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Liposuction is one of the two most popular cosmetic surgery procedures performed in the United States, falling a close second only to Breast Augmentation in the number performed. (www.cosmeticplasticsurgerystatistics.com) There is a high level of patient satisfaction with this procedure. Patients have found that Liposuction can deliver the body shape that has eluded them regardless of any amount of diet or exercise they have endured. Also important is the fact that the tiny incisions heal so completely as to be invisible, ultimately concealing the evidence that their improved shape was anything other than genetically acquired.
Liposuction techniques have continued to evolve and the equipment has become more sophisticated with time. Unfortunately, much of the more recent technology is based on marketing agendas, rather than scientific research. Physicians and patients alike should be mindful of this fact.
Historically, Liposuction was first introduced in the early 1980s. Results were limited by the amount of blood loss incurred and blood transfusions were sometimes needed. By the mid-1980s, the development of the Tumescent Technique revolutionized Liposuction both in terms of safety and results.
The Tumescent Technique initially involved combining normal saline (sterile water containing the normal concentrations of the various salts found in the body) with epinephrine, a powerful vasoconstrictor (causes blood vessels to contract and thereby reduces or stops blood flow to an area). This innovation effectively controlled blood loss and allowed safe extraction of a much larger amount of fat. This enabled Liposuction procedures to go from the removal of two to three liters (a liter being slightly larger than a quart) to many times that amount.
In time, lidocaine (a local anesthetic) was added to the normal saline and epinephrine solution. An adequate level of local anesthesia could be accomplished with this combination so that Liposuction no longer always required general anesthesia. This also opened the door to Liposuction being performed by non-surgeon physicians of many different specialties.
The Tumescent Technique is the gold standard of Liposuction. It is the most effective method of Liposuction known and is the technique against which all other Liposuction techniques are measured in terms of results and safety. I believe it is best to have a board certified plastic surgeon certified by the American Board of Plastic Surgeons.
Liposuction is performed with cannulas, cylindrical steel tubes of varying lengths, diameters and tip shapes. In the early days of Liposuction, fat extraction was done with large bore cannulas, 5, 6, 7 and 8 millimeters in diameter. The procedure has evolved to use much smaller cannulas, 2, 3 and 4 millimeters in diameter. Not only are the smaller diameters less traumatic to the tissues, but also they also allow for a smoother, more even extraction of fat.
The cannulas are designed to attach to plastic liposuction tubing that is attached to a liposuction machine. This machine provides varying amounts of negative pressure to create a vacuum. This is the primary function of the liposuction machine, although it also has a portion that provides positive pressure to inject the tumescent fluid. Also, mounted on the liposuction machine, are the canisters that receive the results of the liposuction, namely the fat and residual tumescent.
First, the liposuction machine is used to inject the tumescent fluid into the designated area of fat using a small cannula. A few moments are allowed for the tumescent to anesthetize, establish bleeding control and emulsify the fat for easier extraction. Then a small bore cannula, attached to the length of tubing providing suction, is inserted into the same small incision and the surgeon proceeds with the careful process of extracting the fat. Guided by the map drawn on the skin earlier in the pre-operative area, with the patient in a standing position, the surgeon uses a back and forth motion with the suction cannula. The fat collects in the suction canister for later disposal, as the surgeon smoothes and sculpts with the cannula. Slowly, the improved contours emerge until the liposuction procedure is completed to the surgeonís practiced eye and esthetic satisfaction.
As liposuction technology advanced, new machines were introduced. The Power-Assisted Lipectomy (PAL) technique placed the cannula into a hand-held power device that moved the cannula back and forth with the push of a button. Although designed to make the liposuction process less laborious, the popularity of the Power-Assisted Lipectomy faded quickly. Better results were still achieved when the cannula was moved solely by the surgeonís arm.
Ultrasonic Liposuction was introduced next. Unlike Power-Assisted Lipectomy, this innovation proved to be very valuable. Ultrasonic Liposuction employs sound waves that have the power to emulsify, or melt, fat. This process also creates heat, which in turn, enhances skin contraction. This technique is especially useful in secondary, or re-do, liposuction cases. Approximately 25% of patients seeking Liposuction at Marin Cosmetic Surgery Center fall into this category. These are patients who are disappointed with their improvement or uneven results after undergoing Liposuction procedures with other providers.
Laser Liposuction is the newest splash on the liposuction scene and Vaser Liposuction is the latest generation of these devices. Whether these new laser methods will pass the test of time is yet to be determined. New laser technology has a history of being extremely expensive with inadequate or questionable documentation of actual results. To date, there is only anecdotal evidence to support superior results using laser methods. No large, valid studies exist that substantiate these claims. If Laser Liposuction does prove it can deliver higher patient satisfaction and better quality outcomes and not fall by the wayside as another over-rated marketing gimmick, it will earn a place at Marin Cosmetic Surgery Center. For the time being, however, Dr. Delgado opts to offer only those procedures he knows to be of sound value for his patients.
What will remain steadfast in the realm of Liposuction is that it is the skill and artistry of the surgeon that determines a successful outcome. The surgeon makes critical decisions that will never be overshadowed by technology of any kind. The amount of fat to extract, the evenness with which it is removed and the blending of one area into another are all artistic judgment calls on the part of the surgeon. Likewise, sound medical decisions, based on years of study and practice, are made by the surgeon, the anesthesiologist and other surgical team members. These are central to your safety while undergoing a procedure such as Liposuction.
Liposuction is effective on people of varying weights and sizes. Results can be impressive, with patients often dropping two to three clothing sizes following this procedure.
Skin with good elasticity will adjust ideally and completely to the trim new contours. Although age is not a major consideration, older patients tend to have less elasticity in their skin and for this reason, will not achieve quite the same results as a younger patient.
There is rarely any improvement in irregularities in the skin, as Liposuction impacts the underlying fat, not the skin itself. The skin acts merely as a drape over the newly shaped contours underneath. Sometimes the heat from Ultrasonic Liposuction will give mal-contraction to the skin.
Although cellulite is not a contraindication for the procedure, Liposuction will not improve this condition, if it exists.
The most commonly treated areas in women are the inner and outer thighs, knees, hips (post iliac crests and flanks), abdomen and arms, while men most often opt for treatment of their chin, waist and abdomen. Most patients are looking for treatment of multiple areas and generally, these can be done in a single procedure.
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