Member Articles on Plastic and Cosmetic Surgery:

If you are someone who is generally in good health and has worked hard to get in shape, lost some extra pounds, but can't seem to shed those troublesome deposits of fat in key areas no matter how diligent and devoted you are, you may be a good candidate for liposuction and liposculpture.

What is the difference between liposuction and liposculpture?
Liposuction is the removal of medium to large amounts of contour fat to reduce the peaks and mounds that portray a heavy and sloppy appearance. These include areas such as below the chin, upper arms, outer breasts, lower abdomen, flanks, hips and thighs. Liposculpture is the removal of small to medium amounts of fat in rather normal to full areas to sharpen features, accentuate the muscles beneath and create a more cut appearance in the neck, lower cheeks, upper abdomen, outer buttocks, calves and ankles.

Who are good candidates for these procedures?
These procedures are for anyone who cannot obtain the trim and properly contoured look with diet and exercise, possess good skin elasticity and  is not looking to lose large volumes of weight. Patients who exceed their body weight by 30-50% may only be candidates for limited fat removal because of safety concerns and should undergo these procedures in stages. Patients who exceed their ideal weight well over 50% should seek other remedies for weight loss as an initial step and  consult a physician experienced in weight management.

Does the removal of fat tighten the skin as well?
Not exactly. In fact some fat deposits on the body may be unforgiving to major fat removal and  lead to more relaxation of the skin. Many new methods are being investigated in order to test their effect on skin contraction and tightening. Ultrasonic liposuction, has been suggested as a stimulus to skin contraction. Some Cosmetic Surgeons are recommending the application of laser energy to the liposuction site. Unfortunately, it is the heat generated by these modalities that is believed to be the stimulus for the contraction process. If the heat of ultrasonic and laser energy combined with the rigors of the suction pressure, is applied too aggressively near the skin, it can lead to serious skin injury. On the other hand, the use of the microcannulaes at less than 3.0 mm in diameter, if applied near the skin in selected areas, can help achieve contraction as the fat is removed with little risk.

How do I decide whether to have liposuction, liposculpture, or ultrasonic liposuction?
The surgeon should review his experience with the various methods and analyze your body type. Some surgeons may advise ultrasonic liposuction for large volume extractions, especially in tough areas such as the back, flanks and  hips. It was designed principally for the hard to extract deep fat and  to reduce surgeon fatigue. External ultrasonic energy can be applied and is recommended by some surgeons before or after the fat is removed by regular liposuction. Ultrasonic liposuction must ordinarily be combined with traditional liposuction when deep and surface fat is being removed. This does add to the operating time and to the cost of the surgery and may offer no advantage for most surgeons. For gynecomastia (large breasts in the male) some experts advocate the sole use of ultrasonic liposuction but it should not be used aggressively near the nipple skin.

Where is the surgery performed?
The surgery can be performed in the hospital, as an inpatient or outpatient, in an outpatient surgery center, or in an accredited office surgery center having capability for local, sedation or general anesthesia.

How is the surgery performed?
The patient is prepared for either local anesthesia, local anesthesia with sedation, or general anesthesia. Tiny cuts are made at the sites where fat is to be removed and a wetting solution is infused to provide some anesthesia, reduce bleeding and improve fat extraction. If straight local is used, then the wetting solution is delivered in large volumes with a high concentration of local anesthetic, to tumesce or create a glistening tightness to the tissues, so that the fat can be comfortably removed with minimal discomfort and practically no blood loss. All the anesthesia is provided in the wetting solution. This requires careful monitoring of the local to avoid toxicity and must be perfomed by those experienced with local anesthesia. If sedation or general anesthesia is used, then lesser amounts of local anesthetic are added to the wetting solution and the solution is applied for its constriction of small blood vessels and low level of blood loss. General anesthesia does permit more areas to be treated in one session and may be more cost effective but one must limit the total volume of fat extracted for the safety of the patient regardless of anesthesia method. The suction instruments called cannulaes are inserted under the skin moved in a back and forth and chriss-cross fashion within the fat (under either hand syringe pressure, gas reciprocation power, or ultrasonic and/or suction-assist pressure) and the fat is vacuumed away. The output of fat is measured in c.c.s, not to exceed 3 to 5 liters in the majority of patients, the patient is checked for symmetry and the procedure is completed when a safe level of fat removal for that patient is achieved. A garment or binder is then placed over the operative site. Rarely a drain may be placed under the skin where a lot of fat has been removed. The patient is monitored for a while to make sure they have received enough fluid hydration and are able to make clear urine. A responsible adult should accompany the patient home for large outpatient procedures and stay with the patient for a while including over night.