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Liposuction, or simply lipo, is a type of cosmetic surgery that removes fat from the human body in an attempt to change its shape.[1] Evidence does not support an effect on weight beyond a couple of months and it does not appear to affect obesity related problems.[2][3]

Liposuction
Dr Vishal Kapoor Performing Liposuction Surgery 01.jpg
A plastic surgeon performing liposuction surgery
Synonyms Lipoplasty, fat modeling, liposculpture, suction lipectomy, suction-assisted fat removal, lipo
ICD-9-CM 86.83
MedlinePlus 002985

Serious complications include deep vein thrombosis, organ perforation, bleeding, and infection.[4] Death occurs in about one per ten thousand cases.[5]

Areas operated on can include the abdomen, thighs, buttocks, and backs of the arms. The procedure may be performed under general, regional, or local anesthesia. It then involves using a cannula and negative pressure to suck out fat.[6] It is believed to work best on people with a normal weight and good skin elasticity.[6]

While the suctioned fat cells are permanently gone, after a few months overall body fat generally returned to the same level as before treatment.[2] This is despite maintaining the previous diet and exercise regimen. While the fat returned somewhat to the treated area, most of the increased fat occurred in the abdominal area. Visceral fat - the fat surrounding the internal organs - increased, and this condition has been linked to life-shortening diseases such as diabetes, stroke, and heart attack.[2]

In the United States it is the most commonly done cosmetic surgery.[6][7]

Contents

UsesEdit

Liposuction is generally used in an attempt to change the body's shape.[1] Weight loss from liposuction appears to be of a short term nature with little long term effect.[2] After a few months fat typically returns and redistributes.[2] Liposuction does not help obesity related metabolic disorders like insulin resistance.[3]

Side effectsEdit

  • Bruising: can be painful in the short term, and should fade after a few weeks.
  • Swelling (medical): should subside gradually over a month or two.
  • Scars: will vary in size depending on the particular procedure, and should fade over the weeks. Scarring is an individual thing, partly dependent on heredity. For some, scar healing may take as long as a year.
  • Pain: should be temporary and controlled by either over-the-counter medication or by a prescription, but may become chronic.
  • Numbness: sometimes persists for a few weeks or be permanent.
  • Post-liposuction fat redistribution or post liposuction weight gain[8]
  • Limited mobility: will depend on the exact procedure.

There could be various factors limiting movement for a short while, such as:

  • Wearing a compression garment
  • Keeping the head elevated
  • Temporary swelling or pain

ComplicationsEdit

There is a spectrum of complications that may occur due to liposuction -- risk is increased when treated areas cover a greater percentage of the body, incisions are numerous, a large amount of tissue is removed, and concurrent surgeries are done at the same time.

When done using local anesthesia the risk of side effects appear less than with general anesthesia.[4] In Europe between 1998 and 2002, 23 deaths mostly from infection occurred.[4]

The more serious possible complications include:

  • Death
  • Allergic reaction to medications or material used during surgery.
  • Infection: any time the body is incised or punctured, bacteria can get in and cause an infection. During liposuction, multiple small puncture wounds are made for inserting the cannula that can vary in size depending on the technique.
  • Seroma: Sometimes the entrapped liquified fat may get accumulated beneath the subcutaneous plain as a seroma. Small seromas get absorbed spontaneously, but larger seromas need aspiration to avoid secondary infection.
  • Damage to the skin.
  • Sometimes the cannula can damage tissue beneath the skin, which may show up as a spotted appearance on the skin surface.
  • Skin necrosis occurs when the skin above the liposuction site changes color and falls off. Large areas of skin necrosis may become infected with bacteria or microorganisms.
  • Puncture of an internal organ: since the surgeon cannot see the cannula during liposuction, sometimes they perforate an internal organ, such as the intestines.
  • Contour irregularities: sometimes the skin may look bumpy and/or withered, because of uneven fat removal, or poor skin elasticity.
  • Thromboembolism and fat embolism: although liposuction is a low-risk procedure for thromboembolism including pulmonary embolism, the risk cannot be ignored.[9]
  • Burns: sometimes the cannula movement can cause friction burns to skin or nerves. Also, in UAL, the heat from the ultrasound device can cause injury to the skin or deeper tissue.
  • Lidocaine toxicity: when the super-wet or tumescent methods are used, too much saline fluid may be injected, or the fluid may contain too high a concentration of lidocaine. Then the lidocaine may become too much for that particular person’s system. Lidocaine poisoning at first causes tingling and numbness and eventually seizures, followed by unconsciousness and respiratory or cardiac arrest.
  • Fluid imbalance: since fat contains a lot of fluid and is removed in liposuction, and since the surgeon injects fluid for the procedure, even a very large amount of it for tumescent liposuction, there is a danger of the body’s fluid balance being disturbed. This could happen afterwards, after the patient is at home. If too much fluid remains in the body, the heart, lungs and kidneys could be badly affected.

CandidacyEdit

One might question who is a good candidate for increased visceral fat, which the procedure causes.[10] It is not a good alternative to dieting or exercising. To be a candidate, one must usually be over 18 and in good general health, have an ongoing diet and exercise regimen, and have fatty pockets of tissue available in certain body areas. Significant disease limiting risk (e.g. diabetes, any infection, heart or circulation problems) weigh against the eligibility of a person for the procedure.[citation needed] In older people, the skin is usually less elastic, limiting the ability of the skin to readily tighten around the new shape. Liposuction of the abdominal fat should not be combined with simultaneous tummy tuck procedures due to higher risk of complications and mortality. Laws in Florida prevent practitioners combining liposuction of the upper abdomen and simultaneous abdominoplasty because of higher risks.[citation needed]

TechniquesEdit

 
Liposuction aspirate

In general, fat is removed via a cannula (a hollow tube) and aspirator (a suction device). Liposuction techniques can be categorized by the amount of fluid injection and by the mechanism in which the cannula works.

The marketing that goes on makes it hard for the consumer to determine truth from exaggeration.

Ultrasound-assisted liposuctionEdit

Ultrasound-assisted liposuction techniques used in the 1980s and 1990s were associated with cases of tissue damage, usually from excessive exposure to ultrasound energy.[11] Third-generation UAL devices address this problem by using pulsed energy delivery and a specialized probe that allows physicians to safely remove excess fat.[12] Surgeons found that in some cases, the UAL method caused skin necrosis (death) and seromas, which are pockets of a pale yellowish fluid from the body, analogous to hematomas (pockets of red blood cells).[citation needed]

 
A 40-year-old woman undergoing a combination liposuction and abdominoplasty. Power-assisted liposuction: the cannula is inserted to about 80% of its full length.

SuturesEdit

Doctors disagree on the issues of scarring with not suturing versus resolution of the swelling allowed by leaving the wounds open to drain fluid. Since the incisions are small, and the amount of fluid that must drain out is large, some surgeons opt to leave the incisions open, the better to clear the patient's body of excess fluid. They find that the unimpeded departure of that fluid allows the incisions to heal more quickly. Others suture them only partially, leaving space for the fluid to drain out.[13] Others delay suturing until most of the fluid has drained out, about 1 or 2 days. In any case, while the fluid is draining, dressings need to be changed often. After one to three days, small self-adhesive bandages are sufficient.

PreparationEdit

Before receiving any of the procedures, no anticoagulants should be taken for two weeks before the surgery. If general anesthesia or sedation will be used, and the surgery will be in the morning, fasting from midnight the night before is required. If only local anesthesia will be used, fasting is not required. Smoking of tobacco must be avoided for about two months prior to surgery, as nicotine interferes with circulation and can result in loss of tissue. Bruising can be seen in people who smoke post surgery.

UsageEdit

Removal of very large volumes of fat is a complex and potentially life-threatening procedure. The definition of "large volume liposuction" varies in the plastic surgery literature, no strict definition exists, and the term is arbitrary; every body is unique, so there is no "One Size Fits All" definition. Most often, liposuction is performed on the arms, abdomen, buttocks, and thighs in women, and the chest, abdomen, and flanks in men. Liposuction was the most common plastic surgery procedure performed in 2006 with 403,684 patients and in the year 2011 with 1,268,287 patients.[14]

HistoryEdit

Relatively modern techniques for body contouring and removal of fat were first performed by a French surgeon, Charles Dujarier. A 1926 case that resulted in gangrene in the leg of a French model in a procedure performed by Dr. Dujarier set back interest in body contouring for decades.[15]

Liposuction evolved from work in the late 1960s from surgeons in Europe using primitive curettage techniques which were largely ignored, as they achieved irregular results with significant morbidity and bleeding[citation needed]. The invention of modern liposuction procedure is linked to the name of two Italian gynecologists, Arpad and Giorgio Fischer, who created the blunt tunneling[16] method in 1974. Then, liposuction first burst on the scene in a presentation by the French surgeon, Dr Yves-Gerard Illouz, in 1982.[citation needed]

Another French surgeon, Pierre Fournier[citation needed] used lidocaine as local anesthetic, modified the incision technique, and began to use compression after the operation. During the 1980s, many United States surgeons experimented with liposuction, developing some variation sedation rather than general anesthesia. Concerns over the high volume of fluid and potential toxicity of lidocaine with tumescent techniques eventually led to the concept of lower volume "super wet" tumescence.

Practitioners often report that many of the modern technologies touted to improve liposuction are simply advertising hooks.

See alsoEdit

NotesEdit

  1. ^ a b Dixit, VV; Wagh, MS (May 2013). "Unfavourable outcomes of liposuction and their management". Indian Journal of Plastic Surgery. 46 (2): 377–92. doi:10.4103/0970-0358.118617. PMC 3901919 . PMID 24501474. 
  2. ^ a b c d e Seretis, Konstantinos; Goulis, Dimitrios G; Koliakos, Georgios; Demiri, Efterpi (2015). "Short- and Long-Term Effects of Abdominal Lipectomy on Weight and Fat Mass in Females: A Systematic Review". Obesity Surgery. 25 (10): 1950–8. doi:10.1007/s11695-015-1797-1. PMID 26210190. 
  3. ^ a b Seretis, K; Goulis, DG; Koliakos, G; Demiri, E (December 2015). "The effects of abdominal lipectomy in metabolic syndrome components and insulin sensitivity in females: A systematic review and meta-analysis". Metabolism: clinical and experimental. 64 (12): 1640–9. doi:10.1016/j.metabol.2015.09.015. PMID 26475176. 
  4. ^ a b c Tierney, Emily P.; Kouba, David J.; Hanke, C. William (December 2011). "Safety of tumescent and laser-assisted liposuction: review of the literature". Journal of Drugs in Dermatology. 10 (12): 1363–9. PMID 22134559. 
  5. ^ Draelos, Zoe (2011). Cosmetic Dermatology: Products and Procedures. John Wiley & Sons. p. Chapter 56. ISBN 9781444359510. 
  6. ^ a b c Norton, Jeffrey A. (2012). Surgery Basic Science and Clinical Evidence. Berlin, Heidelberg: Springer Berlin Heidelberg. p. 2014. ISBN 9783642572821. 
  7. ^ Khan, MH (November 2012). "Update on liposuction: clinical pearls". Cutis. 90 (5): 259–65. PMID 23270199. 
  8. ^ Hernandez, Teri L; Kittelson, John M; Law, Christopher K; Ketch, Lawrence L; Stob, Nicole R; Lindstrom, Rachel C; Scherzinger, Ann; Stamm, Elizabeth R; Eckel, Robert H (2011). "Fat Redistribution Following Suction Lipectomy: Defense of Body Fat and Patterns of Restoration". Obesity. 19 (7): 1388. doi:10.1038/oby.2011.64. PMID 21475140. 
  9. ^ Liposuction Information Archived 2006-06-16 at the Wayback Machine. from the FDA
  10. ^ Hernandez, Teri L; Kittelson, John M; Law, Christopher K; Ketch, Lawrence L; Stob, Nicole R; Lindstrom, Rachel C; Scherzinger, Ann; Stamm, Elizabeth R; Eckel, Robert H (2011). "Fat Redistribution Following Suction Lipectomy: Defense of Body Fat and Patterns of Restoration". Obesity. 19 (7): 1388. doi:10.1038/oby.2011.64. PMID 21475140. 
  11. ^ Jewell, M (2008). "Innovation in Plastic and Aesthetic Surgery Lipoplasty". Innovations in Plastic and Aesthetic Surgery. pp. 443–53. doi:10.1007/978-3-540-46326-9_55. ISBN 978-3-540-46321-4. 
  12. ^ De Souza Pinto, Ewaldo Bolivar; Chiarello De Souza Pinto Abdala, Priscila; Montecinos Maciel, Christovam; De Paula Turchiari Dos Santos, Fabiana; Pessoa Martello De Souza, Rodrigo (2006). "Liposuction and VASER". Clinics in Plastic Surgery. 33 (1): 107–15, vii. doi:10.1016/j.cps.2005.09.001. PMID 16427979. 
  13. ^ MedlinePlus Medical Encyclopedia: Liposuction
  14. ^ http://www.isaps.org/Media/Default/global-statistics/ISAPS-Results-Procedures-2011.pdf[full citation needed]
  15. ^ Glicenstein, J (1989). "L'affaire Dujarier" [Dujarier's case]. Annales de Chirurgie Plastique Esthétique (in French). 34 (3): 290–2. PMID 2473691. 
  16. ^ "Coleman III, William. P.: The History of Liposculpture". Retrieved 2013-08-25. 

External linksEdit