ABDOMINAL LIPOSUCTION

        Liposuction is a surgical procedure that uses a suction technique to remove unwanted fat from specific areas of the body, such as the abdomen, hips (Love Handles), back rolls, thighs, buttocks, arms or double chin. Liposuction also shapes (contours) these areas. Other names for liposuction include lipoplasty and body contouring.
         When you gain weight, fat cells increase in size and volume. In turn, liposuction reduces the number of fat cells in a specific area. The amount of fat removed depends on the appearance of the area and the volume of fat. The resulting contour changes are generally permanent as long as your weight remains stable.
        
Tumescent liposuction : Also called as ‘Wet Liposuction’ which has replaced the age old dry liposuction due to its distinct advantages. In this the surgeon injects a sterile solution into the areas that are being treated. This is normal saline to which an anesthetic drug (lidocaine) and epinephrine, a drug that causes the blood vessels to constrict are added. This fluid causes the fat layer to swell and stiffen which makes fat removal easy. Added drugs relieve pain and decrease bleeding. The surgeon then makes a tiny 4 mm cut into the skin and inserts a cannula under your skin. Cannulas are thin and long metal tubes having few side holes near their blunt tip. The cannula is connected to a powerful vacuum machine which sucks fat and fluids as the cannula is moved to and fro by the surgeon manually. In addition to this traditional manual liposuction there are others which use different mechanisms to ease the fat removal.
Power-assisted liposuction (PAL) : This is the most common type of assisted liposuction which utilizes a mechanically reciprocating cannula. The 3 mm strokes at its tip can be up to 4000 cycles per minute to disrupt the fat which is simultaneously sucked through the same cannula as liquefied fat. Its dramatic how much more effectively we can treat them, how much better patients feel, how much more satisfied they are, and how far superior the results are compared to traditional liposuction.
Ultrasound-assisted liposuction (UAL) : This type of liposuction needs to be used in conjunction with traditional liposuction. During UAL first the surgeon inserts a thin metal rod under your skin that emits ultrasonic energy from its tip. This ruptures the fat-cell walls and breaks down the fat. Then it becomes easier to remove by liposuction cannulas. A new generation of UAL called VASER-assisted liposuction uses a device that may improve skin contouring and reduce the chance of skin injuries.
Laser-assisted liposuction (LAL) : This technique uses high-intensity laser light to break down fat for removal. During LAL, similar to UAL, the surgeon inserts a laser fiber through a small incision in the skin and emulsifies fat deposits. The fat is then removed via a cannula.
Water jet-assisted liposuction (WAL) : This technology uses a special cannula with tube in tube configuration. A very fine but forceful jet of sterile water escaping from its tip disrupts the fat which is sucked through the inner tube. As saline itself is used to break the fat cells, prior tumescence is not required. It is claimed that the harvested fat is in a better state for fat grafting.

             Some liposuction procedures require only local anesthesia i.e. anesthesia limited to the specific area of the body. If more areas are to be done on lower body, then preferably it is done under regional anesthesia such as epidural or spinal anesthesia which numbs body from abdomen below. For still more areas on upper and lower body general anesthesia may be required which induces a temporary state of unconsciousness. Patients may be given a sedative, typically through an IV line, to help them remain calm and relaxed. The surgical team will monitors the heart rate, blood pressure and blood oxygen level throughout the procedure.

             The procedure may last up to several hours, depending on the extent of fat removal. If patient had general anesthesia, they wake up in a recovery room. They typically spend at least a few hours in the hospital so that we can monitor the recovery. If they are in a hospital, they may stay overnight to make sure that there is no dehydrated from fluid loss.

As with any major surgery, liposuction carries risks, such as bleeding and an unusual reaction to anesthetic agents. Possible complications specific to liposuction include:

• Contour irregularities : The overlying skin may appear bumpy, wavy or withered due to uneven fat removal, poor skin elasticity and unusual healing. These changes may be permanent. Damage beneath the skin from the thin tube (cannula) that's used during liposuction may give the skin a permanent spotted appearance.

• Fluid accumulation. Temporary pockets of fluid (seromas) can form under the skin. This fluid may need to be drained with a needle.

• Numbness : One may feel temporary or permanent numbness in the affected area. Temporary nerve irritation also is possible reflecting as a hypersensitive skin to touch. Usually it reduces over the period and by gentle massage of the area. Nerve energizers may also help early recovery.

• Infection : Skin infections are rare but possible. A severe skin infection may be life-threatening.

• Internal puncture : Rarely, a cannula that penetrates too deeply may puncture an internal organ. This may require emergency surgical repair.

• Fat : Pieces of loosened fat may break away and become trapped in a blood vessel and gather in the lungs or travel to the brain. A fat embolism is a medical emergency.

• Kidney and heart problems : Shifts in fluid levels as fluids are being injected and suctioned out can cause potentially life-threatening kidney, heart and lung problems.

• Lidocaine toxicity : Lidocaine is an anesthetic often administered with fluids injected during liposuction to help manage pain. Although generally safe, in rare circumstances, lidocaine toxicity can occur, causing serious heart and central nervous system problems.

• Skin loss : At places there may be superficial or full thickness skin loss which needs dressings or further treatment. The risk of complications increases if the surgeon is working on larger surfaces of your body or doing multiple procedures during the same operation. Talk to your surgeon about how these risks apply to you.

           After liposuction, swelling typically subsides within a few weeks. By this time, the treated area should look less bulky. Within several months, expect the treated area to have a leaner appearance.

           It's natural for skin to lose some firmness with aging, but liposuction results are generally long lasting as long as you maintain your weight. If you gain weight after liposuction, your fat distribution may change.

• The first step is to consult with your surgeon. Talk about your goals, the options, the risks and benefits, and the costs. Ask all your questions.

• If you decide to go ahead with liposuction, your surgeon will give you instructions on how to prepare for it. These may include diet, smoking and alcohol restrictions.

• Tell your surgeon about any allergies you have and any medications you take, including over-the-counter and herbal supplements. He will likely recommend you stop taking certain meds, such as blood thinners and certain painkillers several weeks before surgery.

• Who is a good candidate for liposuction?

In general, good candidates for a liposuction include: Adults within 30% excess of their ideal weight who have firm, elastic skin and good muscle tone. Healthy individuals who do not have a life-threatening illness or medical conditions that can impair healing.

• What do I need to know before undergoing liposuction?

The first step is to consult with your surgeon. Talk about your goals, the options, the risks and benefits, and the costs. Ask all your questions.

• How is the liposuction procedure done?

Your liposuction will take place at your doctor's surgery center. Make sure that the place where you're getting it done is accredited, and is known for its professional standards, safety and good results.

You'll go home the day of the procedure. Make sure to have someone drive you home afterward. (If you're having a lot of fat removed, you should get the surgery done in a hospital, where you might stay overnight).

Before your liposuction starts, your doctor might mark the areas of your body that will be treated. He may also take photos to use later for before-and-after comparisons.

Next you'll get either general anesthesia, which means you will not be awake during the procedure or a "local," which means you will be awake but not feel any pain.


• How long does recovery after liposuction last?

You might not have to stay in the hospital depending on the type of surgery you had. But you should expect bruising, swelling, and soreness for at least a few weeks.

Your surgeon may require you to wear a compression garment for 1 to 2 months after surgery to control swelling.

You'll probably also have to take some antibiotics to prevent infection. Most people can return to work within a few days and get back to normal activities within 2 weeks. But every person is different.

• What are the risks of liposuction?

Cosmetic surgery is still surgery, so there are some risks. You can help reduce them by making sure it is done only by a specially trained, board-certified cosmetic surgeon. There are several possible risks directly related to liposuction that you still have to consider, including:


• Bleeding
  
• Complications from anesthesia
  
• Shock (usually from not getting enough fluid during surgery)
  
• Fluid accumulation (pockets of fluid forming under the skin)
  
• Infections (strep, staph)
  
• Fat embolism (when tiny pieces of fat break away and block blood flow)
  
• Burns from instruments
  
• Uneven fat removal
  
• Reactions to lidocaine
  
• Change in skin sensation; numbness
  
• Damage to nerves, blood vessels, muscles, lungs, and abdominal organs Another risk is a blood clot in your deep veins. Clots can be very dangerous if they travel to other parts of your body, such as your lungs.

• Are the results of liposuction permanent?

The fat cells are removed permanently during liposuction. But you can gain weight back, with new fat cells, which usually go to different areas of your body.

To keep your new shape after surgery, follow a diet that includes lots of lean protein, fruits and vegetables, whole grains, and low-fat dairy. And exercise regularly.

• Is liposuction covered by health insurance?

Because liposuction is a cosmetic procedure, most health plans don't cover it. Talk to your insurance company and your surgeon about the costs and payment options, as well as who pays if you have any complications.

           Before the operation, patients will need to undergo some health tests to ensure they are fit for surgery.

           The following recommendations may be made.

           People who use regular aspirin and anti-inflammatory drugs should stop taking them at least 2 weeks before surgery.

           Women may be asked to stop taking the contraceptive pill.

           Patients with anemia may be asked to take iron supplements.

           The individual will need to signed an informed consent form. This confirms that they are fully aware of the risks, benefits,
           and possible alternatives to the procedure