Surgery » Liposculpture

What is Liposculpture?

Liposculpture (or Liposuction) is a procedure in which small suction tubes are inserted under the skin to gently remove excess fat deposits.

Who is a good candidate for liposculpture?

Liposuction may be suitable for anyone concerned with fat deposits on the upper arms, stomach, 'love handles', buttocks, inner or outer thighs, knees or ankles.

Who is not a good candidate for liposculpture?

Liposculpture may not be suitable for someone with any of the following:

• Excessive obesity
• Fluctuating weight
• Concerns with cellulite
• Unrealistic expectations

The Procedure

Dr Oates and Dr King perform Tumescent Liposculpture technique in our government licensed  Academy Day Hospital (on site at Academy Facial Plastics) under a combination of twilight sedation and local anaesthesia. The modern tumescent technique involves the infiltration of a diluted local anaesthetic solution into the area treated prior to removal the fat. The advantage of this technique over older techniques is a reduction of bruising, bleeding, dehydration and pain.

The Recovery

You will remain in the recovery room for approximately 1 hour after the procedure and you will need a family member or friend to drive you home. After the procedure a special garment will be fitted to the treated area(s). The garment is worn continually for one to two weeks, however it can be removed for showering and laundering. There-after you can reduce the amount of time you wear the garment depending on the amount of residual swelling.

In the first 24 – 36 hour there may be considerable leakage of excess tumescent fluid, which may be blood stained. Remember to plan for this on the drive home and in bed the first night.

How long do I need off work?

Most patients take between two to seven days off work, this depends a lot on the amount of physical activity involved.

Is there discomfort?

Post-procedure, most patients compare the soreness to a heavy workout at the gym. This discomfort is easily controlled with Panadol.

Important Information about Tumescent Liposuction

Risks of liposuction surgery

Any surgery involves the risk of thrombo-embolism (blood clots), infection, bleeding, scarring, or serious injury; however, tumescent liposuction has an amazingly good safety record. One of the reasons that tumescent liposuction is so safe is that general anaesthesia is not required. A recent survey (in the USA) involving over 15,000 patients who had tumescent liposuction without general anaesthesia, revealed no serious complications, no serious infections, no hospitalisations, no blood transfusions, and no deaths. The greatest risks of liposuction are those associated with general anaesthesia, so by eliminating general anaesthesia, the risks of liposuction are dramatically reduced. Patients can minimise the risk of surgical complications by not taking medications or over-the-counter preparations that might adversely affect the surgery. Patients should inform the surgeon of any medications being taken either regularly, or occasionally, including herbal remedies.

Risks of irregularities of the skin

Tumescent liposuction using micro cannulas is the least likely to cause any significant or noticeable post surgical irregularities of the skin. By swelling the fatty compartment, the tumescent technique permits more accurate removal of fat with greater assurance that the liposuction cannula will not inadvertently approach too near the undersurface of the skin, which could cause irregularities. Thus, the tumescent technique helps to minimize the risk of post-surgical irregularities or rippling of the skin. Liposuction might improve pre-existing irregularities of the skin, such as dimpling or cellulite, but prospective patients should not assume that there will be significant improvement. It is unrealistic to expect perfectly smooth skin. Patients should expect that their skin will have approximately the same degree of dimpling and irregularities as existed before tumescent liposuction surgery. Ultimately, after liposuction the skin texture should be within normal limits. A casual observer should not notice any evidence of surgical irregularities of the skin. However, it is possible that a noticeable skin irregularity may result and require a little touch-up liposuction.

Risk of scarring of the skin

Incisions for liposuction may result in scarring, however the incision made for inserting the cannulas are usually less than 2 to 3 mm in length and are virtually invisible once healed. Although you may be able to find them on close examination, most other people would not be able to see them. Some patients may experience temporary hyper-pigmentation (darkening), which usually fades after several months. Some patients may have a genetic pre disposition for persistent discolouration at the incision sites. Patients that have experienced hyper-pigmentation or hypo-pigmentation (pale or light-coloured scars) in the past might expect also to experience it with these incisions. Certain areas of the body, such as the back or upper flanks, may be more likely to have pigmentation changes.

Cellulite

Liposuction of the thighs, while improving the silhouette does not necessarily eliminate the subtle puckering of the skin, often called cellulite. Cellulite results from the pull of fibrous tissue that connects skin to underlying muscle. Although tumescent liposuction may reduce the degree of cellulite, it is unlikely to eliminate it. Liposuction should not worsen cellulite.

Liposuction is not an appropriate treatment for obesity. Liposuction is not a substitute for a prudent diet, good nutrition, and regular exercise. Obese patients may be good candidates for limited liposuction, if their goal is simply to improve the shape of certain limited areas of the body.

Post-operative healing

Normal healing after tumescent liposuction involves a limited but definite degree of soreness, swelling, bruising, and lumpy firmness. A temporary mild numbness (paraesthesia) of the skin may persist for up to 4 months. Most patients can actually see some improvement of their silhouette within one week after surgery. However, because of the slow resolution of post-surgical swelling, the ultimate results following liposuction usually require 3 to 4 months to be achieved.

Realistic expectations

Although the results of liposuction are often quite spectacular, it is not realistic to expect perfection. It is impossible to guarantee the precise amount of improvement that will result from liposuction. Patients should not have unrealistic expectations. Although patients can usually expect to achieve at least 50% improvement, it is unreasonable to expect 95% improvement or near perfection. For the perfectionist or for liposuction of a very large area, maximum improvement may require a second procedure, for which there would be an additional fee.

Patients who are satisfied with a 50% improvement would be reasonably good candidates for liposuction. The 50% improvement is intentionally a vague measurement. It indicates a definite perceptible improvement, but something short of perfection. If a 50% improvement makes a patient happy, it is likely that these expectations will be met. Our patients generally achieve more than a 50% improvement.

Longevity of results

The fat cells that are removed by liposuction do not grow back. If the patient later gains or loses weight, the change tends to be distributed proportionately over the entire body. Although one can expect some changes with ageing, provided that the patient does not gain large amounts of weight, the patient's new, more pleasing silhouette is relatively permanent. If there is a large weight gain after liposuction surgery, new fat cells may be created.

Before Liposuction Instructions

The Academy Facial Plastics wants to provide you with the very best surgical care. You can help to minimise the risk of complications by carefully reading and following your pre-operative and post-operative instructions. Please ask us to clarify any questions you may have.

Do not take Aspirin (Aspro), Ibuprofen (Nurofen), Naproxen (Aleve), or any other non-steriodal anti-Inflammatory drugs (NSAID's) similar to these medications for 1 week before surgery as these will promote bleeding and bruising. It is permissible to take paracetamol (Panadol, Heron).

Do not drink alcohol for 4 days before surgery, this might decrease resistance to infections. Similarly red wine, garlic powder supplements and vitamin E impairs normal clotting and can predispose people to excessive bleeding and bruising.

Do not take decongestants, such as Sudafed or Actifed, for 1 week before surgery. Do not take appetite suppressants, such as Reductil for at least 2 weeks before surgery. Do not take thyroid medication such as Thyroxine on the day of surgery. These drugs can cause the heart to beat to rapidly.

Do not take antidepressants such as Zoloft (sertraline) and herbal remedies unless specifically approved by your surgeon for 2 weeks before surgery.

Do not drive home. Before the day of surgery, make arrangements to have someone drive you home from the surgical facility.

Do not wear unnecessary jewellery, do not apply perfume (deodorant permissible) and minimize use of cosmetics.

Diet before surgery. If your surgery is scheduled to begin before 9.30 am, do not eat solid food after midnight prior to surgery. If scheduled to begin after 11.30 am, you may have a light breakfast before 8 am, but only clear liquid for lunch. Please minimize caffeine the day of surgery. You will be given a snack as soon as surgery is completed.

Loose clothing: There is usually considerable drainage of slightly blood-tinged anaesthetic solution after surgery. Since this drainage might stain clothing, we suggest that you choose your clothing with this in mind. Because we will apply elastic support garments on top of some bulky absorbent gauze padding, your clothing should be very loose and comfortable.

Women: Wear a comfortable bra, one that you do not mind getting stained from the ink that is used to mark the surgical areas. Do not wear a exercise sports bra if you are having liposuction on you abdomen or torso.

Men: For liposuction of the abdomen or flanks, speedo-type swimming trunks are the easiest type of garment to wear into the operating room for surgery. Jockey-type underpants are acceptable.

Moisturisers: Do not use moisturiser or soap that contains moisturisers for at least a week before surgery. The ink markers used to outline the areas on your body to be treated by liposuction will rub off too easily if you have recently applied a moisturiser to your skin.

Towels and plastic sheets: Plan ahead and avoid staining the car seat with blood-tinged anaesthetic solution. Bring a towel and a plastic sheet (such as a bin liner) to cover the car seat during the ride home.

Weight and diet: Do not fast or undergo dramatic weight loss just before surgery. All patients should have a stable, well-balanced diet at least two weeks before surgery. Liquid diets, extreme low-calorie diets and rapid weight loss diets may predispose patients to cardiac irregularities, surgical complications and poor wound healing.

Music: Patients usually enjoy listening to soothing quiet music during surgery. We have a selection of compact discs. If you would like to bring your favourite CD's with you on the day of the surgery you are welcome, however please write your name on the cover of your CD.

What to expect on the Day of Tumescent Liposuction

1. On arrival in the surgical facility reception area you will be greeted and then taken to the recovery room to change into a surgical gown. After one last trip to the bathroom, pre-operative photographs may be taken and the areas on your body that are to be treated with liposuction are marked with a felt-tip pen. It usually takes about 30-45 minutes after arrival before the surgery begins.

2. For safety purposes we routinely place an intravenous (IV) access in your arm. A blood pressure cuff is placed on your opposite arm and cardiac monitor leads are placed on your chest. Next, using extremely thin and short little needles, Dr. Oates  or Dr King will anaesthetise the skin at the sites where the longer needles will be inserted, to anaesthetise the subcutaneous fat. Patients usually experience a slight pricking sensation as the skin becomes numb.

3. A large volume of dilute tumescent anaesthetic solution is carefully and gently injected into the targeted fat. Once an area has been well infiltrated with the anaesthetic solution, the fat is usually completely numb. The infiltration of the local anaesthetic is a slow, careful process that can occasionally take as long to complete as the liposuction itself.

4. Experience has shown that giving a sedative by mouth permits better anaesthesia, alterntively IV sedation may be used. This is because an alert patient is more capable of detecting subtle areas of incomplete anaesthesia. A patient who is too sedated might easily ignore an incompletely anaesthetised area and may feel more discomfort when liposuction is actually done. Therefore minimising sedation actually maximises patient comfort.

5. Absorbent pads are placed over the incisions. The incisions are so small that no stitches are required, the compression garments are pulled on, you are ready to go home once you are full alert. Because of residual local anaesthetic no significant soreness begins for several hours after completing the liposuction. Although you will feel well enough after surgery to drive yourself home, you must not do so because large amounts of local anaesthetic may cause some drowsiness.

6. The tumescent technique minimises post operative discomfort. Because the residual local anaesthesia lasts for 18 to 36 hours, plain Paracetamol is usually sufficient to treat post-operative discomfort. With the tumescent technique the patient usually has no post-surgical nausea and no unpleasant feeling of a hangover usually associated with general anaesthesia.