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iposuction Surgery, Liposculpture

How to perform Liposuction Surgery

How to performed Liposuction Surgery

  • A small incision is to be made on the skin where the area is wanted to be treated (Liposuction Surgery)
  • A narrow metal tube (cannula) is to be inserted through the incision into the fatty area
  • By working the tube back and forth, the fat cells is to be shaved off in tunnels and evacuated through attached tubing to suction.
  • The tunnels and spaces would be suctioned and  then contracts by the use of a compression garment to create the new contour is called liposuction surgery

Ultrasonic Assisted Liposculpture

  • In this technique ultrasonic waves are produces by a generator, which can be introduced into the tissue by a small incision to disrupt the fat cell (Lipocytes) and release the fat.
  • Then free fat is to be removed from the tissues by the use of an aspiration cannula as the same way of regular liposuction.
  • It is also known as Suction Assisted Liposculpture or SAL.
  • In this technique greater volumes of fat can be removed.
  • In this technique, infiltrate  high volumes of crystalloid fluid subcutaneously it contain low concentrations of lidocaine and epinephrine followed by suction-assisted aspiration of fat, by using small aspiration cannulas.

It is a method for performing liposuction surgery with the patient under local anesthesia.

Indications

  • Liposuction is generally performed for the reduction of fatty deposits that are well localized and often seem to involve a genetic susceptibility.
  • Other indications include lipoma removal,, axillary hyperhidrosis,, evacuation of hematomas, pseudogynecomastia, and the controversial staged liposuction for persons who are morbidly obese

Liposuction can also be used in combination with other procedures such as

  • Abdominoplasty (tummy tuck) ,
  • Arm Lift ,
  • Thigh Lift,
  • Breast Reduction, where specific fatty areas can also be contoured.

Contraindications

  • If the person is having unrealistic  expectations
  • Person is having poor physical health
  • Person went down crash dieting immediately prior to consultation
  • Obesity is morbid

Laboratory Studies

  • A Complete Blood Count, to see the hemoglobin level, especially important when performing large volume liposuctions, in which a large blood volume may be lost.
  • clotting studies
  • Electrolytes
  • Urinalysis
  • Radiographs
  • Imaging Studies
  • Chest radiograph
  • ECG

Relevant Anatomy

  • There are two main layers of subcutaneous fat, deep and superficial.
  • Liposuction would be primarily focused on the deeper layer of fat since suctioning is safer and easier there.
  • Suctioning in the superficial layer allows the surgeon to achieve subtle benefits in the Procedure.

Types of infiltration techniques

  • Historically, there are 4 different infiltration techniques would be used for suction-assisted lipectomy (SAL): dry, wet, superwet, and tumescent.

Dry

  • Fluid would not be injected into the subcutaneous fat layer before sucking.
  • Around  25-45% volume of blood is aspirate.
  • This technique would not be used commonly in large volume suctions.

Wet

  • This technique is  pioneered by Illouz in the early 1980s.
  • An infusion of 100-300 cm3 of saline is to be injected into each site of fat,it is  removed before suctioning.
  • The aspirated blood volume would be lowered to 20-25% of the total aspiration.
  • Hettler’s addition of 1:200,000 to 1:400,000 epinephrine / adrenaline to the pre-suctioning fluid in 1983 reduced blood loss even more. Less than 15% of blood is aspirated.

Superwet

  • This technique was devised in the late 1980s.
  • It consists of an infusion of fluid containing epinephrine and low doses of local anesthetic in a 1:1 ratio for the volume of expected aspirate.
  • Blood loss is reduced to approximately 2% of the aspirated volume.

Tumescent  

  • In Tumescent technique (or wet method) administered the injection into the tissues prior to commencing liposuction.
  • A solution of normal saline, local anaesthetic and vasoconstrictor agents has been found to increase the amount of fat removed and also decrease the amount of post-operative bruising.
  • In the tumescent technique, large volumes of dilute lidocaine and epinephrine are injected into the subcutaneous fat before the procedure.
  • Klein described this technique in 1990.
  • Large volumes of saline containing 1:100,000 epinephrine and 2% lidocaine were injected subcutaneously before suctioning until the tissues were tense.
  • The injected fluid volume was greater than that expected to be suctioned.
  • Blood loss is approximately 1% of the aspirated volume.
  • Most modern liposuction is a combination of these 2 techniques.

Tumescent   Liposuction Procedure

  • On the day of surgery, medicine to be given a person to help them relax and then the area to be liposculpted is outlined with a marker.
  • Preoperative photographs are to be taken for documentation.
  • The marked area is numbed with a local anesthetic and then a large amount of dilute anesthetic solution is carefully injected into the fat deposits
  • In this procedure, We wait 30 to 45 minutes for the anesthetic to get completely numb the area
  • The deep fatty layers is to be systematically suctioned using a series of small tubes  / cannulas  which is to be inserted through small cut and attached to a suction.
  • There is virtually no blood loss.
  • In addition to being much safer than liposuction performed under general anesthesia
  • The tumescent technique also allows the surgeon,patient to stand up closing of the procedure to assess for in-completely removal of fat deposits.
  • Bruising and pain are also reduced with this technique.
  • At the closing of the procedure, the small incisions are bandaged
  • A compression garment / bandage would be applied to prevent bleeding and reduce swelling.

Post Procedure

  • Although patients are completely ambulatory for this surgery, it is recommended resting for the initial postoperative period.
  • Person is getting minimal to moderate pain and it can be treated with oral medication.
  • Patients can usually return to normal activities within a week, but vigorous activity should be avoided for several weeks.
  • Person should be worn the compression garment 24/7 for the first six weeks to maximize flattening of the site and adherence of the skin and remaining fatty layer to the muscles of the body.