What is liposuction?
Liposuction is an operation in which selective fat deposits are removed by sucking the fat out through a hollow metal tube.
Who will the operation NOT help?
Liposuction is not an operation to help you lose weight. All surgery is potentially dangerous, so if you are overweight it is far better to lose weight by a combination of diet and exercise. However, some people find that despite losing weight, they are unable to shift certain deposits of fat, such as the “love handle” area, the thigh area, the central tummy area etc. If, having lost weight you still find certain areas are more “fatty” than you like, then liposuction may help.
What types of liposuction are available?
There are several different types of liposuction available. Each has a specific advantage in different clinical situations. The choice for which type of liposuction is most appropriate will be discussed and decided upon during the consultation:
- Suction Assisted Liposuction: the original liposuction method, suited to smaller areas of liposuction
- Power Assisted Liposuction: the handpiece oscillates thus reducing surgeon fatigue, which in turn improves the safety of liposuction. This is my preferred device for the majority of liposuction cases.
- Ultrasound Assisted Liposuction: tends to be better in more fibrous areas such as the breast and upper back regions. It allows liposuction in areas that are too tough for SAL or PAL alone.
Is the effect permanent?
Any fat cells which are removed by liposuction, are removed permanently and the body does not replace them. If a patient does put weight on following liposuction, the fat is stored more or less equally in all fat cells throughout the body; thus, all remaining fat cells will enlarge, but the contouring effect of the missing fat cells will remain, so the effect is permanent.
Is liposuction available on the NHS?
Liposuction for cosmetic reasons is not available on the NHS.
How is the operation done?
Small areas of fat can be removed under local anaesthetic, but generally the operation is done under a general anaesthetic (with you asleep). The extent of the fat deposit is marked out on your skin with a pen, and then several 1cm long stab incisions are made. Initially a dilute solution of anaesthetic agent and adrenaline is injected into the area to reduce pain and bleeding. Then a slim (3-4mm diameter) hollow metal tube is inserted through the stab incision. One end of the hollow tube is connected to suction tubing and a vacuum source. The metal tube is then vigorously moved back and forth and the fat is literally broken up and sucked out.
Once the desired result has been achieved, the tiny holes are closed with buried dissolvable stitches and surgical tapes applied. Finally the skin is taped into position to encourage it to shrink up and stick, and to prevent any fluid from accumulating in the spaces where the fat has been removed. A tight elasticated pressure garment is then put on over the surgical tapes to add further compression.
What are the limitations of the procedure?
The main limitation of the procedure is that if the skin quality is poor and lacks elasticity, once the underlying fat is sucked out if the skin cannot retract to take up the slack, the skin may hang in an ugly redundant fold.
Another limitation is judging the exact amount of fat to remove. If too little fat is removed, the bulge will remain (though will obviously be smaller). If too much fat is taken, a permanent dent will remain. It is fairly simple to go back and take a little more fat away, but much harder to put fat back in. For this reason I usually err on the side of caution and would much rather leave a little too much fat in than take too much away.
How long is the operation?
The length of a liposuction procedure varies according to how much fat needs removing. Generally liposuction takes between 30 minutes and 2 hours.
How many days in hospital?
Liposuction is usually done as either a day case procedure (home on the same day) or a single night stay.
Postoperative Follow Up
After discharge you will be provided with written information to explain the postoperative course. An appointment will be made to see my Cosmetic Nurse one week after your operation. She will remove your dressings and inspect your wounds, which may or may not have healed at this time. If the wounds have healed you will be given advice on wound care, bathing and exercise advice. If they have not quite healed by this one week visit, she will reapply the dressings and arrange to see you again the following week. Once your wounds have healed you will be given an appointment to see me six weeks after your operation. You should continue to wear your pressure garment until you see me. At this appointment I will check on the early outcome of surgery; if all is settling satisfactorily I shall arrange to see you for a final visit six months later.
What are the possible risks?
Any surgery has the potential for complications. Although liposuction is generally a very safe operative procedure, it does carry the following risks:
Infection; infection is a fairly rare complication (1%) and can result in swelling, redness and tenderness either spreading out from the stab incision scar or may develop anywhere over the liposuctioned area at any time for up to 3 weeks after surgery. This usually responds well to a course of antibiotics.
- Bruising: bruising happens almost always with liposuction and should be considered inevitable. The bruising may range from very minor to black and blue. It usually settles within 2-3 weeks.
- Bleeding: bleeding can occur at any time over the first ten days after surgery, and therefore it is wise to avoid any strenuous exercise over this time. For the first week after surgery you should try to limit movements at the liposuction site. Should a bleed occur under the skin, the area may swell quite dramatically, it can be quite painful and tender. If this happens you may need to return to theatre to have the blood clot removed and the bleeding stopped.
- Ugly scarring: most stab wounds will initially be red and a little thickened for the first six months or so, but will eventually settle very nicely to leave a thin, pale, flat scar. Occasionally however, scars may become red, raised, wide, itchy or ugly. This is fairly uncommon.
- Numbness: The nerves to the skin can be stretched or even torn during the liposuction procedure and result in numbness of the overlying skin. This is quite common and it usually recovers completely, though there is a small chance that a small area of numbness may be permanent.
- Seroma: occasionally fluid can collect in the area following liposuction. This results in a bulge or swelling. It is treated by inserting a needle and sucking the fluid out, though it often recurs and can take several months to settle. This seroma may lead to internal scarring and create ugly folds and irregularities in the overlying skin. To reduce the risk of a seroma, you should wear the compression garment for the first 6 weeks after surgery.
- Blood clots: occasionally a blood clot may form in the deep veins of the legs (deep vein thrombosis). These clots can have the potential to break off and travel inside the veins into the lungs (pulmonary embolism). Any liposuction to the leg carries a slightly higher risk than average of causing a blood clot in the leg veins. To reduce the risk of this happening you will be given surgical compression stockings to wear throughout the first 2 weeks after surgery. If possible, special inflating compression devices will be applied to your legs in theatre and worn for the first 24 hours in hospital, and you will be given a daily injection to slightly thin your blood.
- Skin redundancy: as already discussed above, if the skin fails to retract adequately it may hang in a redundant fold. This fold can be removed but this is likely to result in an unsightly scar. It is best therefore to avoid liposuction if your skin quality is poor, or only remove a little fat if there is any doubt.
- Irregularity: great care will be taken to ensure the remaining fat is left smooth to form a natural contour. However, internal scarring, seroma formation, bleeding etc can result in irregularity and unevenness at the liposuction site. This is difficult to correct, but deep massage over several months may help to smooth it out.
- Under or overcorrection: The amount of fat which needs sucking out is a matter of judgement and there is therefore scope for error. In general, it is better to remove too little rather than too much fat; as it is far easier to repeat the procedure than it is to put fat back. In general terms it is not possible to restore fat to areas which have been over-reduced.