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How do I determine if I am a good candidate
for Tumescent Liposuction?
Most people are actually good candidates for tumescent liposuction.
In general, the ideal candidate for liposuction is a person who
is: (1) in good health, exercises regularly, is within 25 lbs.
of his or her ideal weight, and has one or more areas of localized
body fat deposits, out of proportion to the rest of their body,
and which have been poorly responsive to diet and exercise; and
(2) bothered by these fatty areas, and is motivated to get rid
of these problem areas once and for all. The "pinch test" is a
way to get an indication of whether the area in question would
be improved by liposuction: The skin and fat are held or "pinched"
between the thumb and the fingers, determining the amount of fat,
its mobility, and the degree to which the enlarged area is due
to a localized superficial fat deposit rather than abdominal musculature,
intra-abdominal fat, or other structures. Age is rarely a consideration.
We have treated quite elderly patients and all have done well.
It is unclear what the lower limit on age should be, be we do
not perform liposuction for patients who are less than 18 years
of age. Your physician will review the above and other relevant
areas with you during your consultation visit and give you an
assessment of whether you are a good candidate with respect to
your medical condition, and what the liposuction procedure would
be likely to accomplish for you.
Can Tumescent Liposuction help me with
weight loss?
Liposuction is not an effective weight loss treatment. Liposuction
is effective for uneven proportions, that is, when one or several
body areas are enlarged with fat deposits out of proportion to
the rest of the body. While obesity in general is more responsive
to diet and exercise, localized fat deposits are less responsive.
But fortunately, tumescent liposuction is effective for treating
these localized areas. This does not mean that you have to be
at your ideal body weight in order to have liposuction. But liposuction
will not decrease your weight; it will only improve the relative
proportions of your fat deposits. For example, if you are somewhat
overweight, but your hips are extra large, liposuction can even
things out, so that your hips would no longer look so large compared
to the rest of you. But your weight would not change, at least
not very much. The reason for this is that if your caloric intake
and expenditure stay the same as before the liposuction, your
wieght will still tend to gravitate to the same level; however
your fat distribution would be more even, so that fat you gained
would go everywhere else but your "trouble areas."
Can Tumescent Liposuction tighten loose
skin?
Yes, liposuction can tighten loose skin. After liposuction, as
the area heals, a layer of scar forms which tightens the different
areas of the skin relative to each other and also relative to
the tissues underneath. You can not see the scarring responsible
for this, because it is in the deep dermis (lowermost portion
of the thick part of the skin) and in the fatty layer.
Is liposuction long lasting, or permanent?
The effects of liposuction are essentially permanent. Your body's
tendency to store fat in the same old favorite areas will be no
longer. This is due to the scarring which occurs in the fat layer,
which limits how much fat the layer can hold after liposuction,
as well as a permanent decrease in the number of fat cells which
were permanently removed by liposuction. This does not mean that
liposuction will keep you from gaining weight. Rather, if you
your caloric balance is such that you would gain weight, you will
gain it; it will just go to new areas, not the former trouble
spots. At least any fat gained will not go to the same old trouble
spots as easily as it did before
How is Tumescent Liposuction performed?
The areas to be treated by liposuction are numbed first with a
tiny injection of standard local anesthetic, just as would be
the case for the removal of a mole or skin lesion. A very small
incision is then made in this anesthetized area. A very narrow
infusion instrument or infusion cannula is then inserted into
the incision, and a very dilute local anesthetic solution is then
delivered to the fatty tissues. This continues until the fat tissue
is "plumped" up somewhat, or "tumesced." The same tiny incision
that was used to infuse the tumescent anesthetic solution is used
to remove the fat. About 10-20 minutes after an area is infused,
it becomes numb, and the actual removal of fat by liposuction
is performed. The fat is suctioned away via a very thin tube-like
instrument, a liposuction cannula, which has small openings or
slits about half an inch from its rounded tip. The other end of
the cannula is attached to a hose which is connected to a collection
vessel and to a vacuum source, an aspirator. The cannula is moved
back and forth, that is advancing and withdrawing, throughout
the fatty area which is to be reduced. Depending upon whether
just one or several areas are treated, areas may all be numbed
at once, and then liposuctioned, or each area may be numbed and
liposuctioned individually. You will actually be able to see the
fat exit through the tube if you wish (almost everybody does look,
at least after a while, and, it's pretty gratifying to see). You
certainly will occasionally feel some discomfort, and you should
be prepared for that. But for the most part, you will be quite
comfortable and talking and joking, (perhaps even reading or watching
a video) etc., throughout the procedure. Because of the tumescent
technique with local anesthetic only, there is very little bleeding,
the safety level of the procedure is greatly enhanced, and you
are not groggy or feeling "out of it" afterwards. Immediately
after all areas are treated, you will stand up and walk under
your own power, get into a compression garment, and receive post-operative
instructions. After you are briefly monitored to see that both
you, your doctor and the staff are all comfortable that you are
feeling fine and doing well, you can be taken home by a friend
or relative.
How long does Tumescent Liposuction take?
How long it takes for your physicians to perform liposuction depends
on many factors. The removal of fat by suction itself can take
from as little as twenty minutes for a very small area (below
the chin, for example), to two hours if larger or multiple areas
are being done. Infrequently, it can take more than a couple of
hours. In our office, the average suctioning time is about one
to two hours. The infiltration of local anesthetic (tumescent)
solution also takes time, approximately one-half as long as the
liposuction itself. The amount of fat removed also affects the
amount of time required to perform the liposuction procedure.
How soon will I see liposuction results?
It is possible that you will see some results immediately after
the liposuction procedure. At least it is possible to easily feel
that the fat has been removed if you touch the area. However,
some of the tumescent anesthetic solution will remain for several
days. Because of this, you will not likely be able to see much
if any difference in the size of the liposuctioned areas for several
days afterwards The body also swells somewhat during healing,
and this "makes up" for the missing fat for a while too. There
is not usually enough swelling to cause enlargement compared to
before liposuction, but it is usually enough to hide the improvement
from liposuction for a few to several weeks. Most patients notice
a definite result by four weeks. Patients frequently need to buy
some new clothes by this time, or they are able to wear some that
hadn't fit for a long time. Improvement then continues, though
more slowly, such that the final results from liposuction usually
occurs only after 6 months.
What anesthesia is used with Tumescent
Liposuction?
With Tumescent liposuction, general anesthesia is not neccessary
and is not used. Many Tumescent Liposuction cases are performed
with local anesthetic only, without any pain related or anxiety-related
medications added. In some cases, Valium or a Valium-like pill
or injection is given. A codiene-like medication may also be given.
It is up to the patients preference whether any of these additional
medications are used. But in any case you would be talkative,
able to answer questions, feel in control, and not be or feel
totally "out of it."
Who can perform Tumescent Liposuction?
Physicians of several specialties perform liposuction. The first
doctors to develop and perform liposuction were gynecologists
who practiced in France. Many American doctors travelled to France
early on to learn the technique. These included dermatologists,
plastic surgeons, gynecologists, and physicians who were specialists
in other fields. Tumescent technique for liposuction is practiced
by at least some doctors in all of the specialties above (& other
specialists too). But since the development, and much of the refinement
of the tumescent technique for liposuction occurred in dermatology,
and because adoption of the technique spread very quickly in dermatology
in the early years, dermatologists are much more likely to use
the tumescent technique as their favored technique for performing
liposuction.
How safe is Liposuction?
There has never been a serious life-threatening complication from
liposuction done under local anesthetic. It has been performed
millions of times since being brought to North America in 1987
and has shown to be one of the safest cosmetic surgeries available.
The problems that have made the press have all been liposuction
being done under general anesthetic.
What areas are most common body regions
treated with Tumescent Liposuction?
Liposuction is most commonly used to treat the abdomen, (both
uupper and lower portions), the hips, waist, thighs, buttocks,
and the neck. Other areas commoly treated include the calves,
knees, ankles, back, arms.
What is Ultrasonic Assisted Liposuction
or UAL?
Ultrasonic liposuction, or Ultrasonic Assisted Liposuction (UAL),
is a technique where ultrasound energy is applied to the fat via
the suction instrument. The ulltrasound energy breaks up and or
melts the fat before it is suctioned out. Ultrasonic assited liposuction
has received a lot of interest. Certainly it seems that someday
it would be possible to improve liposuction technique by utilizing
some sort of energy at the instrument tip to improve the speed
of the procedure or some other aspect of it. However, at this
time ultrasonic-assisted liposuction has some drawbacks which
do not appear to be outweighed by the benefits (certainly not
all physicians would agree on this). The energy which is applied
has caused some undesirable side efects, including burns and other
trauma on the skin and elsewhere. Therefore, the use of ultrasound
in liposuction remains somewhat controversial. We do not perform
ultrasonic liposuction. Early on, lasers were very much promoted
for the treatment of virtually anything involving the skin. However,
after a few years it became clear that for each type of laser,
the therapeutic window (i.e., that which it does well) was very
small, maybe only one disease, or one type of skin problem per
laser. (for some early lasers, the window was zero, although it
took a while for everybody to figure that out). After a number
of years (about 25), some lasers finally evolved that were (and
are) clearly fantastic for a particular skin problem, and this
trend continues. Perhaps lasers, ultrasound, or some other advance
will bring about the third major advance in liposuction, whatever
it may be, but I do not think we are there yet, at least not with
ultrasonic liposuction in its current forms.
Will Tumescent Liposuction remove cellulite?
No, liposuction is not a very effective treatment for cellulite,
at this time anyway. Cellulite is occasionally improved somewhat
by liposuction, but getting rid of cellulite is not a good reason
to have liposuction.
Can I have other operations with Tumescent
Liposuction?
Can I have other operations with tumescent liposuction? Yes, it
is possible to combine tumescent liposuction with injection of
the fat, laser procedures or other procedures. However, the safety
of liposuction (whether its tumescent liposuction or non-tumescent
liposuction) is dramatically better if one does not undergo too
much surgery at once. Therefore, ask your physician or physicians
about combining procedures together, since it may be better to
have them done separately, or at least in two settings instead
of one. Certainly it is a convenience to the patient (and also
for the doctor) to "get it all done at once," but may be a good
idea to keep the above in mind.
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