Liposuction is a surgical treatment to remove fat from under the skin. Since its inception in 1977, the procedure has been widely used as a cosmetic procedure to improve body contour. However, plastic surgeons must perform this treatment with care in order to produce satisfactory results and minimize complication.
Indications
Liposuction is indicated for patients who have excessive fat in areas such as the trunk, abdomen, and thighs, and wish to improve his or her appearance by removing these fat deposits. The plastic surgeon must take into account various factors, such as skin integrity and the nearby presence of vital structures, to determine if liposuction from the target site can be performed safely and effectively. Patients who may not be suitable for liposuction include those with minimal fat, existing medical conditions that preclude surgical intervention, and unrealistic expectations about cosmetic results. For these patients, other appropriate options may include diet, exercise, and psychological counseling.
Technique
Before liposuction, the patient remains in a standing position as the surgeon carefully marks the treatment sites. The surgeon must also choose the cannulas, or tubes, that will be used for the procedure. Cannulas are available in many lengths and diameters for specific areas of the body.
There is an important preoperative step called infiltration in which the target tissue is injected with a combination of fluid and epinephrine. This is to minimize bleeding during the actual treatment. Depending on the amount of fluid and epinephrine is used, the liposuction can be described as a wet, superwet, or tumescent technique. There is also a dry technique without infiltration that is not commonly used today, reserved mainly for small-volume liposuction.
When it is time to begin liposuction, the patient is put under general anesthesia. Multiple incisions are made in the target sites before cannulas are inserted into these incisions. The cannulas are connected to a vacuum pump that proceeds to remove fat by suction. The surgeon removes fat from the deep layers as well as the superficial layers to further improve contour. Liposuction at a target site ceases when the surgeon determines that the desired appearance in that area has been achieved.
Complications
Aside from the possibility of unacceptable postoperative cosmetic deformities, liposuction poses the risk for a variety of adverse events. They include, but are not limited to, bleeding into tissues (hematomas), fluid collections (seromas), infections, skin necrosis, injury to vital organs, and pulmonary embolism involving blood clots or fat. The risk for complications increases with a greater number of treatment sites and a greater volume of fat aspirated, especially for large-volume aspirations involving at least five liters.
References
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