirin in order to minimize the possibility of excess bleeding. Antibiotics may be prescribed prior to surgery to prevent infection. Photo-graphs are often taken before and after surgery in order to evaluate the final results. The areas to be contoured are marked with a special marking pen.

The Procedure

Liposuction surgery can be performed in the physicians office, an outpatient surgical facility or a hospital, depending on the physician's and patient's preference. It can be done under general anesthesia with the patient asleep or under local anesthesia in which the area is numbed and the patient remains awake. Pre-medication administered to help the patient relax. When performing what is known as the "tumescent" procedure, the physician injects a large amount of diluted local anesthetic solution into the area. This procedure has the advantage of reducing pain and bruising in the area.

The physician then makes a small incision in the skin and inserts a tube (cannula) either attached to a high pressure vacuum suction (Fig. B) or to a syringe system. The fat is loosened from surrounding tissue by moving the tube back and forth and is then removed or vacuumed from the body with the suction device. The physician determines the amount of fat to remove by feeling the skin and pinching the tissue.

Fig. B

Some physicians are now using ultrasound-assisted lipoplasty (UAL), which significantly differs from traditional liposuction. In UAL, mechanical sound waves are transmitted via a generator to the tip of a suction cannula. When this cannula comes in contact with fat cells, it causes them to emulsify or to become fluid.

The liquefied fat is then removed from the body by suction. UAL has the additional risk of causing burns to the area and it's long term effects are unknown at this time.

After the incisions are closed, a compression dressing or bandage is applied to the area to prevent bleeding, reduce swelling, and support the affected area. The procedure can last from thirty minutes to several hours depending upon the amount of fat removed.

Following Surgery

The dressing remains in place for seven to ten days depending upon the extent of the surgery and the individual's healing process. A surgical compression garment may also be worn. Because liposuction surgery does not involve large incisions and extensive cutting, pain is minimal to moderate and is controlled with oral medication. Antibiotics may be prescribed to prevent infection.

Most patients are completely ambulatory immediately following surgery, but rest is recommended for the initial postoperative period. Patients are usually able to return to normal activities within a week although vigorous physical activity is discouraged for several weeks.

Some swelling and discoloration can occur but usually disappear within a month. Scars, which fade significantly with time, are, for the most part, inconspicuous because they are made within the natural creases of the body whenever possible.

Complications connected with this surgery are rare: however, an uneven skin surface, bleeding, infection, numbness and discoloration can occur. Some of these conditions correct themselves in time; others respond to medications. There are certain inherent risks connected with every surgical procedure which should be discussed with the physician. Patients can minimize complications by carefully following directions given by the physician.

It is important to remember that liposuction surgery, while not a cure for generalized obesity, is an excellent procedure that can benefit those who want to remove unsightly fat from localized areas. Patients who choose this type of surgery, however, must have realistic expectations about the outcome and understand that final results may not be apparent for up to one year.





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