Liposuction
(Liposculpture)

Several different liposuction methods exist, and they have been developed, in part, to enable practitioners to treat patients without the need for using in-patient hospital facilities and general anaesthesia.

The original method is often called suction-assisted lipectomy. It involves using a sterile metal tube attached to a vacuum pump, which a surgeon passes through subcutaneous fat deposits, sucking up the fat and depositing it in the vacuum pump’s storage bottle. It is very similar, in principle, to your domestic vacuum cleaner and used expertly, in the correct tissue planes, it is very effective.

Prior to suction the areas to be treated are infiltrated with a solution of saline, adrenaline (to decrease bleeding) and local anaesthetic solution, which allows larger volumes to be sucked away safely in one go. There are two variants to this method: ‘super-wet’ and ‘tumescent’ liposuction. More fluid is used in tumescent liposuction allowing it to be used without general anaesthesia. I always perform liposuction under general anaesthesia, so I infiltrate volumes in the ‘super-wet’ range.

When surgeons talk about liposculpture, they are simply saying that they use their liposuction equipment to sculpt the subcutaneous tissues by targeting different areas of fat at different levels and to different degrees to try and achieve the aesthetic result you desire.

This is best decided during a consultation, but the best candidates for liposuction are physically and mentally healthy adults who despite exercise and a healthy lifestyle have localised deposits of superficial fat that resist all efforts to shift them.

You are likely, therefore, to be within 10Kg (20 lbs) of your ideal weight.

If you are hoping this will represent a quick way to lose weight, this is not the operation for you. Likewise, if you have loose folds of skin after weight loss, or your skin is relatively inelastic, I am likely to suggest an alternative treatment to achieve your goals realistically.

Also, if you are a smoker, you will be asked to stop smoking for six weeks before surgery and to avoid inhaling other peoples’ smoke secondarily. Smoking significantly increases the risk of postoperative complications and often ruins the results of this operation, so I do not perform this operation on smokers.

As outlined above, I perform a ‘super-wet’ variant of suction assisted lipectomy when treating the abdomen and the legs. This requires general anaesthesia. Before surgery I will make guidance marks on your skin, then these regions are injected with wetting solution (saline, adrenaline, and local anaesthetic) after which inconspicuous incisions used to introduce the suction canulae through which fat is sucked away in several planes to achieve an even, sculpted and aesthetic result.

During your consultation, I will take a full medical history and ask you specifically about any medical conditions you may have, as well as any previous surgery you have undergone. I may need to write to surgeons who have operated on you in the past to discover what you have had done, so the more detailed information you can bring with you, the better.

I will examine you completely, then focus on the areas you wish to have treated with liposuction to assess whether you have muscle or soft tissue herniae there, and to assess the size, symmetry, and shape of your excess subcutaneous fat. I will also look at the quality and elastic tone of your abdominal skin.

Finally, I will then take standardised-view photographs in order to help plan and discuss your operation. During this discussion I will explain about the advantages and disadvantages, side effects and possible complications of liposuction.

Before surgery, you will meet and be assessed by your anaesthetist who will prescribe medications for your comfort and to lessen anxiety if need be.

On the evening before, or the morning of your operation I will review what we have discussed and planned previously, and we will both sign your operative consent forms. Then I will draw the guidance lines on your skin to indicate the areas to be treated with liposuction.

The operation is performed under General Anaesthesia so you will be asleep. The procedure takes a variable amount of time depending on how much is being removed from how many areas. As an illustration, extensive liposuction to the abdomen and both legs may take 1 – 2 hours.

After surgery you will be monitored in a recovery area. You will have some discomfort following surgery for which you will receive pain relief. You will able and encouraged to walk with help within 8 – 12 hours of surgery to maximize your recovery.

Typically, you will leave hospital the next day.

Following surgery, you will wear a compression garment for three weeks, 24 hours a day; 7 days a week (except when washing it or you!) and then during the night for the next two weeks as this helps resolve the bruising and swelling that will form in the areas treated. Most of it will resolve over 2-3 weeks and even before that, you will see an improvement in contour and shape of the treated areas, but your final result will mature over 3-6 months. When you are discharged from hospital, someone must drive you home and someone must stay with you to assist you the first few days whilst at home.

You will feel tired and sore for about a week after liposuction but maybe more or less depending on your tolerance and the extent of liposuction. Again, depending on your occupation, your tolerance and the extent of the liposuction you have had, you will be able to return to work in 1-2 weeks.

The scars from this procedure are multiple, short ones, designed to heal inconspicuously. That said scar healing is dependent on multiple competing factors which include: my surgical technique; wound tension and position; any post-operative trauma and infection; but mostly on your genetic makeup. I lend my expertise to provide you with the least noticeable scar possible, but because everyone’s result is unique, wound healing and your abdominal scar appearance are only partly under my control.

All new scars benefit from friction-free massage (using Vaseline, for instance, to lubricate the massaging process). Beginning to massage scars two to three weeks after surgery, will help them mature, soften and flatten faster than if left to their own devices.

New scars should be protected from sunlight for 2 years to avoid them pigmenting differently to the surrounding skin and becoming a different colour permanently. Factor 15 sun block should be applied whenever they are exposed – even to a British winter sun.

Finally, you must realise that you can still gain weight and deposit fat in the areas that have been treated as not all fat has been removed from these regions, so if you gain over 10 Kg in body weight, the chances are these regions will fill out again although usually with a better contour.