Liposuction
Safe-effective- permanent removal of fat

Well-shaped figure is a dream of every person. Hereditary factors, aging, pregnancy etc. can make you de-shaped. People try so much to shed their extra fat. They do diet restriction or go to gym for exercise or try for body wraps etc. But certain body fats are resistant, it will never move what ever you do. Liposuction can help a lot to shade this unwanted fat and attain nice body shape.

Liposuction is currently the most frequently requested cosmetic surgery in the world. Liposuction by tumescent technique is safe and more precise. It has quicker recovery times.

For women, trouble spots tend to be the hips, the thighs, the sides of the knees, the tummy, back rolls and the arms. For men, it's the belly button region, chest and the "love handles" around the hips. Both sexes may also have excesses in the buttocks, neck, cheeks, and chin.

How it is done?
The concept of liposuction is surprisingly simple. Liposuction is a surgical technique that improves the body's contour by removing excess fat deposits located between the skin and muscle. Very small incision in inconspicuous site is made on skin. Special fluid (Tumescent fluid) is injected into the fatty area to be dealt with. Few minutes are given to act. It loosens and liquefies the fat and makes it bloodless too. Once the fat is liquefied it is sucked out by cannula with the help of syringe or machine from the same incision. Once the fat is sucked out, pressure garment is given to compress treated area, so skin drapes nicely. Large amount of fat can be removed without big cut or scar on body.


Lipo-sculpture
Surgical skill and an eye for symmetry and contour are required to achieve good results. This is very important and it differentiates best surgeon from others. Liposuction is not merely removal of fat. In fact it is lipo-sculpture, fat is removed to give beautiful shape to body and so sometimes it is necessary to inject fat in some area of depression along with liposuction!!

Power Assisted Liposuction
Power-assisted liposuction refers to a new technology whereby the tip of the cannula vibrates at a rapid speed. This vibration loosens the fat cells so that they may be suctioned away gently with less trauma to the surrounding tissues. PAL is performed using tumescent technique. This maximizes the effectiveness of the fat removal and patient comfort, and it helps to minimize bruising. Power-assisted liposuction has several important advantages over the suction-assisted liposuction (SAL). These benefits include increased safety, decreased anesthesia time, less bruising, faster recovery, increased efficacy and greater precision.

Advantages of Power-Assisted Liposuction
Improved Safety
Shorter Procedure
Less Bruising and Swelling
Faster Recovery
Less Discomfort
Greater Precision

Tumescent Technique

The tumescent technique for local anesthesia involves the injection of large volumes of saline, very dilute lidocaine (local anesthetic) and epinephrine (drug that shrinks capillaries) into subcutaneous fat. The word tumescent means swollen and firm. With the tumescent technique, the volume of dilute lidocaine that is injected into fat is so large that the targeted areas literally become tumescent (swollen and firm). The tumescent technique produces profound and long-lasting local anesthesia of the skin and subcutaneous fat.

The drug epinephrine (adrenalin) provides profound localized vasoconstriction that it virtually eliminates surgical bleeding during tumescent liposuction.

Benefits of tumescent liposuction

Minimal bleeding during and after surgery
Bruises are less
Loosens the fat easily
Lidocaine decreases the chances of infection
Exaggerates the deformity and so more perfection is achieved.


How much blood is lost during tumescent liposuction?
Blood loss is about one percent (1%) of the fat removed; it comes to 15 to 30 ml (1 to 2 tablespoons) during large volume liposuction. With the advent of the tumescent technique, blood transfusions are no longer a part of liposuction surgery.

Anaesthesia
Tumescent fluid contains local anesthetic agent, it numbs the area. In addition, intravenous sedation is given for more relaxed state during the procedure, when required. For patients who have more extensive procedures, regional anesthesia (usually an epidural block) or general anesthesia is used.

Hospital Stay

Most of the time it’s a day care surgery, but if it is a mega liposuction or combined with other surgery 2 / 3 days hospitalization is must.

Pressure garment






With the tumescent technique, there is always a certain amount of blood-tinged anesthetic solution which remains beneath the skin where the fat has been suctioned. This blood-tinged fluid causes bruising and the post-operative swelling known as "osmotic-edema". The function of the compression garment is to encourage the rapid drainage of the residual blood-tinged tumescent anesthetic solution from beneath the skin, or to force the absorption of the blood-tinged anesthetic solution into the body's blood vessels. It decreases the swelling. It supports the operated tissue. It is to be worn for 6 weeks. The garments are usually crotch less so that the patient can urinate and defecate without having to remove the garment.

Follow up visit
We call patient within a day or two after surgery and again a week later. But we keep in touch with patient by telephone and/or e mail. Thus, while patients are informed that they may return at any time for a follow-up visit, most patients will only return for a personal encounter if there is a specific concern or problem.

Recovery
Most patients with moderate or small liposuction can return to a desk-type job within 1-3 days after tumescent liposuction. There is no limitation to physical activity other than what common sense would dictate.

Bed rest
In case of small or moderate liposuction one should never be confined to bed after liposuction. In fact we recommend immediate walking on the evening of surgery.
For major and supra major amount of liposuction patient is advised to move from the day after surgery.

Back to work
Most patients should be able to return to normal desk-type work within 1 to 3 days after moderate liposuction. Although soreness and tenderness will limit the speed with which a patient can move about, patients should be reasonably comfortable while sitting at a desk or working at a computer.

The more areas treated by liposuction on a single day, the more soreness and disability the patient can expect. Patient who has major or supra major liposuction may require 5 -7 days of rest but not exactly bed rest. One can move around but there will be soreness and pain.

Exercise
Within one to two days after surgery, all patients should be physically able to walk around inside the house and go for short walks around the neighborhood. Most patients can resume their routine exercising within 2-3 weeks after liposuction. Initially, patients should not attempt too much exercise. It is recommended that patients start out by doing about 25% of their usual amount of exercise, and thereafter increase their daily exercise as tolerated.

Air Travel
Most patients can fly on a commercial airline within 24 hours after small or moderate liposuction. We recommend 10-14 days time for major or supra major liposuction.

Sexual activity
There are no restrictions regarding sexual activity after liposuction other than limitations imposed by postoperative soreness and tenderness of the treated areas. Otherwise liposuction usually does not interfere with a patient having gentle sexual encounters.

Complications

The following is a list of the most serious risks, which fortunately are rare.

Infection
Although there have been reports in the medical literature of patients who have had serious infections following liposuction surgery, infections after tumescent liposuction are extremely rare. Lidocaine, the local anesthetic that is used for the Tumescent Technique has been shown to be bactericidal, it kills bacteria. Pre operative, peri operative and post operative antibiotics are given to remain on safer side.

Hematoma or Seroma
Bleeding into a closed space under the skin (hematoma), or the leakage of serum into closed space under the skin (seroma) can occur after liposuction. There is an increased risk of these types of complications associated with obesity.

Seromas after mega liposuction (more than 6 liters) are the result of surgical trauma which injures or destroys the lymphatic vessels within the targeted fatty tissue. It is generally a nuisance, but not a serious complication. Without treatment, a seroma will usually resolve slowly over several weeks.

Seromas are prevented by the use of Microcannulas, open-drainage" technique and by using efficient compression garments.

Nerve Damage
Permanent nerve damage is very rare with tumescent liposuction. Nevertheless, nerve injury is a known risk of any surgery.

Swelling or Edema
Temporary swelling of areas treated by liposuction is part of the natural healing process, and usually resolves within 4 to 12 weeks. By allowing incision sites to remain open (not closed with stitches), post-operative drainage of the residual blood-tinged local anesthetic solution can occur. By encouraging this drainage of inflammatory fluid, the degree and intensity of postoperative swelling and edema is minimized.



Dr. Ashit Shah MS, MCh
Aesthetic Plastic Surgeon
Dr. Hema Shah MB,DGO