Liposuction is the surgical aspiration of fat from the subcutaneous plane leaving a more desirable body contour and a smooth transition between the suctioned and the non-suctioned areas.
Patient selection is a critical determinant of a good aesthetic surgical result, especially in body contouring. Not all patients who request liposuction are good candidates.
The consultation begins with an assessment of the patient’s goals
1) What does the patient wish to change about his or her body?
2) What does the patient hope to accomplish with liposuction?
The surgeon then provides the patient with a realistic appraisal of what can and cannot be accomplished with liposuction. Some patients may require alternative procedures (such as an abdominoplasty) or liposuction combined with an open surgical procedure.
Patients who are particularly poor candidates for liposuction
(a) perfectionists with imperceptible “deformities,”
(b) severely depressed patients with eating disorder problems, and
(c) significantly overweight patients who are incapable of weight reduction and expect surgery to do it for them.
(d) Thin, stretched skin with striae (indicatingdermal breakage) with high degree of laxity
Body areas treatable with liposuction
Numerous body areas are amenable to liposuction given the plethora of equipment now available. Today’s patient can be treated from head to toe. The face and neck can be successfully treated with liposuction, although fat injection instead of aspiration is increasingly popular. The trunk, including the abdomen, back, breast (gynecomastia), and posterior hips (flanks), and the lower extremity, including the knees, calves, and ankles, have all been successfully treated with liposuction. The upper arm is also well suited for liposuction when the skin is not too loose. The buttocks can be successfully treated but should be approached with some degree of caution. Creation of a flat or ptotic buttocks is not only unsightly, but usually requires excisional measures to repair.
The pubic area, when preeminent both in women and men, can also be treated with liposuction.
Liposuction should not be offered as a treatment for obesity.
Abnormally distributed bulges of fat or fat that is distributed outside the confines of the ideal body shape are the “target” areas that are commonly suctioned.
The patient will experience copious serosanguineous drainage from incision sites for approximately 24 to 36 hours, which can be alarming to family and friends if they are not informed in advance.
Drains are recommended when >2,000 mL lipoaspirate is removed from the abdomen alone.
Maximal swelling can be expected at postoperative days 3 to 5.
Compression garments are generally encouraged 24 hours per day for 4 to 6 weeks.
Patients should begin ambulating on the day of surgery. Oral fluids and a high protein diet are encouraged. Pressotherapy should be performed (with compression garments on!) twice a week in the first 2 weeks. After that pressotherapy and massage (done manually with pressure or with mechanical aids) should be done once a week during 3-6 months.
Postoperative follow-up visits are scheduled at 7 days to remove sutures; 2 weeks to make sure that bruising is subsiding normally and to advance the patient’s activity; 6 weeks to make sure that edema is subsiding normally and to assess the early result; 3 months to assess early result; and 6 months to assess final result.
Physical activity should be low for the first week to discourage edema, followed by a gradual increase in activity during the second week, depending on the amount of suction that was done. At the end of the first week, most patients can return to work and should be encouraged to begin light exercise, such as brisk walking on a treadmill (with compression garments on!). At 3 to 4 weeks, if edema and bruising are resolving appropriately, the patient should be advancing to full activity, and may “wean” him- or herself out of the compression garment over the course of a week.
Any surgical procedure has risks. Fortunately, serious complications are rarely associated with liposuction procedures.
The most common undesirable sequela after liposuction is contour irregularity. Contour irregularities generally fall into four categories: (a) overcorrection, (b) undercorrection, (c) failure of skin retraction or abnormal skin retraction, and (d) complex deformities consisting of combinations of a, b, and c.
Revisionary procedures should be performed only after all the swelling has completely subsided.
Other risks, fortunately rare include unusual bleeding, which could result in unusual ecchymosis or permanent skin discoloration, hematoma, seroma, infection, dysesthesia, fat embolism, thromboembolism, fluid imbalance, lidocaine toxicity, skin necrosis, perforation of viscera, and death, fortunately, are rare.