Frequently Asked Questions
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Frequently Asked Questions – Liposuction
What is "fat?"
While we all know what fat is in the context of our daily lives, things like butter and oil, which are comprised of fatty acids, when we refer to fat in our bodies below our skin we are talking about something more complex. Adipocytes or fat cells are the cells that store the fat in our bodies. We are all born with about the same number of these cells and we don’t grow substantially more of them during our lifetime. Rather, the amount of fat inside each cell increases or decreases. Adipocytes contain a fat vacuole where the fatty acids are stored. When we “gain weight” the vacuole of fat enlarges with an increased quantity of fatty acids, and when we “loose weight’ the contents of the vacuole decreases, but we don’t gain or loose the actual number of fat cells we have. These adipocytes are arranged in a complex structure below the skin. The adipocytes exist within a honeycomb-like structure comprised of connective tissue and blood vessels.
Liposuction or suction-assisted lipectomy is a process in which the adipocyte cells are removed, not just the fat within the cells. This changes the relative number of cells in the operated areas. This means that additional weight gain will be distributed proportionally all over the body to the remaining adipocytes that remain and that new adipocytes do not “grow back” at the site of previous surgery, making the new contours relatively permanent.
What is Liposuction?
What is the process of liposuction?
The process of liposuction begins with placement of tumescent fluid which contains a fluid similar in electrolyte composition to that of the human body. Lidocaine for numbing and epinephrine for vasoconstriction to prevent bleeding are added to the fluid. The fluid is placed under the skin during a process called infiltration. The fluid also serves as a medium to allow transmission of the VASER ultrasonic energy. VASER ultrasonic energy is administered by the VASER machine that has been specifically designed to deliver ultrasonic energy for the purpose of liposuction. The ultrasonic energy “shakes” apart the connections between the adipocyte fat cells, breaking them into packets of approximately 20 to 40 cells, without significantly injuring or rupturing the cells. This leaves the cells viable and ready for autologous fat grafting if desired. Ultrasonic energy often results in less trauma to the tissues, resulting in less pain, swelling, and downtime for patients. Ultrasonic energy allows for greater fat extraction. Up to 50% more fat may be removed over competitors not using ultrasonic energy for the separation phase of the procedure. Ultrasonic energy also provides the ability to make smoother and more controlled contours, including removal of fat from the superficial layer, which in the past without ultrasonic energy resulted in lumps, bumps, and contour irregularity, often referred to as “bad liposuction.” The separation phase is followed by the extraction phase in which the fat is suctioned from below the skin. This is the phase that many associate with the term liposuction. Some practitioners have attempted to combine all liposuction phases into one, largely due to either training or trying to reduce time of the procedure. In the single phase approach, the adipocytes are either mechanically cut or ripped out with the extraction cannula, combining the separation phase with the extraction phase. This, however, may result in greater trauma, bruising, and contour irregularity. In our process, the extraction phase is followed by a fat equalization phase, in order to optimize contour outcomes.
Liposuction contours are usually long lasting provided there is limited weight gain and weight loss. Fluctuation in weight of 10 pounds or less is usually well tolerated with regard to preservation of liposuction contours.
Are the contours from liposuction long lasting?
What is the ideal weight for liposuction?
Liposuction is not a weight loss procedure and is typically not performed on patients with a body mass index (BMI) greater than 37. A steady weight is recommended. The procedure is performed and contours are created for the patient based on the weight of the patient on the day of surgery. For patients with a relative steady weight, losing weight prior to the procedure is not recommended, rather their “winter weight” or “post-holiday weight” is desired.
Yes. When more calories are consumed than are metabolically burned, the excess energy is captured in carbon chains as fatty acids which are in turn stored in adipocytes.
Can you gain weight back after liposuction?
Do you gain twice as much weight back?
No. One pound of fat is equivalent to 3600 kcal of excess energy. Weight gain itself does not change. However, weight gain patterns can be in different places than prior to surgery because storage cells have been removed from certain areas. While liposuction is feathered and blended into adjacent non-operated areas there can be disharmony between operated and non-operated areas with weight gain. Additionally, the loss of fat from an operated area can give the perception of weight gain in the non-operated area that now has a greater subcutaneous fat thickness relative to the operated area.
Liposculpting is when liposuction is used to take varying amounts of adipocytes from different areas to create more desirable contours, shapes, curves, and proportions, effectively sculpting the subcutaneous fat.
What is liposculpting?
Is liposuction a weight-loss procedure?
No. Liposuction is a sculpting procedure, improving overall contour. Contours are created for the weight of the patient on the day of surgery.
Largely, weight loss can be divided into bariatric surgery (which may be a restrictive procedure, malabsorptive procedure, or a combination of both) or behavior modification (diet and exercise), which may be assisted by medications.
What are methods of weight-loss?
What fat does liposuction address?
Subcutaneous fat only. Liposuction does not address visceral fat because it is below the abdominal wall musculature and surrounds the internal organs. Use of a liposuction cannula in this space could result in severe, life-threatening injury to internal organs. Liposuction does not address excess skin and connective tissue or skin laxity. If excess skin or skin laxity is present, liposuction can actually make skin folding worse if the skin does not contract.
Some results are immediate. However, bruising, swelling, and induration are typical. Swelling may increase for up to 4 weeks. Tissues begin to soften between weeks 8 and 12, with final results becoming apparent after 16 weeks. Because swelling may be directly related to the degree of tissue trauma, each side may heal at different rates, creating the appearance of asymmetry until both sides are able to reach similar healing at 16 weeks.
How long does it take to see results from liposuction?
Will I have a drain?
Drains are specific to the procedure and body area. Drains stay in place for 1 to 3 weeks with an average of about 2 weeks. Once the drain output is less than 25 mL per 24 hour period, the drain is removed.
Garments are specific to the procedure and body area. Garments are typically worn full-time for 2 weeks after surgery, but use may be extended an additional 2 weeks depending on progression.
How long do I wear garments after surgery?
Is liposuction surgery?
Yes, liposuction is a surgical procedure that can have complications. Adherence to strict guidelines and instructions is imperative to maximize safety.
Complications can occur with any invasive procedure, including injury to the skin from the ultrasonic probes and suction cannulas, both from thermal and mechanical causes. However, these complications are rare. The most common complications are fluid accumulating under the skin, called a seroma if it is fluid and more rarely a fluid collection called a hematoma if it is blood. Other potential complications include contour irregularity, asymmetry, skin folding or creasing from underlying skin laxity and loss of elasticity, or a reaction to anesthetic agents, which could cause heart, lung, or nervous system issues.
What are the potential complications of liposuction and use of ultrasonic energy?
Can liposuction be performed awake, or does it require general anesthesia?
Liposuction can be done awake with multi-modal medication or can be performed under general anesthesia. Any patient aware of difficulty numbing in the past, such as at the dentist offices, who has a low pain tolerance, or feels particularly anxious about undergoing a wide-awake procedure is strongly encouraged to undergo the procedure under general anesthesia.
No. All patients must have a caretaker who is willing to pick up the patient after the procedure and stay with the patient for the next 24 hours, whether the procedure was performed awake or under general anesthesia.
Can I drive myself to the procedure?
Are there medications or substances that need to be avoided prior to surgery?
These medications are discussed at the pre-operative appointment and include anything that can make you bleed or have a reaction to anesthetic agents. Many vitamins and supplements can cause bleeding and most are discontinued 2 weeks prior to surgery, as well as any aspirin, aspirin containing products (Excedrine, Alka-Selzer, etc), and non-steroidal anti-inflammatory drugs (Ibuprofen, Aleve). Medications that interact with lidocaine metabolism include methamphetamines (including many ADHD and diet medications), cocaine, and Selective Seratonin Reuptake Inhibitor (SSRI) anti-depression medications. These substances are prohibited 2 weeks prior to surgery. Patients on these medications that are not able to be off medications for 2 weeks prior to surgery and 2 weeks after surgery, may elect for general anesthesia in which lower concentrations of lidocaine may be possible, or choose to stage multiple body areas so that lower doses of lidocaine may be utilized. For patients on semiglutide medications, many have a half-life of 3 weeks and patients must be off them for 6 weeks prior to surgery. Patients on biologic and small molecule drugs can be at higher risk of severe complications due to immunosuppression and delayed wound healing.
SChedule a consultation
Have any questions?
We are always open to talking with you.
To schedule a consultation please feel free to call the office at 720.215.0700
or
Click the link below to leave us a message.
