Liposuction: Procedure, Techniques, Risks, and Indications

Liposuction or lipoplasty is a cosmetic surgical procedure used for correcting deep and superficial fat accumulations. This procedure aids in body contouring and is performed by syringe method or power pump method. With technology advancement, laser and robotic liposuction are the latest techniques of liposuction.

Process of liposuction - 

 Liposuction is generally performed by two methods: the syringe method and the power pump method. Small volume procedures or procedures primarily for harvesting fat can be performed with syringe liposuction. The syringe technique used blunt-tip suction cannulas connected to a syringe.

The suction depends upon 

• Pre-operative photographs are taken for record.

• Areas to be suctioned are marked using circular pattern and those to be avoided are marked with hash marks.

• Local or general anaesthesia is used followed by Wetting solution administration.

• Small incisions are given with 15 blade scalpel followed by cannula insertion. Movements given create tunnels.

• Cannulas are 2–4.6-mm with length ranging from 15 to 45 cm

• The dominant hand controls the cannula and non-dominant hand palpates areas of adiposity and monitors the cannula depth.

• In tumescent liposuction, the surgeon injects sterile solution of salt water, anaesthesia and vasoconstrictor. Vasoconstrictor narrows the blood vessels into the area from where the excess fat needs to be extracted. The injection causes swelling. This is followed by cannula insertion which is connected to a vacuum that draws fluid from the body. The body is replenished with intravenous fluid. This is the most common technique performed.

• In Ultrasound-assisted liposuction (UAL), ultrasound cannula is used. This cannula is a metal rod that transmits vibrations which breaks down the adipose cells and makes their removal easier. This may be used in combination with tumescent liposuction. 

•  In Laser-assisted liposuction (LAL), high intensity laser fibre is used. This break targeted adipose tissue followed by suctioning by cannula. 

• VASER assisted liposuction has the biggest advantage that it causes minimal skin injury which improves the results of body contouring. 

• In Power Assisted Liposuction or PAL, canula inserted moves in back and forth motion. This allows extraction of resistant fat more easily and quickly.  This procedure is less painful. It also minimises post-operative pain. This technique is indicated for those requiring fat removal in larger volume and who have previously undergone liposuction.

• Temporary drains are placed after the procedure for removal of excess fluids. Patients may experience swelling, pain and bruising at this stage.

• After liposuction, painkillers are prescribed to reduce pain and antibiotics are given to reduce the risk of infection. To reduce swelling, patients are advised to wear tight compression garments. Post operative instructions usually include no exercise for a week, rest, timey medications and dietary restrictions.

• In areas with dense fibrous attachments running to the underlying deep fascia defines the natural shape and curve of the body. These areas are not included in liposuction because if suctioned, these areas can become a major cause of contour deformities.

RISKS ASSOCIATED WITH LIPOSUCTION:

Although liposuction is a safe procedure, it has complications. Surgeons usually discuss them before the procedure and prior to taking informed consent.

Some of the common risks associated with liposuction are:

• Reaction to anaesthesia.

• Oedema, ecchymosis, hematoma and seroma.

• Irregularities in the skin, under correction and overcorrection, asymmetry, skin laxity and skin necrosis.

• Fluid accumulation under the skin.

• Scar related complications.

• Numbness.

• Skin infection

• Puncture of an internal organ.

• Fat embolism

• Deep vein thrombosis.

• Damage to blood, nerves and blood vessels.

• Heart and lung complications.

According to American Society of Plastic surgeons, some of the othrt complications of liposuction are:

• Cannula breakage

• Chances of Irregular pigmentation

• Need a second surgery.

• In some cases, wound healing may be poor.

• Ultrasound techniques increase the risk of thermal burn or heat injury.

Who should opt for liposuction

In liposuction, fat is removed from specific areas of the body like abdomen, back, buttocks, thighs, arms, chin, waist, breast and neck. 

It is indicated for those who have healthy body weight but are unable to lose fat in particular areas of the body.

Liposuction is a completely safe procedure but the patient should be an ideal candidate for liposuction.

Some of the common indications of liposuction are:

• One with normal body contour or slight deviation from body contour but excess fat deposition in a particular area of the body.

• One with normal and stable body weight for at least 6 to 12 months of duration.

• The person should not be obese or overweight.

• The skin laxity meaning, saggy skin should be minimal.

• The skin must have firmness.

• There should be minimal to moderately excess deposition of adipose tissue.

• For breast reduction in females. In women, heavy breasts may cause neck pain, back pain, skin problems so when liposuction is performed in combination with traditional resection mammoplasty, it not only allows volume reduction but also easy surgical procedure. The results achieved are excellent.

• Gynecomastia/enlarged male breast.

• Patient should be within 30% of BMI

• Large lipoma 

Contraindications of liposuction includes:

• Poor health.

• Deep vein thrombosis

• Body dysmorphic disorder

• Diabetes, coronary artery disease and immune disorders.

It is crucial to discuss medical history thoroughly with the doctor because certain medical conditions may increase the complications of liposuction.

Overall, liposuction is a safe and completely elective procedure. For maintenance of long term results, one must maintain healthy body weight following liposuction.