Liposuction

Fatty deposits under the skin can be reduced and reshaped through this ingenious technique which was first decribed around 30 years ago. At the MH – Clinic, liposuction is most often used as part of other procedures, such as neck liposuction in a facelift, or to the abdomen and flank regions in abdominoplasty. Mr McDiarmid also performs liposuction as a sole procedure in patients deemed appropriate for this treatment. The main limitation of liposuction is not simply the absolute volume of fat cells that can be removed but rather being unable to predict how elastic the overlying skin is. If the skin is not elastic an unattractive contour may result. Not every patient desiring liposuction is a suitable candidate for it and any concerns regarding unpredictability of skin shrinkage should be frankly addressed with patients at consultation.

WHAT DOES IT INVOLVE?

The area in question is marked before surgery. The choice between general and local anaesthesia, with or without sedation, depends on the size and position of the area in question and also the patient’s wishes. We use the tumescent technique which entails the fat to be removed, being first injected with an infiltate of local anaesthetic, hyalase (an enzyme which breaks the bonds between fat cells) and adrenaline to minimise bleeding. Deposits of subcutaneous fat are then removed using a special canula (tube) attached to a suction pump. Several litres of fat can be safely removed in a single session with minimal blood loss. Often several incisions are made around the same fat deposit in order to allow the tracks of the canula to intersect with each other and minimise the potential for ridging or unevenness. The edge of the area being treated is then bevelled off (so-called ‘feathering’) and a single suture or steristrip is applied to cover the wound. Specially made compression garments are worn for four to six weeks afterwards to help to sculpt the remaining fat into a smooth natural shape. Patients sometimes choose to purchase two garments, one being slilghtly looser-fitting for the first two weeks post-operation, the other being tighter for weeks three to six when some of the swelling has gone down.

Ultrasonic assisted liposuction (UAL) is a recent innovation which melts the fat under the skin. Although it may reduce the effort required by the surgeon to perform liposuction, it carries far greater inherent dangers of unknowing damage to deep structures that ordinary tumescent liposuction does not have and, as such, we do not feel that it is adequately safe for our patients. Power assisted liposuction (PAL) is a wonderful way of improving the efficiency and evenness of liposuction as well as encouraging shrinkage of the overlying skin. Using a reciprocating or rotating cutting head, large volumes of fat can be removed. This technique is the primary way that Mr McDiarmid performs liposuction and he feels that it represents the best balance of safety and effectiveness for his patients.

WHAT ARE THE SCARS LIKE?

Tiny marks are left which are less than five milimetres in length and almost always imperceptible.

HOW PAINFUL IS IT?

The treated area can remain sore for several days following surgery but the pain is rarely severe and usually subsides rapidly. Patients are offered a short course of pain killers on discharge form hospital.

WHAT HAPPENS AFTER SURGERY?

Patients should limit their activity for the first few days after surgery as they will be bruised and sore. Specially made compression garments are worn for four to six weeks afterwards to help to sculpt the remaining fat into a smooth natural shape. This is absolutely crucial in order to minimise the possibility of irregularity. Ordinary lycra cycling shorts or vests are simply not adequate as they crease and fold very readily and can permanently indent the healing fat underneath. The small additional cost of a bespoke compression garment is only a tiny fraction of the overall cost of the surgery and is a worthwhile investment. After two weeks, patients are reviewed in the clinic and all steristrips and sutures removed. A final follow-up is performed at three months for post-operative photography.

WHAT COULD GO WRONG?

Irregularities, lumpiness or asymmetries occur rarely and are usually prevented by wearing a compression garment. Bleeding, infection and seroma (collection of a quantity of clear fluid under the skin) are all extremely rare complications.