Liposuction: Candidacy, Procedure & Recovery
As far as fat removal and contour restoration are concerned, Liposuction is the gold standard. Liposuction is a procedure through which body fat is removed via small, quarter-inch incisions in your skin, the epidermis and dermis, to get at the fat tissue itself which resides in and is removed from the subcutaneous tissue. Since its original inception and debut more than 30 years ago, liposuction itself has dramatically evolved and is in fact the second most popular cosmetic surgery procedure in America today. In the 1970s, contour irregularities were actually commonplace with liposuction — an unsightly occurrence felt to be attributable to the larger incisions being made at the time, and the suction tubes that were about the size of your little finger.
Today, the incisions are a significantly smaller quarter-inch and are made with suction tubes that are just 3-4 millimeters in diameter. The actual technique has also changed as well to improve results, including the development of different types of liposuction, some of which are:
- Power-Assisted (MicroAire) Liposuction, which involves a vibrating suction cannula. This method utilizes a powered device that produces tiny, rapid vibrations that first break up the fatty tissue, so that it can then easily be suctioned out. This method is safer, can remove more fat in less time, and presents superior post–operative results.
- Ultrasonic-Assisted (Vaser) Liposuction, which combines heat as well as sound waves to liquefy the fat and the heat provides a component of skin tightening. Vaser stands for Vibration Amplification of Sound Energy at Resonance.
To be complete, there is another form of liposuction:
- Called SmartLipo, it uses a laser to heat body fat to a temperature of about 900 degrees, at which point it liquefies. The problem with this form of the procedure comes from how the laser is introduced into the body: it runs through a small cannula that also heats up. The endpoint in SmartLipo is temperature—when the skin reaches a certain temperature, the surgeon stops. The problem is that patients have gotten burned from the cannula being too close to the undersurface of the skin.
With liposuction at the Plastic Surgery Institute of Washington, our endpoint is pinch. We know how much fat to leave behind to minimize contour issues while still achieving a liposuction patient’s desired look.
Think of your body as a skin envelope with fat as the contents. Fat is not the issue or problem — fat can always be removed. The real issue is the skin. If there is excess skin, the patient may be left with an empty envelope, and in need of actual skin removal. Therefore the ideal candidate for liposuction has excess fat that they can’t get rid of, without too much excess skin.
Liposuction is an outpatient surgery. It begins with anesthesia. Depending on the extent of the procedure and number of areas to be treated, there are a couple of methods of anesthesia that can be applied for patient comfort: Local Anesthesia, Local Anesthesia with Intravenous Sedation (IV Sedation), or General Anesthesia. In most cases, because multiple areas of treatment are involved, general anesthesia is utilized. If a patient plans to get liposuction on only limited areas, the doctor might consider local anesthesia with IV sedation.
On the day of the procedure, all particulars of the treatment are reviewed and the patient is physically marked to identify the areas to be suctioned. (Our envelope now has an address—we’re getting somewhere). Markings are confirmed by the patient and any areas missed are identified and also marked. In many cases, to achieve the patient’s intended look, areas will need to be treated on the front and back sides of the body. In those cases, patients are prepped awake circumferentially; front, back, and sides. This allows the patient to be turned over without interruption during the procedure, reducing the chances of infection or contamination. The patient is then placed in a sterile gown on sterile sheets, and the treatment is performed. Upon completion of the procedure, a compressive dressing is applied to minimize swelling and the quarter-inch incisions are sutured to minimize scarring.
Liposuction is a bruise. You will have a component of bruising and swelling that may last for a few weeks. Exercise is limited in the first two weeks to casual walks. At two weeks, one can walk fast on a treadmill or use an elliptical machine. Exercise can be progressively increased based on how you feel the following day. The better you feel, the more you can incrementally continue to add to your exercise regimen. As far as work, if you can work from home, you will be working within several days. If you have to go to work, you will probably take a week off.