Liposuction. Introduction Liposuction is a surgical procedure to remove fat deposits from under the skin in order to shape the body.

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1 Liposuction Introduction Liposuction is a surgical procedure to remove fat deposits from under the skin in order to shape the body. You may be considering having liposuction. The decision to have liposuction is yours and you should make it after being informed about the benefits and risks of liposuction. This reference summary explains liposuction. It discusses the indications, alternative treatments, preparation, the procedure, the risks and complications, and what to expect after surgery. Liposuction The body stores excess sugar in the blood as energy. Excess sugar in the body is converted to fat and stored in fat cells. When the body needs extra energy, the fat is converted to sugar for energy. Fat cells are present under the skin throughout the body. However they are more concentrated in the abdomen, hips, thighs, calves, arms, buttocks, back, and neck. Fat is also stored inside the abdomen around the stomach and intestines. Gender and genetic differences help decide where fat is stored as well. Where fat get stored is also a function of the person s genes. Though dieting should burn fat throughout the body, sometimes it may not take it from the desired location where the fat is stored. Dieting tends to decrease the size of the fat cells but does not get rid of the actual fat cells. Therefore when a person puts back on the weight they have lost it tends to come back in the areas where they had the most fat originally. Liposuction is a surgical procedure that removes fat deposits from selected body locations in order to shape the body. The fat is removed from under the skin using a 1

2 vacuum-suction canula. The canula is a medical device that looks like a pen and is hollow inside. Fat can also be eliminated using an ultrasonic probe that breaks up fat into small pieces then removes it with suction. This break up process is called emulsification. Liposuction may be performed on the abdomen, hips, thighs, calves, arms, buttocks, back, neck, or face. It can also be used to reduce the breast size in men with large breasts, a condition known as gynecomastia. In some cases, liposuction can be medically indicated to remove fat tumors known as lipomas. However, it is mostly an optional cosmetic procedure for shaping the body. For this reason, it is usually not covered by medical insurance. Check with your health insurance company. Liposuction results may not be permanent. If the patient gains weight after liposuction surgery, the fat may return to sites where the liposuction was performed or to other sites. Alternative Treatments To shape your body and trim the fat, you may consider dieting or exercising as an alternative to liposuction. You can also use clothing and makeup to de-emphasize areas of the body that have fat. Men could consider growing a beard to hide fat in the neck. Preparing for Surgery Your doctor will first examine you to determine if you are a good candidate for surgery. People who have a serious medical condition, have an infection, or edema are not candidates for liposuction. Make sure to tell your doctors about all the prescription and off-the-shelf medications you are taking, including nutritional and herbal supplements. Some of these may interfere with anesthetics taken during liposuction. 2

3 You should stop the use of aspirin or aspirin-containing products, as well as over-thecounter pain medications like Excedrin, ibuprofen, Motrin, Advil, Aleve, or similar products 7 days before the procedure. Taking such products can increase the risk of bleeding during or after the procedure. After the procedure, your doctor will tell you when it is safe to restart these medications. People who are on blood thinners, such as warfarin or Coumadin, cannot have liposuction without normalizing their INR first. Your doctor will evaluate the skin at the site where you are considering liposuction to determine if the skin is elastic enough to shrink after liposuction. If it is not, it will be baggy after liposuction. Your physician may prescribe an antibiotic for you to take before and after the surgery. This is to prevent infections. The purpose of the initial consultation about liposuction is to inform you about whether you are a good candidate for this type of surgery, the benefits and the risks of the procedure. Ask your doctor any question you have about liposuction during your consultation. You may be tired or uncomfortable after liposuction. You will not be able to drive yourself home. Discuss this with your physician before the procedure. You will need to have someone drive you home after the liposuction procedure and stay with you for the first 24 hours. Surgery Liposuction may be performed in a doctor's office, a surgical center, or a hospital. On the day of surgery, the physician will mark your body with a pen to show where the fat that will be removed is located. Then you will receive anesthesia, which is medicine that prevents you from feeling pain. Depending on the liposuction procedure and your doctor, you may have local anesthesia, local anesthesia with sedation, regional anesthesia, or general anesthesia. During general anesthesia you will be asleep; during local or regional anesthesia you will be awake but won t feel pain. 3

4 Once the anesthesia is given, the physician will make a small incision and fluid will be injected into the area to be liposuctioned which will help reduce bleeding and help break up the fat cells. After that, a canula, a hollow tube that is about the size and shape of a skinny pen, will be inserted into the incision. It is connected to a vacuum pump. The physician moves this canula back and forth to suction out the fat. The fat and liquid that has been removed are collected in a flask. The physician will monitor that amount very carefully. Because it may be necessary to replace some of that fluid. This is done with an intravenous line or an IV line. Risks and Complications Like any surgical procedures, liposuction surgery has risks and complications. You should know about them in order to determine if the risks outweigh the benefits for you. If you decide to have liposuction, knowing about these complications may help you detect and treat them early, if they should happen. The risks and complications include Risks related to anesthesia, Risks related to surgery in general, and Risks specific to liposuction. Risks of general anesthesia include nausea, vomiting, urinary retention, cut lips, chipped teeth, sore throat, and headache. More serious risks of general anesthesia include heart attacks, strokes, and pneumonia. Your anesthesiologist will discuss these risks with you and ask you if you are allergic to certain medications. Local anesthesia has also risks resulting from high doses of Lidocaine. The signs of this are lightheadedness, restlessness, drowsiness, tinnitus, slurred speech, metallic taste in the mouth, numbness of the lips and tongue, shivering, muscle twitching and convulsions. Lidocaine toxicity may cause the heart to stop, which can be fatal. Blood clots in the legs can occur due to inactivity during and after the surgery. These usually show up a few days after surgery. They cause the leg to swell and hurt. 4

5 These blood clots can become dislodged from the leg and go to the lungs where they will cause shortness of breath, chest pain and possibly death. It is extremely important to let your doctors know if any of these symptoms occur. Sometimes the shortness of breath can happen without warning. The best known method of preventing this dangerous complication is getting out of bed shortly after surgery and walking at least two to three times a day. Risks related to surgery include infection, bleeding and skin scars. Infections are rare. Keeping the wounds clean prevents infections, but they may still happen even if you follow good hygiene. Infections can be treated with antibiotics. Some infections are serious and life threatening. Bleeding can occur during the operation or afterwards. In rare cases you may need a blood transfusion. Bruising in the area of the liposuction is common and may last for a few weeks. There may be scars at the site where the doctor made the cut to insert the liposuction canula. These scars are usually small and fade with time but in some people, scars may be larger or more noticeable. One of the more common complications that may occur after liposuction is a wavy or bumpy appearance in the liposuctioned area. In areas that are wavy and bumpy prior to surgery, liposuction is not likely to eliminate that problem. Cellulite, which is pitting or pin point depressions of the skin, is not eliminated by liposuction and may be made worse by the procedure. A possible complication that is specific to liposuction is organ puncture. During liposuction, the physician is unable to see where the canula is. It is possible to puncture or damage internal organs during liposuction. This may happen, for instance, if the intestines or arteries and veins are punctured during abdominal liposuction. When organs are damaged, surgery may be required to repair them. Such perforations may also be fatal. Injuring nearby nerves can also lead to paralysis, numbness and painful conditions. This complication is very rare. Embolism may occur when fat is loosened and enters the blood through blood vessels ruptured during liposuction. Pieces of fat get trapped in the blood vessels, gather in the lungs, or travel to the brain. The signs of pulmonary emboli may be shortness of breath 5

6 or difficulty breathing. If you have the signs or symptoms of emboli after liposuction, it is important for you to contact your physician and you may need to seek emergency medical care. Fat emboli may cause permanent disability or, in some cases, be fatal. After liposuction, there may be a pooling of serum, the straw colored liquid from your blood, in areas where tissue has been removed. You may experience "paresthesias" which is an altered sensation at the site of the liposuction. This may either be in the form of an increased sensitivity in that area, or the loss of any feeling in that area. If these changes in sensation persist for weeks or months you should inform your physician. In some cases, these changes in sensation may be permanent. Swelling or edema may occur after liposuction. In some cases, swelling may persist for weeks or months after liposuction. The skin above the liposuction site may become necrotic or "die." When this happens, skin may change color and be sloughed (fall) off. Large areas of skin necrosis may become infected with bacteria or microorganisms. During ultrasound assisted liposuction, the ultrasound probe may become very hot and can cause burns. During surgery, your doctor will watch for fluid imbalance, and give you fluids through the IV if needed. However, if fluid imbalance persists after you go home, it can result in serious conditions such as heart problems, excess fluid collecting in the lungs, or kidney problems as your kidneys try to maintain fluid balance. After Surgery Depending upon the amount of fat removed and where the surgery is done, you may leave the doctor's office soon after the surgery or you may spend the night at the hospital. Ask your doctor how long it will be before you will be able to return to your normal level of activity or if you will need to miss work after liposuction. The cuts where the doctor inserted the canula may be leaky or drain fluids for several days. In some cases, the doctor may insert a drainage tube to drain fluid away from the wound. 6

7 You will wear special tight garments to keep your skin compressed after the liposuction procedure. Your doctor will tell you how long to wear these, usually for weeks. Some doctors provide these garments but others will tell you where to purchase them before your surgery. Your doctor will also probably give you some after-surgery instructions. This will include information about wearing compression garments, taking an antibiotic, if one has been prescribed, and the level of activity that is safe for you after your liposuction procedure. Compression Garment When the anesthesia wears off, you may have some pain. If the pain is extreme or lasts a long time, you should contact your physician. You will also have some swelling after the surgery. In some cases, this swelling will remain for weeks or even months. If you have pain and swelling, this may be a sign of infection and you should contact your physician. The cosmetic effect after liposuction may be very good and many patients report being satisfied. However, it is possible that your appearance after liposuction may not be what you expected or wanted. Liposuction results may not be permanent. If you gain weight after liposuction surgery, the fat may return to sites where you had liposuction or to other sites. Conclusion Liposuction is a cosmetic surgical procedure in which fat is removed from a specific area of the body by means of suction. Most patients are pleased with the outcome of their liposuction surgery. Some may not be satisfied if they do not have realistic expectations. Like all surgical procedures, liposuction has risks and complications. You should know about them before you decide to have liposuction. Knowing about them may also help you detect them early and seek treatment. This summary provides general information about liposuction to help you understand this procedure. Ask your doctor about the benefits and risks of the liposuction procedure he or she recommends for you. 7

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