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Liposuction
Overview
Liposuction has recently
become one of the most sought after plastic surgery procedures. It effectively removes fat that cannot be lost by diet or
exercise. In addition, the fat cells that are removed are
gone forever. Most people have at least some areas of fat
on their bodies that just will not to go away no matter how
hard they diet and exercise. This is a common complaint. The fact is, both men and women have characteristic fat areas
that do not seem to go away. In men, these areas tend to
be around the abdomen and the love handles. In
women, fat accumulation tends to occur on the hips, flanks,
thighs, and, to a lesser extent, abdomen. These are the areas
where liposuction works best.
Even though liposuction removes fat,
it is best performed on people who are not markedly overweight. The ideal candidates are the people who are within 30 to 40
pounds of their ideal body weight and have localized areas
of fat. Liposuction can, and often is, used to treat multiple
areas. It is not uncommon to do the abdomen, hips, flanks,
and thighs all at one time.
Liposuction works best on people who
have skin that is healthy and able to stretch back when the
fat is removed. People who have poor skin, which usually
includes the elderly, or have a lot of fat to be removed from
one area will not receive an outstanding result. They will
certainly benefit, but because their skin is incapable of
stretching back exactly where it should, it may not resume
the ideal contour of the body. In these cases, it is sometimes
necessary for some skin to be removed. This is often the
case when there is a significant amount of loose skin within
the abdomen. Often, liposuction alone is inadequate and an abdominoplasty might be necessary.
Other areas that can benefit from liposuction
include: the arms, breasts, calves, knees, and area under
the chin. These areas, however, do not respond quite as well
as those mentioned above. Liposuction, especially ultrasonic
liposuction, may help cellulite somewhat but do not expect
dramatic improvements as cellulite remains a difficult problem
to treat.
Liposuction is performed by first infiltrating
the desired fat to be removed with a special fluid. Then,
a small suction cannula is inserted through tiny incisions
to remove the fat.
Dr. Cruise has extensive experience with
liposuction and body contouring. Safety is the number one
concern. This is why he limits the amount of fat to be removed
to 5000 cc's which is the guideline recommended by the American
Board of Plastic Surgery. If more fat needs to be removed,
it can be done more safely as a second procedure. Removing
greater volume subjects the patient to risks that can not
be justified for a cosmetic procedure.
Many people wonder if the fat that is
removed during liposuction will return. The answer to this
is NO. Fat that is removed is gone forever. The reason for
this is that after adolescence, humans lose the ability to
make new fat cells. Obviously, the fat cells that remain
after liposuction can significantly expand. Fat removal from
liposuction is a permanent solution to only the areas operated
on. There is a problem, however, when a person who has had
liposuction in one area gains a significant amount of weight. This additional weight accumulates in the areas other than
where liposuction was performed. This can create contour
irregularities. This can be corrected by either weight reduction
or liposuction in those areas that have gained fat.
 Dr. Cruise's philosophy regarding liposuction
 During consultation, I will take multiple digital pictures of the areas you are concerned with. At that time, I will display them on the monitor and we will go over exactly what it is you would like to accomplish.
Just about everyone has areas of fat that bother them and do not go away no matter what. For most men, this area is their love handles. God created us such that these areas persist despite dieting and exercise. Liposuction is the only option.
Fat, in certain areas such as the face, is very attractive and associated with youth. Extreme dieting and exercise, while it may help to get rid of fat in undesirable areas, will also cause loss of facial fat which creates an old, gaunt appearance. Isn't it ironic? Loss of fat in the body is a good thing but loss of fat in the face is bad. This is why liposuction is extremely useful. It allows selected fat loss where you want it and does not cause facial fat loss where you don't want it. In fact, the fat that is liposuctioned can be transplanted to areas around the eyes and cheeks to create permanent facial rejuvenation. This is an effective way to markedly improve the sunken-in look characteristic of aging, as well as correct fine wrinkles and re-create youthful, prominent cheeks. This is truly a win-win situation.
I am a big advocate of health and nutrition and I will help you with these issues in conjunction with liposuction. This is a way of looking at the big picture to obtain the desired results
Benefits
The main benefit of liposuction is removal
of fat which is resistant to other forms of treatment such
as diet and exercising. A two-hour liposuction procedure
can do what thousands of hours in the gym and unpleasant dieting
could not. It removes areas of fat permanently. Recent research
has shown that fat removal via liposuction has certain health
advantages as well. These health advantages include improvements
in heart disease and diabetes.
Outlined below is a brief review of the
benefits of liposuction.
- Liposuction removes fat that is resistant
to exercise and/or dieting.
- The fat removal is permanent.
- In women, especially useful for abdomen,
hips, flanks, thighs, buttocks, neck, and back.
- In men, especially useful for abdomen,
"love handles", back, neck, and chest.
- It is performed via tiny, hidden incisions.
- It enables to sculpt thighs with a
more desirable contour.
- it Is easily combined with fat injection
for facial rejuvenation.
- Multiple areas can be liposuctioned.
- People of all ages are eligible.
Possible complications
Liposuction in Dr. Cruise's hands rarely has complications but they must be discussed. The most common complications are: inadequate fat removal or contour irregularities. Because Dr. Cruise has extensive experience in liposuction these are uncommon. If they do occur, Dr. Cruise addresses this in several ways including external ultrasound, endermology, selective liposuction, etc. Other possible complications include infection and wound healing problems, decreased skin sensation, and fluid or blood collection.
Are
you a good candidate?
People who make the best candidates for
liposuction are those that are within 30 to 40 pounds of their
ideal body weight and want to have localized fat removed. Liposuction can remove significant amounts of fat but weight
reduction is not the purpose of liposuction. Weight reduction
does occur with large volume liposuction removal but, to be
safe, Dr. Cruise does this over more than one session because
removing too much fat at once can be dangerous.
Brief outline of areas were liposuction
is useful.
- Calves and knees.
- Inner and outer thighs.
- Hips and flanks.
- Buttocks.
- Love handles.
- Back and chest.
- Upper arms.
- Neck and jowls.
Prior to surgery
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Medications. Certain
medications thin your blood and should not be taken within
3 weeks of surgery. The most notable is aspirin and aspirin
containing products. Vitamin E and many herbal products
also thin the blood and should not be used within three
weeks of surgery. Dr. Cruise will go over this more thoroughly
prior to the procedure.
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Sleep. It is important
to get a good night's rest prior to the procedure. If
you think this may be a problem, please, do not hesitate
to ask Dr. Cruise for something to help you sleep.
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Smoking. Do not
smoke within 3 weeks before and after surgery. Smoking
has a profound effect on reducing wound healing capabilities. It significantly increases the likelihood for infection,
wound healing problems, and scar formation. It also affects
your airway making the anesthesia much more difficult.
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Eating. Do not
eat within 8 hours of surgery and do not drink within
6 hours of surgery. It is OK to take medications with
a sip of water. Please discuss all medications with Dr. Cruise and the anesthesiologist.
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Washing. It is
a good idea to wash the surgical area thoroughly the night
before and the morning of surgery. Do not forget to wash
inside your bellybutton if liposuction is being performed
on the abdomen.
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Arrival. It is
best to arrive on time to make sure things run smoothly. Please be sure to have someone else drive you.
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State of mind. Remember, this should be a happy and exciting time. A
certain amount of nervousness is normal but you should
not be overly concerned. Dr. Cruise and ICRS are both
well trained and experienced. Excessive worrying can
actually be detrimental and you should discuss this with
Dr. Cruise prior to surgery so that something can be prescribed
to make sure you remain calm.
Consultation
We have outlined below what you can expect from your liposuction consultation. Read carefully, as there are many suggestions that will save you time, clear up questions, and help you convey to your plastic surgeon what you want to accomplish.
 Health History
All cosmetic surgery consultations begin with a thorough health history. This is especially true if general anesthesia is being used but also applies to local anesthesia. Liposuctions can be done under either general or local anesthesia. The type of anesthesia depends on how many areas are being liposuctioned and the discomfort tolerance of the patient. Single areas such as abdomen or lateral thighs can be done under a type of local called tumescent anesthesia. Tumescent anesthesia is a local anesthesia mixed with saline and then injected into the subcutaneous fat. This effectively numbs the area. Multiple areas and sensitive areas such as the medial thigh are often done under general anesthesia. Each plastic surgeon has his/her own strategy regarding the type of anesthesia used.
Prior to meeting with Dr. Cruise you will be given a health history questionnaire to fill out in the waiting area. There are five areas of your health you will be asked about. Be sure to answer it with detail so that your surgery and anesthesia can be optimized for you.
General health problems are important to discuss so that your surgery is as safe as possible. Be sure to mention any chronic illness. Of particular concern are: high blood pressure, diabetes, heart problems, liver and kidney disease, stroke, cancer, bleeding problems, and wound healing problems.
What will Dr. Cruise do if I have medical problems?
In short, he will make sure your health is optimized as much as possible to ensure your safety. This may mean referring you to your private physician.
If you have a health problem or are over 50 years of age you can often save yourself time by getting a letter from your private physician prior to your cosmetic consultation stating what the health problem is, how it is being treated, and whether or not you are able to tolerate general anesthesia safely.
If you are seeing any specialist (cardiologist, kidney doctor, psychiatrist, etc. ) be sure to bring a letter from them stating you are able to tolerate surgery.
Be sure to let your plastic surgeon know if you have ever had a blood clot.
On your questionnaire you will be asked about previous surgeries. Be sure to identify any problems you may have had with anesthesia. Of particular concern are previous cosmetic surgeries especially if you do not like the result and are interested in revision.
Be sure to list all medications you take including aspirin and over-the-counter medications. These are important as they may increase bleeding and affect your surgery. It is extremely important to stop taking aspirin and aspirin containing products at least 10 days before surgery. Tylenol is a good alternative. Here is a partial list of aspirin containing products and other products to be avoided prior to surgery.
Information about medications that cause allergies is very important so that these medications can be avoided. Of particular importance is the reaction you had, especially if you had trouble breathing. Be sure to include this information. Nausea is not an allergy but it is important to mention as well.
These there will certainly affect your surgery and MUST be mentioned so that your surgery can be optimized. Smoking causes a profound decrease in wound healing and will lead to worse scarring and a less favorable result. With large procedures such as a face lift, neck lift, tummy tuck, and breast lift smoking must be stopped at least 2-3 weeks before and after surgery. Otherwise, the results could be disastrous leading to non-healing wounds, poor scarring, and/or infection. With smaller procedures such as eyelid surgery, nose surgery, breast augmentation, and liposuction smoking will hurt the overall result but this may or may not be noticeable. In this case smoking cessation is strongly advised but is not mandatory.
What Do You Want To Change?
It is important that you have a clear idea of what you want changed when you go for a consultation. The least favorite thing a plastic surgeon wants to hear is: What do you think I need done?
Look in a mirror and identify what bothers you. Be specific. It may be helpful to look back at younger pictures to see if that problem always existed or if it is part of aging. Bring the picture as it may be helpful.
Physical Exam
The key to the liposuction exam is to determine exactly what is causing the problem. Some problems can be treated with liposuction while other require removal of excess skin. Sometimes a combination of the two is best. This section will help you decide what is best for you.
This web site is designed to educate you so that your plastic surgery experience achieves yours goals. Part of our responsibility is to make sure that your goals are realistic. With this in mind we will first outline which patients are not good candidates for liposuction.
Not all areas respond well to liposuction. Most people feel that if they have a fatty area it can just be sucked away and the problem will be solved. This is not the case. There are other issues that must be considered.
Redundant skin usually is best treated with removal. This is especially true with medial thigh, and arms, and often abdomen. If liposuction is done in these cases then a poor result is likely. When the fat is removed, the loose skin becomes even looser often with waviness because the skin does not have the ability to recoil. This elastic skin contraction is extremely important and is elaborated on throughout this section.
The entire basis of liposuction depends of skin contraction. Poor quality skin does not have this ability. Poor quality skin is identified by stretch marks, cellulite, scars, age, and a certain thin dermis feel that only your plastic surgeon can determine.
Stretch marks show that the skin does not have much elastin, which is necessary for the skin to contract. Therefore, after the skin has been stretched (i.e. pregnancy or weight gain) it cannot recoil back. The skin essentially forms scars that are represented by stretch marks. These scars have no capacity to contract.
Unfortunately, cellulite also responds poorly to liposuction. Ironically, this is why some women want liposuction in the first place. Cellulite is skin that has fat in the subcutaneous areas separated by fibrous septa. These septa break the fat into compartments. Sometimes, when this fat is removed the cellulite can become more prominent. Currently, there are no good answers to this problem but certainly muscle tone and proper diet help.
Scar tissue is devoid of elastin. It has NO ability to contract. Areas with scars are often best revised. Since a scar is already there a good plastic surgeon can perform a scar revision that will result in a less conspicuous scar. As a bonus, a skin and fat removal can be done at the same time, thus, creating a win-win situation.
Notice how the title is Aged Skin and not a specific age. This is because different people's skin age differently. Amazingly, even skin on different areas of the same person age differently. The bottom line is that the older the patient is, the more likely is he/she to benefit from skin excision than liposuction. The good news is that older skin forms thinner, less visible scars than younger skin.
Once again, skin contraction depends on elastin within the dermis. Areas that have a thin dermis do not have much elastin. Areas that are notorious for thin dermis are the medial thigh, and the inner arms. Pinch these areas and feel for yourself. This is why a medial thigh lift or arm lift is usually a better choice. An exception to this is the young patient with thick, elastic skin in these areas.
This is almost exclusively a male concern. The problem is that this fat is NOT subcutaneous fat that is amenable to liposuction. This fat is under the muscle within the abdomen itself. It is hard, therefore, pinching it is difficult. Because it is intra-abdominal it is not accessible to liposuction and can only be lost by diet and exercise.
Liposuction is not meant to be a weight loss procedure. In fact, most plastic surgeons will limit the amount of fat removed so that patient safety is maintained. Many will not exceed 5000 cc's (11 lbs. ) in one operation. The fact is, massive liposuction often leads to skin waviness as well as skin sag. Skin excision is often a better way to go.
What Makes a Good Candidate For Liposuction?
Basically, anyone who is not a bad candidate as outlined above is a good candidate. Below are some common examples of the patient who is likely to obtain a good result from liposuction
The ideal candidate is one who is at, or just slightly above, his/her ideal body weight but has one fatty area that just will not go away. With women this is often the lateral thigh(saddlebags) or the abdomen. With men, this is usually the flanks (love handles) and abdomen.
Fat within the lateral thigh area is easily liposuctioned AND the skin in this area has a thick dermis that allows it to contract well.
Abdomen is usually has a thick dermis and responds favorably.
This areas usually have a more fibrous fat but still respond favorably.
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Knees, calves, medial thighs, back, arms, and neck
These areas are highly variable and must be considered individually. Good results are possible if good quality skin is present.
Anesthesia
ICRS uses only board certified anesthesiologists
to make sure you have the best anesthesia possible. The anesthesiologist
will discuss with you what type of anesthesia is best for
you. He/she will take into consideration your medical history,
the procedure, and your personal wishes.
The type of anesthesia depends on the
amount of areas to be liposuctioned. Dr. Cruise routinely
does single-area liposuction under local anesthesia. If more
areas are involved or you are quite anxious, general anesthesia
is best. Dr. Cruise will discuss this with you during your
consultation.
After
the procedure
The time necessary to perform the procedure
depends on the number of areas being liposuctioned. The range
is anywhere from 1 to 4 hours.
Immediately. Right after the operation you will be nursed for 1 or 2 hours
and encouraged to walk around. Dr. Cruise is a strong advocate
of good pain relief. You will be given as much pain medication
as necessary both immediately after the operation and for
the next 4 to 5 days. Of course, there will be swelling and
bruising but there is surprisingly little pain. You will
be wearing a lightly compressive garment to minimize swelling. It is important to wear this at all times except when showering
for the first six weeks to make sure your skin redrapes to
your newly contoured body. Because a lot of fluid is injected
into the tissues being liposuctioned, you will have a significant
amount of oozing. You will be asked to drink a lot of fluid
to make sure you are not dehydrated. You should continue
to drink a lot of fluid for the first 24 hours.
That evening. It is recommended that you take it easy. You can eat and
drink. You can get up and walk around but not too much as
this may increase swelling. You should sit with your legs
elevated to encouraged venous return. Take as much pain medication
as necessary and try to go to sleep early. You will be given
medication to help keep the swelling down as well as to prevent
infection.
First
48 hours. The next day, you can remove the compressive
garment and shower. The shower water should be cool. While
you are showering have someone wash and dry the garment as
it will have dried blood and fluid on it. Put the garment
on so that there are no creases bunching up and pinching your
skin. The importance of wearing this compressive garment for
6 weeks cannot be overstated.
First
week. Your first postoperative visit will be 1 week
after the procedure. Dr. Cruise will make sure everything
is healing properly.
Beyond. It will take 4 to 6 weeks for the majority of the swelling
to go down. Complete resolution of the swelling will take
six months. Skin redraping takes quite a while as the skin
needs time to contract to its new body contour. The final
result will not be seen until at least 6 months when all the
swelling is down and skin contraction is complete.
Recovery
time
Time off work is highly dependent on
how large of an area is liposuctioned. If a single area is
liposuctioned then it may be possible to return to work the
very next day. As more areas are liposuctioned the amount
of bruising and swelling increases and, therefore, the recovery
time increases. If several areas are liposuctioned, it will
take about 3 weeks for the majority of swelling and bruising
to resolve. Some people with sedentary jobs go back to work
after 4 days. If your job, however, requires strenuous activity
then it may take up to 2 to 3 weeks to return to work.
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