INTRODUCTION

What is Liposuction?

Liposuction is a surgical technique that improves the body's contour by

removing excess fat from deposits located between the skin and muscle. Liposuction
involves the use of a small stainless steel tube, called a cannula (from the Latin word
for reed, tube, cane). The cannula is connected to a powerful suction pump and
inserted into the fat through small incisions in the skin. Fat removal is accomplished as
the suction cannula creates tiny tunnels through the fatty layers. After surgery, these
tiny tunnels collapse and thus result in an improved body contour. Liposuction is one
of the most popular cosmetic surgeries that remove unwanted fat deposits from
specific areas, including the abdomen, hips, buttocks, thighs, knees, chin, cheeks,
neck, chest and upper arms. This procedure has become very popular with women
who account for eighty percent of all lipoclastic surgeries. Men seem to be catching
on, wanting to eliminate "love handles" around their waist or unwanted fat from their
back or neck.

Definition

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.

Why do Liposuction?

Liposuction can remove fat that patient have not been able to shift with diet or
exercise. The fat cells will not be replaced by your body, so there should be a long-lasting
change in your body shape, especially if you exercise, eat a healthy diet, and maintain a
healthy weight after the operation. Liposuction is not a treatment for weight control or
obesity and it cannot remove cellulite or stretch marks.

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ISSUES OF LIPOSUCTION AND WEIGHT CONTROL

The Myth Of Liposuction For Weight Loss

In a culture that is very much focused on instant gratification, we hold our weight
loss up to the same standards, expecting pounds to shed immediately and muscles to be
defined with the lifting of one weight. It is no wonder that more and more people turn to
liposuction for weight loss – a procedure that rids the body of pockets of fat. But what
people fail to realize is that liposuction for weight loss does not address the underlying
weight issue and will not achieve desired results without the use of proper diet and
exercise.

Liposuction is a surgical procedure that involves the making of several incisions

around a particular area of the body that is storing excessive fat deposits. A surgeon then
inserts an instrument into the incisions that allows them to vacuum out excess fat. The
procedure, however, is far more invasive then it sounds; the surgeon must aggressively
attack fat to remove it from the body and to maintain a consistent and smooth appearance.
The liposuction patient – who is most often put under general anesthesia – faces recovery
time like any other surgery - and some pain following the procedure.

What has been shown is that liposuction works for trouble spots that have not
adequately responded to proper diet and exercise. An overall healthy person often
responds well to liposuction if they are using the procedure as a supplement to good
nutrition and healthy physical habits. However, liposuction for weight loss in a patient
who is overweight, physically unfit, and in the habit of eating poorly will almost always
fail. The reason is that liposuction for weight loss is not a magic bullet. In such a case, the
patient is required to adopt healthy eating habits and proper exercise in order to maintain
the look of the liposuction.

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THE IMPORTANCE OF WEIGHT CONTROL

How do I determine my ideal weight?

Because healthy people come in all shapes, sizes, and weights, many weight-
management experts now avoid using the term ideal weight—a concept derived from the
height-weight tables once used by insurance actuaries—and instead focus on body mass
index and waist circumference (or waist-hip ratio). These measurements better represent
the degree and/or location of body fat, which is most important in determining health
risk.

While the number on the scale can provide a general indication of whether a
person's weight falls within a range that is healthy for him or her, the body mass index
offers a more revealing look at someone's overall risk of disease and is widely accepted
by all major health organizations for the classification of overweight and obesity. BMI is
typically calculated in one of two ways:

• BMI = kg/m2. Weight (kilograms) divided by height (meters) squared

• BMI = Weight (pounds) multiplied by 703, divided by height (inches) and

divided again by height (inches)

Population data indicate that a BMI between 18.5 and 24.9 is considered healthy
for most people, while those with BMIs between 25 and 29.9 are considered overweight
and therefore at increased risk for developing weight-related illnesses. In general, the
higher the BMI, the greater the risk.

People with BMIs of 30 or greater are considered to be obese, a category that is

divided into three classes based on BMI:

• Class 1 = 30 to 34.9. High risk. Typically 30 to 40 pounds overweight

• Class 2 = 35 to 39.9. Very high risk. Typically 40 to 100 pounds overweight

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• Class 3 = 40 or greater. Extremely high risk. Typically 100 pounds or more
overweight

Because the accumulation of visceral fat (internal fat that collects around the
organs and midsection) is thought to be associated with higher health risks than fat
located elsewhere in the body, waist circumference is another good way to assess weight-
related health risks. In general, men whose waists measure more than 40 inches and
women with waist circumferences larger than 35 inches are at greater risk for many
serious medical conditions than people who are smaller around the middle.

Weight-management recommendations

Experts offer the following general suggestions to people striving to manage their weight:

Eating and drinking :

• Keep in mind that foods that are heart-healthy are usually weight-friendly, too.

• Add more healthful food choices to your pantry, and remove less healthful
ones.

• Drink plenty of water, and eat a variety of fresh fruits and vegetables.

• Eat only when you're hungry.

• Know what proper portions of food look like, and exercise portion control.

• Control between-meal snacking.

• Significantly reduce your intake of calorie-dense foods (those with high fat
and/or sugar content that leave you hungry).

• Cut back on or eliminate sugary drinks.

• Tailor your eating to something you can stick with and that makes you feel
satisfied. Remember that there are many ways to eat healthfully.

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TECHNIQUES OF LIPOSUCTION

There are various techniques for doing liposuction. Some techniques are now
longer considered safe (Dry Technique), and some are recognized as world-wide
standards of care (Tumescent Technique).

These are the list of liposuction techniques and explanations :

Tumescent Liposuction

The word "tumescent" means swollen and firm. By injecting a large volume of very
dilute lidocaine (local anesthetic) and epinephrine (capillary constrictor) into
subcutaneous fat, the targeted tissue becomes swollen and firm, or tumescent. The
tumescent liposuction technique is a method that provides local anesthesia to large
volumes of subcutaneous fat and thus permits liposuction totally by local anesthesia. The
tumescent liposuction technique eliminates both the need for general anesthesia and need
for IV narcotics and sedatives. The tumescent technique for liposuction :

• provides local anesthesia

• constricts capillaries and prevents surgical blood loss
• provides fluid to the body by subcutaneous injection so that no IV fluids are needed

Dilution & Vasoconstriction Produce Safety

Tumescent liposuction totally by local anesthesia has proven to be extremely safe

despite the use of unprecedented large doses of lidocaine and epinephrine. The
explanation for this remarkable safety is the extreme dilution of the tumescent local
anesthetic solution. Large volumes of dilute epinephrine produce intense constriction of
capillaries in the targeted fat, which in turn greatly delays the rate of absorption of
lidocaine and epinephrine. Undiluted lidocaine and epinephrine is absorbed into the
bloodstream in less than an hour. Tumescent dilution causes widespread capillary
constriction which causes the absorption process to be spread over 24 to 36 hours. This
reduces peak concentration of lidocaine in the blood, which in turn reduces the potential
toxicity of a given dose of lidocaine. Dentists typically use concentrated epinephrine

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which may cause a rapid heart rate if the epinephrine is rapidly absorbed. When very
dilute tumescent epinephrine is used, the wide spread vasoconstriction slows the rate of
epinephrine absorption, which in turn prevents an increase in heart rate.

Dry Technique

Dry Technique Dry Technique (no longer used) required general anesthesia. The
dry technique derived its name from the fact that it did not use injections of local
anesthesia into the fat before liposuction. This technique was abandoned because of the
excessive blood loss it caused. Blood composed approximately thirty percent (30%) of
the tissue that was removed by liposuction using the dry technique.

Comparing Dry and Tumescent Techniques

The tumescent technique for local anesthesia improves the safety of large-volume
liposuction by virtually eliminating surgical blood loss and by completely eliminating the
risks of general anesthesia. All patients were treated as outpatients. There were no
hospitalizations. There were no transfusions. There were no complications. There were
no seromas. The mean volume of whole blood aspirated by liposuction was 18.5 ml. For
each 1000 ml of fat removed, 9.7 ml of whole blood was suctioned.

Wet Liposuction Technique

The Wet Liposuction Technique also required general anesthesia. The wet
liposuction technique required the injection of approximately 100 ml of local anesthesia
containing epinephrine. Although the wet liposuction technique caused less blood loss
than the dry technique, blood loss with the wet liposuction technique was still excessive
and dangerous. Blood composed approximately 15% to 20% of the tissue removed by
liposuction using the wet technique.

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Super Wet Technique

Super Wet Technique also requires general anesthesia. The super wet technique
requires the injection of a volume of dilute local anesthesia that is less than half the
volume used for the tumescent technique. Surgical blood loss with the super wet
technique is greater than the tumescent technique but significantly less than the wet
technique. Approximately eight percent (8%) of the fluid removed by super wet
liposuction is blood.

Ultrasonic Assisted Liposuction (UAL)

Ultrasonic Assisted Liposuction (UAL) requires the use of a large volume of

tumescent fluid and uses either a metal probe or metal paddle to deliver ultrasonic energy
and heat into subcutaneous fat. Internal UAL is the term used to describe the technique
where a long metal probe, which may be solid or hollow, is inserted into fat through a
large incision.

Among those surgeons who do internal UAL, most rely on the use of general
anesthesia or heavy IV sedation. Internal UAL has largely been abandoned because of the
risk of full-thickness skin burns and severe scaring. The initial reports of internal UAL
were unrealistically enthusiastic. External UAL requires the use of tumescent fluid and
uses a metal paddle applied to the skin and directs ultrasonic energy into subcutaneous
fat. External UAL does not improve liposuction results and can cause burns to the skin.
Because there is insufficient proof of the safety of UAL devices, the FDA (Food & Drug
Administration) has never given approval for marketing and advertising of UAL devices
to be specifically used for liposuction.

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Vaser - Ultrasonic Liposuction

Vaser liposuction, also called LipoSelection, is another alternate technology to

traditional liposuction. Vaser ultrasonic liposuction is still a process by which fatty
deposits are removed from beneath the skin to improve the aesthetics of a particular body
part. Optimally, patients who are treated by Vaser liposuction are in good physical
condition and are looking for a contouring or body sculpturing as opposed to using
liposuction as a way to lose weight.

Sound Surgical Technologies, LLC in 2002, introduced vaser ultrasonic

liposuction. This FDA technology uses sound waves to gently loosen fat and pave the
way towards liposuction and smooth contouring of the body.

In the case of vaser liposuction, tumescent liquid, or a saline solution mixed with
anesthetics, is injected into the body area being treated. Instead of using a cannula and
manual movement to break down the fat tissue, or a laser, or water pressure, vaser
liposuction uses ultrasound high frequency vibration to break fat cells apart.

The cosmetic surgeon uses Vaser ultrasonic probes, inserted into the fatty tissue
to gently break the fat cells down. The vibration gently disengages and loosens the fat
cells and ultimately emulsifies the tumescent fluid that has been infused into the body
area. Once the emulsification is in process, a small cannula is used to remove the liquid
and the fat cells. Some of the local anesthetic remains in the tissue and that helps to
reduce post-procedural pain.

This process is considered gentler that the more traditional liposuction techniques
and ultimately offers your cosmetic surgeon a great deal of control and you get the
smooth, contoured look for which you are looking. Additionally, vaser liposuction is
specifically designed to loosen fat but to protect and preserve other tissues and by using
the saline solution there is typically less bleeding and bruising.
Areas on the body that are especially well suited to vaser liposuction include the thighs,
knees, abdomen, love handles, arms, chest, chin and neck.

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Power Assisted Technique (PAL)

Power Assisted Liposuction (PAL) devices have recently become available. PAL
devices use power supplied by an electric motor or compressed air to produce either a
rapid in-and-out movement or a spinning rotation of an attached liposuction cannula.
Advocates of PAL assert that it makes liposuction easier for the surgeon. While some
liposuction surgeons have expressed enthusiasm about PAL, many others remain
skeptical about any advantages of PAL. There are no objective scientific publications to
support the enthusiastic claims made by manufacturers of PAL devices.

Laser Lipolysis, Laser Liposuction or Liposculpture

Laser liposuction was developed as an alternative to the manual method used in

tumescent and traditional liposuction. It was also developed to help cosmetic surgeons
target specific body parts that were difficult to access with the more traditional methods,
but are perfectly suited to laser body sculpting.

Laser lipolysis, which is also known as liposculpture and laser liposuction is

somewhat different than traditional liposuction. In some techniques of laser lipolysis,
suction is used, while in others no actual suction is actually used. Instead of using the
cannula to remove fatty deposits beneath the skin, the cannula actually houses a laser and
the laser is used to literally melt the fat of the target area away.

Once the fat has been liquefied, it is drained from the body using tiny incisions or
gently suctioned away. The procedure is considered gentler than other liposuction
techniques because of the smaller cannula used and because of the smaller size of the
incisions. This also means less scarring. Because of the heat used in the procedure, the
body naturally reacts by contracting the tissues near procedure which causes the skin to
tighten and become smoother.

These lasers are specially designed to target only fat cells, protecting muscle and
nerve tissue. This precision often means less pain, faster healing and very little bruising

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after the procedure. Additionally, different companies have created liposuction lasers that
use specific wavelength frequencies for optimal results.

Laser lipolysis offers the same contouring and visual improvement of traditional
liposuction and is actually being used more often in small areas of treatment.
Specifically, many liposuction surgeons opt to use laser liposuction on the chin, jowls or
face of a patient because of the precision of the procedure and the great success. The
excess pockets of fat that can develop in this area can be melted with precision and the
tightening of the skin operates almost as a face or neck lift. There are a number of
companies who have developed different lipolysis lasers, each of which has a specialty.

SmartLipo - Laser Liposuction

Smart Lipo is actually where laser liposuction began. Brought to

the marketplace by Cynosure, the SmartLipo system offers all the benefits
of a high quality laser lipolysis system and the benefit of experience in the
market. The SmartLipo system has truly been tested and proven successful
and is an established technology with an excellent reputation.

When a doctor uses SmartLipo, the small cannula and powerful

laser offers precise targeting of even the smallest body part. This means a
doctor can target pockets of fat that would otherwise be untreatable with traditional
liposuction. The laser not only melts the fat and facilitates its removal; it also causes
small blood vessels to coagulate immediately which reduces bruising and the chance of
blood loss. Finally, that same laser stimulates collagen retraction and skin tightening
which are optimal for shrinking the skin once fat has been melted and removed.
SmartLipo is often used in conjunction with cellulite treatments and can be used with
only local anesthetic, which reduces patient health complications from general anesthetic.

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CoolLipo - Laser Liposuction

CoolLipo, like other laser lipo systems is a technology that uses

laser wavelengths to dissolve fat and firm the skin. Cool Lipo candidates
are in good health and are not planning to use liposuction as a weight
loss technique, but rather for body contouring and sculpturing. CoolLipo
by CoolTouch, Inc. is designed specifically for smaller areas of
treatment in the face, chin and neck areas. This includes fat deposits that
are particularly stubborn and resistant to any kind of weight loss or
traditional liposuction.

In these areas on the face, many people assume the only option is a face lift or
neck lift when in fact, Cooltouch Lipo is also a viable solution. The idea is that getting
laser lipolysis is less invasive than a full face or neck lift and that the recovery time will
be substantially shorter. Also, traditional liposuction is very difficult to use in these areas
of the body because of the small volume of fat and all the other anatomical structures and
tissues that need to be protected.

The cannula and laser are used in the fatty portions of the jowls, chin or neck to
remove, very carefully, excess or fatty tissue. The Coollipo laser is specifically designed
to protect tissues other than fat. Because CoolLipo is designed for contouring the face
and neck, the laser also maximizes the other benefit of laser lipo - the skin tightening and
collagen renewal.

CoolLipo laser liposuction uses a 1320 nm wavelength that is known to have

maximum benefit for collagen rejuvenation and skin firming. The CoolLipo also uses a
short pulse width that ensures maximum fat removal and that non fatty tissues are
protected. This laser liposuction technology also uses a high peak power for gentle but
thorough “fat disruption”. Once the fat is disrupted and removed, the skin in the face and
neck firms and tightens so you get the look of a facelift in an outpatient procedure, with
minimal healing time in most cases.

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ProLipo - Laser Liposuction

Cosmetic surgeons using ProLipo or laser Sciton are using laser

liposuction for specific and precise contouring of the body. Like other
laser liposuction technologies, ProLipo laser liposuction uses a small laser
housed in a cannula to melt and dissolve fatty tissues that are resistant to
diet and exercise. Laser liposuction is also often used in parts of the body
where traditional liposuction is not available or not optimal for the best
possible results.

Like other laser liposculpture, the ProLipo can be used under local anesthetic and
the use of the laser typically reduces bleeding and bruising. By eliminating the need for
general anesthesia, the cost of procedures is lowered and the risk to patients is
substantially lowered. In some cases, Pro Lipo is performed under general anesthesia,
especially if it is being used in conjunction with other cosmetic procedures, but the areas
of the body treated with ProLipo will be quick to heal. The ProLipo is a laser lipolysis
technology that offers multiple wavelengths during the course of your laser lipo
procedure. This means your cosmetic surgeon can use the correct wavelength and laser
power for each individual situation and body part being treated. The cosmetic surgeon
can remove more fatty deposits or focus on tightening the skin or do these things
simultaneously.

The Pro Lipo uses two wavelengths, the 1064 nm and a 1319 nm. The 1064 nm is used to
disrupt and melt the fatty tissue. ProLipo has optimized their laser to effectively break up
superficial vascular fat. The 1319 wavelength is extremely effective for prompting
collagen regeneration and skin tightening and can be used in conjunction with the
1064nm wavelength or each can be used separately.

The object of Sciton’s ProLipo is to give the doctor maximum flexibility and
precision in patient treatment. The ProLipo is known to have excellent results in areas
that are traditionally resistant to traditional liposuction including part of the thighs, the
upper abdomen, the lower abdomen, the upper arms and the chin and neck. In some

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cases, cosmetic surgeons have also been known to use ProLipo laser lipolysis in
conjunction with traditional liposuction for the best results. In other words, they may use
traditional liposuction for larger areas of treatment and then follow it with ProLipo for
specific liposculpture. ProLipo has an excellent reputation as a top notch laser lipo
technology.

LipoLite - Laser Liposuction

LipoLite is a laser liposuction technology available to patients

who are in good health and who are not using liposuction as a measure
for weight loss. LipoLite laser has been used very successfully in body
sculpting and contouring – and like other laser liposuction techniques is
particularly good with small areas that don’t work well for traditional
liposuction and are resistant to weight loss and exercise.

The LipoLite laser liposuction technique uses the 1064 nm

wavelength to melt away and remove fat from beneath the skin. The tiny cannula and
fiber optic laser make for minimal invasiveness during the procedure. In fact, many
physicians will use traditional liposuction techniques for the larger sites being targeted on
a patient’s body and then will follow up with laser lipolysis from a technology like
LipoLite.

The LipoLite laser liposuction difference is in their SelectPulse™ technology.

Basically, doctors can use this technology to deliver short pulses of low energy or longer
pulses of higher energy, either of which can be necessary depending on the patient and
the body part being treated. This means that LipoLite laser liposuction can treat areas
that are fibrous or have tissue that would be traditionally resistant to laser lipo and that
this technology is adept at destroying fat cell membranes for maximum results.

Like other laser lipolysis treatments, LipoLite is considered an outpatient

procedure and is often conducted in a cosmetic surgeon’s office using only local
anesthesia. Procedures usually last between 30 and 60 minutes per body part being
treated. The incision and treatment is typically very small and the recovery time is short.

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LipoLite is most often used on parts of the body like the face, neck, bra line, belly, male
chest and stubborn areas of the thighs. Many surgeons will use traditional liposuction and
do “the detail work” with laser lipolysis.

i. LipoTherme and LipoControl - Laser Liposuction

LipoTherme by Osyris Medical is another well regarded laser

lipolysis technology. Using a small laser housed in a cannula, fatty
deposits are disrupted with heat, facilitating their removal and the look
and contour you desire. Laser lipolysis like the LipoTherme is often
used in areas where traditional liposuction would not be successful and
in parts of the body where diet and exercise will not be able to reduce
the fatty deposit.

In the case of the LipoTherme, a 980 nm wavelength is

used to target and emulsify fatty deposits below the skin. They
have a specially designed and patented cannula that houses the
laser and offers smooth and consistent contouring and results and
a tiny incision that heals quickly and results in less scarring.
LipoTherme laser liposuction offers control and precision to
cosmetic surgeons, allowing them to target the smallest and most
stubborn pockets of fat.

The real difference that Osyris Medical has brought to the market is in their
LipoControl technology, which is used in conjunction with their LipoTherme laser
liposuction treatment. LipoControl offers an actual on screen image of the patient’s area
of treatment, beneath the skin, so the surgeon can see exactly where they are and what
they are doing. The technology uses heat imaging to map the location of the laser and
cannula and the laser power strengthens and weakens as the surgeon moves the cannula
beneath the skin. In fact, if the surgeon stops movement altogether, the LipoControl will
turn off the laser. This kind of control and protection is a great advance in laser
liposuction.

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 When LipoControl and LipoTherme are used together, cosmetic surgeons are able
to offer the best possible results to patients. This kind of laser liposuction is perfect for
small, precise areas like the face, neck, back, parts of the abdomen and arms. In most
cases, like other laser liposuction, LipoControl and LipoTherme are used in outpatient
procedures and the use of the laser technology reduces bruising and bleeding. Typically
only a local anesthetic is needed, which reduces both cost and risk to the patient.

Water Jet Assisted Liposuction

Water jet assisted liposuction is another method of liposuction being

used by cosmetic surgeons today. As in all types of liposuction, fatty deposits
are removed from beneath the skin for a more contoured look. Liposuction is
optimal for people who are in good physical shape and who aren’t interested
in using liposuction as a weight loss measure.

Instead of injecting the body with tumescent fluid and removing the fat
cells manually with a cannula, or using laser technology to melt and dislodge
the fat, water jet assisted liposuction actually uses a slightly pressurized stream of saline
to dislodge fat and simultaneously remove the cells. Instead of destroying fat cells, this
type of liposuction loosens the fat cells to facilitate more gentle removal. Water Jet
Assisted liposuction injects tumescent fluid (saline and medicines including a local
anesthetic) into the body part being treated. Tumescent fluid is proven effective and
several alternate liposuction technologies are now using the tumescent technique for its
local anesthetic benefits. In the case of water jet assisted liposuction, it then uses different
processes to actually remove the fat and manage fluid levels.

Once the local anesthesia has taken hold, a cannula is then introduced into the
tissue to irrigate and then simultaneously suction the loosened fat cell from the body.
Finally, any remaining fluid is removed. The procedure is considered gentle and
minimally invasive and the force seen in traditional liposuction methods is not needed
when using jet-assisted liposuction. There is usually very little bruising or swelling and

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water jet assisted liposuction often has a very short recovery time, partially because the
use of water means that there is less tissue trauma to the body.

This is another liposuction technology that does not require general anesthetic,
which reduces risks to the patient and reduces costs. Also, because of the fluid
management used in this technique, the surgeon can do a more detailed anatomical
assessment while conducting the procedure, so the results are excellent. Basically, the
area of the body doesn’t swell up, so the cosmetic surgeon can actually see the results of
the liposuction as he or she is doing it.

Right now, one of the better known technologies in use is Body-Jet Liposuction
by Eclipse. Launched into the marketplace in 2009, water jet assisted liposuction is
quickly gaining popularity. These new technologies that offer a gentler and more precise
approach are quickly adopted because of their effectiveness and the quick healing time.

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 FACTORS

Important factors that affect the success of abdominal liposuction include : the
amount and location of abdominal fat, history of weight gain and weight loss, history of
pregnancy, the age and the sex of the patient.

Criteria Explanations

Previous Pregnancy A previous pregnancy tends to stretch the abdominal muscles, and cause the lower
abdomen to bulge to a certain degree. This curvature of the abdominal wall
muscles determines the flatness or the shape of the abdominal silhouette after
liposuction. Nevertheless, the vast majority of women who have been
pregnant are ultimately very happy with results obtained by liposuction alone,
and do not require an abdominoplasty (tummy tuck).

C-Section Bulge The Pfannenstiel incision is the name for the incision across the lower abdomen
that is typically made for Cesarian sections, or a hysterectomy. A common
but undesirable consequence of a Pfannenstiel incision is a persistent bulge of
subcutaneous fat just above the incision. Liposuction can easily repair this
annoying deformity.

Prior obesity Prior obesity and subsequent weight loss produce fat that is more fibrous. This
makes liposuction more difficult.

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 Criteria Explanations

Location of Location of abdominal fat is an important factor in predicting the success of

Abdominal abdominal liposuction. Abdominal fat occurs in two different levels:
Fat superficial and deep. Superficial abdominal fat is located just below the skin
and above the abdominal muscles. The deep abdominal fat is located inside
the abdominal cavity on the intestines. Some people have more deep
(intestinal) fat than subcutaneous fat. Subcutaneous fat can be removed by
liposuction. Intestinal fat cannot be removed by liposuction because it would
be too dangerous. Fat on the intestines can only be diminished by weight loss
through diet and exercise. Thus liposuction cannot remove all of the
abdominal fat. Most patients have more subcutaneous fat than intestinal fat.
Thus, most patients will see a good cosmetic improvement with abdominal
liposuction.

Age Age of the patient is not an important factor in the success of liposuction. Some of
the happiest patients are women who are more than 60 of age. In a healthy
older woman, liposuction can improve an obese abdomen with little risk or
discomfort.

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Female Patients Female patients have softer and less fibrous fat than men, and therefore liposuction
on a woman is easier to perform.

Successful Liposuction

This is defined and determined by the degree of a patient's happiness with the
results. Ultimately the patient's opinion of the cosmetic results depends on multiple
factors, including :

the patient's expectations

the patient's preoperative cosmetic deficiencies

the surgeon's technical skills and technique. The results are never completely predictable.

COMPLICATIONS

A surgical complication is defined as any undesirable result of surgery. The most

common complication of liposuction is a result that produces an unhappy patient. The
most common cause of an unhappy patient is a patient's unrealistic expectations before
surgery. Avoiding unrealistic expectations requires careful and accurate communication
between patient and surgeon. Detailed information about specific complications is :

Complication Explanation

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1. Excessive Liposuction
1. Common & Minor Common & minor complications are conditions that do not threaten
Complications
2. Rare & Severe Complications
3. Drugs That Increase Bleeding
The greatest risks of liposuction are associated with the tendency of
some surgeons to do too much surgery on the same day. The three
types of excessive surgery include :
• removal of an excessive volume of fat by liposuction on a single
day
• liposuction of an excessive number of body areas on the same
day
• combinations of liposuction and other unrelated surgical
procedures which involves excessive surgical trauma and
prolonged exposure to general anesthesia.
a patient's life, normal body functions or the ability to work. These
include superficial irregularities of the skin, seromas, hematomas,
focal skin necrosis, allergic reactions to drugs, visible or disfiguring
scars, discoloration of the skin, fainting during or after surgery,
temporary bruising, numbness or nerve injury, and temporary
adverse drug reactions. Most of these complications can be
considered minor, however some may become quite serious. Post-
liposuction syncope (fainting) the next morning at home, especially
after urinating is not rare. This can be serious if the patient falls and
experiences a head or neck injury.
associated with liposuction include problems with anesthesia, blood
clots in the leg or lung, injury to the abdominal organs, excessive
intravenous fluids, excessive blood loss, excessive loss of body heat
(hypothermia), infections, allergic drug reactions, aspiration
pneumonia (most likely under general anesthesia), cardiac arrest and
potentially fatal cardiac arrhythmias, permanent nerve damage, brain
damage due to lack of oxygen under general anesthesia, and
seizures.
Drugs that increase bleeding, if taken by a patient soon before
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4. Risks of Local Anesthesia
5. Risks of General Anesthesia
having liposuction, can cause liposuction complications such a
hematoma (a large collection of blood trapped beneath the skin), or
excessive bleeding that might require hospitalization. Among the
more common drugs that can interfere with normal clotting of blood
are aspirin, ibuprofen (Motrin, Advil), and warfarin (Coumadin).
Even vitamin E, red wine, and some herbal remedies can cause
prolonged bleeding. Patient are provided with a long list of
prescription drugs and non-prescription drugs that interfere with
bleeding.
Lidocaine is the safest of local anesthetics available for liposuction.
At lidocaine concentrations in the blood exceeding 6
milligrams/liter, patients might experience some toxicity. Blood
concentrations of lidocaine in excess of 12 milligrams/liter can
produce serious cardiac toxicity. The maximum recommended
dosage of lidocaine for tumescent liposuction is 50 mg/kg (50
milligrams/kilogram of patient weight). The most extraordinary
aspect of the tumescent technique is its unprecedented safety record
when used as directed. Most liposuction surgeons know that it can
be dangerous to give a patient a dosage of tumescent lidocaine that
exceeds 50 mg/kg. All liposuction-related deaths have been
associated with either the use of general anesthesia, or IV sedation,
or lidocaine doses in far in excess of 75 mg/kg. The tumescent
technique is dangerous in the hands of surgeons or anesthesiologists
who have not had specific training in the technique. There has never
been a reported death associated with tumescent liposuction totally
by local anesthesia.
General anesthesia for liposuction can be considered safe when :
• the general anesthesia is administered by a board certified
anesthesiologist,
• liposuction is not performed with other unrelated surgical
procedures
• there is no excessive liposuction.
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 The most dangerous aspects of general anesthesia are respiratory
depression and impairment of protective airway reflexes. The risks
of general anesthesia include human error, unsuspected inherited
hypersensitivity to anesthetic drugs, accidental overdose of
anesthesia, any undetected airway disconnection or airway blockage.
General anesthesia, which increases the risk of vomiting and impairs
protective airway reflexes, can cause aspiration of stomach contents.
Because general anesthesia impairs the ability to breathe, when a
complication does occur it can lead to disaster.
6. Dangers of Ultrasonic Ultrasonic Assisted Liposuction (UAL) requires the use of
Liposuction tumescent fluid and uses either a metal probe or metal paddle to
deliver ultrasonic energy and heat into subcutaneous fat. Internal
UAL has largely been abandoned because of the risk of full-
thickness skin burns and severe scaring. The initial reports of
internal UAL were unrealistically enthusiastic. Some authors did not
report their complications, and others have learned of major UAL
complications after publishing their articles. Because of insufficient
proof of safety, UAL devices have not been approved by the FDA
for use in doing liposuction.

SAFETY
Safety is a Relative Term
It is impossible to prove that a surgical procedure is absolutely safe. On the other
hand it is realistic and appropriate to compare two procedures and conclude that one is
relatively safer than the other. Prospective liposuction patients should strive to understand
the options that are available and choose the safest procedure.

Preventing Complications
Preventing complications should be the most important concern of both patients
and liposuction surgeons. Surgeons can reduce the risk of complications by proper
selection of patients. Surgeons should avoid patients who have
• unrealistic medical expectations

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 • a history of significant medical problems.
Patients can reduce the risk of complications by
• resisting the temptation to save time by attempting to do multiple unrelated
surgical procedures along with liposuction
• resisting the temptation to maximize the volume of fat removed on a single
day.
It is much safer to divide one very large liposuction procedure into two or more separate
procedures done on separate days. Liposuction by general anesthesia can be considered
safe, however, liposuction totally by local anesthesia is safer.

TREATMENT

Is liposuction a treatment for weight loss?

Liposuction is a procedure for shaping the body and is not recommended for
weight loss. It is a surgical procedure in which fat is removed from under the skin
with the use of a vacuum-suction cannula (a hollow pen-like instrument) or using an
ultrasonic probe that breaks up the fat into small pieces and then removes it with
suction.

Persons with localized fat may decide to have liposuction to remove fat from
that area. It doesn’t guarantee permanent weight loss. To avoid weight gain after
liposuction, people need to eat right and be physically active. Complications from
liposuction may include infection, embolism (fat gets trapped in the blood vessels,

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gathers in the lungs, or travels to the brain), puncturing of organs, seroma, pain or
numbness, swelling, burns, skin problems, and reactions to the anesthesia.

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FAQ ABOUT LIPOSUCTION :

Who is a good candidate for liposuction?

A good candidate for liposuction is defined as any patient who is likely to be happy
with the results of liposuction. The best candidates for liposuction are in good
health and have realistic expectations of what liposuction can accomplish and can
provide a good candidate with a significant improvement, but it is unlikely to
achieve perfection. There is no definite age or weight limit for patients who are
"good candidates" for liposuction. Many liposuction patients are of average size but
are concerned about localized accumulations of fat. However, some of the happiest
patients have been individuals who are somewhat obese. A good candidate usually
has one or more localized accumulations of fat that can be removed by liposuction.

Who is not a good candidate for liposuction?

A person who expects absolute perfection is not a good candidate for liposuction.

Excessively obese patients are usually not good candidates for liposuction.

A person who has a serious medical problem is not a good candidate for liposuction.

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Is liposuction a reasonable treatment for obesity?
Liposuction is not a good treatment of obesity. Liposuction is not effective, even as
a last resort, for people who are unable to lose weight by dieting and exercise.
Obese patients almost always regain the weight that is removed by liposuction
unless there is a dramatic reduction in calorie intake (by dieting) or a significant
increase in calorie expenditure (by exercising). Whenever large-volume liposuction
has been used in an attempt to treat obesity by surgery, there has been a significant
increase in the incidence of serious surgical complications. It is not safe to remove
huge amounts of fat by liposuction. It is dangerous to remove more than 8 to 10
pounds of fat by liposuction in a single day. Thus, liposuction will not be of any
significant benefit for an obese patient who believes that liposuction will aid in the
effort to lose weight.

On the other hand, an overweight person whose weight has been stable for many
years and has certain problem-areas of fat may be a good candidate for liposuction.
Liposuction in an obese patient is reasonable when the goal is to improve a
troublesome body contour area. It is not reasonable to use liposuction as a surgical
technique for weight loss.

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REFERENS

1. http://www.liposuction.com
2. http://www.copacabanarunners.net/i-liposuction.html
3. http://www.weight-loss-surgery-info.com/liposuction.html
4. http://www.tip2000.com/health/liposuction.asp
5. http://www.usnews.com/health/family-health/articles/2008/08/19/weight-
management.html
6. http://www.copacabanarunners.net/i-liposuction.html
7. http://ezinearticles.com/?The-Myth-Of-Liposuction-For-Weight-Loss

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