Liposuction is the technique that consists of aspirating fat from those areas where there is excess. On the contrary, lipofilling is the technique through which we infiltrate the extracted fat into those areas where it is missing. The term liposculpture is commonly used to refer to the association of both techniques.
- Liposuction is not a technique to lose weight : Although we lose weight secondarily, the ultimate objective is to modify the amount of adipocytes in each area of the body, or in other words, modify the location of fat deposits in the body. We will never accumulate so much fat in the previously liposuctioned areas no matter how much weight we gain. The classic paradigm of liposuction is the thin girl who accumulates all her body fat in her pockets. Once liposuctioned, when you gain weight the fat will be distributed evenly throughout the body.
PRELIMINARY ASSESSMENT
In the first consultation we will evaluate your case in a personalized way. In this first consultation it is not only about seeing what areas you want to have liposuction, but also about analyzing where you accumulate body fat. Often our patients come with an idea of one or two areas they want to liposuction and we end up recommending liposuction of more areas. Because? Well, because once the intervention has been performed, if we do not treat all the areas where fat accumulates, later, when you gain weight, those untreated areas may worsen.
- Classic example: A man comes to our office to have liposuction of his abdomen. During the examination we observed that he also had fat deposits on the flank, in the breasts (gynecomastia) and on the inner side of the thighs. If we only treat the abdomen, after a few months the chest, flanks and inner thighs will worsen, acquiring an unbalanced appearance that will require a new intervention.
TYPES OF LIPOSUCTION
There are many liposuction techniques, although basically all of them are similar. They vary depending on the amount of infiltrated liquid, the type of cannulas we use and whether we also add a thermal method to increase skin retraction.
- Ultrasonic and laser liposuction : These are thermal liposuction methods that heat while dissolving fat before being extracted using conventional cannulas. In the 2000s they had their boom but little by little they have fallen into disuse due to the large number of complications, adhesions, irregularities and unwanted retractions that they produce. We must bear in mind that these techniques not only damage the skin and cutaneous vascularization from a mechanical point of view but also add a thermal factor that is not very controllable. In our opinion, they are very aggressive techniques with very high rates of bad results, so we do not apply them.
- Subdermal liposuction : Very superficial liposuction, popularized decades ago by Dr. Gasparotti. It consists of liposuction very close to the skin so that the skin retracts more (increasing mechanical damage to the dermis so that more fibrosis is generated). It is indicated in some very specific body areas. The main risk is the greater number of irregularities it leaves behind.
- VASER Liposuction (vibroliposuction) : The cannula vibrates while we aspirate. It is used with the theory that this vibration loosens the fat deposits before suctioning them, facilitating their extraction, so that the surgeon becomes less tired.
- SAFE Liposuction : It consists of releasing the adipocytes with a special cannula that does not aspirate before passing the classic cannulas that aspirate. This is the personal technique of Dr Simeon Wall who defends the theory that in this way the fat is extracted more easily, with less effort on the part of the surgeon.
- Conventional liposuction : Classic liposuction with cannulas that suction but do not heat the skin. Subdermal fat is spared and deep fat is extracted. Described by a gynecologist and popularized by the French plastic surgeon Illouz in the 80s. The technique has been refined with more or less fine cannulas, modifying the suction pressure and the amount of infiltrated liquid (dry, wet, super wet or tumescent). This is the technique used by 95% of plastic surgeons currently, since it is the safest and has the fewest associated complications. This is our technique of choice.
TECHNIQUE
Liposuction, contrary to what most people believe, is one of the surgeries that is most dependent on the technique and experience of the surgeon. It requires a lot of concentration to leave exactly the same amount of fat in all regions of the body and has the added difficulty of being a blind technique, in which we depend only on what we feel to the touch, since we cannot open and observe what we see. It happens in the subcutaneous plane. We recommend that this type of surgery be performed in a hospital operating room and with the presence of an anesthetist, in addition to insisting that the surgeon be a specialist in plastic, reconstructive and aesthetic surgery. Although legally in Spain any doctor, even without having taken the MIR or having completed a surgical specialization program, is accredited to perform any type of intervention, that does not mean that he is qualified or trained. If even in the hands of a trained and accredited plastic surgeon, in a hospital and with the presence of an anesthetist, complications can arise, performing this type of surgery in non-accredited clinics, without an anesthetist and without a plastic surgeon can be catastrophic.
AREAS THAT ARE LIPOSUCTED
- Abdomen : The most classic, especially in men, but also the most complex. Liposuction in the abdomen is a solution to fat accumulation but it does not eliminate excess skin. It is performed when the accumulations are mild or moderate but there is good skin retraction (no stretch marks, young patient) and when abdominoplasty is not desired (accepting that the skin will not retract completely).
- Flanks and back : This is a classic liposuction area with very good retraction and little risk of irregularities since the subdermal fat is thicker than in the abdomen.
- Cartucheras : The region of fatty accumulation typical of the female sex, although not exclusive. It has an intermediate retraction between the abdomen and the back. If there is cellulite or irregularities in the skin, it should be noted that after surgery they will be more noticeable. You almost always have to also treat the “banana” area, which is the fat just below the buttocks.
- Inner thighs : This area has little subdermal fat, so it is easy for irregularities or adhesions to remain. On the other hand, it is an area that is not very exposed to sight where above all we look for the functional element, to prevent the thighs from rubbing against each other.
- Knees : This area is very grateful, it retracts the skin well and we usually treat it both posteriorly, in the region of the crow’s foot, and anteriorly, above the kneecap.
- Arms : The arms are an area with a high risk of irregularities and irregular retraction, as is the inner surface of the thighs, since there is little subdermal fat. Despite this, they are a very grateful area and desirable to treat before the accumulations are so large that it is also necessary to remove excess skin (brachioplasty). The typical area we treat is the posterior region, although occasionally it is necessary to also treat the anterior surface.
- Double chin : The double chin is due in part to a decrease in the platysma muscle, descent and excess of skin and accumulation of fat. In young patients where there is only excess fat, liposuction can be performed with good results. In older patients, the ideal is to perform a cervicofacial lift and in the context of this surgery, if we consider it necessary, add liposuction of the fat in that region.
- Breast : In men, one way to treat excess fat and mammary gland (gynecomastia) is through liposuction. Good results as long as the gynecomastia is not only gland-dependent; if there is a lot of gland and little fat, direct removal via the periareolar route is better.
- Buttocks : We rarely liposuction the buttocks. On the other hand, it is the area that is most frequently filled with fat (lipofilling or Brazilian butt lift).
TYPE OF ANESTHESIA
In general we prefer general anesthesia for convenience for our patients. We use locoregional anesthesia in very specific cases, when we are going to treat one or two areas maximum and our patient requires it.
POSTOPERATIVE
In the immediate postoperative period we do not suture the incisions (scars of less than 1 cm that over time will be almost invisible), but rather we let the infiltrated fluid drain spontaneously through them. A compression belt is required in all areas we have treated. During the first three days we will not remove it at all. On the third day we can shower (shower less than 5 minutes and with warm water) and we will put on the girdle again (we recommend buying two girdles for hygiene and comfort).
The girdle remains in place for one month postoperatively, except for the double chin, where we will have it for only 2 weeks.
The result per month is still not very valuable. In the third or fourth month the result can be assessed at 80%. After one year the result, both in quantity of fat and in quality and skin retraction, is definitive.
FREQUENT RISKS
Irregularities : When a lot of fat and excess skin is extracted, the retraction and rearrangement of the skin can leave irregularities.
Flaccidity : If we remove a lot of fat in an area, excess skin will remain unless we remove it (lipoabdominoplasty, leg lift or cruroplasty, arm lift or brachioplasty, circumferential abdominoplasty to tighten the back and lateral aspect of the thighs…).
Cellulite : If there was cellulite before surgery, the alteration of lymphatic drainage can increase it.
Liposuction is not a technique to treat cellulite!