LIPOSUCTION
Aesthetic surgery:
This document has been written by the French Society of plastic Reconstructive and Aesthetic Surgery (SOFCPRE).
DEFINITION, AIMS AND PRINCIPLES
Liposuction can radically and definitively diminish localized areas of protruding fat.
These localized areas of protruding fat do not go away with strict diet and exercise.
Conversely, liposuction is not a way of losing or controlling weight. Thus, a properly performed liposuction will not replace an improvement in lifestyle. Liposuction is not a treatment for obesity.
The principle behind liposuction (as presented in 1977 by Yves-Gérard ILLOUZ) is to remove fat through very small skin incisions, with atraumatic and blunt-tipped cannulas. These cannulas are attached to a closed negative pressure system, which permits safe and sterile aspiration of excessive fat cells.
Insofar as these fat cells do not have the ability to replicate, there will be no recurrence of the overcrowding of adipocytes.
In practical terms, liposuction can be applied to numerous body areas: hips, outer thighs, abdomen, knees, calves, ankles and upper arms. Technical improvements have allowed its operation to extend to the face and neck (i.e., double chin and round face).
Recent progress in the field of superficial liposuction, performed with very thin cannulas have reduced skin trauma or bruising. By enhancing skin shrinkage, when performed with great attention and skill, the final result has even improved.
Meanwhile, it must be born in mind that liposuction, however common a procedure it has become, remains a genuine surgical procedures, that ought to be performed by a skilled and qualified Plastic Surgeon, specially trained for this technique, in a truly surgical environment.
The treatment of such localized fat deposits can’t be reimbursed by health insurance.
BEFORE THE OPERATION
A preoperative check-up is made following your surgeon’s recommendations.
You will have a consultation with the anaesthesiologist at latest, 48 hours prior to surgery.
Smoking is not not formally forbidden but stopping a month before the procedure is recommended in view of its adverse effect on wound healing.
No medication containing aspirin will be taken for 10 days before surgery.
According to the type of anaesthesia chosen, you may be asked not eat or drink for 6 hours before surgery.
HOSPITAL STAY AND TYPE OF ANAESTHESIA
Type of anaesthesia:
Liposuction can be performed, depending on the amount of areas to be treated, either under local anaesthesia; local anaesthesia associated with intravenous sedation or general anaesthesia. In some cases, regional anaesthesia, such as an epidural, could be used.
The type of anaesthesia will be chosen after a discussion between yourself, your surgeon and your anaesthesiologist.
Hospital stay:
The duration of hospitalisation depends on the amount of fat removed. It can be short (a few hours) for small liposuctions under local anaesthesia, or longer (1 or 2 days) for larger liposuctions under general anaesthesia.
THE PROCEDURE
Every surgeon has his or her personal technical habits, which he or she adapts to every new case, in order to obtain the best possible results. However, there are common principles:
Skin incisions are small (3 to 4 millimetres) and discrete, usually hidden in a natural fold.
Fat cells from deep and superficial fat layers are aspirated through smooth cannulas tunnelled though subcutaneous tissue layers, taking care to avoid nerves and blood vessels. This procedure treats the deep and superficial fat.
The amount of fat removed is adapted to the amount of the overlying skin, which represents a fundamental factor for the quality of the final result.
Post-operatively, a pressure dressing is applied with an elastic bandage. Very often a special pressure garment is put on top of it.
The duration of the procedure depends on the amount of fat removed and on the number of body areas to be treated. It can vary from 20 minutes to 3 hours (average time is 1 to 2 hours).
AFTER THE OPERATION: POSTOPERATIVE CARE
The time needed to recover from surgery is proportional to the amount of excess fat removed.
After surgery, you will observe swelling and bruising in the treated areas.
Pain can vary from one patient to another, but it is usually mild, due to the use of very thin cannulas.
Fatigue is common in the first few post-operative days, especially after large liposuctions.
You can go back to your usual activity 3 to 6 days after surgery, again depending on the extent of your liposuction and your type of professional activity.
Bruising usually disappears 10 to 20 days after surgery.
It is strongly recommended that you wear a pressure garment for 2 to 4 weeks.
It is possible to start sports again at least 3 weeks after surgery.
Regions operated for at least 3 weeks should not be expose to sunlight or UV.
There is no dramatic improvement in body contour in the first 2 to 3 weeks, because of the tissue swelling (edema) in the areas operated on.
It is only after 3 weeks and with the resorption of this edema that results will begin to appear. The skin will retract completely in 3 to 6 months over the new contours and readapt to the new silhouette.
THE RESULT
The final result can be best appreciated 6 months after the procedure. It is most satisfactory when the patient selection and technique are properly done, permitting removal of localized fat deposits and producing skin retraction.
The goal of this surgery is to make an improvement and not to achieve perfection. If your wishes are realistic, the result should give you great satisfaction
DISAPPOINTING RESULTS
It has already been explained how liposuction, when correctly indicated and performed, can offer a real improvement to patients in terms of satisfying results and conformity to their expectations.
In some cases, localized imperfections can be observed, which must be distinguished from genuine complications: insufficient corrections, residual asymmetry, surface irregularities. These can be corrected secondarily under local anaesthesia after 6 months.
POSSIBLE COMPLICATIONS
Liposuction, even if performed for aesthetic reasons, is a genuine surgical procedure, carrying the risks associated with all medical procedures, no matter how mild they might appear.
There are surgical and aesthetic complications.
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For the anaesthesia, the anaesthesiologist will explain the risks during the preoperative consultation. You must be aware that anaesthesia can cause unpredictable reactions, which can be difficult to control: the presence of an experienced anaesthesiologist, in a surgical context, means that, statistically, the risks are practically negligible.
In fact, techniques, products and monitoring methods have progressed considerably over the last twenty years, offering optimal safety, especially when the operation is elective and the patient is in good general health.
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Concerning surgery: by choosing a competent and qualified Plastic Surgeon, experienced in performing this procedure, you limit, but do not entirely eliminate, surgical risks.
Real complications are rare after a well-done liposuction:in practice, care in the choice of what should be done and in the surgical procedure means that these can be effectively and truly prevented.
Among possible complications, although the are very rare, you must be aware of the following:
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Thrombo-embolic accidents (blood clot in the veins of the legs, pulmonary embolism) are rare, but can be life-threatening. They can be prevented by strict prophylactic measures, such as standing and walking as soon as possible after surgery, wearing compression stockings, or heparin therapy (low doses of heparin injected under the skin)
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Unless an associated bleeding disorder is present, bleeding is rarely serious.
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Lymphatic effusion may very occasionally undermine a correctly performed liposuction.
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Similarly, localized skin necrosis, which lengthens the period of healing and can leave scars, may be observed.
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Infection can be prevented by prescribing an antibiotic prophylaxis.
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Finally, metabolic disturbances were observed during liposuction of excessive quantities.
All things considered, the risks must not be overestimated, but you must be conscious that an operation, even a minor one, always has some degree of unforeseeable unknown factors.
You can be assured that if you are operated on by a qualified Plastic Surgeon, he will have the experience and skill required to avoid these complications, or to treat them successfully if necessary.
These are the facts that we wish to bring to your attention, to complement what you were told during the consultation.
Our advice is for you to keep this document and to read it and think it over carefully after your consultation.
Once you have done this you will perhaps have further queries, or require additional information.
We are at your disposal should you wish to ask questions during your next consultation, or by telephone, or even on the day of the operation, when we will meet in any case, before the anaesthesia.
"Copyright", © "All Rights Reserved" SOFCPRE, any reproduction, even partial, of these texts is prohibited without permission from the French Society of Plastic Reconstructive and Aesthetic Surgery. A copy or reproduction by any means whatsoever, including photocopying, photography, screen capture, copy, paste, recording or otherwise, constitutes an infringement punishable under the Act of March 11, 1957 on the protection of copyright.
Authorization for reproduction of March 10, 2009, for: MCEI (www.chirurgiens-plasticiens.info).
This factsheet has been designed under the auspices of the French Society of Plastic Reconstructive and Aesthetic Surgery (SOF.CPRE) as a complement to your first consultation; to try to answer any questions you can ask yourself if you intend to use a surgical lipo-filling.
The purpose of this paper is to bring you all the information necessary and essential for you to make your decision with full knowledge of the facts. So is it advisable to read with the greatest attention.