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Liposuction, or liposculpture as opposed to the old fashioned "dry" liposuction, is a procedure that can help sculpt the body by removing unwanted fat from specific areas, including the abdomen, hips, buttocks, thighs, knees, upper arms, chin, breasts, cheeks and neck. During the past decade, liposuction, which is also known as "lipoplasty" or "suction lipectomy", has benefited from several new refinements. Today, a number of new techniques, including ultrasound-assisted lipoplasty (UAL), the tumescent technique, and the super-wet technique, are helping many plastic surgeons to provide selected patients with more precise results and quicker recovery times. Although no type of liposuction is a substitute for dieting and exercise, liposuction can remove stubborn areas of fat that don't respond to traditional weight-loss methods. Because of the low risk and excellent results, at the Riley Surgery Center we prefer the “Tumescent” technique for liposuction. The nature of this technique will be discussed later.
If you're considering liposuction, this brochure will give you a basic understanding of the procedure -- when it can help, how it is performed and how you might look and feel after surgery.
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The best candidates for liposculpture
To be a good candidate for liposuction, you must have realistic expectations about what the procedure can do for you. The best candidates for liposuction are normal-weight people with firm, elastic skin who have pockets of excess fat in certain areas. However, overweight does not necessarily mean you can’t have the procedure done. Massive overweight cannot be treated with liposuction. You should be physically healthy, psychologically stable and realistic in your expectations. Your age is not a major consideration; however, older patients may have diminished skin elasticity and may not achieve the same results as a younger patient with tighter skin. Liposuction carries greater risk for individuals with medical problems such as diabetes, significant heart or lung disease, poor blood circulation, or those who have recently had surgery near the area to be contoured.
All surgery carries some uncertainty and risk
Liposculpture is normally safe, as long as patients are carefully selected, the operating facility is properly equipped and the physician is adequately trained. At the Riley Surgery Center, we boast an excellent staff of experienced doctors and nurses, as well as a state-of-the-art Surgical Suite.
However, it's important to keep in mind that even though a well-trained surgeon and a state-of-the art facility can improve your chance of having a good result, there are no guarantees. Though they are rare, complications can and do occur. Risks increase if a greater number of areas are treated at the same time, or if the operative sites are larger in size. Removal of a large amount of fat and fluid may require longer operating times than may be required for smaller operations.
The scars from liposculpture are small and strategically placed to be hidden from view. However, minor imperfections in the final appearance are not uncommon after lipoplasty. The skin surface may be irregular, asymmetric or even "baggy," especially in the older patient. Numbness and pigmentation changes may occur. Seroma, a retention of fluids at the operation sites, may occur and may require needle aspiration. Sometimes, additional surgery may be recommended.
Planning your surgery
In your initial consultation, the surgeon will evaluate your health, determine where your fat deposits lie and assess the condition of your skin. The surgeon will explain the body-contouring procedure that may be most appropriate for you. For example, if you believe you want liposuction in the abdominal area, you may learn that an abdominoplasty or "tummy tuck" may more effectively meet your goals. Risks and limitations will also be discussed. And, be sure to tell the surgeon if you smoke, and if you're taking any medications, vitamins, or other drugs. In your initial consultation at the Riley Surgery Center, the surgeon will also explain the type of anesthesia to be used and a preoperative evaluation by the anesthesiologist is customary, typically the day prior to the operation. During the consultation, before and after pictures are displayed to help you better understand the concepts presented. Also the costs involved will be discussed.
Preparing for your surgery
The surgeon will give you specific instructions on how to prepare for surgery, including guidelines on eating and drinking, smoking, and taking or avoiding vitamins, iron tablets and certain medications. You will be asked to bathe with an anti-septic soap prior to surgery (prescribed). Though it is rarely necessary, the doctor may recommend that you have blood drawn ahead of time in case it is needed during surgery. This is called autologous blood donation, which means you receive your own blood during surgery. In any case, iron tablets and folic acid are prescribed well in advance of the surgery to make sure that you have a more than healthy blood count so loss of some blood during the operation is permitted without leaving you feeling weak.
Where your surgery will be performed
Liposculpture is performed in our state-of-the-art Surgical Suite at the Riley Surgery Center. However, if a large volume of fat will be removed, or if the liposuction is being performed in conjunction with other mayor procedures, a stay in the hospital may be required. Liposculpture in our clinic is performed on a day care basis. You do not stay overnight. Ambulatory nurse care is available on request and a same night house (or hotel) visit by our anesthesia nurse is standard.
Types of anesthesia
Liposculpture in our clinic is usually performed under general anesthesia. If only a small amount of fat and a limited number of body sites are involved, liposculpture can be performed under local anesthesia, which numbs only the affected areas. However, if you prefer, the local anesthesia is usually used along with intravenous sedation to keep you more relaxed during the procedure. Regional anesthesia can be a good choice for more extensive procedures. One type of regional anesthesia is the spinal block, which also has lasting postoperative pain control, an adjuvant our patients become to appreciate. However, some patients prefer general anesthesia, particularly if a large volume of fat is being removed. In any case, a nurse anesthetist and anesthesiologist are present to make sure you are completely secured during the procedure.
The surgery
The time required to perform liposculpture may vary considerably, depending on the size of the area, the amount of fat being removed, and the type of anesthesia used.
Liposculpture is a procedure in which localized deposits of fat are removed to recontour one or more areas of the body. Through a tiny incision, a narrow tube or cannula is inserted and used to vacuum the fat layer that lies deep beneath the skin. The cannula is pushed then pulled through the fat layer, breaking up the fat cells and suctioning them out. The suction action is provided by a vacuum pump. If many sites are being treated, the surgeon will then move on to the next area, working to keep the incisions as inconspicuous as possible.
Fluid Injection, a technique in which a medicated solution is injected into fatty areas before the fat is removed, is commonly used by plastic surgeons today. The fluid -- a mixture of intravenous salt solution, lidocaine (a local anesthetic) and epinephrine (a drug that contracts blood vessels) -- helps the fat be removed more easily, reduces blood loss and provides anesthesia during and after surgery. Fluid injection also helps to reduce the amount of bruising after surgery. Large volumes of fluid are injected in the tumescent technique. Tumescent liposuction, typically performed on patients who need only a local anesthetic, usually takes significantly longer than traditional liposuction. However, because the injected fluid contains an adequate amount of anesthetic, additional anesthesia may not be necessary. The name of this technique refers to the swollen and firm or "tumesced" state of the fatty tissues when they are filled with solution. In our clinic, we often use intravenous sedation as an adjuvant to the anesthetic fluids. The procedure typically takes one to three hours of surgery time.
About other liposuction techniques
The super-wet technique is similar to the tumescent technique, except that lesser amounts of fluids are used. Usually the amount of fluid injected is equal to the amount of fat to be removed. This technique often requires IV sedation or general anesthesia and typically takes one to two hours of surgery time. The difference with the tumescent technique is gradual. However, we believe that the more fluid is injected, the better the results.
Ultrasound-Assisted Lipoplasty (UAL).
This technique requires the use of a special cannula that produces ultrasonic energy. As it passes through the areas of fat, the energy explodes the walls of the fat cells, liquefying the fat. The fat is then removed with the traditional liposuction technique. UAL has been shown to improve the ease and effectiveness of liposuction in fibrous areas of the body, such as the upper back or the enlarged male breast. It is also commonly used in secondary procedures, when enhanced precision is needed. In general, UAL takes longer to perform than traditional liposuction. However, there are also points to consider with this technique. For example, in UAL, the heat from the ultrasound device used to liquefy the fat cells may cause injury to the skin or deeper tissues. In general, UAL is more complicated than other liposuction techniques and therefore carries more complications. Also, you should be aware that even though UAL has been performed successfully on several thousand of people worldwide, the long-term effects of ultrasound energy on the body are not yet known.
After your surgery
After surgery, you will likely experience some fluid drainage from the incisions. Occasionally, a small drainage tube may be inserted beneath the skin for a couple of days to prevent fluid buildup. To control swelling and to help your skin better fit its new contours, you will be fitted with a snug elastic surgical garment to wear over the treated area for a few weeks. Antibiotics are prescribed to prevent infection. Iron tablets are sometimes prescribed to help you regain any blood loss. Pain medication is standard, as well as sleeping tablets to help you get trough the first uncomfortable nights. Don't expect to look or feel great right after surgery. Even though the tumescent technique is believed to reduce some postoperative discomforts, you may still experience some pain, burning, swelling, bleeding and temporary numbness. Pain can be controlled with medications prescribed by the doctor, though you may still feel stiff and sore for a few days. Sometimes, fluid extracting medication (furosemide) is prescribed if swelling is marked and the use of anti-bruising crème (hirudoid) is standard in our clinic. Post-operative massage has proven to be a welcome adjuvant in liposculpture, improving contours, accelerating slenderness and alleviating stiffness. It is normal to feel a bit anxious or depressed in the days or weeks following surgery. However, this feeling will subside as you begin to look and feel better.
Getting back to normal
Healing is a gradual process. You are advised to start walking around as soon as possible to reduce swelling and to help prevent blood clots from forming in your legs. You will begin to feel better after about a week or two and you should be back at work within a few days following your surgery. The stitches dissolve on their own within the first week to 10 days.
Activity that is more strenuous should be avoided for about a month as your body continues to heal. Although most of the bruising and swelling usually disappears within three weeks, some swelling may remain for six months or more. You will be scheduled for follow-up visits to monitor your progress and to see if any additional procedures are needed. If you have any unusual symptoms between visits -- for example, heavy bleeding or a sudden increase in pain -- or any questions about what you can and can't do, our staff can be contacted 24 hours a day.
Your new look
You will see a noticeable difference in the shape of your body quite soon after surgery. However, improvement will become even more apparent after about four to six weeks, when most of the swelling has subsided. After about three months, any persistent mild swelling usually disappears and the final contour will be visible.
If your expectations are realistic, you will probably be very pleased with the results of your surgery. You may find that you are more comfortable in a wide variety of clothes and more at ease with your body. And, by eating a healthy diet and getting regular exercise, you can help to maintain your new shape.
The costs
Tumescent liposculpture at the Riley Surgery Center ranges from US$ 2000,00 (for limited areas) to US$ 4000,00 (for extensive liposuction). Prices quoted are all inclusive and include peri-operative consultations and companionship, pre-operative anesthesia consult, anesthesia fee, operating room, same night anesthesia nurse visit, 2 surgical pressure garments and before and after photos (which can also be e-mailed to you). Operation report and a cost breakdown are provided on request free of charge. Initial consultation (US$ 50,00), ambulatory nurse care (US$ 30,00 per visit) and all prescribed medication are excluded.
Financing is available. In addition, quoted prices are subject to discounts if you are local or medically associated.
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