Liposuction in Manhattan Beach, CA
The removal of fat using a suction cannula was popularized by a Frenchman, Dr. Illouze in the early 80′s and shunned by North American surgeons for a number of years. Nevertheless, it went on to become the most popular aesthetic procedure in the United States.
The liposuction cannula is a hollow metal tube up to six millimeters in diameter with a handle at one end and a hole at the other. Suction is applied at the handle end. The end with the hole looks like an organ pipe: the opening is on the side and the tip is sealed off. When the surgeon moves the cannula back and forth through the tissues, fat bulges into the opening and is broken off by its metal edge. Suction then removes the fat from the cannula. Blood vessels and nerves are pushed out of the way so there is less bleeding and numbness than one would expect. Because the cannula is narrow, only small incisions are required. Consequently scars are minimal.
To minimize blood loss even more, the tissues are pre-treated with injections of large quantities of fluid containing epinephrine (adrenaline). Epinephrine causes the blood vessels to constrict and thereby reduces bleeding. It also makes the fat easier to aspirate. This is known as the ‘wet’ or ‘super-wet’ technique. Up to five liters of fat may be removed from a patient at one sitting for safe day case surgery. More than five liters is an indication for overnight admission.
Advances in technology have more recently given us ultrasonic liposuction (e.g., the ‘Vaser’). This device consists of a cannula that transmits ultrasonic energy to emulsify the fat and thereby facilitate its removal. However, the initial tide of enthusiasm for ultrasonic liposuction has now receded through the eddies of peer evaluation. Suffice it to say that although it makes liposuction quicker and less tiring for the surgeon, there are more complications for the patient than with conventional methods. To the ‘artists’ in the plastic surgery community, the difference between the Vaser and a traditional cannula is the difference between a high power machine tool and Michelangelo’s hammer and chisel. Personally, I use the ultrasonic method only in places where fat is hard to extract: the breast and the back. Which would you prefer?
Liposuction has become so popular that many different medical specialists have selflessly taken up the cannula in the endless battle against bulging flesh. Most of these are not actually Plastic Surgeons: many are not surgeons at all. Caveat emptor! Misadventures in aesthetic surgery have resulted from excessive amounts of fluid being removed during liposuction coupled with insufficient intravenous replacement. Injury from the cannula can result from poor knowledge of anatomy and ignorance about the general management of the surgical patient.
The ideal patient for liposuction is of normal or slim build with excellent skin tone, but has atypical bulges of fat in localized areas: for example, the hips, the abdomen, the back, the knees and the thighs. A person who is evenly overweight with loose skin is a poor candidate; however it is fair to say that there is a whole spectrum between these extremes, and everybody has to be judged individually. Because of this, not every individual will have an outstanding result, but many will be improved. Others will need body contouring by other methods.
Liposuction is usually performed under either general anesthesia, or – for very small areas – local anesthesia with intravenous sedation. A five liter liposuction may comfortably be carried out on a day surgery basis, but greater volumes or the addition of other procedures would lead me to recommend an overnight stay.
We restore, rebuild, and make whole those parts that nature has given but which fortune and time have taken away, not only that it may delight the eye but that it might buoy up the spirit, and enhance the psyche.
Gaspare Tagliacozzi (1545-1599)