The modern era of liposuction plastic surgery started in 1980 when Swiss and French physicians first presented their techniques of “lipolysis.” Viewed from the current perspective, the description of their procedures were revolutionary, but primitive by today’s standards.
The newer techniques of liposuction are safe and consistently produce results that were not obtainable in the past. All aspects of the newer techniques have been analyzed to maximize the patient’s safety during the liposuction surgery: the metabolism of fat, the anaesthesia, and the reproduction of standard techniques that afford the patient good results and maximize the patient’s safety and comfort.
It should be noted that there is no ideal method for liposuction. Each liposuction method has its advocates, and may produce good results. The important is the experience of the surgeon, and his ability to produce consistently good results with minimal complications. However, newer innovations have made the results more predictable and consistent.
This procedure, first introduced by French and Swiss practitioners around 1979, is still the most commonly used technique of liposuction. It consists in inserting a metal cannula (tube) below the skin to evacuate fat. This cannula is attached to a high-pressure pump, or to a syringe to facilitate the removal of the fat. Since the early 1980’s this method has been employed in Europe as well as in the United States with good results.
This method not only depends on the surgeon’s experience and expertise, but also depends on his stamina. The procedure is physically demanding, because the work of the removal of the fat is manual. The later developments of ultrasound liposuction (UAL) and power-assisted liposuction (PAL) have enabled the surgeon to focus on results and technique because the surgeon has less muscle fatigue.
Ultrasound liposuction (UAL or ultrasonic liposuction) was introduced in 1993 in Europe and in 1995 in the United States. Dr. Cerqueiro was one of the first practitioners being trained in ultrasound liposuction in the United Kingdom having used the procedure in Birmingham (United Kingdom) shortly after its introduction.
The principle of ultrasound liposuction is similar to that used by a dental hygienist to remove plaque from your teeth. A sound wave is delivered through a probe that helps emulsify the fat in the surrounding tissue.
In the hands of the experienced physician, the operation is easier to perform allowing better results to be achieved, and possibly allowing more skin retraction to follow. Ultrasound liposuction is useful in revision cases and large volumes. It also allows easier treatment in areas with very dense fat like the back areas and the waist, in first instance in male patients.
We emphasize that ultrasound is especially helpful in certain cases, but the experience of the surgeon is as critical as the tools that we use. Still good results may be obtained without the ultrasound, the surgeon’s experience and aesthetic judgement are the mayor factors simply increasing the index of patient satisfaction and safety, and reducing the need for further “touch-ups.”
This procedure was first described in 1990, and now is used throughout in all of our procedures. It has become the most widely used method of anaesthesia and infiltration for liposuction throughout plastic surgery. This method describes the introduction of a dilute solution of lidocaine and epinephrine into the tissues prior to surgery to aid in the anaesthesia, to minimize the amount of blood that is lost, and to aid in the production of a smoother result. It may be combined with other forms of anesthesia-intravenous sedation or a general anaesthesia.
Dr. Cerqueiro routinely uses tumescent infiltration on all patients. The procedure can be performed under IV sedation and local anaesthetic or under general anaesthesia depending on patient preference, the areas involved and the extent of the liposuction.
Recently a new tool has been added to the armamentarium of the liposuction surgeon. Power-assisted liposuction augments the above procedures. It is similar to the ultrasound method for its association with a aid sunction system. In this case the vibrating cannula enables the surgeon to remove fat with less mechanical work, thereby allowing him to perform the procedure more rapidly, and allowing the removal of more fat with the same mechanical effort.
The moving cannula is similar to the motion of an electric toothbrush. The cannula moves rapidly with a short excursion. As in all other modalities, the cannula is attached to the vacuum machine.
There is no general consensus on what is the preferred technical option and the experience and judgement of the surgeon appears to be the most determinant factor. The most common areas for liposuction in the male patient are the waist (“love handles”) the abdomen and the breast (gynecomastia).This abnormal pattern of fat distribution may exist even in the slender patient and in most cases it is not dependent on dietary abnormalities, but as the result of the genetical herence. In adolescent or older males, breast development may be unsightly. Ultrasound is especially effective in the correction of gynecomastia.
The liposuction procedure for the treatment of one area takes less that 30 minutes, and often can be combined with other areas.
Liposuction plastic surgery is individualised according to the needs of the patient.
The operation usually takes one and a half to two and a half hours, depending on the amount to be suctioned, and the number of the body areas.
The patient then is monitored in the recovery area, and leaves the hospital approximately 2-3 hours after surgery. If there is a large amount of fat removed during the procedure, it is advisable to stay in town for 24 hours after the procedure. Our office will help you make arrangements if you prefer to stay outside the Hospital.
In women the most frequent areas of liposuction are the thighs (outer, inner and circumferential) hips, buttocks, arms, knees and abdomen. Other areas include the area beneath the chin and the back.
In men, different areas are treated as stated above.
The amount of fat that may be removed varies from patient to patient. This is based on the health of each patient and safety standards. Massive amounts of fat should not be removed at one time, because there would be the possibility of a surgical trauma dued to the excessive redistribution of of body fluids. The patient should be comfortable at all times, and the convalescence should be manageable and comfortable. Routine amounts of fat that are removed during liposuction range from 2 liters through 5 liters. This is a volume and contour procedure, not the surgical answer to diet management. It is often necessary to seek dietary counseling support to ensure that the procedure’s results are not short-lived.
Most of our patients with one liposuction area have their surgery performed under intravenous sedation anaesthesia and are kept comfortable at all times.
With sedation the patient is breathing without the assistance of the anesthetist, but is totally unaware of the procedure that is being performed. On larger liposuctions, you may have a general anaesthesia. All of our anaesthetists are fully qualified hospital-based specialists, highly experienced and have the means to monitor the patient condition during throughout the operation process.
Dr. Cerqueiro believes that the choice of anesthetists is as critical as the choice of plastic surgeons.
The length of the time needed after the liposuction depends on the amount of fat that is removed and the reaction of each patient. Other factors include the general health of the patient, the age of the patient and the elasticity of the skin. Most of our patients return to work in 3 to 5 days after the procedure. It may take up to two weeks to resume exercise and normal activity. Patients are instructed to wear a garment for several days after surgery.
After this time, a support such as exercise shorts may make you more comfortable, but is not mandatory. Postoperative massage and ultrasounds (similar to orthopedic injuries) may also be useful.
Bleeding and infection are rare. Skin loss has been described, but is exceedingly rare. With tumescent liposuction cases with irregularities have been minimized but can also occur.
Dr. Cerqueiro will address all potential complications during your consultation.