Liposuction

Liposuction, also known as lipoplasty (“fat modeling”), liposculpture or suction lipectomy (“suction-assisted fat removal”) is a cosmetic surgery operation that removes fat from many different sites on the human body. Areas affected can range from the abdomen, thighs, buttocks, to the neck, backs of the arms and elsewhere. The fat is usually removed via a cannula (a hollow tube) and aspirator (a suction device).
Liposuction is not a low-effort alternative to exercise and diet. It is a form of body contouring with significant attendant risks[1] and is not a weight loss method. The amount of fat removed varies by doctor, method, and patient, but the average amount is typically less than 10 pounds (5 kg).

There are several factors that limit the amount of fat that can be safely removed in one session. Ultimately, the operating physician and the patient make the decision. There are negative aspects to removing too much fat. Unusual “lumpiness” and/or “dents” in the skin can be seen in those patients “over-suctioned”. The more fat removed the higher the surgical risk.

As shown previously, reports of people removing 50 pounds (22.7 kg) of fat are exaggerated. However, the contouring possible with liposuction may cause the appearance of weight loss to be greater than the actual amount of fat removed. The procedure may be performed under general or local (“tumescent”) anesthesia. The safety of the technique relates not only to the amount of tissue removed, but to the choice of anesthetic and the patient’s overall health. It is ideal for the patient to be as fit as possible before the procedure and to have given up smoking for several months.

Techniques

Liposuction techniques can be further categorized by the amount of fluid injection and by the mechanism in which the cannula works.
Amount of fluid injection

Dry liposuction

The dry method does not use any fluid injection at all. This method is seldom used today.

Wet liposuction

A small amount of fluid, less in volume than the amount of fat to be removed, is injected into the area. It contains:
Lidocaine: as a local anesthetic
Epinephrine: to contract the blood vessels and thus minimize bleeding
A salt solution: to make it saline, like our body fluids
This fluid helps to loosen the fat cells and reduce bruising. The fat cells are then suctioned out as in the basic procedure.

Super-wet liposuction

In this method, the infusate volume is in about the same amount as the volume of fat expected to be removed. This is the preferred technique for high-volume liposuction by many plastic surgeons as it better balances hemostasis and potential fluid overload (as with the tumescent technique). It takes one to three hours, depending on the size of the treated area(s). It may require either:
IV sedation as well as the local lidocaine, or
Complete anesthesia

Tumescent liposuction

In the classic tumescent technique, a large amount of fluid is injected into the area, perhaps as much as 3 or 4 times the volume of fat to be removed. It is the same saline fluid as the super wet technique, but it’s increased quantity creates space between the muscle and the fatty tissue, which creates more room for the suction tube (cannula) that the surgeon uses to remove the fat cells. Depending on the size of the area(s) being worked, this procedure takes longer than other techniques must as the large amount of infiltrate must be introduced slowly.

The high volumes of fluid and local anesthetic required for this technique have limited its use with larger people.

Laser assisted liposuction

Laser assisted liposuction is a type of liposuction that utilizes preliminary emulsification of fat using a canula tipped with a diode laser emitter. This fat is then removed with a traditional SAL technique. The advantages (if any) and risks associated with this type of technology is still being evaluated.

Mechanism of liposuction

Suction-assisted liposuction (SAL)

Suction-assisted liposuction is the standard method of liposuction. In this approach, a small cannula (like a straw) is inserted through a small incision. It is attached to a vacuum device. The surgeon pushes and pulls it carefully through the fat layer, breaking up the fat cells and drawing them out of the body by suction.

Microcannula liposuction

Microcannula or very small liposuction cannula permit fine close to surface contouring sometimes through much smaller incisions.

Ultrasound-assisted liposuction (UAL)

Also referred to as ultrasonic liposuction. A specialized cannula is used which transmits ultrasound vibrations within the body. This vibration bursts the walls of the fat cells, emulsifying the fat, i.e., liquefying it, and making it easier to suction out.
UAL is a good choice for working on more fibrous areas, like the upper back, or male breast area
It takes longer to do than traditional liposuction, but not longer than tumescent liposuction
There is slightly less blood loss
So far, there appears to be slightly more risk of seromas forming (pockets of fluid) which may have to be drained with a needle
After ultrasonic liposuction, it is necessary to perform suction-assisted liposuction to remove the liquidied fat.

Power-assisted liposuction (PAL)

PAL uses a specialized cannula with mechanized movement, so that the surgeon does not need to make as many manual movements. Otherwise it is similar to traditional UAL.
External ultrasound-assisted liposuction (XUAL or EUAL)
XUAL is a type of UAL where the ultrasonic energy is applied from outside the body, through the skin, making the specialized cannula of the UAL procedure unnecessary.
It was developed because surgeons found that in some cases, the UAL method caused skin necrosis (death) and seromas, which are pockets of a pale yellowish fluid from the body, analogous to hematomas (pockets of red blood cells).
XUAL is a possible way to avoid such complications by having the ultrasound applied externally. It can also potentially:
Cause less discomfort for the patient, both during the procedure and afterwards
Decrease blood loss
Allow better access through scar tissue
Treat larger areas
At this time however, it is not widely used and studies are not conclusive as to its effectiveness.

Water-assisted liposuction (WAL)

WAL uses a thin fan-shaped water beam, which loosens the structure of the fat tissue, so that it can be removed by a special cannula. During the liposuction the water is continually added and almost immediately aspirated via the same cannula. WAL requires less infiltration solution and much less intraoperative swelling. This allows the surgeon to better realize the target result. The cannula movements are very subtle, helped by the water beam. This is a new technique that there is not much published yet in the medical literature.
Not approved by the FDA in the US.

Stitches

To stitch or not to stitch; that is the surgeon’s decision. Since the incisions are small, and since the amount of fluid that must drain out is large:
Some surgeons opt to leave the incisions open, the better to clear the patient’s body of excess fluid. They find that the unimpeded departure of that fluid allows the incisions to heal more quickly by themselves.

Others stitch them only partially, leaving space for the fluid to drain out
Others delay stitching until most of the fluid has drained out, about 1 or 2 days.
In either case, while the fluid is draining, dressings need to be changed often. After one to three days, small self-adhesive bandages are sufficient.

Preparation

Before receiving any of the procedures described above:
No anticoagulants should be taken for two weeks before the surgery.
If receiving general anesthesia or sedation, and the surgery will be in the morning, fasting from midnight the night before is required. If only local anesthesia will be used, fasting is not required.
Smoking must be avoided for about two months prior to surgery. Nicotine interferes with circulation and can result in loss of tissue.

The procedure

In all liposuction methods, there are certain things that should be done when having the procedure:
The candidate and the surgeon will agree ahead of time on exactly which area(s) will be treated and both will discuss what outcome to expect
A consent form is signed on the day of surgery
An antibiotic will be given either about an hour beforehand, or afterwards
The targeted areas are marked on the body while the candidate is in a standing position
Sometimes photos will be taken of the area to be treated, so the patient will have before and after photos
In the operating room, a sterilizing solution such as Betadine, is applied to the relevant areas
Local anesthetic is injected and the patient may be given a sedative, either orally, or through an IV injection
Incisions are small, about a quarter to a third of an inch
The patient will probably have an IV fluid line, since they will be losing fluid with the fat, and the fluid balance must be kept intact
There will be some monitoring devices attached to the body to keep track of the blood pressure, heart rate, and blood oxygen level
The patient will feel only a scraping or rasping sensation from the cannula movement
Usually the patient can get up, walk around, and go home the same day if they did not receive general anesthesia, although they’ll need someone else to drive

Recovery

Depending on the extent of the liposuction, patients are generally able to return to work or school between two days and two weeks. A compression garment or bandage is worn for two to four weeks. If non-absorbable sutures are placed, they will be removed after five to ten days.
Any pain is controlled by a prescription or over-the-counter medication, and may last as long as two weeks, depending on the particular procedure
Swelling will subside in anywhere from two weeks to two months
Bruising will fade after a few days or maybe as long as two weeks later
Numbness may last for several weeks
Normal activity can be resumed anywhere from several days to several weeks afterwards, depending on the procedure
The final result will be evident anywhere from one to six months after surgery, although
the patient will see noticeable difference within days or weeks, as swelling subsides

Expediting recovery

The patient should:
Drink enough water to prevent dehydration
Avoid using ice packs or heating pads on the treated areas
Postpone soaking the wounds until they are sealed (usually 48 hours for sutured wounds and a little longer for unsutured ones).
If any dizziness is experienced, the patient should take it easy: stand up slowly, get some help for the shower, remove the compression garment slowly, etc.
The suctioned fat cells are permanently gone. However, if the patient does not diet and exercise properly, the remaining fat cell neighbors could still enlarge, creating irregularities.

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Source and reference: Wikipedia.Org