LIPOSUCTION

Liposuction dominates modern cosmetic surgery as the most commonly performed procedure.

The old surgeries for fat and skin removal, such as the “tummy tuck,” are significantly more risky than liposuction alone. Cosmetic results may also be inferior compared to skilled liposuction.

Recovery is usually reasonable, with most people back to work within just a few days to a week, depending on the circumstances.

Liposuction isn't a surgical cure for overeating, but is useful in the treatment of some overweight people along with exercise and diet.

The liposuction procedure has changed dramatically since it was first introduced in 1979. What began as a high-risk surgery requiring routine blood transfusions and often a lengthy hospital stay has evolved into a simpler procedure usually performed in an outpatient surgery center. In the early days, patients were hospitalized for up to seven days. General anesthesia was used (which itself presented risk), bleeding was often heavy, post-operative pain was excruciating, and bruising lasted for many weeks. Patients often stayed in bed for several weeks. With all that in mind, added to the negative media reports, popular opinion held that liposuction was a bizarre, complicated and expensive procedure.

Modern liposuction, by comparison, is completely different. It is usually virtually painless. Bleeding, infection and other complications are rare. Unfortunately, many of the old myths still live on, and realistic information is hard to come by. 

Liposuction vs. “Tummy Tuck” or Abdominoplasty

The “tummy tuck” is one way to improve saggy “pot bellies.” The surgeon takes the saggy skin of the lower abdomen and cuts a big “smile” incision from hip to hip, removes the skin and fat between the belly button and pubic hair, and sews it all up. This is major invasive surgery. There are significant chances for infection and skin death, and the procedure has the highest fatality rate of all cosmetic surgeries. Some tummy tuck patients have difficulty walking without pain for several weeks. Additionally, most tummy tucks produce unacceptable scarring. A patient who was ashamed to show his belly before because it hung down is still ashamed of the area afterwards because of the one- or two-foot-long scar. The “belly button” often has to be repositioned, and this can look strange. And the contours are not always very natural. From the side, the profile may show a very flat abdomen, while from the front, the hips may be too big.

Most “pot bellies” can be treated with liposuction alone. liposuction shrinks the skin and results in a reasonably good lower abdomen shape, Sometimes the skin texture is altered and wrinkles result, but it's generally better than taking a chance with the many problems mentioned above.

Dr.jeffrey Klein,Dermatologist,Father of Liposuction

How to Prepare for Liposuction

How many times have you stood in front of the mirror wishing that you could simply remove fat from your body by some miraculous, magical process? Before the 1980s, such an idea seemed ridiculous. Now, not only is it possible, but it also involves less pain, and the results are spectacular.

But it's not magic. A physician's primary responsibility is to let patients know that liposuction is not usually about weight reduction. It's about reshaping and contouring the body, though in cases where large quantities of fat are removed, weight reduction does occur. When we work with overweight patients in our office, we like to know that they have some history of attempting to control their weight with diet and exercise. The ones who get the best results are those who demonstrate a willingness to continue that commitment even after liposuction. Providing counseling for overweight patients about diet, exercise, and a healthy lifestyle is important before making a commitment to surgery.

The Truth about Fat

By the time we reach physical maturity, we have a fixed number of fat cells in our bodies. When we gain weight, those cells actually grow in size. They aren't thought to multiply; it's believed that each cell actually gets “fatter.” Liposuction cuts the number of fat cells in a local area of the body, but whatever cells remain can still expand if you gain weight. If, after you've had liposuction, you eat improperly without exercising, the extra calories always find a home. If you really lose control of yourself and gain a lot of weight, areas that were not treated, such as face, arms, buttocks, neck or breasts, can balloon.

For those with weight problems to begin with, I cannot emphasize enough how important it is to watch the diet and stick to an exercise program after liposuction. Liposuction is a wonderful procedure to be sure, but it is not a surgical cure for bad eating habits or an alternative to keeping fit.

operating room with emergency medical equipment

Your Expectations

It's important to have realistic expectations about results. Outcomes are age-related, and they are also related to the shape you're in when you start out. For example, if you're a 26-year-old woman in reasonable shape, you might look like a swimsuit model after liposuction. But if you're 46 years old and 50 pounds overweight, you obviously won't get the same result. The vast majority of properly selected liposuction patients are delighted with their results in the hands of Dr.Mokarami . It's not unusual to lose one to three dress sizes (depending on the areas treated and the amount of fat that's been removed), and you may need to buy a new wardrobe Be realistic about where you are, and where you'd like to be.

Part of the preparation for any cosmetic procedure involves talking to your spouse, children, friends and other loved ones about your plans, and preparing them for the “new you.” This sounds exciting of course, but it isn't always as easy as it seems. Some of us are in relationships in which we're expected to be depressed and lack confidence in ourselves. If we change, it can upset a balance that's been a comfortable, but unhealthy, habit for years. This may apply to professional as well as to personal relationships. If you have the courage to change, a new life is waiting for you. For many people, cosmetic surgery can be the first step.

Most people are in good enough general health to undergo liposuction, but there are some situations in which the procedure is not recommended, specifically if a patient has an unstable medical problem such as poorly controlled diabetes or heart disease.

Compression garment accelerate The healing Process

How It's Done

During your initial consultation, Dr.Mokarami will take a good look at your body. You'll be expected to stand there in your underwear while he studies the parts of your body that you like the least; your “saddlebags,” wide hips or thighs, sagging stomach or facial jowls. Sometimes the doctor will draw on your skin to show you which areas might be slimmed down. You'll go home with markings that look like a baby has finger-painted on you. You'll also go home excited about the prospect of transforming those areas into something that makes you feel proud.

 For the “torso” cases, we may be able to sculpt everything from the bra-line to the lower hip all the way around the body, front and back (of course, for some young, fit people this isn't necessary). Properly done, this produces a figure that looks good from every angle.

Upon arrival at the surgical center the morning of your procedure, you may be given a pill such as Valium® if you're nervous. You'll lie on the table and have your fatty areas filled with the “tumescent solution” of sterile salt water, adrenaline and anesthetic.

When the local anesthetic has taken effect, tiny openings are made in the skin surface (you shouldn't feel a thing). These openings are made in the areas where the fat is to be removed, most often under the buttocks, on each hip, and in the navel. A thin tube called a “cannula” (about 2.5 to 4 millimeters in diameter) is then inserted through these openings directly into the fat. The fat is then sucked out through a plastic tube into a disposable container. The whole procedure is usually painless, and depending on the quantity of fat being removed, can take anywhere from 30 minutes to several hours. An average liposuction procedure removes about two to six quarts of fat. During the procedure, you can be awake the whole time . Some patients request mild sedation and are content to lie quietly listening to music and relaxing. The experience can actually be fun, and it can give you an opportunity to bond with Dr.Mokarami by telling stories and using this time to get to know each other better.

When you're finished, you'll be “wrapped up” in a girdle that stays on most of the time for about a month. Many doctors use 6" x 12" foam pads placed directly on your skin over the treated areas The girdle will be worn to hold your skin tightly and help keep the foam pads in place . You can often go home an hour or two later (you will need to have someone drive you home, since there may still be some medication in your system).

When you get home, you may be sleepy and want to relax for the remainder of the day and evening. Most of our patients are advised, for a day or two, to take up to 1,000 mg of Tylenol® (acetaminophen) every four hours while awake The next day, you'll feel some discomfort, depending on the amount of fat that was removed, and you will probably feel a bit bound-up by the foam pads and the garment. Some patients say they feel as though they'd spent the whole day doing sit-ups with an over-zealous trainer. Moving from one position to another seems to increase the discomfort. The third or fourth day is usually the worst. Then things begin to improve.

Recovery

We advise our patients to do whatever activity they can do comfortably. On the first day you can walk around the house. The second day you may be able to go out for an errand or two. By the third or the fourth day, you might be able to return to work if you want. You should be able to resume all your normal activities in three to seven days, except for strenuous exercise or heavy lifting (no kick boxing for five weeks!). We advise avoiding sit-ups for several months if your abdomen was liposuctioned. If you do too much abdominal exercise too soon, you could end up with lumps. Some larger cases, or older patients may have fatigue for a week or longer. After your shower, squeeze the water out of the garment and pads with towels and then blow them dry with a hair dryer using the cool setting for about 20 minutes.

You will experience major drainage from the incision sites during the first 12 hours following your liposuction. This will gradually decrease and end sometime within three to seven days, depending on how much fat was removed and the areas that were treated. It’s perfectly normal and nothing to be alarmed about. The excess tumescent solution is just leaking out, and it can be pink to red in color because it is mixed with a tiny bit of blood (total blood loss from liposuction done with tumescent anesthesia is typically modest.You may wish to purchase a second girdle so you can wear one while laundering the other.

The girdle must be snug and sometimes you’ll need the next size smaller if you later buy a second one. Patients are often overjoyed when they look into the mirror at this stage. There is a noticeable difference, but the best news is that it keeps getting better. Your body will be very swollen, and even though you can see your new shape, it will be somewhat camouflaged by puffiness. This gradually decreases over a couple of months, so your body will actually be changing and shrinking for the next four to eight months. You may also see bruising in some areas, but this will be gone in about two weeks.

After you've stared at yourself in the mirror for a while, the garment must be put back on, and it should be worn for three to four weeks. Some people like wearing it longer because it can sometimes be more comfortable with it on. It keeps the muscles and skin from moving around too much, kind of like a giant ace bandage, and this helps decrease the swelling and seems to relieve some soreness. When the garment is off, you may feel stiff and slightly sore. When it's on, the soreness may decrease dramatically.

By about the third week, you may start thinking about buying some new clothes. But hold out a little longer on the shopping spree as the suctioned area should continue to shrink if you don't lose control of your eating. Also, some patients (especially the larger volume cases) have a kind of “grace period” after liposuction, during which their appetites actually decrease. There may be a period of three to six months in which you won't be as hungry as before, and this may contribute to weight loss.

Risks

When liposuction is done under local anesthesia , complications which may result from general anesthesia are rarely an issue. Heart and respiratory problems are unlikely. Generally speaking, blood transfusion is needed in fewer than 1 in 1,000 cases. Most studies of modern liposuction show an infection rate of less than one percent of cases. I won't claim that liposuction is risk-free, but it is very safe compared to most other surgeries

Results

When you take the garment off permanently, you will more than likely love what you see in the mirror. You'll still be slightly swollen, but any bruising should be gone. You'll probably have lost a clothing size or two, and may continue to lose weight for the next several weeks. Younger people with healthy, elastic skin will find that their skin shrinks back into shape quickly. Older people, people who've had a lot of fat removed, or people who have gained and lost a lot of weight, take a bit longer, and will get less smooth results. They may also notice that the skin which once covered a lot of fat may appear somewhat wrinkled. In time, it often shrinks into place on its own. The skin is a very plastic organ, especially in younger patients, and exercise always provides an enormous benefit (although you shouldn’t do sit-ups or crunches for four to five months after abdominal liposuction).

You may find yourself buying more fashionable, form-revealing clothes, and wearing them proudly. You may also feel lighter, which improves your attitude and overall well-being. Remember that results are relative to where you started.

If you take good care of your new body by exercising and eating right, it can be maintained for many years. If you don't stay fit and if you gain weight, you won't be happy.

The New Ultrasonic Liposuction and Vibrating Cannulas — Improvements?

Since 1996, ultrasonic liposuction has been widely advertised. There are two types: internal and external ultrasonic liposuction. With internal ultrasonic liposuction, a cannula that is specially designed to transmit ultrasound waves is inserted into a person’s fat and moved around, and the fat is broken up. Large holes need to be placed in the skin to use the large ultrasonic liposuction instrument. This machine makes the procedure somewhat easier for the physician. The physician does not have to use all the muscle power to push the cannula past resistance. Instead, the cannula glides into the tissues. The cannula holes in the skin are usually larger than with traditional liposuction.

External ultrasonic liposuction involves using a machine such as a physical therapist might use. A device is placed on the surface of the skin. This supposedly helps to break up the fat. This may make the cannulas go into the fat a little more easily, and some physicians have reported improved skin results in a shorter time interval. Our experience with external ultrasonic liposuction is that it doesn’t work, providing unimpressive results, if any. Obviously, the amount of energy delivered through the skin has to be a small amount because the ultrasound machines can burn the skin surface if too much energy is used.

The medical journals have published many reports documenting the problems patients have after internal ultrasonic liposuction. It appears that sometimes complications occur in as many as 50 percent of patients who have this procedure. These complications, such as seromas (fluid collections underneath the skin) and prolonged time off work due to pain, are not generally life threatening but can be quite irritating. In addition, many physicians have reported skin burns.

A great number of physicians who were initially enthusiastic about this machine have given it up. Also, many of the benefits that were initially thought to occur due to the ultrasound seem to be actually a result of using the tumescent anesthetic.

This technology is not an improvement. Our small cannula liposuction is still superior. Ultrasound is being pushed by influential commercial advertising supported by very few clinical experiences showing no proof of the superiority of the ultrasound... ultrasonic lipoplasty is about to disappear... we have stopped using this technique because of the many problems and no evidence of clinical superiority over a classic lipoplasty. Once again, I wish to tell doctors using the ultrasound technique to be aware of its dangers as well as an absence of progress when compared to simple lipoplasty using micro cannulas, tumescent technique, and crossed planes.

Lastly there is a lot of marketing about the reciprocating or rotating cannula for liposuction. My experience with these instruments proved to me that they do seem to be pure hype, without any clinical benefit — useful only for advertising purposes.