Liposuction is defined as the removal of fat from deposits beneath the skin using a hollow stainless steel tube (called a cannula) with the assistance of a powerful vacuum. Liposuction can be accomplished either with the use of general anesthesia, or with heavy IV sedation, or totally by local anesthesia.
1. Tumescent Technique – A saline solution is injected through slit incision in the skin, and then allowed to diffuse (percolate) through the fatty tissue. Best for in-office surgery, since agents in the solution reduce bleeding. This technique is the safest and it allows for a faster recovery, but it’s also the most expensive. Percolating can take up to 60 minutes, which means an extra hour of operating-room costs.
2. Ultrasound-assisted Lipoplasty (UAL): An ultrasonic vibrating probe “liquefies” the fat before it is suctioned. It can be done externally, through a hand-held device applied to the skin, or internally, through a vibrating canule. UAL is the preferred method in clinics.
Modified Tumescent Liposuction
Modified tumescent liposuction refers to a combination of tumescent local anesthesia plus some form of systemic anesthesia (general anesthesia or heavy IV sedation), they must be administered by an anesthesiologist.
The Different Liposuction Techniques
There are many ways to do liposuction, for example liposuction can be accomplished painlessly either totally by local anesthesia or with general anesthesia. In the realm of liposuction, maximum speed and maximum volume of aspirate are not criteria for excellence. Ultimately, excellence is measured in terms of patient happiness which is a function of safety, patient comfort, finesse, and quality of results.
Liposuction complications are often the direct result of lack of caution, poor judgment, over confidence, ignorance about pharmacology, or adherence to faulty dogma.
The "Art of Liposuction"
Liposuction is a medium of artistic expression that displays itself in (1) a practical application of scientific knowledge, (2) the production of what is beautiful, (3) a perfection of workmanship, (4) a perpetual quest for improvement in technique, and (5) a skill attained through clinical experience, and above all (6) making people feel happy about what they see in the mirror.
Artistry and Safety are Related
In order to master an artistic liposuction technique, the surgeon must have the skill and intelligence to avoid exposing patients to unnecessary dangers. The true artist provides better results, and uses the safest technique and never forgets the duty to "first, do no harm." . It is not artistry to take unnecessary risks or push liposuction to the limits of safety.
Risks of Liposuction
As with any surgery, liposuction carries some risks. These include:
- The formation of fat clots or blood clots, which can loosen and move to the lungs (a potentially fatal condition called pulmonary embolism)
- Too much fluid loss, leading to shock and potentially death
- Fluid accumulation
- Nerve damage that causes numbness or changes in sensation
- Swelling that lasts for several weeks or months after the procedure
- Skin death (necrosis), in which the skin above the liposuction site sloughs off and dies and/or becomes infected
- Burns from the ultrasound probe
- Punctures to the organs (For example, the intestines may be punctured during abdominal liposuction.)
- Drug reactions, including reactions to the lidocaine fluid that is injected in the tumescent and super-wet techniques
- Rippling or indentation under the skin if the doctor removes too much fat
- Scarring (although doctors make every attempt to keep the scars small and hidden)
The tumescent technique for liposuction is unquestionably the safest form of liposuction. When tumescent liposuction is done correctly (not excessively), it is a very safe procedure, there have been no reported deaths associated with tumescent liposuction totally by local anesthesia. The dilute epinephrine contained in the tumescent anesthetic solution profoundly shrinks capillaries and thus virtually eliminates surgical blood loss.
Smoother Cosmetic Results
The tumescent technique permits the use of microcannulas which in turn yields smoother cosmetic results. Traditional liposuction cannulas (stainless steel tubes) have a relatively large diameter and remove fat rather quickly. However, with the use of large cannulas (diameter greater than 3 millimeters) there is an increased risk of irregularities and depressions in the skin. Microcannulas with a diameter less than 3 millimeters, allow fat to be removed in a smoother and more uniform fashion. Some surgeons prefer larger cannulas because it allows liposuction to be done more quickly.
After tumescent liposuction, there is a certain amount of blood-tinged local anesthetic solution that remains under the skin. This excess fluid is either slowly absorbed over several weeks into the blood stream, or it can be rapidly removed by drainage through skin incisions and absorbed by special absorptive pads (HK Pads).
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IAPAM's 7 Top Anti-Aging Trends for 2009. Jeff Russell. http://www.prweb.com/releases/antiaging/trends/prweb1907894.htm
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Liposuction: Facts and Myths . Diana Bocco. http://www.googobits.com/articles/1045-liposuction-facts-and-myths.html/Liposuction/