Fat Today, Gone Tomorrow


Dr. Hussein Ghanem Discusses the Latest in Liposuction

Recent advances have taken a lot of the stress out of liposuction, Dr. Hussein Ghanem gives us the update.

CEM: What are the latest developments in Liposuction procedures?  

HG: Advances in both technique and equipment have greatly enhanced the safety and cosmetic outcome of liposuction. Perhaps the greatest contribution is the introduction of the tumescent technique under local anesthesia.

Tumescence means filling the fat prior to liposuction with a solution containing a local anesthetic to avoid general anesthesia, and a vasoconstrictor to prevent bleeding.  An added advantage of the local anesthetic is that the patient remains conscious, thus if the surgeon inadvertently touches the abdominal muscles, the patient would alert him or her before injuring the muscle or even worse, entering the abdomen or chest of the patient with the suction cannula, causing organ injuries. So far, there have been no reports of serious complications with this technique for more than 15 years. The maximum safe volume of fluid to be injected is 4 liters in a single sitting.

Besides anesthesia, several other advances have been introduced. In power-assisted liposuction, a small caliber vibrating cannula is introduced to extract the fat in a smooth non- aggressive manner, resulting in superior results with much less bruising.

In laser-assisted liposuction, a laser fiber is introduced prior to the powered cannula to aid in dissolving the fat, enhancing the outcome, and possibly tightening the skin. In ultrasound- assisted liposuction, ultrasound energy is used to help damage the fat cells.  Laser-assisted and ultrasound-assisted liposuction should only be performed by physicians licensed in laser surgery to avoid a very rare complication of burns.

What other advances are popular now with liposuction and fat transfer?

Micro-fat and nano-fat transfer are new procedures where liposuction with specialized micro-cannulas provides a source of both fat and stem cells that could replace dermal fillers as they are longer lasting, possibly permanent, and the stem cells have the added advantage of providing remarkable skin rejuvenation for the face.

Most important points to know:

Current techniques

Power assisted Tumescent Liposuction: New Swiss and German machines create certain vibrations that are targeted at breaking down the fat deposits while removing it through a thin tube under local anesthesia.  It combines the safety of tumescent liposuction with the ease and power of the vibration machines, while avoiding the possible risks of laser and ultrasound.

Laser Assisted Liposuction (Slim Lipo): Laser energy is applied to help liquefy the fat and facilitates its removal through liposuction.

Ultrasound Assisted Liposuction:  Ultrasound energy is applied to help break down the fat and help its removal through liposuction.

Tumescent liposuction with local anesthesia: This is the most common type of liposuction and combines both power-assisted and laser-assisted liposuction. It involves the infiltration of fluid into the area to be suctioned. The fluid has a local anesthetic as well as adrenaline to reduce bleeding and prolong the anesthetic effect. The surgeon uses a thin tube (cannula) attached to a vacuum to remove fat from under the skin. Local anesthesia is safest while the tumescent fluid facilitates aspirating the fat outside the body.

What can the patient expect before, during and after the procedure?
The patient experience includes a clinic visit and blood tests. Patients are admitted and change into a sterile gown. Local anesthesia is administered through a fine needle attached to a specific machine and then the surgeon waits 20 to 30 minutes for full anesthetic and vasoconstrictive effect to avoid bleeding. A laser fiber may then be used to melt the fat, followed by powered liposuction through a small cannula. The entry point is small and doesn’t need a stitch for closure. >>

The patient then wears a constrictive gown and is discharged from the hospital usually within 2 hours. For the following 24 hours, the injected fluids pass out of the small liposuction holes. Discomfort and pain gradually resolve over a few days.

To what extent does the new technology help avoid possible complications?
Vibrations allow liposuction machines to pass smoothly within the fat cells avoiding burns and bruises that were possible with earlier techniques. Local anesthesia avoids the complications of general anesthesia and prevents injury to unwanted areas because the patient is awake and will feel the suction cannulas if they go out of the target areas.

Is liposuction suitable for everyone?
Liposuction should be viewed as a body-shaping, not a weight-loss procedure, so it is most suitable for patients close to their normal weight rather than obese patients. Patients should not be taking snit-coagulant treatments (blood thinners like aspirin) and should be of general good health.

Can you get a good result from liposuction if you have cellulite?
Power-assisted and laser-assisted liposuction can smoothen cellulite irregularities, while conventional liposuction could enhance skin deformities.

What are the most common areas people choose for liposuction?
Abdomen, flanks, outer thighs, neck and arms.

Can it be combined with other cosmetic procedures?Liposuction is frequently combined with micro-fat transfer as a longer-lasting substitute for dermal fillers with an added advantage of including fat-derived stem cells to enhance the quality of the skin.

When micro-fat transfer is planned for rejuvenating the face, very small cannulas are used to extract the fat, which is then transferred to the face along with the accompanying stem cells known as adipose (fat) derived fat cells.  Using small cannulas allows a uniform extraction and injection procedure, giving better access to the blood supply ensuring long term survival of the grafted fat cells. This is a simple clinic procedure.

What are the biggest misconceptions about the procedure?

We see a lot of patients coming for liposuction while what they really need obesity surgery like balloons or gastric bypass surgery.

What side effects can you expect?|
With traditional liposuction significant bruising or bleeding was common. With power-assisted or laser-assisted liposuction under tumescent local anesthesia, usually only minor bruising is observed.  Pain is usually quite tolerable and most patients don’t need pain-killers.

Burns and organ injury are extremely rare and occur mainly when liposuction is performed under general anesthesia. No serious complications have been reported with local anesthesia, however some patients need sedation, or rarely, general anesthesia.

Side effects may also include minor hematomas or mild pain or discomfort. Complications are extremely rare and almost nonexistent with qualified physicians licensed in laser surgery.   Injecting more than 4 liters of fluid or liposuction for large areas of fat might require hospitalization to monitor the urine flow and is better avoided for safety concerns.

How long is the recovery period?
In most cases patients return to regular activity within 3 days.

Are men turning more to liposuction for cosmetic improvement?
Many men are concerned regarding body image under peer pressure and media pressure glorifying a perfect body.  Cosmetic procedures have thus been on the rise in men.

Which areas do men usually target when requesting lipo?
With a rising desire among men to obtain perfect bodies, many men request liposuction for stubborn fat areas in the abdomen and flanks. Many men are very upset with a larger than normal male breast and benefit a lot from liposuction of the male breast. Also some men are very concerned with localized fat in the lower abdomen giving the impression of smaller male genital organs, and thus also request liposuction of the lower abdomen.

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