Liposuction using the latest tumescent technique is the method of choice to shape the body. Despite conscientious exercise and dieting, there will always be some areas of localized fat deposit, which are not responsive. For those who are not overweight, liposuction is used for body contouring. Although it is not a weight reduction technique per se, it can help the more obese to reduce the girth, make it easier for them to exercise and give them incentive to persevere with dieting at the same time. Through very small incisions in inconspicuous locations, fat can be removed using a fine metal cannula. It can be performed for virtually the entire body. However, the most common being the abdomen, thigh, arm, chin, back, buttock and calf.
Liposuction is not just an exercise to remove fat. It is an art in body contouring where excess fat is removed but leaving an adequate healthy layer of fat to maintain a smooth body contour. The tumescent technique is most commonly employed in liposuction. A quantified amount of fluid with medication is infiltration into the fat layers via small stab incisions. The purpose of the tumescent fluid is to loosen up the fat layer as well to cause vasoconstriction for the purpose reducing bleeding during suction. Additional tool (like microaire) is used to provide mechanical vibration at the tip of the metal cannula to help further loosen up the fat before suction. Ultimately the loosened fat is sucked out through a thin metal cannula and suction pump. As this technique is purely mechanical is does not cause any thermal damage to the surrounding fat layers left behind. This less traumatic technique allows faster recovery with less post-operative scarring in the treated area. There is less risk of seroma or thermal damage to the underlying fatty tissue and necrosis of overlying skin.
Liposuction is a surgical procedure, which has to be done with the safety of the patient in mind. By removing fat from certain part of the body, there is associated tauma to the treated area and the body is subjected to stress as in any surgical patient. The larger the area of treatment, the more severe is the surgical stress and trauma to the body. There is a need for resuscitation and maintainence of the body fluid balance to prevent hypotension. Long operating hours can predispose patient to hypothermia due to long exposure time. To achieve optimal balance in treatment outcome and patient safety, it is recommended that a staged procedure be done for multiple areas of treatment and when large amounts of liposuction is required. As a general guide, if the liposuction procedure required takes more than 4 hours, a staged operation is recommended.
In patients who have some excess skin in the lower abdomen, a lower lipectomy may be done in combination of liposuction to firm up the lower abdomen. Lipectomy removes an ellipse of skin and fat to prevent the formation of an apron in the lower abdomen after liposuction. This procedure is sometimes called a mini-abdominoplasty.
The possible complications for liposuction(< 10%)include haematoma, infection, skin necrosis, sepsis, subcutaneous scarring, rippling and uneven contour. All these potential complications can be minimized if the procedure is done in an established set-up like a hospital and with careful and meticulous technique employed by a trained plastic surgeon. The surgical procedure can take 1-4 hours depending on the extent of treatment required. Small areas of treatment can be done as day surgery. Hospitalization for a day is recommended for large areas of treatment and long operating hours. The recovery time is about 1-2 weeks.
Abdominoplasty is suitable for patients who have a lower abdominal apron, multiple striae on the skin and divarification of the recti muscle. Frequently they are associated with thick layers of fat deposits in the abdomen as well as the waist-line and hips. Sometimes they are associated with a significant ventral hernia in the midline due to tearing of central raphe and separation of the abdominal recti muscle.
An abdominoplasty involves (i) removing the lower abdominal apron, excess skin and fat below the umbilicus, (ii) lifting the upper abdominal skin flap to expose the midline divarification or hernia, (iii) repair of the ventral hernia or divarification and lastly (iv) pulling the upper abdominal skin flap down to close and repositioning the umbilicus through a new hole in the skin flap.
When there is an associated thick fat deposit in the abdomen and waistline, a second stage liposuction procedure 6 months later is recommended to further contour the body. A staged procedure is recommended for safety reasons as well as to avoid surgical complications like skin flap necrosis and delayed wound healing.
The procedure takes about 3-4 hours under general anaesthesia. Hospitalization for 2 days is recommended for recovery and rest. An abdominal binder for support is advised after the surgery to protect the repair for a month. The recovery time is about 1-2 weeks. Full recovery to resume normal exercise may take about 4-6 weeks.