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The History of Liposuction
In the late 1970's, liposuction or suction lipolysis was developed so that localized fat could be surgically removed without leaving a significant scar. The most recent innovation is referred to as the tumescent or wet technique. Dr. Jeffrey Klein, a dermatologist who wanted to reduce the risk of the procedure as well as improve the healing time and the cosmetic results of liposuction, developed the tumescent technique.
Although exceptions exit, liposuction is designed for people who are close to their normal weight and have found that through diet and exercise they are unable to rid themselves of unwanted fat deposits. A typical example is the saddlebag or "riding breech" deformity on the upper outer thigh. This is often an inherited problem that persists despite vigorous exercise and dieting. The fat deposits collect in the hip, buttocks, and thigh areas creating a silhouette in the shape of a violin. This problem can be corrected with liposuction.
A more shapely and attractive leg can be created with liposuction by removing excess fat on the inner and outer thigh, the inside of the knee, and the upper portion of the calf and ankle. Liposuction is not limited to buttocks and limbs. Fat may be removed from the abdomen of individuals who have muscle ton and skin elasticity. Liposuction of the neck, jowls, and cheeks gives a better profile without the need for more extensive surgery. This procedure can also be used for reduction of excess fat in the arms and in the lateral portion of the breasts. Men appreciate the benefits of liposuction for reducing their love handles and pot bellies.
For the safety of the patient and medical staff, pre-operative blood tests are done. These tests are done the week prior to the surgery. The tests are done include tests for HIV, hepatitis B, hepatitis C, and blood stability.
Finally, on the day of the procedure, prior to the beginning of surgery the locations of the fat to be removed are mapped out on the skin with a permanent ink pen while the patient is standing so the effects of gravity can be noted.
Next, the incision sites are anesthetized and the incisions are made. Needles are then inserted through the incisions to introduce the medicated saline solution into the subcutaneous fat. The actual injection of the solution is almost painless.
The bulk of the solution is made up of saline, which is similar to the make up of the body's fluids. Four medications are added to the saline: lidocaine, epinephrine, bicarbonate, and cortisone. Lidocaine is a local anesthetic, which numbs the area to be treated. Post-operative discomfort is also minimized since the local anesthesia remains in the surgically treated areas for approximately 18 hours after surgery. Any further discomfort can be managed comfortably with an analgesic such as Tylenol.
Epinephrine, which temporarily shrinks capillaries, dramatically reduces both the bleeding during surgery and bruising after surgery. Most patients can return to work and begin exercising again within a day or two after surgery.
The tumescent solution is buffered with bicarbonate with brings the pH of the solution closer to that of the body.
The mild cortisone controls inflammation, which in turn results in less post-operative swelling and discomfort.
The tumescent technique also dictates the use of very small circular cannulas to suck out the fat. These small cannulas allow the surgeon better control over the direction, depth and amount of fat removed during surgery. This reduces the risk of irregularities. Because smaller cannulas are used, only small incisions are required. The incisions are so small that sutures are not necessary.
A waiting period of 30 to 90 minutes takes place after the area has been well infiltrated with a large volume of tumescent solution. This allows the local anesthetic and blood vessels constrictor to take effect to ensure the area is completely numb and that bleeding will be minimal.
A suction cannula is then inserted into the targeted layer of fat through the small incision. The cannula is connected to a machine that provides a gentle suction force. The small cannula is pushed back and forth in several directions through the saline engorged fat; the fat is sucked into a reservoir bottle. It is important that the surgeon leaves a small layer of fat under the skin to avoid puckering and to maintain a soft, supple feel to the skin.
Once an adequate amount of fat has been removed, absorbent pads are placed over the tiny incisions and held in place by a pressure garment (binder). The incisions are not sutured in order for the remaining solution to drain off into the pads. This helps minimize swelling, bruising, and soreness.
Eighty percent of the tumescent solution is absorbed into the body and excreted in the urine and 20% is either sucked out with the fat or drained out through the tiny incision sites. The solution that drains from the incision is 98% saline solution and 2% blood. The blood gives the solution a red appearance. Drainage is greater immediately after the procedure and gradually subsides over 2 to 4 days for larger areas and 1 to 4 days for smaller areas such as under the chin. The binder is to be worn continuously for the first four days and on and off for the following 2 weeks.
The tumescent liposuction technique employs a few 4mm-entry sites that heal rapidly and are not noticeable 6 months after the procedure.
Body movement and physical activity is encouraged after tumescent liposuction because it facilitates drainage of the residual solution. Normal activities may be resumed within 48 hours of tumescent liposuction but activities should be restricted to 25% of that which would normal take place, then gradually built up to a full routine by the end of 1 or 2 weeks. 24 hours after tumescent liposuction a person may begin driving a car, shopping, working, and low impact exercising. High impact sports should be delayed for a few weeks and integrated slowly.
Dr. William Hanke recently completed a survey that demonstrated the safety of the tumescent liposuction technique. Sixty-six dermatological surgeons reported that were no transfusions, hospitalizations, or major complication in the 15,000 cases reviewed utilizing the tumescent technique. Nevertheless, all precautions are taken and side effects may occur even in the best of hands.
Ultrasonic liposuction is a new technique where sound waves are passed along the cannula causing emulsification of the fat prior to aspiration. This allows the surgeon to get close to the skin surface while reducing the risk of unevenness and wrinkling. Many surgeons feel the ultrasonic technique provides an added dimension of safety in high volume fat removal, particularly when combined with the tumescent technique.
Image Cosmetic Center is the first facility in the Atlanta area, and one of the first in the Southeast offering Morwekk America(tm) equipment, the recognized leader in liposuction. |
