The concept of liposuction is surprisingly simple. Liposuction is a surgical technique that improves the body contour by removing excess fat deposits located between the skin and muscle. Liposuction is the removal of unwanted lumps, bulges, and areas of fat using thin suction tubes (cannulae) that are placed into the body fat through small incisions. A vacuum is applied through a hose attached to the cannula. This draws fat out of the body.

Is liposuction an alternative to weight loss programmes?

No, Liposuction is usually not intended as a weight-loss technique. Liposuction is commonly used to remove stubborn, diet- and exercise-resistant fat deposits and to sculpt the body into a slimmer profile. It should be clearly understood that liposuction is a cosmetic surgical method of improving the shape of the body and not a method of reducing 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.

Mechanism of liposuction

Liposuction surgery removes fat by two mechanisms.

• Removal of fat cells: When liposuction is performed, the cannula is passed through the fat to create tunnels and fat cells are removed from the body.
• Damaging the fat cells: The motion of the cannula damages many of the remaining fat and other fibrous cells. These remaining damaged fat cells get absorbed slowly .

Is liposuction a new procedure?

Yes, liposuction is a relatively new form of cosmetic surgery. However, it has, nevertheless, become a very commonly performed cosmetic procedure. It is interesting to note that the procedure was first described by a Italian gynecologist DR Giorgio Fischer (thus Dr. Jayashree is only continuing this tradition-over 1/3 of doctors who undergo training in liposuction are obstetricians). In India, while the procedure has been performed by plastic surgeons in the conventional method, microcannular tumescent liposuction totally under local anesthesia is a very new procedure.

What are the methods of liposuction?

Liposuction can be accomplished in many ways:

• Conventional liposuction using large cannulae under general anesthesia-this is largely used by plastic surgeons. It uses larger cannulae to remove fat and hence is faster. However , it needs hospitalization and has several disadvantages( see under tumescent liposuction)
• Microcannular tumescent liposuction totally by local anesthesia-also called tumescent anesthesia.

History of liposuction

Liposuction was initially developed in 1978-1982 in Italy and France, and introduced into the United States in 1982. At that time liposuction could only be performed under general anesthesia and was called dry liposuction when no fluid was introduced in to fat. Later a small amount of fluid was introduced in to fat and was referred to as the wet technique.

These methods were associated with so much blood loss that patients frequently required hospitalization and blood transfusions. In 1985, Dr. Jeffrey A. Klein, M.D., a dermatologist in California, revolutionized liposuction surgery when he developed the tumescent technique, which permits liposuction totally by local anesthesia and virtually eliminates surgical blood loss. Because the tumescent technique is by far the safest form of liposuction, it has become the world wide standard of care. Not only has the tumescent technique proven to be safer than the older techniques that required general anesthesia, it has also proven to be less painful, has minimized post-operative recovery time, and has produced optimal cosmetic results.

Previously (and even now by most doctors) , liposuction has been performed as follows:

1. General anesthesia
2. Introduction of small amount of fluid
3. Making large incisions ( 1.5 cms) to introduce cannulae
4. Sucking the fat out through large cannulae 1cm in diameter
5. Suturing the incision wounds of cannulae

While the procedure was quick (lasting 2-3 hours) and thus saved time for the surgeon, it had several disadvantages:

• Since the method was under general anesthesia, patient had to be hospitalized
• This added significantly to the cost.
• General anesthesia always has its risks.
• Use of large cannulae causes damage to tissue and hence bleeding is more.
• Since large cannulae were used to suck out fat rapidly, these needed large incisions which had to be stitched leaving behind significant scars.
• Recovery time was slow, as after any procedure under general anesthesia.

The "Art of Liposuction"

Liposuction is a medium of artistic expression that displays itself in (1) a practical application of scientific knowledge, (2) the production of what is beautiful, (3) a perfection of workmanship, (4) a perpetual quest for improvement in technique, and (5) a skill attained through clinical experience, and above all (6) making people feel happy about what they see in the mirror.

In liposuction, maximum speed and maximum volume of aspirate are not the criteria for excellence. Ultimately, excellence is measured in terms of patient happiness which is a function of safety, patient comfort, finesse, and quality of results.

We practice the safest form of liposuction in our centre as DR Jayashree has been trained by DR Klein, father of modern tumescent liposuction.

Indications for liposuction

What is fat?

Fat is an yellowish tissue containing cells filled with chemicals such as cholesterol, triglyceride etc. The source of fat is the diet we eat. Fat performed important functions in animals, such as temperature regulation and protection. With evolution, these functions have lost their importance in man. On the contrary, excess fat is associated with several health problems such as heart disease, diabetes, stroke, hypertension, hormone problems such as infertility etc.

Where is fat normally present?

Most of the fat is present in the skin- in an inner layer called subcutaneous layer. Smaller amounts are also present in side the abdomen. Fat in the skin contributes to the shape and appearance of the person. However, it is not uniformly distributed. Several areas such as buttocks, thigh s abdominal wall have greater amount of fat. When a person puts on weight, fat tends to get distributed more in these areas.

Does the total number of fat cells in the body increase as a person gains weight?

In the initial phase , when a person is gaining weight, there is an increase in the size of fat cells. However, there is a maximum size to which fat cells can grow. With significant weight gain new fat cells are created from other body cells called fibroblasts. Hence there is an increase in both the size and number of fat cells in the human body , when a person gains a large amount of weight. When a patient loses amount of weight by dieting, the fat cells simply shrink in size, but do not necessarily diminish in number. It is far more difficult to decrease this number of fat cells. Liposuction is a method of decreasing the fat cell number.

What is resistant fat?

In women and men, fat deposits may be formed beneath the chin and on the flanks, hips, abdomen, inner and outer thighs, knees, and lower legs. This fat does not reduce even after dietary programmes and slimming machines and is called resistant. Liposuction is a procedure to remove such fat and bring about improvement in appearance of the person.

Why is liposuction required?

Fat located in any area of the body, and especially the abdomen, hips, and under the chin is often resistant to diet or exercise. Similarly, after pregnancy, the fat on the abdomen and hips may persist despite concerted efforts at dieting and exercising. Further, Localized accumulations of fat are often inherited and frequently impossible to eliminate by exercise or dieting. After the age of 30, an individual often gains fat according to a genetically predetermined pattern. For these people, liposuction is the only realist means of significantly changing the body’s silhouette. In effect, liposuction is equivalent to being able to focus the effects of dieting to specific areas of the body.

What are the common areas in which liposuction is useful?

The most frequently treated areas in women are the abdomen, hips, thighs, and knees. In men, the love handles (flanks), abdomen, and enlarged male breasts (gynecomastia) are most often treated. Other areas treated in men include the arms, neck, and face. Interestingly, sweat glands in the underarm can be removed by liposuction to reduce excessive sweating. Chin is another area which can be treated by liposuction.

Who is a good candidate for liposuction?

The best candidates are those in good health, have localized deposits of fat , are not grossly obese and have realistic expectations of what liposuction can accomplish. Liposuction can provide a good candidate with a significant improvement. It should be noted that like any cosmetic procedure, patient should not expect 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. 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.

Can liposuction be used for female breast reduction? What about in men?

Yes, tumescent liposuction is a very effective method of breast reduction for both women and men with very rapid recovery. For women liposuction typically reduces the breast size by 35% to 45%, and produces a noticeable elevation or lifting of the breasts. Liposuction elevates the female breasts by removing fat and reducing the weight of the breasts, thus permitting the natural elasticity of breast tissues to contract and give the breast a noticeable lift. Postoperative recovery after liposuction of female and male breasts is very quick, with patients typically able to return to work in one to three days.

How much fat can be removed? How many pounds?

The maximum amount of fat that can be removed safely is probably about 6 to 8 pounds (3 to 4 liters). The greater the volume of fat removed on a single day the greater the risk of serious complications. If a patient requires more than 6 to 8 pounds of fat, it is safer to divide the liposuction into separate surgical procedures each separated by 3 to 4 weeks.