Much of our physical appearance is due to heredity and many aspects of the way we look such as, color of our eyes, height and hair, are out of our control, many things however, such as our weight can be broadly controlled.   It is thus widely accepted that it makes sense to eat a healthy diet and to exercise.   Therefore people who are truly concerned about their appearance adhere reasonably well to the various regimens available.   However sometimes despite all our best efforts to lose or control the fat, some regions of the body contain stubborn diet and exercise resistant fat.   Resistant, localized fat deposits are usually an inherited problem, so don't blame yourself for their presence.

What is Liposuction?

Liposuction is the removal of localized unwanted lumps and bulges of fat by the use of thin straw like metal tubes called cannulaes.   In women and men, these localized fat deposits may be formed virtually anywhere on the body but are more commonly deposited on the abdomen, hips, flanks, inner and outer thighs, knees and chin. In men a condition called gynecomastia(localized fatty breast enlargement) is sometimes encountered.

These cannulaes are placed into the body fat through small incisions.   A vacuum is subsequently applied through a hose attached to the cannula and the fat is drawn out of the body.   Liposuction is not an alternative to weight loss and exercise, but a means of resculpting the body into a slimmer profile by removing the fat not responsive to the most diligent efforts.   It is currently the only proven method for removing fat cells in certain areas.

What is the history of Liposuction?

Through is a relatively new form of cosmetic surgery, it has nevertheless become the most commonly performed cosmetic procedure.   Liposuction was the first published in 1974 and popularized around 1980.   Since this time it has undergone a number of refinements, including the development of smaller finer cannulaes called micro-liposuction.

Am I a suitable Candidate?

You must have a consultation to be able to determine if you are a suitable candidate for liposuction.   The best patients have localized fat and relatively smooth skin.   Rarely are patients perfect candidates - so it is Dr. Loeb's job to balance how much fat to remove with the degree of laxity in your skin.

A thorough medical history and appropriate physical examination will be taken to ascertain your health status.   If you are a smoker you will be asked to stop smoking well in advance of the surgery.   Smoking seriously constricts blood vessels and therefore decreases blood flow to a given area resulting in poor healing.   Aspirin, certain anti-inflammatory drugs and other medications can cause increased bleeding, so you must avoid these.

Determining your suitability will partly be defined by the quality of your skin.   In most cases the skin being a dynamic organ, is able to shrink and reaccomodate to the new body contour after liposuction.   In some cases however, patients may have decreased skin elasticity as witnessed by loose, hanging, or wrinkly skin in the affected area.   In these cases liposuction alone will not produce the desired result and you may therefore require some form of skin removal / reduction instead (i.e. tummy tuck) or perhaps in combination with liposuction.

The best patients for liposuction are those individuals who are active and healthy, of average or near average weight (within 12-15% of their ideal weight), and have reasonably good skin tone and elasticity.   Age by itself is not a significant factor and in fact patients from age 16-65 have benefited from liposuction.

You should also understand that liposuction by itself will not improve the skin condition known as cellulite.

What does the operation involve?

The following is a description of the classic liposuction method utilizing "a wet technique".

To begin the operation a number of tiny incisions (about 3-4 mm) are made in the skin in the areas to be treated.   These slit incisions are made, when possible in inconspicuous places.   Subsequently the areas are injected with the solution mentioned previously.   The solution is then allowed to diffuse and take effect (about 5 - 10 minutes) throughout the target fat.   As mentioned the solution will numb the areas as well as reduce bleeding by temporarily closing down the capillaries.   The appropriate cannulaes are inserted into the fat, then through backward and forward stroking motions the fat is loosened and drawn off by a strong vacuum pump.

Since the fat is removed by suctioning small "tunnels" through the fat.   The skin remains intimately connected to the underlying muscles by multiple attachments called fibrous septa.   These can be described as being the body's "Velcro".   It is this process and these structures, which assures that the skin will not hang in loose folds after Liposuction.   The fat is removed by doing as little damage to the septa, which also contain blood vessels, nerves and lymph vessels.   For this fat to be removed without serious damage requires an excellent knowledge of the anatomy, an appreciation of body proportions and of course, surgical and mental stamina.

Throughout this procedure Dr., Loeb is always conscious of leaving a smooth layered thin blanket of fat attached to the underside of the skin, in order to minimize the possibility of any irregularities or rippling of the skin.

Because you'll also lose some fluid along with the fat during liposuction, it is normal practice for the anesthesiologist to give intravenous fluids to replace those lost in the procedure.

What type of anesthetic is used?

Liposuction can be performed successfully either with local anesthetic alone, local anesthesia with mild sedation (twilight anesthesia) or with a General anesthetic (completely asleep).   If you decide to have it done with local anesthetic, you will probably feel some vibration and friction during the procedure.   You may also occasionally feel a stinging sensation as the cannulae moves closer to the muscle.   Obviously if you are put to sleep then you will not be aware of anything.   In most cases we recommend letting the anesthesiologist make you sleepy enough you are not aware, and do not feel the surgery.

The decisions are best made after a thorough consultation and discussion with Dr. Loeb.

How long does the surgery take?

This depends on the number of areas treated and the amount of fat, which will be removed.   Therefore this can be anywhere from 30 minutes to 2 hours.

Do I need to stay in overnight?

In 99% of the cases you may go home a few hours after the surgery.

How much fat can you extract?

It is important to understand that there is a maximum safe limit to the amount of fat that can be extracted during any one operation.   This is usually up to 3 litres.   There are special cases where more will be removed.   In some instances you may need a second surgery (at a reduced fee).   It is usually best to wait at least three months between procedures.   This will be discussed during your consultation.

How much weight will I lose?

The answer is very little.   In fact, the first few weeks after surgery you may notice a slight increase in weight due to water retention.   The reason that you don't lose much weight is because taking out up to 2.5 or even 3 litres of fat (only makes you lose 6 pounds).   This is because fat cells don't actually weight that much.   On the other hand however, depending on the treated area of course, you will notice a significant decrease in girth measurements.

Is it painful?

They are few forms of surgery that are completely painless.   Discomfort is a euphemism for pain and many doctors use these interchangeably. In the case of liposuction, the degrees of pain vary from patient to patient but this can easily be controlled by pain medication. The initial pain lasts around one week however they may be residual soreness in the treated area, for up to three weeks.   We give everyone 28 pain pills - they usually don't take more than 5!

Will the fat come back?

The short answer to this is no.   As fat cells have achieved their set number in any given part of the body by puberty, increased caloric intake will not lead to volume gains in the treated site.   It is important nonetheless to maintain your weight afterwards by sensible eating and regular exercise.   You must understand that if you do take in excess calories after surgery, you will then notice other areas of the body increasing in size.   Of course if there is a massive weight gain previous treated areas can even expand!

What happens immediately after the Operation?

After your surgery, depending on which area you've had treated, you will find that snug elastic compression body stocking or garment will be in place.   This must be worn over the treated area to control swelling and bleeding, and to help your skin shrink to fit your new contour.   You will need to wear this garment compression continuously for three weeks (apart from taking it off for a shower) after surgery, then just in the daytime for a few weeks more.

What kind of effects can I expect after Surgery?

You are likely to experience swelling and bruising to varying degrees.   Sometimes this bruising to vary degrees.   Sometimes this bruising is quite spectacular.   Bruising can take up to 3 weeks to disappear although very occasionally a light tinge of yellow can still be seen in the skin up to 2 months following treatment.   Tissue swelling, while expected, can last up to 4 weeks.   In fact because of this swelling you will probably not notice any change in your size immediately after surgery.   It is important to remember that when the abdominal area is treated, the swelling and bruising can migrate downwards to the groin and genital region.   In men this would mean substantial swelling, bruising and discomfort of the external genitalia.   This usually lasts about 7-10 days, and one may benefit from the use of support underwear instead of boxer shorts.

At around 2-3 weeks after surgery, you will discover that the areas treated will feel hard and irregular.   This is part of the normal healing response.   The body starts to lay down scar tissue (which is hard in nature) in response to surgery in an attempt to "heal" itself.   This scar tissue can also block lymph drainage channels temporarily and occasionally cause the skin overlying the treated area to look dimpled or take on an "orange skin" appearance.   Thankfully the scar build up ceases and eventually resolves completely, along with its manifestation.   However this period of hardening and irregularity can take up to 4 months to resolve.

You will also experience sensory changes in the area treated.   This may result in numbness of the skin or alternatively it may feel hypersensitive. Either way this usually temporary and returns to normal in about 6-8 weeks.

Overall because of these effects, it's not unusual to feel depressed in the days or weeks following surgery.   Try to keep in mind that this is normal and will subside as you begin to look and feel better.

What are the scars like?

Scars are not a complication but a normal event after any surgery.   Thankfully, scars in liposuction surgery are tiny.   Depending on the area(s) needed to be treated, scars about 3-4 mm in length will form.   These are usually placed in natural folds of the skin where possible.   Generally two incisions are required for any given area.

Thankfully the scars in Liposuction are short and generally heal quite well, gradually fading with time.   However it is important to keep in mind that this may take up to two years to complete.   If you are of a darker skin type however, then expect your scars to be darkly colored for a longer period of this time (about two years).   Daily massage of the scars during this time period is advised to expedite and facilitate this process.   You must however that no responsible surgeon will ever be in a position to promise any scars ultimate appearance.

All surgery carries some uncertainty and risk. When liposuction is performed by a qualified Plastic Surgeon, complications are infrequent and usually minor.   Still individuals vary greatly in their anatomy, their physical reactions, and their healing abilities.

Thus complications that can occur include thickened, deeply colored or unattractive scars at the site of the small incisions; irregularities of contour or dimpling of the area treated; unevenness or asymmetry between sides; prolonged numbness and swelling; hematoma or seroma formation (a collection of blood and fluid under the skin that must usually be drained by the surgeon), and infections.   In extremely rare cases, skin loss resulting in permanent scarring has been reported.

You should have your final shape by 3 months.   In   rare cases a minor 20 minute touch up may be needed for small irregularities where the skin didn't contract or fluid collected.

You can reduce your risks by closely following Dr. Loeb's advice both before and after surgery.

How long before I get back to normal?

The recovery time varies with how many areas are treated and the type of activity the patient intends to resume.   It is important to realize that although only tiny incisions are made, liposuction creates a large wound hidden under the skin and therefore as healing is gradual process, adequate rest in the days after surgery will be required.   However you should start walking around as soon as possible to improve the circulation and avoid stagnation of blood which could lead to the formation of blood clots.

  Most patients resume light activities within 2-3 days and depending on their work can be back between 3-7 days.   However because of variations in swelling and bruising, sometimes this may be delayed up to 7-10 days.   Exercise is usually recommended at about 10-14 days.   Don't be depressed however if it takes you longer to resumes your full activities.   Remember every individual is different and   variations occur.

Summary

Liposuction is the most popular cosmetic surgery procedure in the United States.   It is a highly effective technique for giving you a new body contour with minimal incisions.   In most instances it improves body image by making you feel better and more comfortable about your body with and without your clothes.

The results are permanent, providing you eat sensibly, exercise regularly, and maintain your weight.   As long as your expectations are realistic, and understand the final results may take a few weeks before becoming apparent, you should be happy with your new shape.