Balance and beauty go hand in hand. Aging, pregnancy and weight gain can all play factors in upsetting the delicate aesthetic balance of the human body. Artists instinctively understand this concept. Cosmetic and plastic surgeons understand it as well but are in the unique position to apply them to the human body. As women age, there is a general tendency for many to accumulate excess fat and develop in their hips and legs. In men, aging and the accumulation of weight centrally, just as frequently, can alter this fine balance. Balance can be restored by removing fat and surgically sculpting these areas by liposuction and by occasionally augmenting the breast with implants in women.
The general public poorly understands or even misunderstands liposuction. However, this does a disservice to the patients who undergo the procedure, and the surgeons who perform it. In reality liposuction is a form of sculpture, a delicate and refined procedure designed to reshape the human body. It may take several hours to remove only a few pounds of fat. Yet the results are often dramatic. A procedure akin to meticulously sculpting a fine work of art… as it should be!
Liposuction, lipocontouring, liposculpture are interchangeable terms and refer to the most common cosmetic operation performed in the United States today. Liposuction is performed far more frequently than breast augmentation, which is the second most common procedure. Over 172,000 women and men underwent liposuction in 1998. This is a 264% increase compared to 1992. Approximately 150,000 or 88 % of these procedures were in women according to a recent study by the American Society of Plastic and Reconstructive Surgeons (ASPRS).
The majority of patients who desire liposuction have tried exercise and diet, but despite their best efforts are left with several localized areas of fat that are resistant. These areas cannot be exercised away. They cannot be dieted away. They are genetic and caused by the complex physiology of the individual. The procedure is best performed in these patients who have localized fatty deposits. It rarely, if ever, is used as a weight loss procedure and is not a substitute for proper nutrition, diet or exercise. However, liposuction, used in conjunction with a proper lifestyle is a powerful tool to help reshape and refine the body.
Liposuction is a relatively new procedure, being popularized in France in the late 1970’s and then being introduced in the United States in the early 1980’s. After introduction into the United States the frequency increased dramatically. More recently, surgeons have refined the techniques to include infiltrating a solution which allows removal of a larger volume of fat with less bleeding and the ability to more finely tune the result. This is commonly referred to as the tumescent technique. The majority of plastic surgeons today use some variation of this technique. The tumescent technique is usually used in conjunction with either the traditional or the ultrasonic liposuction
In the late 1980’s surgeons began working with ultrasonic probes, which uses sound waves and energy to assist in breaking up the fat cells. This makes the fat easier to remove, and potentially allows for greater volume removal with less bleeding and bruising. Ultrasonic liposuction seems to work best in certain limited situations; such as in patients who have previously undergone liposuction, the male breast and the upper back. The jury is still out regarding the ultrasonic technique. Women make up a much larger proportion of liposuction patients as compared to men. Common complaints in women include the inability to find clothes that fit properly or comfortably and the desire to achieve balance of their upper and lower body. Women tend to accumulate fat in primarily in their abdomen, the posterior waist or hip area, the outer thigh or saddlebag area and the inner thigh. Removal of fat in these areas can dramatically change the way clothes fit, and one’s perception of the shape of the body. Although the way the clothes fit may be significant the change in dress size is rarely any greater than one or two sizes. Other areas commonly treated are the knees, calves and ankles, upper arms and neck.
Liposuction is the most common cosmetic procedure performed in men. 20,000 men underwent liposuction in 1998…more than any other single procedure. Men are almost always exclusively concerned about the abdomen and love handle area, where they tend to accumulate fat. They are usually seeking a smaller waist, which accentuates their upper torso and chest. They also commonly seek treatment of the male breast (gynecomastia) and other areas such as the neck. The procedure entails making several small incisions, usually one quarter of an inch or less and inserting fine cannulas or tubes which gently and slowly removes fat cells. Some of the incisions can be hidden in natural skin creases or even the belly button to camouflage the scars. The excess fat is removed and the areas are sculpted to achieve the desired postoperative contour. The procedure usually takes several hours and may be performed under either general or local anesthesia with sedation.
Recovery is relatively quick. The procedure is usually performed as an outpatient except when it is done for the removal of larger volumes. Patients generally return home following the procedure to recover at home. Most patients may return to work usually 5-7 days following the procedure. Patients may begin more strenuous activities such as aerobics or working out 10 to 14 days following the procedure. A compression garment similar to a girdle or biker shorts is usually worn underneath the clothes for approximately one month. There are limitations to liposuction. First, and this cannot be overemphasized, liposuction is not a weight loss procedure and the amount of fat to be removed is limited and should be determined after consultation with your surgeon. Liposuction, in general, will treat the fatty areas only and do not have a significant effect on the skin. Therefore loose skin with poor tone will most likely show no improvement even after liposuction. Stretch marks will not be effected. A problem area such as the abdomen, which is frequently plagued by excess fat as well as loose skin and stretch marks, may be better treated with an abdominoplasty or tummy tuck. Similarly, in the legs or lower body, a lifting procedure may be recommended to obtain the best results. Lastly, weight gain is possible after the procedure. The basic physiology of the body is not altered and failure to attend to diet and nutrition can certainly lead to weight gain afterwards. However, the new contour should be maintained, even with increased weight. Cellulite is poorly treated with liposuction. Newer treatments such as endermology, which is a non-operative treatment, may hold promise for cellulite, minor skin irregularities and contour deformities. Endermology uses a combination of skin massage, external suction and rollers to improve skin tone. But this is no panacea and a course of 10-15 treatment sessions lasting 30-minutes is usually recommended. Monthly treatments are also felt to be necessary for maintenance of a good result. Presently, liposuction remains the most popular cosmetic procedure and rightly should be considered an art form. It is safe, effective and the vast majority of patients are satisfied with their results. Friends or acquaintances that have undergone the procedure themselves refer most of the patients seen by plastic surgeons. The above information is not meant to be a complete or thorough discourse on the subject, only an introductory primer. Medical knowledge and surgical techniques are constantly evolving. One of the most important factors, which cannot be underestimated, for a successful procedure is the development of a good relationship with your doctor. To be properly informed a full and open discussion should be had with a physician.