The basic technique of liposuction
As the procedure has been developed and refined, several variations have been introduced. However, the basic technique of liposuction, as described above, is used in all patients undergoing this procedure. The fluid is a mixture of intravenous salt solution, lidocaine (a local anesthetic) and epinephrine (a drug that contracts blood vessels). It helps the fat be removed more easily, reduces blood loss and provides anesthesia during and after surgery. Fluid injection also helps to reduce the amount of bruising after surgery. Fluid Injection is known to be a technique in which a medicated solution is injected into fatty areas before the fat is removed, is commonly used by plastic surgeons today. The amount of injected fluid varies depending on the preference of the surgeon. Because the injected fluid contains an adequate amount of anesthetic, additional anesthesia may not be necessary. Large volumes of fluid are sometimes as much as three times the amount of fat to be removed. These are injected in the tumescent technique, which kind of liposuction, typically performed on patients who need only a local anesthetic, usually takes significantly longer than traditional liposuction (sometimes as long as 4 to 5 hours). The name of this technique refers to the swollen and firm or “tumesced” state of the fatty tissues when they are filled with solution. The super-wet technique is similar to the tumescent technique, except that lesser amounts of fluid are used. This technique often requires IV sedation or general anesthesia and typically takes one to two hours of surgery time. Usually the amount of fluid injected is equal to the amount of fat to be removed. Ultrasound-Assisted Lipoplasty (UAL) is technique that requires the use of a special cannula that produces ultrasonic energy. When it passes through the areas of fat, the energy explodes the walls of the fat cells, liquefying the fat that is then removed with the traditional liposuction technique. It is also commonly used in secondary procedures, when enhanced precision is needed. Commonly, UAL takes longer to perform than traditional liposuction. UAL has been shown to improve the ease and effectiveness of liposuction in fibrous areas of the body, such as the upper back or the enlarged male breast. What about the risk and the uncertainty? As long as patients are carefully selected, the operating facility is properly equipped and the physician is adequately trained, liposuction is normally safe. Even though many body-contouring procedures are performed outside the hospital setting, be certain that your surgeon has been granted privileges to perform liposuction at an accredited hospital. At least your surgeon should have basic (core) accredited surgical training with special training in body contouring. Ask your doctor about his or her other patients who have had similar procedures and what their results were. More extensive liposuction procedures require attentive after-care. Find out how your surgeon plans to monitor your condition closely after the procedure. Your doctor must have advanced surgical skills to perform procedures that involve the removal of a large amount of fat (more than 5 liters or 5,000 ccs). Though they are rare, complications can and do occur. Risks increase if a greater number of areas are treated at the same time, or if the operative sites are larger in size. Removal of a large amount of fat and fluid may require longer operating times than may be required for smaller operations. For this reason it’s important to keep in mind that even though a well-trained surgeon and a state-of-the art facility can improve your chance of having a good result, there are no guarantees. The combination of these factors can create greater hazards for infection; delays in healing; the formation of fat clots or blood clots. These may migrate to the lungs and cause death. Other is excessive fluid loss, which can lead to shock or fluid accumulation that must be drained. Friction burns or other damage to the skin or nerves or perforation injury to the vital organs may occur and unfavorable drug reactions. In UAL, the heat from the ultrasound device used to liquefy the fat cells may cause injury to the skin or deeper tissues. It is of great importance to be aware that even though UAL has been performed successfully on several thousand people worldwide, the long-term effects of ultrasound energy on the body are not yet known. There are also points to consider with the newer techniques. In the tumescent and super-wet techniques, the anesthetic fluid that is injected may cause lidocaine toxicity if the solution’s lidocaine content is too high. It may also cause the collection of fluid in the lungs if too much fluid is administered. Imperfections in the final appearance are not uncommon after lipoplasty. The skin surface may be irregular, asymmetric or even “baggy,” especially in the older patient. Numbness and pigmentation changes may occur. Sometimes, additional surgery may be recommended, although it is thought that the scars from liposuction are small and strategically placed to be hidden from view.