Liposuction - Lipoplasty

Liposuction, also known as liposculpture, 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, 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.

Good candidates for liposuction

To be a good candidate for liposuction, you must have realistic expectations about what the procedure can do for you. It's important to understand that liposuction can enhance your appearance and self confidence, but it won't necessarily change your looks to match your ideal or cause other people to treat you differently. Before you decide to have surgery, think carefully about your expectations and discuss them with your surgeon. The best candidates for liposuction are normal-weight people with firm, elastic skin who have pockets of excess fat in certain areas. 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.

Liposuction - Lipoplasty

Planning your surgery

In your initial consultation, Dr. Kim will evaluate your health, determine where your fat deposits lie and assess the condition of your skin. He will explain the body-contouring methods 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. Individuals considering liposuction often feel a bit overwhelmed by the number of options and techniques being promoted today. However, Dr. Kim can help in deciding which is the right treatment approach for you, He will consider effectiveness, safety, cost and appropriateness for your needs. This is called surgical judgment, a skill that is developed through surgical training and experience. Dr. Kim also uses this judgment to prevent complications; to handle unexpected occurrences during surgery; and to treat complications when they occur.

Dr. Kim’s education and training have helped to form his or her surgical judgment, so take the time to do some background checking. Patients are encouraged to consider a doctor certified by the American Board of Plastic Surgery ("ABPS") such as Dr. Kim. By choosing a plastic surgeon who is certified by the ABPS, a patient can be assured that the doctor has graduated from an accredited medical school and completed at least five years of additional residency - usually three years of general surgery (or its equivalent) and two years of plastic surgery. To be certified by the ABPS, a doctor must also practice surgery for two years and pass comprehensive written and oral exams.

Liposuction - Lipoplasty

Preparing for your surgery

Dr. Kim 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. If you develop a cold or an infection of any kind, especially a skin infection, your surgery may have to be postponed.

While you are making preparations, be sure to arrange for someone to drive you home after the procedure and, if needed, to help you at home for a day or two.

Where your surgery will be performed

Liposuction may be performed in a surgeon's office-based facility, in an outpatient surgery center, or in a hospital. Smaller-volume liposuction is usually done on an outpatient basis for reasons of cost and convenience. However, if a large volume of fat will be removed, or if the liposuction is being performed in conjunction with other procedures, a stay in a hospital or overnight nursing facility may be required.

Anesthesia for liposuction

Various types of anesthesia can be used for liposuction procedures. Together, you and your surgeon will select the type of anesthesia that provides the most safe and effective level of comfort for your surgery. Dr.Kim typically will use general anesthesia to minimize pain during the procedure and have the ability to suction aggressively if need be.

Liposuction - Lipoplasty

Anesthesia for liposuction (continued)

If only a small amount of fat and a limited number of body sites are involved, liposuction can be performed under local anesthesia, which numbs only the affected areas. However, if you prefer, the local 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 epidural block, the same type of anesthesia commonly used in childbirth.

However, some patients prefer general anesthesia, particularly if a large volume of fat is being removed. If this is the case, a nurse anesthetist or anesthesiologist will be called in to make sure you are completely asleep during the procedure.

The surgery

The time required to perform liposuction may vary considerably, depending on the size of the area, the amount of fat being removed, the type of anesthesia and the technique used. There are several liposuction techniques that can be used to improve the ease of the procedure and to enhance outcome.

Liposuction is a procedure in which localized collections of fat are removed to recontour or reshape 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 or a large syringe, depending on the surgeon's preference. If many sites are being treated, your surgeon will then move on to the area, working to keep the incisions as inconspicuous as possible.

Liposuction - Lipoplasty

The surgery (continued)

Fluid is lost along with the fat, and it's crucial that this fluid be replaced during the procedure to prevent shock. For this reason, patients need to be carefully monitored and receive intravenous fluids during and immediately after surgery.

1. The surgeon inserts a cannula through small incisions in the skin. At the other end of the tube is a vacuum-pressure unit that suctions off the fat. 2. A snug compression garment worn after surgery helps reduce swelling. Technique variations The basic technique of liposuction, as described above, is used in all patients undergoing this procedure. However, as the procedure has been developed and refined, several variations have been introduced. 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.

Liposuction - Lipoplasty

Technique variations (continued)

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.

The amount of fluid that is injected varies depending on the preference of the surgeon. Large volumes of fluid -- sometimes as much as three times the amount of fat to be removed -- 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 (sometimes as long as 4 to 5 hours). 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.

The super-wet technique is similar to the tumescent technique, except that lesser amounts of fluid 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.

All surgery carries some uncertainty and risk

Liposuction is normally safe, as long as patients are carefully selected, the operating facility is properly equipped and the physician is adequately trained.

Liposuction - Lipoplasty

All surgery carries some uncertainty and risk (continued)

As a minimum, your surgeon should have basic (core) accredited surgical training with special training in body contouring. Also, even though many body-contouring procedures are performed outside the hospital setting, be certain that your surgeon has been granted privileges to perform liposuction at an accredited hospital. Your doctor must have advanced surgical skills to perform procedures that involve the removal of a large amount of fat (more than 5 liters or 5,000 ccs); ask your doctor about his or her other patients who have had similar procedures and what their results were. Also, more extensive liposuction procedures require attentive after-care. Find out how your surgeon plans to monitor your condition closely after the procedure.

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 combination of these factors can create greater hazards for infection; delays in healing; the formation of fat clots or blood clots, which may migrate to the lungs and cause death; excessive fluid loss, which can lead to shock or fluid accumulation that must be drained; friction burns or other damage to the skin or nerves or perforation injury to the vital organs; and unfavorable drug reactions.

Liposuction - Lipoplasty

All surgery carries some uncertainty and risk (continued)

There are also points to consider with the newer techniques. 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. Also, you should be aware that even though UAL has been performed successfully on several thousand people worldwide, the long-term effects of ultrasound energy on the body are not yet known. In the tumescent and super-wet techniques, the anesthetic fluid that is injected may cause lidocaine toxicity (if the solution's lidocaine content is too high), or the collection of fluid in the lungs (if too much fluid is administered).

The scars from liposuction are small and strategically placed to be hidden from view. However, 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. Sometimes, additional surgery may be recommended.

After your surgery

There will be fluid drainage from the incisions after the procedure. It may be beneficial to place plastic on your bed so it doesn't get soaked from the drainage. To control swelling and to help your skin better fit its new contours, you may be fitted with a snug elastic garment to wear over the treated area for a few weeks. Dr Kim may also prescribe antibiotics to prevent infection.