Fat removal/liposculpture

Tumescent Liposuction is one of the most commonly performed medical aesthetic procedures in the UK and United States. It is also referred to as liposculpture, Lipolysis, lipoplasty, body sculpting and suction-assisted lipectomy. The specific tumescent technique, allows liposuction to be performed under local anesthesia, minimizing blood loss and the risks of general anesthesia. Since its inception, liposuction performed with the tumescent technique has had an excellent safety profile.

Laser (Smartlipo, Advanced Laser lipo), Ultrasound (vaser), radiofrequency (Bodytite), water jet, (body-Jet) and micro-canula liposuction.

In the past few years various devices such as fibro-optic lasers, ultrasound, radiofrequency, water jet, and micro-canula liposuction amongst others have been introduced to compliment tumescent liposuction treatments. These types of liposuction devices have received wide media attention and some studies have shown that these devices can reduce downtime, complications and improve results and skin tightening. The BCAM is not in a position to recommend any of these particular devices over another but urges all patients to discuss the various types of treatments and associated devices with your BCAM doctor who will be able to give you their opinion as to what they recommend. You may find it useful to consult with a few doctors before you reach your decision.

The following general information applies to all of the various tumescent liposuction techniques with or without the use of additional devices as discussed above.

Indications

These treatments are generally performed for the reduction of focal adipose accumulations unresponsive to diet and exercise. Common anatomical areas include the following:

Upper and lower abdomen, flanks, upper back, thighs, knees, calves, ankles, upper arms, Specific forms of liposuction, such as micro-canula liposuction have recently been used for breast reduction as an alternative to traditional breast reduction surgery.

Other situations exist that may benefit from tumescent liposuction. These include lipoma removal, axillary hyperhidrosis; evacuation of haematomas, pseudogynecomastia and staged liposuction for persons who are obese.

  • The patient must have realistic expectations. Patients should realise that, although the cellulite's appearance may improve, it is not expected to lessen. The patient should be in good physical health. A healthy well-balanced diet is important in maintaining the postoperative results as well as in ensuring excellent healing during the convalescence. Crash diets immediately prior to the consultation to be considered a candidate for surgery may increase the risk of complications as a consequence of electrolyte imbalances or nutritional deficiencies. The physician should be confident that patients' motives are well founded and that the discontent with their physique is not a displaced unhappiness with a distinctly separate situation in their life, such as marital or employment difficulties.
  • Some patients have tried to diet many times in their life but tend to regain the weight. Not uncommonly, patients who undergo liposuction notice that their appetite decreases for several months postoperatively. This decreased appetite can provide the impetus for the patient to protect his or her investment by not overindulging in the future. Furthermore, some patients who are fixated on losing that last little bulge may adversely affect the quality of their life by excessively exercising at the expense of time that could be spent with their family, with their friends, or at work. Because that bulge may be refractory to exercise-induced volume reduction, they may increase their efforts unsuccessfully and further detract from other elements of their life. Liposuction could provide them an instantaneous relief. Another recently described benefit of liposuction in women is possible breast enlargement in patients undergoing liposuction in other body areas.

Contra-indications

  • Unrealistic patient expectations
  • Poor physical health of patient
  • Morbid obesity (megaliposuction controversial due to higher risk of mortality from fluid shifts)

Pre treatment consultation

It is recommended that all patients should have a pre treatment consultation where the history is explored in detail. Medication intake; medication allergies; prior surgeries and results, including scarring; history of medical diseases, especially bleeding diatheses; personal and family history of cerebral vascular events; phlebitis; seizures; myocardial infarctions or angina; congestive heart failure; and hepatic disease all should be discussed. The patient's goals should be understood. Explanation of the procedure, its risks, alternatives, benefits, and convalescence should be explained, and questions should be answered. The insertion marks should be planned; if at all possible, to be placed in hidden areas while the patient is wearing the typical item of clothing (e.g. swimwear, undergarment).

Postoperative care

  • These treatments are performed on an outpatient basis, requiring only a few hours, and the patient can return to home that day.
  • Returning to a normal activity level can occur within a few days to a couple of weeks.

Side effects

Common and expected side effects include;
Swelling, bruising, post treatment discomfort, leakage from incision wounds.

Complications

  • Complications of liposuction performed with a pure tumescent technique have been minimal. The most significant complications have been attributed to concurrent sedation or general anesthesia or fluid shifts secondary to large volume liposuction (more than 4 litres). Fatalities have been associated with other concurrent surgical procedures, for example abdominoplasty performed with abdominal liposuction.
  • In an American Society for Dermatologic Surgery study of 15,336 patients, 2 deaths were noted. In addition, no reports of pulmonary emboli, viscus perforation, thrombophlebitis, hypovolemic shock, seizures, or toxic reactions were described.
  • Reported complications include, infection, irregularities, seromas, haematomas, burns, scars, temporary skin hypersensitivity and/or numbness, hyperpigmentation, contact dermatitis.

Questions to ask your BCAM doctor

  • Am I a suitable candidate?
  • What type of treatment do you recommend and why?
  • What training have you had?
  • How many treatments have you performed?
  • What can I expect during and after the treatment?
  • What side effects am I likely to experience and what do you recommend to manage and help with these?
  • What complications have you experienced with your patients and how many?
  • How have you managed these complications?
  • What are the post treatment guidelines?
  • What follow up do you recommend?
  • Where do you perform this treatment and is the premises CGC registered for the treatment?
  • What out of hours arrangements do you have?
  • Can I see before and after photos of patients you have treated?

What you should know

Cosmetic medical procedures should only be undertaken by registered medical practitioners.

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