Liposuction: Remove Stubborn Fatty Deposits and Slim Down
Liposuction is one of the most commonly requested procedures in all of plastic surgery. It is a surgical procedure rather than a non-surgical one. Sometimes gets mischaracterized as a non-surgical procedure, the reason why is the incisions are very small and hard to see. That's one of the big benefits.
Liposuction has been around for many decades. Body contouring was first pioneered in Rome, Italy in the 1970s and the actual first liposuction for fat removal was in 1982 by Dr. Yves-Gerard Illouz.
How is liposuction performed?
What liposuction is, is we insert these cannulas, cannulas means hollow tubes, underneath the skin, and it removes the fatty tissue somewhere between the muscle layer of your body and the skin. Liposuction works for subcutaneous fat but it doesn't work well for intra-abdominal fat.
The kind of fat that we develop from, for example, drinking too many beers, that kind of the fatty tissue is called visceral fat - it’s the kind of fat that causes our abdomen to look like an apple. Liposuction is not a technique for that.
When liposuction is performed, patients are anesthetized. I perform liposuction in the operating room with a board-certified anesthesiologist watching your vitals. Before we begin the actual liposuction process, we add some fluid to the fatty tissue that we're going to remove, it’s called tumescent fluid. Tumescent fluid is a mix of the following types of fluids:
IV fluids that are isotonic with your body
Numbing medication - usually lidocaine, which is in the family of novocaine, like you would get if you were to go for dental procedure. It's very dilute.
Epinephrine - sometimes we call it adrenaline. It's something your own body makes on its own and that's important because the epinephrine - what it does is it tells the blood vessels around the fat to shrink down so it makes the procedure safer. It makes the blood vessels shrink, so that we're less likely to damage them and also, you're less likely to bruise afterward.
Depending on the surgeon's technique, it varies and how much of this tumescent fluid we place in the body. There are safe limits based on the patient's body weight, so we definitely want to stay within those limits for a very, very safe procedure. For example, too much lidocaine can cause some issues as well. Once the tumescent fluid is infiltrated in the area we're going to perform the liposuction, we wait. We give it some time for that epinephrine to work.
Then what we do is we re-prep the skin, drape it in a sterile fashion again, and then usually from the same hole that we use to put the fluid in, we then insert the liposuction cannulas. The cannulas are stainless steel, hollow tubes that have little openings on the tips. They're usually about the thickness of a pencil or thinner depending on in what area we're going to work on and how much fat is to be removed.
For example, if I was working on neck liposuction, I would use a much thinner cannula. Body liposuction would use a thicker cannula to start with so you can get the volume of fat done quickly. Then I usually finish with a finer tip cannula to even out any lumps and bumps.
Recovery after Liposuction
What's also very important is after liposuction, because we have this empty space where the fat cells were, we want that to heal down without any boggy fluid or anything. We want that scar tissue to compress. After a liposuction procedure, I request that patients wear a compression garment for four to six weeks.
On the waist and abdomen area - it could be like a garter.
On the arms - we wear a sleeve.
On the chin, it's a neck sleeve. This can be very annoying to wear all day every day, so usually, we require it at night while you’re asleep.
Regardless of the area, we have something that's going to compress around the body part so that the skin lays really flat. I always tell patients that recovery is part of the operation so it's more than just a request. “Please wear a compression garment for the best results,” and most patients who are motivated enough to have a liposuction procedure, they do follow the recovery directions to a “T” because they want the best result.
That's a liposuction procedure and a very, very basic nutshell,
Types of Liposuction Procedures
There are some adjunct types of liposuction procedures that we can do. It’s not to benefit the patient as much, but it does make it a little easier on the surgeon.
Power Assisted Liposuction
This is when we put a tiny little rotor on the tip of the cannula. It helps remove the fat without having me having to use my arm muscles back and forth a little bit. That can speed up the liposuction procedure if we have a lot of fat to remove.
Laser-assisted liposuction
A cannula tip that delivers heat energy to tissue to break down tissue even further to make it easier to remove. I do not use this method for my liposuction procedures.
Ultrasound-assisted liposuction
A type of liposuction that uses ultrasonic waves and heat to break down the fat to be removed later. This version can also be used to minorly tighten the surrounding skin. I do not use this method either.
As a plastic surgeon, oftentimes there's an additional need for significant skin removable - that's the one thing liposuction cannot do, it cannot remove skin. This is why I have to make sure that the patient is a good candidate for liposuction rather than another type of procedure.
Good candidates for liposuction:
You are close to your normal body weight
You don't have any saggy skin
There are not a lot of stretch marks on the area that's overlying the area we're going to remove the fat from - we want the skin to snap back and lay flat
Not a good candidate for liposuction:
Somebody who lost a lot of weight. Typically in the lower abdomen, there's a lot of excess skin. Liposuction is not going to do a lot of good because the issue is not fat, but it's actually extra skin. Those patients are more better served with, for example, with a tummy tuck.
If an older patient comes in with some sagging skin on the neck asking for neck liposuction - that can make things look worse, right? Because neck liposuction would accentuate the excess skin if we remove excess fatty tissue. Those patients are better served with a neck lift or a facelift.
Conclusion on Liposuction
Liposuction is a fairly easy procedure to perform and is readily available by a lot of surgeons. This is something that happens in the operating room and should be performed by a board-certified plastic surgeon. In the end, it's the patient’s selection, who they are the most comfortable with, and who they think is going to a great job, that's the most important.
Again, a good patient is a person who has good overlying elastic skin that will snap back, who also has an adequate area of fat that can respond to treatment. It tends to work best for areas that we have localized area of a fatty deposit that's just not responding to diet and exercise, areas that tend to be responsive around the:
chin
arms
flank area in the waist
These are the most common areas that I get requested to do liposuction.
And finally, just a clarification, liposuction is not a good weight loss tool. Candidates who want a 360-degree liposuction that make it really look like you lost weight - there are other ways to do that in a more effective way.
If you are interested in getting liposuction in Columbus Ohio, contact Dr. Okada and schedule an in-person consultation.