Liposuction is a procedure where fat is removed from the body by loosening & sucking it out with the help of a suction apparatus. Fat collections around the hips, thighs, buttocks, abdomen, arms, upper chest, etc. can be reduced by this procedure.
Liposuction is neither a substitute nor a cure for obesity.
In men the paunch and the love handles are the areas most sought after and of course the male breasts, which are dealt with in a separate section.
Another area where Liposuction in men differs from women is because of the type of fat distribution. Fat in men tends to be more fibrous. Secondly, a major portion of the fat is intra abdominal and hence not amenable for treatment with liposuction.
It is a procedure more useful for body contouring by removal of fat from particular areas. But, of course there is an overall reduction in body weight.
People with mild to moderate obesity, with healthy elastic skin or patients with localized collections of fat in certain areas, get the best results after liposuction. The healthy elastic skin shrinks after the removal of fat from those areas and drapes well giving good long term results.
People who have excess skin following massive weight loss, old age and after multiple pregnancies, will need excision of the excess skin to get a satisfactory contour, and hence are good candidates for a lipectomy rather than a liposuction.
The fat cells in the body are constant after puberty, but each fat cell may accumulate as much fat as is consumed. The cells removed during liposuction, are removed permanently & do not come back again.
When the patient gains weight, the size of the fat cells increases & when he or she loses weight, the size decreases. Hence some amount of control, restraint along with an exercise schedule has to be maintained even after the procedure.
The procedure is performed under general or regional anesthesia. For small areas it can be done under IV sedation as well along with tumescence.
Before the operation, the areas to be sucked are marked out carefully in erect position. The most common method used now is theTUMESCENT technique but sometimes the SUPER WET technique can also be used
A solution of local anesthetic, some drugs and saline is injected into the areas to be sucked. A small cut of 0.5 – 1 cm is made in well concealed areas usually within skin creases so that they are not noticeable. Suction cannulae of different sizes depending on the area to be suctioned are inserted & fat is sucked out. The suction is done in such a way that wrinkles & grooves are not seen and it doesnt produce any areas of depression. The edges are smoothened out using smaller cannulae. Though it is a blind procedure the surgeons hands guide the cannula to areas that need suction. This is where the surgeons expertise comes into play.
The removed material usually consists of 80-85% fat & the remainder being blood, plasma, injected fluid. The same procedure is repeated in all the areas to be sucked.
Mega Liposuction which is a procedure where the aspirate is more than 5 liters at a time, is becoming more relevant in todays context. This is a procedure better suited for overweight people but are who are well motivated, are on a steady weight pattern and on a proper exercise and diet schedule and of course are not in the Morbidly Obese category.
Sometimes multiple sittings maybe required if the patient is obese. Megaliposuctions are not for everyone and not all surgeons perform it. It requires a team approach to help reduce the duration of surgery. Also the anaesthetists need to be trained to monitor patients intra and post op. This procedure usually requires hospitalization.
This procedure is coming into vogue because, this can help the patients kick start their weight loss schedule by taking care of the initial reduction of certain areas which helps them follow their exercise schedules more regularly. So, the motivated patient is a very important criteria. Secondly, these patients are not in the morbidly obese category to go in for a Bariatric Procedure which again has its limitations and indications.
Six Pack Abdomen or Abdominal Etching
This a further refinement in liposuction where in the muscle attachments of the Rectus Abdominis muscle in the front of the abdomen is further accentuated with the use of Liposculpting giving a Six Pack Abdomen which otherwise requires a lot of major abdominal training and exercise. But it gives good long lasting results only in men who are health conscious and maintain gymming regularly to maintain the results and not put on weight again.
After the Surgery
Snug or tight compressive dressings are applied for 6 – 8 days to help in shrinkage of the skin, to decrease swelling and prevent any blood or serum collections. In most instances, the patient will be required to wear a pressure garment or girdle for several weeks to months during the healing period. This helps in reducing the swelling and shrinkage of the skin to its new position. One might feel localized areas of hardness or firmness in the suctioned areas for 2-4 months following surgery.
Pain is usually present for a day or two after surgery. During the healing period, numbness or discomfort may be present for variable periods of time. Sometimes discoloration (bluish black) may be present which may last up to 2-3 weeks following surgery. Swelling takes 2-3 weeks to come down & it takes 2–4 months for the swelling to completely disappear.
Depends on the expectations of the patients and the amount of fat that is suctioned out. Usually patients with good elastic skin & those who come for limited contouring are very happy. Older patients & grossly obese patients may not be very happy with the results as the skin shrinkage might not be as desired and may require additional procedures to correct the skin excess
Perfection & symmetry are aimed for but are not possible in every patient.
Also in some patients all unwanted fat cannot be removed in one sitting, in these patients, the procedure may have to be repeated, but only after all swelling resolves anywhere between 3 – 6 months.
Rarely rippled or uneven skin or areas of loose skin could result which might require minor revision surgeries to correct them.
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