Liposuction

Introduction
Liposuction is a technique used to remove unwanted fat deposits. It was developed in the 1970's and is therefore well tested and gives predictable results. It is best suited to removing localised deposits of fat from the hips, tummy, waist or thighs. It can also be used in combination with other procedures such as facelifting, to remove fat from the neck, or with a tummy tuck (abdominoplasty) to remove fat from the waistline. It is a technique for improving body shape rather than helping with weight loss.

More recent developments, known as liposculpture, have added considerable refinement to our ability to reshape the contour of the body. However it is not a substitute for a controlled diet and results are best in patients who are not overweight but who have localised collections of fat. Good results also depend on elastic skin that will adapt to a new contour when the underlying fat is removed. With age skin becomes less elastic but the condition of the skin rather than your chronological age is the most important factor. This will be carefully assessed at your consultation with Mr Grover.


Before and after photos of patient operated on by Rajiv Grover


What are the different types of liposuction?
How do I prepare for surgery?
Where will my surgery be performed?
What type of anaesthetic will be used?
What does the operation involve?
What happens after the operation?
Will the fat come back?
What are the risks?

What are the different types of liposuction?
Liposculpture
Liposculpture is an adaptation of liposuction which employs the use of much finer cannulae allowing the removal of fat in a more controlled manner. As it causes less trauma to the tissues it can be used closer to the surface of the skin therefore giving superior results. Mr Grover favours this technique over standard liposuction as it provides greater refinement in body contouring.

Tumescent Liposuction
This is a technique in which a medicated solution is injected into fatty areas at the time of surgery. The fluid is a mixture of intravenous salt solution, local anaesthetic and adrenaline (a drug that constricts blood vessels). This allows the fat to be removed more easily and reduces pain following the operation. Tumescent fluid injection during surgery also helps to reduce the amount of bruising after liposuction / liposculpture. This is routinely used by Mr Grover to enhance outcome and reduce pain and bruising when he operates.

Ultrasound-Assisted Lipoplasty (UAL)
This technique requires the use of a special cannula that produces ultrasonic energy. As it passes through the areas of fat and the energy liquefies the fat making it easier to remove.

UAL has been shown to improve the ease and effectiveness of liposuction in fibrous areas of the body, such as the upper back or the enlarged male breast.

How do I prepare for surgery?
It is very important to avoid taking any Aspirin or products containing Aspirin for 2 weeks either side of the operation since Aspirin causes bleeding and has a very adverse effect on bruising. The same is true for non-steroidal anti-inflammatory drugs (such as Brufen and Neurofen). If you are a smoker it is helpful to stop for two weeks before surgery and for a week afterwards so as to help the circulation of blood to the skin. If you are taking the contraceptive pill it may be wise to stop it and use an alternative method of contraception for one cycle before the operation as this can improve the circulation in the legs following surgery.

Where will my surgery be performed?
The surgery is performed at the King Edward VII Hospital in central London where Mr Grover works as a Consultant Plastic Surgeon. You will be admitted on the day of surgery, and may need to stay overnight. You will need a friend or relative to accompany you home when you leave hospital after surgery.

What type of anaesthetic will be used?
Liposuction and liposculpture is usually performed under a general anaesthetic, so you'll sleep through the entire operation. Occasionally with very localised areas it may be possible to perform liposuction under local anaesthetic with some sedation.

What does the operation involve?
Liposuction and liposculpture is performed via small 5 mm incisions through which the fine cannulae remove unwanted fat. Before performing the liposuction, fluid is injected into the fat as this allows the fat to be removed more easily and reduces pain following the operation (tumescent technique). The small incisions usually result in scars that are barely visible once healed and which are carefully positioned to be as inconspicuous as possible. At the end of the procedure an elasticated garment is applied over the area treated. This should be worn for 4-6 weeks in order to maximise compression and remodelling of the skin. In most cases liposuction requires one night stay in hospital depending on the volume and areas treated.

What happens after the operation?
Discomfort following the surgery varies from one patient to another but is not usually great. It is important to mobilise as soon as possible after the operation as resting in bed is not good for the circulation in the legs. You should keep the scars clean and dry until the sutures are removed between 10-14 days after surgery. Returning to work will depend on the extent of the liposuction but is usually between 10 and 14 days after surgery.

It is important to wear an elasticated garment to apply light pressure over the treated area for 4-6 weeks following liposuction. This helps to reduce the swelling and encourages the skin to conform to its new shape. Vigorous exercise should not be resumed until all bruising has settled which usually takes 3-4 weeks. After 4-6 weeks you will have a good idea of the result, but this continues to improve for 3-6 months as the skin and fat becomes softer and smoother. The best results are obtained in slim people with localized fat deposits, as the tighter the skin the better it will adapt after fat removal.

Will the fat come back?
If you maintain a steady weight the short answer is no. People are born with a fixed number of fat cells in the body and fat is laid down in proportion to their distribution. After liposuction fat cells are removed and so if you gain weight it will preferentially be laid down elsewhere rather than at the site of your liposuction. However if you are careful with your weight and diet, the change in contour will be permanent.

What are the risks?
Complications following liposuction/liposculpture in correctly selected patients are extremely uncommon.
  • Some irregularity in the skin is occasionally seen but with modern instrumentation this is rare. However in the period after surgery it is not uncommon to see some waviness in the contour of the skin which is related to swelling and this resolves over 2-3 months.
  • Infection is a theoretical risk of any operation but extremely unusual after liposuction.
  • Bruising and some swelling is to be expected after liposuction. Some people bruise more easily and so will see more discoloration in the skin than others. This almost invariably resolves soon after surgery.
  • Deep venous thrombosis (blood clot in the deep leg veins) is a potential risk of any operation and so is a potential risk with liposuction. Its risk can be lowered by mobilising after surgery and this will be encouraged following your operation.
Summary
Procedure time 60-90 minutes
General / Local anaesthetic General
No. nights in hospital 1 night
Time off work 1-2 weeks
Sensitivity period 10-14 days
Back to normality / sports 4 weeks

Liposuction is the most popular cosmetic surgery procedure worldwide. It is a highly effective technique for improving body contour with minimal scarring. The results can be permanent, providing you eat sensibly, exercise regularly, and maintain your weight. With realistic expectations and the understanding that the final results may take a few weeks before becoming apparent, you should be happy with your new shape.

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