Liposuction and Liposculpture

General information
Liposuction is a technique which was developed in the 1970's. In essence it involves
the insertion of a metal tube (cannula) underneath the skin and using
high vacuum suction fat is sucked (aspirated). This technique is improved after injecting
fluid into the fat causing the fat to swell allowing it to be more readily aspirated.
As techniques have evolved smaller cannulae and different shaped cannula
allow more refinement in which areas fat are removed and this combined with
re-injecting fat allows one to sculpt the body hence the coining of the term 'liposculpture'


See patient experiences


Frequently Asked Questions:

What patients are suitable for liposuction/liposculpture?

Patients who are at their ideal weight or slightly above are ideally suited for these procedures. Liposuction can, at the very most, only remove between 4-8 pounds of fat and thus it is not a means of weight loss. Liposuction is thus really a means of addressing stubborn pockets of fat, which are localised in certain areas, and which seem to be refractory to diet. Because liposuction removes the volume it is also important that the skin quality is elastic so as to shrink to the reduced volume beneath. Patients who have excess lax skin, especially of the abdomen e.g. if they have had children, may be better suited to have abdominoplasty surgery but this will depend on their overall objectives and how this fits in with their lifestyle and this can be discussed with Mr Fogarty, so as to best serve their needs.

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What is involved in the surgery of liposuction/liposculpture?

The type of anaesthesia that is administered will depend on the volume of liposuction required, the patients general health and of course, their personal preferences. Local anaesthetic (eg. lignocaine, as used in dentistry) will allow numbing of the skin/fat and allow the suction to be carried out. Local anaesthetic is however painful to inject thus it may be combined with intravenous sedation to ease the injecting process. Sedation and local anaesthetic however is limited in that only a certain dose of local anaesthetic may be used in any 24 hour period, otherwise toxicity may occur, and thus for larger volumes of liposuction a general anaesthetic is safer, with the risks of a general anaesthetic causing severe problems being very small (1 in 250,000). For small volumes of liposuction however, local anaesthetic with or without sedation is very satisfactory but if patients are nervous about procedures then they may request a general anaesthetic. If a general anaesthetic or sedation is to be administered, a Consultant Anaesthetist will be present to administer this. Before the procedure itself Mr Fogarty will mark the areas that require treatment so that you can see which areas will be focused on. Then after anaesthetic is administered small 4-5 mm incisions are made around the site of suction. The incisions heal leaving very small scars that are almost invisible. After an incision is made local anaesthetic fluid which contains a vasoconstrictor agent (ie. reduces bleeding) is injected. This improves the safety of the liposuction and greatly reduces any bruising. A metal cannula is then inserted into the incisions and the excess fat can be removed to a degree that leaves a residual safe volume of fat. This is important as fat will carry with it blood supply to the skin and excessive suction can damage the blood supply causing potential problems (see below). At the end of the procedure the incisions are left open but are dressed with elastaplast bandage and this allows any excess blood and fluid to leak out. This means that bruising is less and recovery is thus speeded up and there are no sutures that need to be removed. At the end of the operation you will be recovered in the recovery area and then in your room. Usually an overnight stay is not required unless surgery is later in the day or if a large volume of liposuction is performed. If there is any excess of ooze on the bandages over the incisions these will be changed as required by the nursing staff. An important part of the post operative recovery is the wearing of elasticated pressure garments which help reduce any post-operative swelling and encourage skin shrinkage. The elasticated pressure garment will be donned in your room prior to discharge or on the night of surgery. Generally most patients find there is minimal pain after liposuction because of the local anaesthetic in the solution that is used whether the procedure be carried out solely under local anaesthesia or whether a general anaesthetic is used. When the local anaesthetic wears off simple pain killing tablets will normally mask the pain very well. When going home it is wise to have a friend drive you home and then you may wish to recuperate in your house for approximately 48 hours but taking care to maintain your hydration by drinking 1-2 litres of fluid per day and it is best to walk around the house as desired so as to prevent any clotting of blood in the lower legs. After 48 hours most patients are able to get out of the house and if pain permits they are able to drive.

One week after surgery you will return to Mr Fogarty's clinic for a wound check, by which stage most of the wounds should have largely healed by that stage. At the one-week post op stage period return to work should not be a problem. When the wounds have totally healed you can shower as required and massaging the skin of the treated areas is very important. Massaging will help minimise any contour irregularities or lumpiness and this should be carried out twice a day with a simple bland moisturizing ointment such as E45 or Nivea. Message of the scars when the wounds have healed is also important as this helps keep them supple.

You will be reviewed again at Mr Fogarty's clinic at 6 weeks and 3 months post operatively. You should notice an improvement in your contour at the 6 week stage and an even greater improvement by the 3 month stage. If there is any bruising after the surgery this is usually resolved within 2 weeks.

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What special preparation should I take prior to liposuction/liposculpture?

It is important that one's weight should not increase prior to the procedure. One's ideal weight should be maintained and thus those refractory pockets of fat that are not responding to diet can then be addressed by the procedure. Thus is it important to maintain healthy diet and exercise before the surgery. Six weeks before the surgery if one is on the oral contraceptive pill this should be stopped and alternative precautions should be taken to prevent pregnancy. This will help to minimise the risk of a blood clot in the legs. If one smokes, it is ideal to stop smoking 6 weeks prior to surgery, as again, this will improve the skin circulation and minimise any complications after the operation. Two weeks prior to surgery if any aspirin or aspirin containing medication or Non Steroidal Anti-Inflammatory Drugs (NSAIDs) eg Brufen or Diclofenac are being taken these should be stopped at this stage as they will tend to thin the blood and increase bruising. One week prior to surgery vitamin C (500mg) once a day should be taken and this will improve wound healing. Some patients also find the use of the homeopathic remedy Arnica (tablets OR cream) helps reduce bruising and this can be taken two days prior to surgery and for one week after the operation.

To help the reduce the risks of infection it is wise to shower daily for three days prior to the operation using a medicated type shower gel/surgical scrub such as one containing Chlorhexadine(e.g Hydrex®, Hibiscrub®) or Betadine (if you are not allergic to iodine). If incisions are to be made in hair bearing areas such as the pubic area it is best shaved, waxed or depilated as dressings can be applied and removed with less discomfort. Elasticated pressure garments are ideal to wear after the surgery and while you will be discharged from the hospital with surgical garments it is a good idea to have replacement garments thus allowing washing of the other garments in case there is any staining. These can be purchased from High Street department stores or online retailers. Bicycle shorts are ideal for thigh and hip liposuction and elasticated panty girdles for lower abdominal liposuction.

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What are the potential complications after liposuction/liposculpture?

Contour/skin irregularities
After fat has been suctioned the body will heal internally with scarring and the scarring tends to contract the overlying skin. Thus excessive amount of scar retraction internally underneath the skin will cause contour irregularities but this is uncommon. The main way of avoiding this is the avoidance of over zealous liposuction and with massage of the skin after the operation to encourage movement and prevent scar tethering internally.

Scar/keloid formation
The incisions used for liposuction are very small approximately 5-6 mm in length. The scars heal by themselves with the first 5-7 days and form red scars and the redness persists for approximately 6 months. When the redness fades the scars are fine white lines and are barely visible. Occasionally however, scars can become lumpy and this lumpiness can increase in size with time and this is a condition known as keloid scarring. The chance of this happening are very slim (1 in 300) but should this occur then the keloid scar needs to be treated with steroid injections into the scar tissue over a number of times.

Infection
In theory infection is possible but it is extremely uncommon ( less than 1 in 100 cases). Usually it will respond to a course of antibiotic treatment.

Numbness
Numbness is common immediately after the procedure but it almost invariably resolves of its own accord.

Deep Vein Thrombosis (DVT)
Deep venous thrombosis is a potential risk of any operation and especially in women who are taking the oral contraceptive pill. Thus it is important to stop the oral contraceptive pill six weeks prior to surgery and take alternative measures. Early mobilization after the operation will encourage the return of the blood in the legs and minimise the risk of DVT and thus mobilizing about the house and home is encouraged as is maintaining ones hydration by drinking at least 1-2 litres of water per day to reduce the stickiness of the blood. Finally pressure garments around the thighs and hips should be firm but not overly tight.

Revision surgery (1 in 20)
The reduction in fat volume will often depend on a number of factors including the following; whether some of the residual fat that is left behind dies and gets resorbed back into the body, the elasticity and contraction of the skin and finally the degree of swelling resolution after the surgery. In order to minimise the risk of damage to the skin circulation (and prevent skin death!) some fat must be left behind under the skin surface. Thus the outcome may not be as a patient had wished for and thus secondary (or revision) liposuction may be required to achieve a patient's goals. Clinics may often reserve the right to charge for such revision procedures should they be required.

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Liposuction /Liposculpture Summary Points
Procedure Time
60-90 MINUTES Anaesthetic General anaesthetic for large volumes Local anaesthetic for smaller volumes Number of nights in hospital Day case or 1 night Time off work 1-2 weeks Return to driving 1 week Recovery overall Results visible at 6 weeks but final contouring probably not reached until 9-12 months after surgery



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