Liposuction Surgery

With age, fatty tissue accumulates in the flanks, lower abdomen and thighs (in women) and the abdomen, flanks and chest (in men). Liposuction is the removal of fat from deposits beneath the skin using a hollow stainless steel tube (cannula) and a powerful vacuum.  This is not a method of weight reduction, but a way to remove stubborn fatty deposits that remain despite dieting, exercise or massage.

In the early days of liposuction, the procedure involved using relatively large cannulae and was associated with extensive bruising and a higher risk of irregularities. Today, liposuction uses much finer cannulae which cause less trauma to the tissues and allow fat to be removed in a much more controlled manner.

Liposculpture

Liposculpture is a surgical procedure in which fat cells are removed from the body.  Liposculpture is a refinement on the process of liposuction and uses finer instruments to target and define very specific areas of the body.  It is important to understand that liposculpture is not a method of losing weight and is not a substitute for diet and exercise, but it can be used on stubborn "pockets" of fat.  It is available to both men and women and is normally done under local anaesthetic and sedation as a day procedure.

There are some new techniques for fat removal using ultrasound and laser systems (laserlipolysis).  These procedures are not generally used to remove large areas of fat, but to target specific areas of fat more precisely.  If you are healthy and wish to remove stubborn fat deposits, then you could consider this procedure.  There are a number of patented names on the market.

Liposoft

The revolutionary Liposoft technique allows accurate body contouring under local anaesthetic.

The procedure is performed as day case using a new device that helps increase the accuracy of sculpting and dramatically reduces recovery time.

This state of the art liposuction technique has many advantages over existing fat removal procedures and uses the newest technology to give wonderful and natural results.

•  Less swelling
•  Shorter recovery times 
•  Local anaesthetic day-case procedure 
•  Ability to stand up during the procedure to allow fine-tuning of the result

What is vaser lipo?

Vaser lipo is form of liposuction that uses ultrasound technology to emulsify and break up unwanted fatty deposits, which are then sucked out using a cannula (hollow tube) attached to a vacuum pump. The advantage of this technique is its accuracy, which, combined with an infusion of tumescent fluid, is used to effectively target fat whilst leaving blood vessels and nerves relatively unharmed. In addition, Vaser lipo can help reduce skin laxity as fibrous strands and structures around the fat cells are preserved, encouraging the skin to retract.

Vaser lipo requires local anaesthetic, and as such reduces the time spent in hospital, and also generally carries less risk than procedures done using general anaesthetic. Also, unlike traditional liposuction techniques, vaser lipo does not require scraping or other manual actions, so the chances of bruising and bleeding are reduced.

As with any cosmetic procedure, there are complications that can result from vaser lipo. Vaser lipo uses high powered ultrasonic energy, and as such there is sometimes increased risk of burns and blistering. The procedure needs to be correctly controlled and monitored by a surgeon who is highly experienced in liposuction treatment.

Quantity of fat, its location, and its stubbornness will influence what treatment is recommended. Treatments such as liposculpture can target stubborn pockets of fat with fine instruments, and liposoft can offer reduced swelling and recovery time by assisting fat reduction and removal using a targeted water jet, and smaller volumes of fluid than more traditional liposuction treatments. 

Each form of liposuction carries its own risks and limitations, and a surgeon should discuss these thoroughly with you in your consultation. It's essential to have realistic goals and to discuss all of the surgical options available in order to find the correct treatment for your individual needs.

What the procedure involves

The infiltration of water jet into the fatty areas during their removal helps to reduce the amount of bruising experienced by the patient after surgery therefore the results can be seen much quicker and recovery time is reduced. The patient may be up and about almost immediately. Shorter operation times can be achieved as well as minimized tissue trauma and less injury to nerves and vessels.

Unlike conventional treatments the body is NOT pumped with a large quantity of fluid. This enables a surgeon more precision when sculpting specific areas during treatment.  If required you may stand up during the procedure as some areas of fat are only easily seen when standing. Having the procedure under a local anaesthetic also makes it much safer.

How does it work?

The procedure involves a tiny incision being made in the skin and a cannula (a hollow stainless steel tube) is inserted by the surgeon. A water jet containing local anaesthetic breaks up the fat cells and allows gentle suctioning of the excess fat. The fat is removed far easier with this technique, and because of easier removal less bruising occurs after surgery. Less injury to nerves and vessels may also be achieved along with a shorter operation time for the patient. Areas that are suitable for treatment include the thighs, tummy (also see the tummy tuck page), upper arms, neck, buttocks, knees, calves and ankles.

Day case procedure

With traditional liposuction, large volumes of fluid are pumped into the body to aid fat removal.  Unfortunately this distorts the contours and makes judgment of the correct amount for removal more difficult.  With Liposoft much smaller volumes are needed which enables the surgeon to more precisely remove specific areas of fat as the contours of the body are not lost due to the body holding large amounts of water. Liposoft is a day case procedure and most patients are able to leave the hospital in as little as just two hours after they have had their treatment.

Benefits of Liposoft

•  Less pain
•  Less bruising
•  Less swelling
•  Less trauma
•  Less distortion of contours
•  Safer
•  Local anaesthetic
•  More accuracy

Risks & Complications

List of potential complications Uneven body contour, dimpling of skin, reaction to medications, haemorrhage, bruising, seroma (fluid under the skin), nerve damage (<1% risk of permanent numbness), infection, fat embolus (<0.1% risk), blood clots, skin necrosis, perforation of the abdominal wall or organs, shock, abnormal scarring, delayed wound healing, alteration in skin pigmentation, swelling, and death (risk 1 in 100,000).  

Deaths secondary to liposuction are a very rare event indeed but may potentially be related to a number of factors, including: blood clots, perforation of the abdominal organs, circulatory shock, and potentially a serious reaction to medications.  

Blood Clots

A deep vein thrombosis (DVT), otherwise known as a blood clot, may occasionally from in the very deep veins of the pelvis and leg following any kind of surgery. DVT's are generally due to the immobility associated with surgery (hence why travellers on planes are also at risk), which encourages clots to form. To help diminish your risk you should ensure that you stand regularly (at least once an hour) and move your feet around when sat or lying down to encourage blood flow.  

Perforation

Perforation of the abdominal wall or underlying organs is something that surgeons take great care to avoid, but surgeons may be limited in what they can see during the surgery, leading to a perforation. Your risk of perforation will be greatly reduced if you ensure your surgeon is experienced in liposuction procedures.  

Shock & Haemodilution

Shock is the result of an inadequate perfusion of the organs by the blood, this may occur because of bleeding, or may be due to the absorption of large amounts of fluid used during the procedure which dilutes the blood (haemodilution). The risk of haemodilution and shock increases with larger areas of liposuction and large volume liposuction should be considered carefully and discussed with your surgeon.  

Lidocaine

Lidocaine (also known as lignocaine) is a local anaesthetic that is used to manage any pain associated with the procedure. Very rarely lidocaine may affect the heart causing it to beat ineffectively, or affect the brain, causing a seizure. Lidocaine is generally a very safe drug but people may be at higher risk of side effect if they are known to have poor liver function or drink high amounts of alcohol.  

Morbidity & Mortality

Liposuction is a very safe procedure when conducted by a properly qualified, experienced plastic surgeon, however, studies show that liposuction to be linked to a small number of deaths. ASPS (American Association of Plastic Surgeons) have reported a mortality rate of 1 in 100,000 liposuction patients. There may be an increased risk associated with: 

• Large volume liposuction

• Performing multiple operative procedures in combination with liposuction.

• Performing the procedure under general anaesthetic

• Patients with pre-existing health problems  

The overall safety of liposuction procedures has been investigated by ASPS's and found to have an overall risk of a significant complication to be 0.03%. ASPS's also found that the overall safety of liposuction is improving in recent years with a 10-fold reduction in serious complications and death. The overall complication rates associated with liposuction found by the ASPS group is as follows:

Complication	Percentage rate	1 complication per….
Skin slough	0.0903%	1 per 1107
DVT's	0.329%	1 per 3040
Pulmonary emboli	0.0266%	1 per 3759
Significant haemorrhage	0.0149%	1 per 6711
Fluid overload	0.0138%	1 per 7246
Fat emboli	0.0053%	1 per 18,868
Perforation of abdomen	0.0021%	1 per 47,619
Lidocaine toxicity	0.0021%	1 per47,619
Shock	0.0011%	1 per 90,909

Thigh Reduction Surgery

In thigh reduction surgery, excess wrinkled skin and fat are removed from your upper and inner thigh to firm and tighten the area. This procedure will leave a scar that begins in the groin area, runs across the inside of your thigh and under the crease of your buttocks.

If you also have significant excess loose skin on your inner thigh extending almost to your knee, additional surgery would have to be done to shape the area and would result in a vertical scar on your inner thigh.

Your consultation

During your consultation your surgeon should ask about your general medical history. You should discuss the outcome you are seeking and whether this is possible and how much scarring you would find acceptable.

• As with any other surgery, the extent of the problem and amount of correction that is necessary would determine how much skin would need to be removed and how extensive the scarring would be.

• Post-operative scars on the body will always be more visible than scars on the face, although much of the scarring can be hidden in your bodies natural folds.

What to expect from your operation

Thigh reduction is usually done under general anaesthesia. It may be performed as a day case or you may spend a night in hospital after your procedure. As part of your operation, the surgeon may perform liposuction on the inner part of the thigh to reduce volume and mobilise the skin.

An incision is made in the groin crease (and inner thigh, if more extensive surgery is being done). The upper part of the skin is undermined and the excess skin would be trimmed. Suspension sutures are used to attach the skin to the groin area and the wounds are closed with or without drains and your wounds would be dressed. The entire operation should take around 1.5 hours. Wearing a compression garment is advisable after this type of surgery.

After your surgery

You should not experience a significant amount of pain. However, suitable pain relief should be provided by your surgeon/anaesthetist.

During your recovery there are several things you should know:

• It is important to take proper care of your wound to reduce the possibility of infection. Antibiotics should be prescribed and you should use an antiseptic wash on the wound area whenever you use the toilet, reapplying a light dressing. Continue wearing your compression garment.

• Avoid exercise for 1 month after surgery. Gradually resume normal activities after 1 month.

• If you do sedentary work (office) you should be able to return to work in around 7 - 10 days.

• You should have 4 or 5 return appointments with your surgeon, or members of his team, to monitor your progress.

The risks

• Bleeding, which is most often manifested as bruising, should not alter at the end result.

• Infection (2% to 3% of cases) can lead to wound breakdown. In most of these cases conservative management using dressings, antibiotic creams, etc., would help the wound to settle down. However, you may require scar revision.

• Deep vein thrombosis and pulmonary embolism are also risks with this type of surgery. It is therefore important to mobilise as soon as possible after your operation.

Arm Reduction Surgery

As we age, the skin of our upper arms begins to sag and hangs from the lower side of the arm when the arm is extended. Arm reduction (brachioplasty) can remove the loose skin and underlying fatty tissue. You should know that you will have a noticeable scar, so please bear this in mind, as you may feel reluctant to bare your arms after the procedure.

This condition can also occur after substantial weight loss, even in much younger people. If you have lost a great deal of weight, this surgery can be an important part of restoring a balanced body shape.

Your consultation

During your consultation your surgeon should take a medical history and ask you about your goals for the procedure. He should discuss the surgery and make sure you understand that you will be left with visible scarring.

As body scars do not fade as much as those on the face, plastic surgeons have made efforts to reduce the visible scars. New techniques have evolved using a combination of liposuction with a shorter scar arm lift, but these are generally more suitable for people with smaller amounts of loose skin and fatty tissue to be removed, and whose skin has retained some elasticity. The surgeon should discuss whether you would be a suitable candidate for this approach. If you have significant sun damage, extensive stretch marks or very loose skin, you would not make a good candidate for short scar surgery.

What to expect from your operation

The procedure is normally performed under general anaesthetic and you can either return home the same day or have an overnight stay in hospital. Depending on the amount of skin & fatty tissue to be removed, the scars may be placed in the armpit; in the armpit, extending a short way on the inner part of the arm or; along the inner arm from elbow to armpit. The procedure normally takes around 1.5 hours.

After your surgery

You should not experience a significant amount of pain. However, suitable pain relief should be provided by your surgeon/anaesthetist.

As you recover there are some things you should expect:

• Some swelling and bruising is normal and should resolve in a matter of days or weeks.

• Absorbable sutures should be used. Your dressings will be removed in 1 week.

• You can wash, but it would be best to keep the dressings dry for the first week.

• Sometimes hands and wrists may swell after surgery on your arms. Try to keep your arms elevated on pillows at your sides in the first week.

• 2 to 4 postoperative visits are usually required, but you may need additional visits if more scar management is necessary.

• The surgeon should suggest ways to minimise your scars, such as using silicone gel and massage for a period of several months, or using a tape impregnated with silicone applied straight over the scar.

• Arm movement should be reduced for 1 month.

The risks

• Complications from arm reduction surgery are rare but may include infection, bleeding and excessive scarring.

Tummy Tuck (Abdominoplasty)

An abdominoplasty, or tummy tuck, is a surgical procedure that can change the shape of the abdomen by removing excess loose skin and fat, and by tightening the underlying muscles.

Why choose tummy tuck surgery?

Tummy tuck surgery is one of the most rewarding and popular procedures available today and can help people achieve a flatter stomach, slimmer overall physique, and a feeling of rejuvenation. It is commonly performed in cases where abdominal skin and muscles have been significantly stretched, such as women who have recently given birth or a person who has gained and then lost a large amount of weight. The procedure can also correct Caesarean scars and reduce the effects of stretch marks.

Is an abdominoplasty right for me?

If you are considering having a tummy tuck procedure, it's essential that you contact an accredited and experienced surgeon for a full consultation. The surgeon will be able to assess your personal needs, and decide whether surgery is your best option. Ideally you should be close to your ideal weight, but it is understood that this is not always possible. The surgeon will discuss whether you should combine the procedure with liposuction, and the position of your scar. Sometimes the position of the scar can be slightly adjusted in light of your preferred form of clothing or underwear, but ultimately the final decision is restricted by your anatomy. The surgeon may also suggest non-surgical alternatives such as tummy tuck cream.

What is involved in the tummy tuck procedure?

There are two forms of tummy tuck surgery. UK surgeons will either perform a full tummy tuck or a partial tummy tuck (apronectomy). The surgery is normally performed under general anaesthetic, and the length varies depending on the patient's needs, but can often take up to three hours.

During a partial tummy tuck, your surgeon will make a large incision across the lower abdomen. He or she will then separate the skin from the abdominal wall and remove any excess fat. The surgeon will then cut away any excess skin before the remaining skin is pulled down to the first incision and stitched together.

In a full tummy tuck, your surgeon will make an incision across the abdomen, just above the pubic region, from hip bone to hip bone. A second incision is then made in order to free the belly button from surrounding tissue, and the skin is then separated from the abdominal wall. The muscles are then pulled down and stitched into the new position, and any fat deposits and excess skin are removed. A new hole is subsequently cut for the belly button, and it is stitched back in to place. Finally, your surgeon will pull the remaining skin down to the first incision and stitch them together.

What happens after the abdominoplasty operation?

After your tummy tuck surgery, drainage tubes are placed under the skin in order to collect any excess fluids. This will be removed after twenty-four to forty-eight hours, but the post-surgery dressing is usually kept in place for a week, and a special compression garment that aids healing is often required, which is worn for up to three weeks.

Abdominal discomfort and tightness may occur after abdominoplasty surgery, but can be controlled with painkillers—although aspirin should be avoided as it can promote bleeding. Swelling and bruising may also occur but will usually disappear within six weeks. Numbness is also known to occur in the lower abdomen, but sensation should return over time.

For a full tummy tuck recovery, you should avoid returning to work for around two weeks—longer if your job requires strenuous activity. It's important to rest fully and to make sure you don't put any strain on the affected area.

Rare tummy tuck complications can include:

• Infection
• Blood clots
• Haematoma
• Prominent scars
• Seroma (fluid collection)
• Skin necrosis (Skin death)

Infection can be treated with antibiotics and drainage, and a seroma can usually be drained by you surgeon using a fine needle. You can reduce the risk of blood clots by moving about as soon as you can after your operation.

More serious wound problems such as skin sloughing off, or liquefied fat draining from the incision, may require additional surgery to allow healing, sometimes utilising skin grafts.

It's important that you research the procedure you're interested in thoroughly before you make any final decisions regarding surgery. You should be completely happy and confident with your surgeon, and aware of the inherent risks and limitations of all surgery. Once you are fully prepared, you stand a good chance of achieving a pleasing outcome.