LIPOSUCTION RISKS





About liposuction

Liposuction, also known as liposculpture or lipoplasty, is an operation that can remove small areas of fat that you haven't been able to shift with diet and exercise. Liposuction is not a treatment for weight control or obesity, and it can't remove cellulite or stretch marks.

Liposuction can be done on your abdomen, hips, thighs, buttocks, knees, ankles, upper arms, neck and sides.

There's a limit to the amount of fat that can be safely removed from an area, so it may not be possible to reduce an area as much as you might like. Your body won't replace the fat cells, so you should have a long-lasting change in your body shape, especially if you exercise, eat a healthy diet, and maintain a healthy weight after your operation. However, putting on weight can cause the remaining fat cells to enlarge.

Getting advice.

It's important not to rush into the decision to have cosmetic surgery. Discuss your options with your GP, who may be able to recommend a reputable surgeon or advise you about choosing a hospital to be treated in.

Before opting for liposuction, discuss with your surgeon what you are hoping to gain from the operation and the result you can realistically expect.

What are the alternatives?

If you want to lose fat from your abdomen, an alternative may be a tummy tuck, where excess fat and skin are removed from the abdomen. However, a tummy tuck is also not a treatment for obesity.

Many creams, diet supplements and beauty treatments claim to reduce stubborn areas of fat and even cellulite. However, there is no scientific proof that they work.

Preparing for your operation.

Your surgeon will discuss how to prepare for your operation. If you smoke, you may be asked to quit, as smoking will increase your risk of getting a chest or wound infection and slow your recovery.

Liposuction is often done as a day case, but you may need to stay in hospital overnight if you are having large areas treated. The operation is usually carried out under general anaesthesia, which means you will be asleep during the procedure. If you're having a general anaesthetic, you will be asked to follow fasting instructions. Typically, you must not eat or drink for about six hours before a general anaesthetic. However, some anaesthetists allow occasional sips of water until two hours beforehand.

Your operation may be done with an epidural if you're only having your lower body treated. Local anaesthetic injections might be an option if you're only having a small area treated. This means that the area will be numb but you stay awake. You may be given a sedative to help you relax during the procedure.

At the hospital, your nurse may check your heart rate and blood pressure, and test your urine.

Your surgeon will usually visit you to discuss the operation and ask you to sign a consent form. This confirms that you understand the risks, benefits and possible alternatives to the procedure and have given your permission for it to go ahead.

Your surgeon will mark the treatment area on your body. Photographs may be taken, so that the results of liposuction can be compared with your original appearance.

About the operation.

There are several different techniques. Your surgeon will explain the options available to you.

Depending on how much fat you are having removed and the technique the surgeon is using, the operation usually takes between one and four hours.
Wet liposuction

Your surgeon will inject a mixture of salty water, local anaesthetic and adrenaline into the fatty area being treated. This helps reduce bleeding, bruising and swelling and makes it easier to remove the fat.

Your surgeon will make a cut in your skin and insert a thin metal tube. This is attached to a vacuum pump or a syringe. The tube is moved vigorously inside the fatty tissue to break it up. The fat and fluid is sucked out. For larger areas, more than one cut may be made to reach all the fatty deposits that are being treated.

Once your surgeon has removed the required amount of fat, the metal tube is taken out and the cuts may be closed with stitches.

A variation of the wet technique is called tumescent liposuction where a larger volume of fluid is injected.

Dry liposuction.

The surgeon uses a metal tube with suction, without fluid injection, to remove the fat. Dry liposuction can cause more bleeding and bruising than wet liposuction, so it's not often used now.
Ultrasound liposuction

If the fat is very dense (for example, on a man's torso) or there is a lot of fat, ultrasound can be used to break up the fat before it is removed.

What to expect afterwards.

Afterwards, the treated area is firmly strapped with bandages. You will usually be fitted with an elasticated support garment. This will help to reduce swelling and help improve your shape.

You will be given painkillers to help relieve any discomfort as the anaesthesia wears off. You can go home once you have made a full recovery from the anaesthetic, but you will need to arrange for someone to drive you home. Try to have a friend or relative stay with you for the next 24 hours.

General anaesthesia can temporarily affect your co-ordination and reasoning skills, so you should not drink alcohol, operate machinery or sign legal documents for 48 hours afterwards.

Before you go home, your nurse will advise you about caring for your stitches, hygiene and bathing. You will usually be given a date for a follow-up appointment.

Recovering from liposuction.

Your surgeon will advise you on the exact post-operative care required as this varies according to the areas treated, how much fat is removed and your natural skin elasticity.

You can usually take over-the-counter painkillers such as paracetamol or ibuprofen if you need them. Always follow the instructions in the patient information leaflet that comes with the medicine.

You will usually need to wear your elasticated garment or bandages for up to three weeks. Don't do strenuous exercise for up to four weeks, but walking and gentle exercises are encouraged. If you had treatment to a large area, you may need to take up to 10 days off work.

If you have had dissolvable stitches, the amount of time they will take to disappear depends on the type of stitches you have. They usually disappear in around two to three weeks, but it can sometimes take longer. Other stitches may need to be removed after about seven days.

It may be several months before you see changes to your body shape as the swelling can take time to settle down. If you have skin with good elasticity, it's more likely to shrink down to fit your new body shape well. It's possible that you still won't be happy with your appearance after the operation.

What are the risks?

Liposuction is a commonly performed and generally safe surgical procedure. However, in order to make an informed decision and give your consent, you need to be aware of the possible side-effects and the risk of complications.

Side-effects.


These are the unwanted but mostly temporary effects you may get after a procedure. Side-effects of liposuction include:

considerable bruising - this can be painful and can sometimes take more than a month to clear
swelling - this may not completely settle for up to six months
scars - these are typically 1 to 2 cm long, pink and noticeable at first, but should become fainter after a few weeks
raised, bumpy veins (thrombophlebitis) around the inside of your knee and inner part of your upper thigh if these areas are treated - this is not the same as deep vein thrombosis and should settle after a few weeks
swollen ankles
If you have large areas treated or are prone to anaemia, you may need to take iron tablets for about a month afterwards.

Complications.

This is when problems occur during or after the operation. Most people are not affected. The possible complications of any operation include an unexpected reaction to the anaesthetic, excessive bleeding and infection. Antibiotics may be needed to help prevent infection.

Other complications specific to liposuction are rare, but can include:

lumpy, uneven results, which may need another operation
fat getting into the blood vessels and travelling to the lungs - this can cause a blockage, called a pulmonary embolism, which can be fatal
numbness - this may last for several months
damage to internal organs - this may require surgery to repair
build up of fluid in the lungs (pulmonary oedema) as a result of the fluid injected into the body
The exact risks are specific to you and differ for every person, so we have not included statistics here. Ask your surgeon to explain how these risks apply to you.


This information was published by Bupa's health information team and is based on reputable sources of medical evidence. It has been peer reviewed by Bupa doctors. The content is intended for general information only and does not replace the need for personal advice from a qualified health professional.
nitial consultation

At the initial visit, your doctor will likely ask you to describe in detail what you would like improved. Be specific about what you would like done. If your surgeon fully understands your expectations, they'll be able to determine whether your goals are realistic. Your physician will evaluate your overall weight, your skin and muscle tone, and the distribution of fat deposits to determine which techniques will be employed, where incisions will be made and what results can be achieved. Your skin type, thickness and texture, your age, if you are a smoker, and pre-existing sun damage will all effect the final result.

Basic procedures and techniques.

Anesthesia: General or Sedation
Location: Hospital, surgical center or office
Surgery time: 30 minutes-4 hours
Quick Fact: Women have softer, less fibrous fat than men - making it easier to perform lipo


Which type of liposuction?
There are two basic techniques used in liposuction: tumescent and ultrasonic. Both techniques share core surgical elements. In fact, even if ultrasound is used, it will be followed by tumescent liposuction.

Tumescent liposuction is also called standard liposuction, liposuction, lipoplasty, liposculpture, liposculption, and suction-assisted lipoplasty. This type of liposuction has been performed in the United States since 1982. First, the surgeon fills the fat with tumescent fluid (a solution containing saline and local anesthetic). Then, the fat is suctioned with long thin rods. The procedure can now be performed through a few small incisions, which can be hidden with natural skin creases. The tumescent technique may reduce blood loss and alleviate pain. The local anesthesia may be supplemented with intravenous sedation or general anesthesia.

Ultrasonic liposuction also starts with filling the fat with tumescent fluid to make the fat stiff. However, the fat is not suctioned, but liquefied with high-frequency ultrasonic energy with a long thin rod that emits ultrasonic waves. The rod is inserted into the fat through a tiny incision and then, the fat is suctioned out.

There are other sub-categories of the two techniques:
Suction-assisted Liposuction (SAL): The traditional method, by which the surgeon removes fat by inserting a small, hollow tube (cannula) connected to a vacuum pressure unit, directing the cannula into areas to be suctioned through tiny incisions.

Ultrasound-assisted Liposuction (UAL): Sound waves are transmitted to the tip of the cannula to liquefy fat before it is removed by suction.

External Ultrasound-assisted Liposuction (E-UAL): External ultrasound waves alter fat cells. The area is injected with fluid containing local anesthetic to transmit ultrasonic energy and liquefied fat is removed by suction.

Power-assisted Liposuction (PAL): A cannula with a back and forth motion of the tip passes through tissue to suction out fat and fibrous, or scarred tissue with reduced effort.

VASER-assisted Liposuction (VAL): Intermittent, or continuous bursts of ultrasonic energy can be used to break up fat cells which are then removed by suction.
There is not a consensus among plastic surgeons as to which technique is superior. There is slightly less blood loss and a greater ability to remove fat in difficult areas with ultrasonic liposuction, but it is also associated with greater complications than tumescent liposuction such as burning and/or tingling, swelling, skin burns and seromas (fluid collecting under the skin). Discuss these technique with your surgeon. Because there are only small differences between the procedures, the technique that your surgeon is most skilled in will cause the least complications.

Anesthesia.
Liposuction can be performed under general anesthesia (in which you are completely asleep) or sedation (very relaxed in a light sleep). It can be performed in the office or hospital. Depending on how many areas are being worked on, surgery lasts from 30 minutes to 5 hours. In addition to fat, the surgeon also removes body fluid in the procedure. Because of this, patients are given fluids intravenously during the operation and there is the possibility that a blood transfusion will be necessary.

After surgery, you will wear a body-compression garment. You must wear this for several weeks. After surgery, you can usually go home. You'll want to make arrangements for a responsible adult to care for you for the first 24-48 hours. If your surgeon performed a large-volume liposuction (over 5 liters) then you should stay in the hospital overnight for observation and safety.

Cellulite.
Do not expect liposuction to improve your cellulite. It may actually worsen it. This is because cellulite is due to superficial fat, which liposuction does not remove. Lipo removes only deep fat.

Tummy Tuck vs. Liposuction of the Abdomen
If you have excess abdominal fat, no stretch marks and fairly good skin tone, you are a good candidate for liposuction. If you have stretch marks, loose skin and a loose inner girdle (all more likely after pregnancy), a tummy tuck is probably your best choice.

Recovery.

Pain Level: Varies depending on procedure (ranges from mild to severe); 3-14 days of pain medication
Swelling: 2 weeks-2 months or more
Bruising: 2 days-2 weeks
Numbness: lasts several weeks
Bandages: Changed in 1-2 days
Work: Return after 1-3 weeks
Exercise: Wait 2-4 weeks
Final result: Seen after 1-6 months

Drink adequate amounts of liquids to prevent dehydration
• Avoid alcoholic beverages for 48 hours before and after surgery
• Wear compression garments as suggested
• Do NOT apply ice-packs or a heating pad to skin on the liposuctioned areas
• Do NOT apply hydrogen peroxide or plastic Band-Aids to incision sites
• Do NOT soak in a bath, Jacuzzi, swimming pool, or the ocean for at least 7 days after surgery in order to minimize the risk of infection
Reduce your risk of fainting at home by: standing up slowly after urinating, remove compression garments slowly, have assistance for your first shower, sit down if you feel dizzy or lightheaded.

Recovery from liposuction can be uncomfortable but most people are back to work within 10 days. During the first few weeks, most people experience varying degrees of pain, burning, swelling and temporary numbness. Pain medications can alleviate discomfort (usually taken for 2 days - 2 weeks) and a body-compression garment will minimize swelling. You will need to refrain from any exercise other than walking for about a week after the procedure. Slowly work your way back to your old exercise routine.

Consider a massage therapist for lymphatic drainage massage to relieve swelling and possible itching (discuss this with your doctor).

Although the new shape of your body usually begins to emerge in the first few weeks, some swelling may remain for several months. Major weight gain or loss after liposuction can produce skin surface irregularities. The final result may not be clear until 6 months after surgery.

Many people assume that because liposuction permanently removes fat cells, it's impossible to regain weight in the treated areas. This is only partially true. Adults have a fixed number of fat cells, and liposuction removes some of these cells permanently. The remaining fat cells can grow bigger, especially if you do not exercise and maintain a healthy diet. This means problem spots can return. However, weight gain after liposuction will usually be distributed to other parts of your body instead of settling back into the old problem areas.

Risks and complications

Deaths related to liposuction surgery can happen for a number of reasons: blood clot, perforation of the abdominal wall or bowels, shock and hemodilution (blood dilution), and possibly excess amounts of lidocaine.

Blood Clots
Blood clots (or deep venuous thrombosis, a DVT) can forms in the deep veins of the pelvis or legs after any surgery. A blood clot forms after prolonged immobility (people on international flights, women on bedrest during pregnancy and patients recovering from surgery are the most susceptible to blood clots). It is important to stand often (at least once an hour), flex the feet more often and generally keep the blood flowing in your legs. If the blood pools for too long in one area, you could be at risk for a blood clot.

Perforation .
Perforation of the abdominal wall or bowels is preventable during surgery. Surgeons are limited in what they can see during surgery and must take extra caution. Choosing an highly experienced surgeon can reduce your risk of such complications.

Shock and hemodilution.
Shock and blood dilution can occur after a patient has had excessive amounts of fluid injected and then excessive amounts of fat and body fluid removed (over 5,000 cc's, about 11 pounds). Large volume liposuction should be considered carefully. It is generally not recommended. However, there are surgeons that specialize in it (See Reuters Health article).

Lidocaine.
Lidocaine use poses particular hazards, especially since experts do not agree on safe injectable levels. "If you get too much lidocaine for too long," says Bruner, "the heart muscles become lazy. On the other hand, the brain becomes very agitated at first, which may cause a seizure, before coma sets in." At least one study links possible lidocaine toxicity to liposuction deaths. People with less than normal liver function or those who have been drinking alcohol may not be able to metabolize lidocaine well.

According to the FDA, a survey conducted by the American Society of Plastic Surgeons (ASPS) of more than 1,500 plastic and reconstructive surgeons in January 1999, there was an unexpected high death rate of one in every 5,000 (or 20 out of 100,000) liposuction patients between 1994 and 1998. These high numbers may be due to an increase in unqualified surgeons performing liposuction during that period. Since 1995, the number of deaths related to liposuction have decreased dramatically, to around 1 in 100,000 (approximately 25 deaths out of 250,000 liposuction procedures per year).

A study published in the scientific journal, Dermatologic Surgery, shows that office-based liposuction may be significantly safer than hospital-based liposuction. No deaths were reported by dermatologists performing approximately 300,000 procedures from 1995 - 2000.

A review of malpractice claims from the Physicians Insurance Association of America (PIAA) showed that of the 257 claims filed from January 1, 1995 through December 31,1997, less than 1 percent were against dermatologists even though dermatologic surgeons perform more than one-third of the liposuction procedures in the United States. In addition, 89% of claims were against plastic surgeons, with patients undergoing liposuction in a hospital setting accounting for 71% of malpractice claims.

According to statistics from their respective professional organizations, dermatologic surgeons currently perform about 100,000 liposuctions annually, with plastic surgeons accounting for more than 170,000 fat removal procedures per year. "Our study found that liposuction is safest when it is performed as a solo procedure under local (tumescent) anesthesia in an outpatient setting by a board-certified dermatologic surgeon. In fact, our data shows that there have been no deaths from liposuction by dermatologic surgeons." William P. Coleman, III, MD, president of the American Society for Dermatologic Surgery.

According to Dr. Coleman, more risks are associated with:
extracting large amounts of fat

using general anesthesia in a hospital setting
performing multiple procedures during the same surgery
The PIAA study confirmed that patients who had liposuction performed under local anesthesia using the tumescent technique had no fatalities and fewer complications.

Source: www.asds-net.org

According to a study by the ASPS Liposuction Task Force, released in October 1998, the rate of significant complications from liposuction is low. The Task Force reviewed 24,295 liposuction surgeries performed by board-certified plastic surgeons for the study and found that only .03 percent reported significant complications.

Factors that increase the risk of complications include: large volume liposuction, because of the use of greater amounts of fluid and anesthesia, as well as removal of more fat; extended length of surgery; multiple procedures; or a patient whose preoperative health is compromised.

In 1997 board certified plastic surgeons formed a task force to investigate liposuction safety. Their research led to increased efforts by ASAPS and other plastic surgery organizations to re-educate plastic surgeons about risk reduction in lipoplasty procedures. Several measures were identified as ways to increase patient safety, including: 1) using stricter patient selection criteria, 2) limiting the length of surgery, 3) avoiding pre-injection of excessive amounts of fluid and local anesthetic, 4) removing a smaller volume of fat, 5) avoiding the combination of liposuction and certain other procedures, and 6) careful postoperative monitoring.

Beginning in mid-1998, the safety record of lipoplasty performed by board-certified plastic surgeons appears to have improved dramatically. In May 2001, a major survey on lipoplasty safety was published in Aesthetic Surgery Journal, the peer-reviewed journal of the American Society for Aesthetic Plastic Surgery. The survey, covering many thousands of lipoplasty procedures performed by ASAPS members from September 1998 through August 2000, showed that the risk of death from lipoplasty performed as an isolated procedure (not in combination with any other surgeries) was 1 per 47,415 procedures, a nearly 10-fold decrease from rates suggested by earlier published surveys.

Scars

Surgical scars are permanent. However, usually only two small incisions (less than 1/4") are made for each area. Incisions are often placed in natural skin creases, are hidden in pubic hair, or inside the belly button so that they are not normally noticeable except on very close observation. Certain areas are easier to hide than others.

To keep scar tissue soft and minimize their appearance, massage them with scar minimizing/reduction creams such as Mederma, and keep them out of the sun.

Scars by area:
Abdomen: at the belly button, bikini line, each side of the abdomen
Arms: along the arm
Breasts: in the breast crease (under the breast)
Chin: under the chin and behind each ear
Knees: usually two tiny incisions per knee, in skin creases
Thighs: depends on fat location, usually on the edge of suctioned area

Source: www.surgery.org

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