DESCRIPTION
Suction assisted lipoplasty (SAL)
or commonly referred to as liposuction is a technique
that was developed in Europe in the mid-1970s. It was
brought to the United States on or around 1982. Since
then, the technique has evolved and many variants have
been developed. Still, liposuction is indicated to treat
and correct localized areas of fatty deposits. These
areas include the flanks, hips, abdomen, neck, arms,
thighs and in some rare cases the lower legs. Both men
and women undergo this procedure. Please note that this
technique is not a substitute for weight reduction.
The original technique described the insertion of fairly
large cannulas (metal hollow surgical tubes) within
the fatty area. This technique was a "dry technique"
and differed significantly from what will be described
below. There were many drawbacks to this technique and
today it has been discontinued for the most part. The
predominant technique used today is "TUMESCENT
LIPOSUCTION". This technique has been used for
a number of years. It incorporates the injection of
a solution comprised of saline (salt water) a local
anesthetic and some adrenalin into the fatty tissue
in order to facilitate the aspiration of the fat. It
is performed with the use of very small cannulas. Thereby
limiting the size of the incision, trauma, bleeding,
bruising, and post-operative pain. This technique expedites
the eventual recovery and return to normal.
Over recent years other techniques
have been devised that you might hear about such as
ultrasonic liposuction, external ultrasonic liposuction
and liposuction with laser light assisted technique.
Suffice it to say that ultrasonic liposuction is a
technique that incorporates the use of ultrasonic
waves to liquefy or emulsify the fat. This technique
requires the fat to be hydrated as in the tumescent
technique and is frequently accompanied by the use
of traditional tumescent liposuction. It carries a
higher complication rate than traditional methods.
Laser assisted liposuction also employs the tumescent
technique and its value has yet to be assessed scientifically.
For the purpose of this informative document, liposuction
and liposculpture will be used interchangeably.
PROCEDURE
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Suction assisted lipoplasty (SAL)
may be performed under general anesthesia or local anesthesia
with intravenous sedation. Unless the area is limited,
we have found that our patients are most comfortable
undergoing their procedure under general anesthesia.
Dr. Perez-Gurri will mark the areas to be aspirated
prior to surgery and in the upright position. Making
very small incisions in multiple areas that will allow
access from different angles begins the procedure. The
tumescent solution is then infiltrated into the tissues.
The solution is given a few minutes to take effect and
the procedure is begun. The cannula is inserted through
the small incision and aspiration is begun. The cannula
may be attached to a liposuction machine or large syringes.
The differences in technique depend on the surgeon and
are both acceptable. The cannulas are then moved in
a radial fashion and the contour is changed. The incisions
are closed and the patient is placed into a compressive
surgical garment (i.e. girdle like garment).
POST-OP RECOVERY
You will be allowed to go home
after your surgery. You will need to wear the surgical
garment for the following 4-6 weeks. It should be
tight fitting but not uncomfortably tight. Dr. Perez-Gurri
will see you the following day. We want you to be
comfortable at home so please wear loose fitting clothes
and flat shoes. You will undergo significant swelling
that will be most pronounce during your first week
post-op. Please do not try on tight fitting clothes,
they will not fit. You need to allow 6-8 weeks for
the swelling to go down. Remember, your body has undergone
a significant amount of trauma as a result of this
surgery. You need to allow time for full recuperation.
You may drive at 48 hours. You may shower at 24 hours.
Your prescriptions will be given to you prior to surgery,
have them filled. Always have someone else administer
your medication to prevent excess ingestion of medicines
by self-medication. You may walk and go to the bathroom
on the evening of your surgery. Certainly by the next
morning you should be walking short distances in your
house. If you have any questions, call the office.
You will visit the office during the first week to
have your sutures removed. Most patients require 2-3
days recovery time before they return to work and
/or drive their car. If your work requires strong
physical activity, it may be wise to plan for 7-10
days of recovery. Exercise may be continued after4
weeks and regular household chores within a few days.
Every patient will experience some thing different.
If you feel great, just don’t over do it.
COMPLICATIONS OF LIPOSUCTION
Although complications are not frequent, you need
to be aware that the following complications may occur:
HYPERTROPHIC/KELOID SCARS, HYPERPIGMENTATION, PARTIAL
OR FULL LOSS OF TISSUE, ALTERED SENSATION (INCREASED
OR DECREASED), ASSYMETRIES, INFECTION, FAT NECROSIS,
POSSIBLE INCREASE IN CELLULITE, SKIN IRREGULARITIES,
CONTOUR DEFORMITIES
Some of these complications if severe enough, may
delay recovery time, require further surgery for correction
at additional costs and may involve other specialists
within medicine. Please be aware that smokers, diabetics
and overweight individuals have a higher incidence
of complications when compared to those who don’t
smoke, have diabetes and/or are overweight. You should
also note that patients undergoing combined procedures
(i.e. tummy tuck and liposuction) also have a higher
complication rate than those undergoing a single procedure.
WHAT & WHAT NOT TO EXPECT
These procedures are considered body contouring in
nature. They are not meant as a substitute for weight
reduction or an exercise routine. We have found that
one of the key factors in achieving patient satisfaction
is patient expectation. There seems to be an inverse
relationship with expectation and satisfaction. That
is, the higher the expectation, the lower the satisfaction.
Body image is unique and what the patient frequently
sees may not be what is seen by the surgeon. Therefore,
it is important that you become keenly aware of your
expectations for the procedure, know its limitations
and fully discuss any concerns that you may have regarding
the procedure with Dr. Perez-Gurri. We encourage questions
and have allowed ample time to answer them personally
or with our literature and videotapes.
OTHER QUESTIONS
What if I get pregnant?
You should be able to carry out your pregnancy. However,
do realize that you will gain weight and that a portion
of that weight will be deposited into the fatty tissues.
Therefore the contour will change. The skin is a wonderful
elastic organ capable of being stretched over time.
It has been our experience that patients may or may
not need further surgery following their pregnancy.
Will I gain weight again and have fat return to those
areas?
There is a commonly expounded theory that fat cells
develop until the age of 2-3 years. Thereafter, fat
cells do not reproduce. However, if you do not watch
what you eat and neglect to exercise the fat cells
that remain have the capacity to expand and therefore
you will gain in that area again. In addition, it
is very likely that you will gain weight in all other
areas.
Are my results permanent?
The fat that has been extracted from the area will
not return. However, as stated above, if you gain
weight, the cells that remain will expand.
Will I be completely flat and shapely?
Maybe yes and maybe no. Remember that if you are overweight
there is always a residual amount of fat underneath
the skin following surgery that will not allow you
to be flat. Even patients who are within their weight
limit may not be “completely” flat because
their expectations exceed the possible surgical outcome.
A better term that we like to use is to leave you
“flatter”. Also remember, body shapes
come in all sizes and configurations and although
this procedure is meant to contour, your bone and
ligamentous structure are a large component of your
shape.
How does my skin influence the results?
If your skin and tissues are flaccid prior to liposuction,
they will probably be even more flaccid afterwards.
Any area that has stretch marks on the skin has been
irreversibly damaged and cannot be expected to react
the same as intact skin.
What if I have "cellulite"
?
Cellulite is a common term used to describe a condition
of the connective tissues in which fat "tethers"
the skin and gives the appearance of "cottage
cheese" or a "mattress" to the overlying
skin. It is seen women and most frequently appears
in the buttocks and thigh regions. Although it may
be seen early on in age, it does tend to get worse
with aging tissues and lack of support. The presence
of cellulite does not disqualify a patient from having
liposuction performed. The patient, however, needs
to realize that liposuction will not eliminate the
presence of cellulite and in some cases may make it
worse.
Will my stretch marks go away?
There are no permanent cures for stretch marks. Different
creams and remedies exist that temporarily hydrate
the skin making the stretch marks less visible but
they do not remove stretch marks. Lasers have been
utilized to treat stretch marks but are only effective
in reducing the color intensity of red/bluish ones.
The above information has been compiled as a benefit
to you. We hope that this document has served to better
inform you on the proposed procedure. We encourage
dialogue. Dr. Perez-Gurri and his staff at Imagos
Institute of Plastic Surgery, Inc welcome your questions.
The above information has been compiled as a benefit
to you. We hope that this document has served to better
inform you on the proposed procedure. We encourage
dialogue. Dr. Perez-Gurri and his staff at Imagos
Institute of Plastic Surgery, Inc welcome your questions.
It is our sincerest wish that your surgical experience
at IMAGOS INSTITUTE OF PLASTIC SURGERY, INC. be a
pleasant and informative one. We recognize that all
patients will experience pre-operative anxiety and
fear of elective surgical procedures is normal. Our
trained professional staff and doctors are here to
serve your needs and answer your questions.
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