Liposuction or Suction Assisted Lipectomy (SAL) has rapidly risen from a European novelty in the late 1970s to the most commonly performed procedure by Plastic Surgeons in America, such that over 100,000 procedures employing SAL are performed annually in the USA alone, SAL is defined as the removal of adipose tissue (fat) by the use of small cannulas placed under negative pressure. The incisions need only be one centimetre in length and are usually orientated so that the passage of the cannulas through the tissues is at right angles, affording a more uniform result. Although relatively simple in theory, the practice of SAL is quite sophisticated requiring careful patient selection, meticulous technique, precise fluid and electrolyte balance and an understanding of the risks and limits of the technique. It is dear to me after numerous consultations with patients requesting liposuction that, perhaps not surprisingly, a large number of them are unaware of the Indications for this operation. All too often requests for this procedure come from patients who suffer from generalised obesity and are looking for a quick way to solve their weight problem. The question "Doctor, howll condition of skin, age, weight, and hormonal influences all make a difference. However it is possible to remove fat deposits under the skin in a wide variety of areas from the chin to the ankles limited only by the surgeon's knowledge and imagination. Good skin elasticity seen in the younger, age groups Is a desirable attribute since it makes for a smooth surface contour. Once SAL Is carried out, the skin envelope has to shrink to adjust to the new, reduced volume of fat and this occurs more quickly and effectively the younger one is. Some patients have lax muscles and loose skin with or without excess fat, and they will require additional procedures like abdominoplasty ("tummy tuck") or thigh lifts.

Liposuction is of no benefit if there is gross skin excess. During the first appointment - The patients suitability for the procedure is many kilos will i lose with this operation?" Is met with great disappointment once I have explained that this is not an operation designed for weight loss. Liposuction is not a substitute for a healthy diet. While the foregoing may seem obvious, I mention it because some patients may expect localised fat removal to effect a dramatic weight loss. This is not possible. SAL selectively removes fat only from those areas in which the patient desires reduction, which are generally "problem" areas in the lateral thighs and buttocks in women and the flanks in men. Let me explain. Fat distribution is determined by two factors, heredity and diet. Heredity determines the number and location of the fat cells, which are fixed and unchanging after puberty. Diet can Increase or decrease the amount of fat in each individual cell but will not affect their total number or distribution. So, if you have a familial tendency for big thighs your strenuous attempts at weight loss will leave you with a thin upper body and larger thighs simply because you have inherited a greater number of fat cells in your thighs. Since actual fat cells are removed by liposuction, the procedure is permanent and following SAL the body will always have less fat in the treated areas.

This will allow for a much more even weight loss or gain. Your appearance after SAL is influenced by a number of factors which are different for each patient. The general state of health, overaassessed, andmeasurements of height, weight and circumference of areas of concern are taken. A general history is also taken and I usually like to explain in detail about the nature of the surgery and what can reasonably be expected In terms of outcome. It is vital importance that the patient expectations are in line with what the surgeon can deliver.

I usually also like to take pre operative photographs (which can be kept by the patient) so that there is some degree of objectivity when looking at the post operative results. It is important to realise, in this context, that soon after the surgery the tissues are swollen and indeed the area may appear larger than before. (Usually the results become apparent to the tune of 50% by the end of three weeks and 100% by three months,) During the first three weeks the patient will have to wear a support garment which will help to reduce oedema (swelling) and restrict bruising of the skin.

The Operation
The Operation lasts from 30 minutes to two hours depending on how many areas are treated. If only a couple areas are treated on the face and neck, local anaesthetic can be given usually with some sedation. Larger areas can be treated under General or regional (Spinal/epidural) anaesthesia. For most procedure a 24 hour stay in hospital is enough and the patients are encouraged to ambulate very early, There are usually no bandages or dressings and only a few sutures are used to close the small incisions. A urinary catheter may be placed prior to surgery if larger degrees of aspiration are performed. This is removed prior to discharge. Oral analgesics given for post operative pain usually suffice and all my patients except those having very small volume removal take an iron supplement for one month after surgery. A short course of antibiotics is also given. Stitches are removed after ten days and the scars are rarely troublesome. They are not noticeable by 12 months following surgery although it is Important to realise that all individuals do not scar to the same extent. As in any form of Aesthetic surgery, where one has to consider that no operation Is absolutely essential, the question of post operative complications and untoward results is of paramount importance. These should be discussed In detail on the first office visit On the whole, a number of studies have shown that serious complications are uncommon with this kind of surgery.

All patients have bruising which can last from 3 to 6 weeks, sometimes longer. A certain amount of numbness or altered sensation in the treated area is to be expected. This usually resolves. As with any surgery, bleeding, infection and complications due to General anaesthesia are possible, Thus while no surgery can be totally safe, liposuction compares favourably with any cosmetic procedure In terms of outcome. Although I make every effort to give as smooth and symmetric a result as possible, small side to side differences can occur. After having spoken to a number of my colleagues, it seems that no one of us is exempt from encountering this occasionally. Some patients will have secondary surgery after six months, most frequently to remove additional fat. It is better to err tot he side of leaving a little extra, since taking too much fat can be Irreplaceable. In summary, the 1990's has seen SAL rapidly developed Into the fine art of body sculpture. In experienced hands and with efficient instrumentation, it is a safe procedure which can afford excellent results in properly selected patients.