LIPOSUCTION

Those stubborn areas of fat that we have tried to exercise or diet away haven't responded. It can be pretty frustrating when we know we're doing everything we should. The exciting news is that with the new liposuction techniques developed in the past few years, we can finally address those fat bulges. Areas on the body that can be effectively treated with liposuction are the abdomen, hips, buttocks, thighs, arms and face, knees ands ankles. Liposuction-a suction-assisted procedure that removes fat cells from certain areas of the body-can help us achieve our desired look.

Some important facts about liposuction:

• Liposuction may also be referred to as lipoplasty, liposculpture or suction lipectomy
• The best candidates for liposuction are normal-weight people with good skin elasticity and realistic expectations.
• The operation and recovery are generally associated with minimal discomfort.
• Intravenous sedation with local anesthesia is generally used.
• Excess fat is broken up and vacuumed out through a tube called a cannula.
• Cannulas are narrower today, so incisions are very small (sometimes do not even require sutures).
• Different sizes of cannulas are used on different parts of the body.
• Liposuction does not affect cellulite and can sometimes aggravate the condition
• Liposuction is not a cure for overeating; fat can return to the treated areas if you gain weight.

ALTERNATIVES TO SURGERY
In most instances, before considering liposuction, most of us do attempt diet and exercise to see if we can affect our fat stores. Our lack of success is what compels us to seek liposuction. This is a reminder that if you are not at your target weight or are not healthy, you have some work to do before liposuction becomes an option. Liposuction is the only remedy for genetically predisposed fat, and areas that have been resistant to other approaches.

PREPARING FOR SURGERY
Your physician should discuss with you what you do not like about your body. The physician should also make an assessment and show you which areas need to be sculpted to accomplish your objectives. The body is three-dimensional and needs to be sculpted as such. The goal is to have your body look better from all angles.
Prior to surgery, you and your doctor will make several important decisions regarding the location of the incisions and your desired look. You will also be given more specific instructions on pre- and postoperative care which would include information about eating, drinking, smoking and taking vitamins and medications. Carefully following these instructions will help your surgery go more smoothly.

THE PROCEDURE
There are several liposuction techniques mentioned below that can be used to improve the ease of the procedure and enhance the outcome. These techniques may be used in addition to the basic procedure of liposuction. Basic liposuction surgery is performed by making tiny incisions, approximately one-half inch in length or less, near the area where fat is to be removed. A thin, hollow tube, called a cannula is inserted, and is attached to a machine or syringe that creates a strong vacuum. Your surgeon will strategically manipulate the cannula under the skin to remove the unwanted fatty deposits.

Tumescent Liposuction
Tumescent liposuction is a fluid-injection technique that helps to reduce blood loss, and lessen the amount of bruising, fatigue and discomfort. A mixture of salt solution, lidocaine (a local anesthetic) and epinephrine (a drug that contracts blood vessels) is injected intravenously into identified areas before the fat is removed. Since there is very little blood loss, more fat can be removed than in the past. Additionally, because the anesthetic remains in the tissues longer, there is much less postoperative discomfort.

Ultrasonic Assisted Liposuction (UAL)
The main function of UAL is to liquefy fat. There are two methods available to accomplish this, both used in conjunction with the tumescent technique. In external UAL, a stylus emitting ultrasonic sound waves is passed over the areas (on the surface of the skin) to be treated to warm the fat. The fat is then "vacuumed" out via a cannula. Some physicians feel that the external UAL also helps distribute the local anesthetic more evenly into the tissues. However, there is currently no data to prove or support this.

Internal UAL is actually two techniques. In the two-stage technique, a probe emitting ultrasonic sound waves is inserted, and the fat is liquefied. The fat is then vacuumed out via a cannula. Because of the possibility of greater complications with this technique, the physician requires additional specialized training. Verify your physician's certificates in this procedure. In the one-stage internal UAL technique, a special cannula (a combination of cannula and probe) emitting ultrasonic sound waves is inserted. As the fat is liquefied, it is vacuumed.

Anesthesia
The type of anesthesia used during liposuction is dependent on the extent of the procedure, the doctor's choice, and the patient's medical history or desires. In most cases, liposuction is performed under intravenous sedation with local anesthesia. In some cases, it is performed under general or epidural (spinal block) anesthesia.

Length of Procedure
Liposuction is usually performed on an outpatient basis and takes one to five hours, depending on the areas to be treated.

Level of Pain/Discomfort
Generally, with liposuction there is minimal pain during the preoperative period. Most discomfort can be controlled with prescribed pain medications or Extra-Strength Tylenol.

PRE- AND POSTOPERATIVE INSTRUCTIONS
The following suggestions are intended to make you feel more comfortable and help you heal:

• Stop smoking, discontinue the use of alcohol, and stop taking vitamin E and any medications containing aspirin or ibuprofen (two weeks pre- and preoperative is usually recommended). Check with your doctor regarding any other medications (including homeopathic/herbal products) that you are currently taking.
• Have someone drive you to and from surgery.
• Have someone stay with you the first night after surgery (optimally, the first twenty-four hours).
• Dressings-if the procedure requires a preoperative garment (to wear 4 to 6 weeks after surgery), it may be provided. You may want to purchase a second garment to wear while you launder the other.
• No aerobic activity for at least three weeks after surgery.

RECOVERY
You may want to sleep the first day after surgery. You could experience tenderness with movement; similar to the way you would feel if you had had an extremely strenuous workout. However, most patients are able to walk around fairly easily directly after surgery.
You can expect to experience some swelling and bruising after surgery. By the third week, you may still have some minor swelling, which can last for months (as long as six to nine). However, the bruising should be gone by the third week but could possibly last for six weeks. You may be instructed to purchase a tight-fitting garment, known as a compression garment, which is worn after surgery to reduce swelling. This may need to be worn for up to six weeks. Your stitches, however, will be removed within a week-and-a-half if they are not the type that dissolves.

RISKS/COMPLICATIONS
Liposuction is the most popular cosmetic surgical procedure sought by men and women today. It has a very high satisfaction rate among patients. However, even with a talented surgeon, and careful planning, there are risks associated with liposuction. These can include excess bleeding, infection, asymmetry or uneven skin surface, hematoma (collection of fluid under the skin), seroma (collection of serous fluid that can accumulate between the skin flap and muscle). Although, complications with this surgery are extremely rare, excess fluid loss can result in a very serious condition or death. Proper monitoring and stringent postoperative care need to be exercised.

Individuals with medical problems such as diabetes or heart or lung conditions are not good candidates due to the increased risks associated with these diseases.

STILL YOU…ONLY BETTER
Who among us hasn't visualized a more slender, contoured body for ourselves? Once the swelling and the bruising subside, you will begin to be able to see your new body taking shape. At about three months after surgery, you will be able to see the final result from your exciting decision. Your clothes will fit better, and if you continue with a healthy exercise and eating program you will be able to maintain your new look.