:: Lakshya Kiran ::





	Also known as liposculpture or suction assisted lipectomy (SAL) is a technique to remove unwanted fat deposits. The unsightly distribution of body fat is usually due to an inborn tendency to deposit fat in one particular area of the body more than other areas. Most common the areas are abdomen, loins or hips, buttocks, thighs and arms. Other areas include the upper back, double chin, neck, inner side of the knees and the ankles. The growth of a benign fat tumour (lipoma) can also be a disfigurement, and in men fatty swellings can develop under the nipples to look like breasts (gynaecomastia).

	Overview
	What can be done? If you have a localised area of fat it is possible to reduce its bulk by an operation called Liposuction. A narrow blunt ended metal tube with holes on sides near its tip called canula is inserted through a small incision in the nearby skin. It is attached to a strong vacuum pump and the canula is drawn back and forth within the area of excess fat. The process removes tunnels of fat leaving the small blood vessels and nerves intact. The skin will then retract. There are some minor variants in the techniques. Most surgeons inject the area to be treated with a solutions called a wet or tumescent technique. Suction is usually applied with a powerful vacuum machine, which creates one atmospheric negative pressure in just 20 seconds. Power and Ultrasound assisted lipectomy is another variant. Will it last? Fat Cells are thought not to be regenerated in adult life. Therefore their removal by liposuction will give a permanent change in contour and will be independent of any changes in your body weight.

	More Information
	What you should do before the operation? You should avoid aspirin and anti-inflammatory drugs for 2 weeks before the operation. You should take iron if you are anaemic. Occasionally your surgeon will advise you to stop taking the contraceptive pill if the liposuction is going to be extensive, perhaps involving skin excision. What can you expect at the time of the operation? The procedure is normally carried out under regional anaesthesia (epidural) as a day case. You may wish to stay the night if you have had many areas treated. Supplementary general anaesthesia is an alternative for the upper part of the body and a local anaesthetic alone is only suitable for small areas. You are likely to need some simple pain killers for a day or so after the procedure and you will be asked to return for follow up periodically for a few visits. A snug pressure garment or corset is usually advised around the lower part of the body. This is used to reduce bruising but can be taken off to wash, quickly dried and put back on. You can take this opportunity to bathe yourself. The corset is usually worn for two to three weeks. You will only need to take a few days off work if a small area is treated, but larger areas may necessitate 7 to 10 days off work. You may be somewhat anaemic and need to take iron. You should remember that discolouration of bruising will last for about a month and you will not achieve your best appearance for three to six months.

	Risks and Limitations
	What are the consequences? You can expect considerable bruising which will be uncomfortable and at times painful. The larger the area treated the greater it will be. Some people bruise more easily than others. The discolouration of this bruising will usually last for about a month, but the lumpiness and swelling of deep bruising can take up to six months to disappear, particularly when the abdomen or ankles have been treated. As swelling can take a long time to settle you may not see the full benefit of the operation for up to six months. Rarely, a greyish stripe can discolour the skin for several months and is more commonly seen when the ankles have been treated. If you have a tendency to be anaemic or if you were to have a large area treated, you may need to take iron tablets for a month. You can expect some numbness in the treated skin which lasts for several months. You will have small scars of up to one centimetre at the site of insertion of the suction cannulae. There is a small risk in some people that these scars may stay red for a while, but they are usually sited in less obvious areas. If you are having treatment to your legs you may find that your ankles are swollen for a few weeks and if your ankles themselves have been treated they may stay swollen for a few months. What Are The Limitations? It is important for you to understand that liposuction is not a treatment for obesity. The amount of fat that can be removed from a localised area is limited by what is safe (maximum of 3 litres) and a natural limitation when no further fat can be removed. Therefore it may not be possible to slim down an area as much as you might like. Further treatments may be carried out in the same area after six months. In certain situations the skin is inelastic and loose. Liposuction in these areas will then tend to leave the skin more loose and it may be recommended that a skin excision be carried out to correct this, either at the same time as the liposuction, or as a second procedure. This is most likely in the abdomen after pregnancy or weight loss, the buttocks or the neck. Dimples and wrinkles of the skin, sometimes called cellulite will not be improved by liposuction. What Are The Risks? Any major operation with a general anaesthetic carries a small risk of chest infection particularly among people who smoke and there is also a risk of thrombosis in the veins of the leg, particularly for patients who are taking the contraceptive pill. Occasionally, heavy bleeding can occur after the operation is finished which may need a further operation and a blood transfusion. Occasionally, infection from germs harbouring in the skin can be troublesome. Infection can be treated with antibiotics but it will delay the healing process, scars are likely to be worse to start with and there may be a need to re-stitch them at a later date. Occasionally, skin can become sloughy and form a scab which gradually separates to leave a broad scar. People who smoke are at greater risk of this happening. Usually the scars settle well to end up as thin lines but they will always be noticeable. However, some people have an inborn tendency for scars to stretch and sometimes they can stay thick, red and irritable for a long time.

	Care & Aftercare
	You need to keep your dressing pads changing as they become wet. On day one it may be two three times but as the days pass, the soakage reduces and within a week maximum the discharge stops. Swelling and bruising may be severe. Your swelling will be worse in the areas liposculpted at least two weeks after surgery than it was before the operation. This is due to the mechanics of liposuction and the body’s response to it. After this the swelling will slowly reduce as healing takes place over the next three to six months. Supportive undergarments are very useful in the immediate post operative period if this is the area liposculpted, please discuss this with your surgeon preoperatively. Please bear in mind that we will endeavor to give you the result you desire but this isn’t always possible due to underlying structures in your own body. This will have been discussed with you at your initial consultation and in your pre operation discussion a few days prior to surgery. The operation we have performed is to ensure a SAFE and NATURAL result. At your follow up appointment you will be given further advice regarding scar massage
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