Liposuction in cosmetic dermatology
Liposuction is fast becoming one of the most commonly performed cosmetic procedures in the western world today. There are basically two methods by which liposuction can be performed, traditional liposuction by general anaesthesia and liposuction by the tumescent technique.
Tumescent liposuction was first used in 1987 by a Californian dermatologist and continues to be the main liposuction technique used by dermatologists today.
What is tumescent liposuction?
Liposuction by this method involves infiltrating fatty tissue with large volumes of dilute local anaesthetic such as lignocaine (lidocaine). This procedure is known as tumescent anaesthesia. The tissue becomes swollen and firm and allows for more controlled removal of fat globules via small cannulas (tubes) that are connected to a vacuum aspiration machine or syringe aspiration system. The anaesthetic solution also contains adrenaline (epinephrine), which causes vasoconstriction (temporary shrinkage of blood vessels), so there is minimal bleeding.
How is the procedure performed?
Liposuction begins with pre-procedure consultation at which time information on the procedure and its possible risks are outlined. The surgeon examines the areas to be suctioned and may take photographs. A medical history and physical examination including blood tests is performed. The patient is also advised of any medications he/she may need to stop taking prior to the procedure being performed to avoid complications.
The following is a brief outline of what happens during tumescent liposuction procedure.
- Surgeon maps the areas to be suctioned and insertion sites are marked
- Local anaesthetic is injected into the insertion sites
- Small cuts are made into the site so that an infusion cannula can be tunnelled into the fatty area
- Tumescent anaesthetic is pumped into the area. This process can take between 30 minutes (chin or knee) to several hours (most other areas).
- Once the area is anaesthetised, an aspiration cannula is hooked up to a machine aspirator or syringe system to suck out the fat globules into a canister
- When the desired result is reached the physician may get the patient to stand up to assess the outcome. If areas have been missed then the patient can immediately return to the table for further suctioning.
After the procedure is finished, dressings and/or special support garments are applied to firmly bound down the area and help the healing process. Usually the patient is observed for at least an hour or more before being discharged home with a friend or relative. Pain is usually minimal and may be relieved by taking analgesics. Patients should be aware there might be leakage of pink-tinged fluid through the cannula holes for 24 hours. This is normal and helps to minimize bruising. Depending on the area treated recovery is usually very fast and in some cases patients may return to work within 24-72 hours after the procedure.
Who is suitable for tumescent liposuction?
Liposuction is suitable for patients whom are near or at their ideal body weight but have localised areas of fat accumulation that have proven resistant to diet and exercise. Liposuction is not a treatment for obesity. It is best viewed as a body contouring procedure. Patients should only be considered for liposuction if they fit the criteria listed below.
- Have realistic expectations and are only slightly to moderately overweight.
- Understand that liposuction is not a substitute for weight loss and that a healthy well-balanced diet is important in maintaining the postoperative results.
- Have tried to eliminate fat bulges through diet, exercise and weight loss programs.
- Have firm, elastic skin and are in good health, both physically and mentally.
- Have distinct areas of localised fat that are disproportionate to the rest of their body.
In women, areas of the body that are most commonly treated with liposuction are the inner and outer thighs, abdomen and flanks, hips, knees, ankles, calves and upper arms. Men mainly request liposuction for gynaecomastia (enlarged breasts) and removal of “love handles” around the waist. Liposuction of the neck, chin and lower abdomen are common in both women and men.
Liposuction is also sometimes used to remove sweat glands in the armpits because of hyperhidrosis or bad odour. Results vary.
Advantages of tumescent liposuction
Tumescent liposuction has a number of advantages over traditional liposuction by general anaesthesia.
|Tumescent liposuction||Traditional liposuction|
|Patient remains awake throughout the procedure and can move as required for the physician to reach certain areas||Patient put to sleep with general anaesthetic which has inherent risks|
|Very little blood loss due to vasoconstriction of blood vessels from adrenaline in local anaesthetic solution||Potentially serious blood loss|
|Minimal bruising which lasts between 7-14 days||Usually significant bruising that can last for 3-6 weeks|
|Pain or soreness post procedure is minimal as local anaesthetic effect may last as long as 24 hours||As soon as general anaesthesia wears off after surgery patient may feel significant pain and discomfort requiring narcotic analgesics|
|Dressings or support garments may be required for 1-3 weeks||Dressings or support garments usually required for 4-6 weeks|
|Patients can usually return to work within 1-2 days after the procedure||Patients usually need to convalesce for 1-2 weeks before returning to work|
|Bacteriostatic lignocaine (lidocaine) may decrease the risk of infection||Increased risk of infection|
|This technique swells and firms the fatty tissue to magnify defects so the physician can accurately remove what is necessary and reduce the risk of post-operative irregularities||May produce dimples if fat is removed to close to skin. May require a secondary operation to fix irregularities.|
|No reported deaths using this method||Death rate of approximately 1 in 5000.|
The one disadvantage of tumescent liposuction is that it takes longer to remove a given volume of fat compared with the traditional general anaesthesia method.