Liposuction Do’s and Don’ts for therapeutic support

Liposuction as we know it today was first described by the French Surgeon Yves-Gerard Illouz in 1982. To some extent, the idea was not original as it had been tried in 1926 by another Frenchman, Dujarier. Unfortunately, it fell out of favour when his patient, a model, lost a limb to gangrene. During the 1980s, the technical details of safe liposuction, lipoplasty or liposculpture, as it is also known, were worked out in extensive clinical studies. Today, liposuction is a remarkably safe and effective procedure, which ranks worldwide, as one of the most consistently popular cosmetic surgical procedures around.

The technique is not a treatment for generalised obesity and is best for isolated pockets of fat deposit, such as over the hips or the ankles, although virtually any part of the body can be treated with appropriately tailored techniques. In theory, liposuctioned fat is removed from areas of bodily excess, by the insertion of a cannula, or suction probe, through a small access incision (3-8 mm) and application of a vacuum to create negative suction pressure. Despite popular perception to the contrary, this is a real surgical procedure, performed under anaesthesia, which may be local or general, and must be treated with respect. In the 1980s, there were numerous deaths reported and a significant rate of serious complications including injury to internal organs, altered fluid balance, infection, bleeding and scarring. Nowadays due to improved techniques and better understanding, such complications are rare but it still pays to do one’s homework. Know that the surgeon is appropriately trained and experienced, and is working out of legitimately licensed premises, before going ahead.

Thanks to thirty years of technologic development, there are several different liposuction techniques available today. The simplest is SAL or suction assisted lipo, which uses a simple cannula passed in and out of the tissues, with a negative pressure load, to extract fat. A major advance was the addition of an ultrasound generating tip to the probe, (hence ultrasound-assisted lipo, or UAL) which helps to melt the fat, thus making its extraction much less traumatic. More recently, laser assisted devices, water irrigation devices and external ultrasound assisted devices have become available, but there is a strong body of opinion which holds that ultimately, the best lipo results are achieved by having an experienced surgeon with a good eye for 3D contour, rather than what particular device or technique he or she favours. The “It’s the wizard, not the wand,” hypothesis.

Generally speaking, most liposuction addresses deeper fat layers, since superficial liposuction can damage the skin, or be more likely to cause visible ripples or dents. Nevertheless there are techniques for performing superficial lipo, such as etching, which specifically target superficial fat and which carry their own well-defined risks.
In treating the pre and post-operative lipo patient, different surgeons will have their own preferences. In my practice, I insist that all candidates for lipo stop smoking at least six weeks prior to surgery. Smoking interferes with oxygen transport and collagen synthesis and will greatly increase the risks of infection; poor wound healing and sub-optimal scarring. I also believe that the fitter a patient is, the better they will cope with surgery, so I recommend an exercise regimen prior to surgery.
Simplistically, liposuction can be thought to honeycomb a block of fat with multiple channels from which the fat has been sucked out; post-operatively it is necessary to compress these voids and hollows, so as to reduce the risk of contour irregularities. Therefore, immediately after surgery patients are put into a compression garment which they should wear 24/7 for four to six weeks.

For the first two weeks, only gentle activity is encouraged, such as walking. This is to decrease the risk of deep vein thromboses, and to hasten fluid drainage from areas of swelling, while not raising the blood pressure sufficiently to provoke bleeding from the traumatised tissues. Bruising, which can be severe is treated with Arnica Montana, or proprietary creams such as Hirudoid® or Traumeel®. After three or four weeks, when the risk of provoking a secondary bleed is reduced, exercise is stepped up and massage is added, as required, to help diminish contour irregularities. In some cases, treatments such as Endermologie® are very effective at smoothing contour.

The question is sometimes asked, “Who is a good candidate for liposuction?” As a general rule, the ideal lipo candidate is relatively young, has good-quality, elastic skin and has an isolated fatty collection such as a buffalo hump, lateral thigh jodhpurs, or a banana roll beneath the buttocks. It has been said that if one can pinch an inch, one can suck it.

Most surgeons are cautious about offering liposuction as an isolated or stand-alone procedure to older patients because although one can reduce the bulk of an area, older skin which has lost its elasticity or which has been significantly damaged, for example, skin with severe stretch-marking, will fail to contract or “take up” adequately, after liposuction. This may tend to leave redundant folds of skin that can be worse than the original problem. For this reason, while liposuction is often an integral part of a brachioplasty (a correction of lax skin and fat on the backs of the upper arm) or abdominoplasty (tummy tuck), these procedures will almost always require actual surgical removal of excess skin as well.

The same phenomenon is seen in patients who have a liposuction-only breast reduction; inevitably this will result in a breast which is deflated and saggier than before lipo. The best breast reductions employ surgery to reduce and shape the breast tissue and skin envelope, coupled with liposuction to reduce the peripheral fat and blend the newly shaped breast into the surrounding tissues, resulting in a smaller, more comfortable breast which is perkier and more aesthetically pleasing.
In my facelifting practice I will often use ultrasound-assisted liposuction with very fine-bore cannulas, to help shape and sculpt the fat around the jaw and neck. Likewise, this technique is my standard approach in dealing with the very fibrous fatty deposits which cause male gynaecomastia, or man boobs.
Another advantage of liposuction which is becoming of increasing importance is that it harvests high-quality fat which is rich in stem cells and which is very useful for injecting as fat grafts. There is good clinical evidence to show that breasts can be enlarged by a cup size with autologous (fat taken from the same patient) fat injections; facial ageing involves wastage and shrinking of facial tissues, especially the fat pads and autologous fat injections to help restore facial volume are enormously beneficial in facial rejuvenation surgery and again, have become almost a standard part of my facelift procedures.

Although a simple technique in essence, liposuction contains many traps for young players. It has the potential to create serious mischief and should never be taken lightly. A very small access incision on the skin surface does not preclude a significant deep injury, as when an abdominal organ such as bowel is accidentally perforated. Pre-operative patients need to be adequately prepared, both psychologically (managing expectations) and physically (being as fit and healthy as possible). Post-operative patients need good wound care, psychological support and encouragement and assistance with managing side effects or complications such as  numbness, altered sensation, swelling, pain and contour irregularity/ asymmetry.

Practiced with skill and safety in appropriately selected patients, liposuction, in all its many forms, is quite justifiably, one of the most effective and popular of modern day body contouring procedures.

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