Liposuction & Body Contouring
________Dr. Mohan Rangaswamy________
Liposuction for Flawless Body Contouring
Liposuction or Suction Assisted Lipectomy (SAL) or Lipoplasty has become the most commonly performed procedure by Plastic Surgeons in most parts of the world; over 347,782 procedures were performed in 2023 in USA alone. Liposuction is defined as the removal of adipose tissue (fat) by the use of small cannulas [tubes] connected to a vacuum source. The fat from a given area is permanently removed. It is the gold standard of body contouring operations.
The cuts for inserting the lipo cannulae are only 3 to 4mm in size and are usually kept in concealed areas. But enough number of mini-cuts are needed to ensure that the cannulas can be passed through the tissues in criss-cross fashion to get a uniform result. Although relatively simple in theory, the practice of SAL is quite sophisticated requiring careful patient selection, meticulous technique, precise fluid and electrolyte balance and an understanding of the risks and limits of the technique. Modern SAL achieves a lot but with surprisingly quick recovery and minimal pain.
Who is a candidate? It is clear to me after numerous consultations with patients requesting liposuction that, a large number of them are unaware of the correct indications for this operation. Many patients who suffer from generalized obesity seek liposuction as a quick way to solve their weight problem. The question, “Doctor, how many kilos I will lose with this operation?” is met with great disappointment once I explain that this is not an operation designed for weight loss. Liposuction is not a substitute for a healthy diet and regular exercise. SAL selectively removes fat only from those areas in which the patient desires reduction, which are generally “problem” areas where the fat seems to be ‘stubborn’. In short Liposuction is a reshaping procedure and not a weight loss procedure.
Fat distribution is determined by two factors, heredity and diet. Heredity determines the number and location of the fat cells, which are fixed and generally unchanging after puberty. Diet can increase or decrease the amount of fat in each individual cell but will not affect their total number or distribution [except rarely]. So, if you have a familial tendency for big thighs your strenuous attempts at weight loss will leave you with a thin upper body and larger thighs simply because you have inherited a greater number of stubborn fat cells in your thighs. These areas are the first to gain and the last to go! But liposuction is effective in removing this fat since it actually removes the fat tissue permanently. Following SAL, the body will always have less fat in the treated areas. This will allow for a much more uniform weight loss or gain.
Your appearance after SAL depends on two factors: the surgical technique and the ability of the skin to shrink (retract) down to the new shape. Skin’s ability to retract is influenced by a number of factors: the general state of health, overall condition of skin, presence of stretch marks, age, race, weight fluctuations and hormonal influences. Good results may be expected in younger persons who are closer to normal weight, whose skin is tight and without stretch marks and who do not have past history of weight fluctuations. But even those with some unfavorable factors can have moderate improvement which can be further enhanced by special tools.
Surgery: The operation lasts from 30 minutes to three hours depending on how many areas are treated. Surgery may take longer if the person has particularly tough or fibrous interior as in re-do cases or where previous fat freezing has been tried. Lipo can be performed under local anesthesia with or without sedation or under general anesthesia; my preference is under sedation.
Fat is suctioned out from the areas in a sequential manner by passing the cannula back and forth. Further refinements are done using still smaller tubes just under the skin in order to encourage skin retraction. There are usually no bandages or dressings but a compression garment is worn. A urinary catheter may be placed prior to surgery if larger degrees of aspiration are performed. This is removed at the end.
Post-Surgery: Patients may be discharged on the same day or after overnight stay. Blood stained fluid may drain out of the puncture holes for 12 to 48 hours. This is the balance from the fluid injected prior to liposuction and nothing to worry about. Oral tablets are usually sufficient for pain. All patients are encouraged to take an iron supplement for one month after surgery. Stitches if any are self-dissolving and the scars are rarely troublesome.
Results: It is important to realize that soon after the surgery, the tissues are swollen and indeed the area may appear larger than before. Even the weight may paradoxically be more! Usually the results become apparent to the tune of 50% by the end of three weeks and 100% by three months. During the first three weeks, the patient will have to wear a support garment which will help to reduce edema (swelling) and restrict bruising of the skin. Minor waving and nodularity improves with time.
Complications: In this area more than any other operation in cosmetic surgery, myths and media mis-information abound. The fact is that liposuction is one of the safest operations. Equally it is also true that it can be a major operation as far as the body is concerned. Some of the liposuction candidates may not be in the best of health on account of some degree of obesity, sedentary habit or other medical factors. In high risk candidates there may be a higher rate of complications.
On the whole, a number of studies have shown that serious complications are uncommon with this kind of surgery when performed by qualified individuals. Thus while no surgery can be totally safe, liposuction compares favorably with any cosmetic procedure in terms of outcome. Dr.Mohan is happy to share that in over 30 years there has not been even a single case of maor complication!
A word of caution! Liposuction seems relatively easy to learn and to perform; so many quacks and some doctors not trained in aesthetic surgery start performing liposuction after attending a weekend course or watching a DVD or video on You-tube! Studies have shown that horrendous complications may result if liposuction is performed by incompetent persons. Persons considering liposuction should verify the antecedents of the surgeon before submitting to this procedure.
Touch-up corrections: Although I make every effort to give as smooth and symmetric a result as possible, small issues such as minor asymmetry or bumpiness may remain after the healing period. After having spoken to a number of my colleagues, it seems that none of us is exempt from encountering this occasionally. A minority of patients will need secondary surgery after six months, most frequently to remove additional fat or improve skin retraction or even out the contours.
Refinements: In the 21st century, liposuction has been considerably refined with respect to better understanding, better instruments, finer bore cannulae and the concept of superficial suction to encourage skin retraction. Innovations like VASER LIPOSUCTION, Power assisted liposuction [PAL], Laser liposuction as well s Syringe liposuction are all helping us to achieve far superior results in a gentler way (see www.vaserdubai.com). Fat grafting is now more routinely combined with liposuction to take body contouring to the next higher plane of sophistication. We are not only simply removing fat but also adding it to strategic locations to achieve a reshaping and re-balancing.
A typical example is removing fat from abdomen and hip rolls while adding the same fat to the buttocks in a woman (popularly called BBL). In selected individuals, Liposuction may be carried to the next higher level of high definition liposuction also being called 3D and 4D liposuction.