LIPOPLASTY. About Fat

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1 LIPOPLASTY LIPOSUCTION AND FAT REMOVAL Liposuction in all its various guises has always been one of the most popular cosmetic surgical procedures. But before we go into details about how Liposuction is performed, let s take a brief look at the problem itself Fat. About Fat Fat is an efficient way for our body to store energy. The basic unit of fatty tissue is the fat cell; technically known as an adipocyte. This simple form of cell consists of little more than a (membrane) bag within which sits the nucleus of the cell surrounded by fat. Throughout our childhood and into early adolescence, we continue to develop more and more fat cells. However, by our late teens to mid-twenties it is believed that we stop making new fat cells. If we take a very simplistic view of an area of the body, then one might imagine the skin, with subcutaneous fat on the inside, with muscles and other structures underneath. As weight is put on, the fat cells increase in size, with the result that the area becomes generally larger. Should weight be lost, then the weight tends to come off uniformly also. So how do we still put on weight as we get older? The answer, is unfortunately, very simple. We just increase the amount of fat stored in each of these fat cells. They simply balloon, sometimes to many thousands of times their original size. Fig 1. The fat cell Fig2. The same fat cell containing more fat Certain individuals have collections of fat in specific anatomical areas (e.g. saddlebags etc). When these patients put weight on, they feel that it has become localised to these areas. In fact, it is just that the greater number of fat cells accentuates the problem 1

2 As a result of these localised deposits, many people are extremely self-conscious about particular areas of their bodies. They often relate that persistent exercise and dieting do little, if anything, to improve their abdominal paunch, or their saddlebags etc. As weight is put on, all fat cells become larger (obesity). As weight is lost, these cells shrink again. However, in these specific stubborn areas, the greater number of cells remains constant even after dieting. Hence, these areas may reduce a little as the fat cells shrink, but are still relatively larger. This results in the classic liposuction patient, who describes that from a relatively early age these larger areas have been present. They have usually been inherited from a parent. If the patient puts weight on, it seems to focus on this area. If they lose weight or exercise, it makes considerably less difference (if any) to this area. Even at his or her lowest weight, this area persists. It can make buying clothes difficult, and can often be an area of considerable dissatisfaction. However, these stubborn areas of excess fat may be easily and permanently, treated by liposuction. To reiterate, this is because, for any adult, the total number of fat cells is relatively constant. This means that they do not re-grow and are not replaced following their surgical removal. Suction-Assisted Lipoplasty Suction-Assisted Lipoplasty is the term that might be applied to a group of operations that are intended, in broad terms, to suck out the excess fat content of localised areas on a person s body. Their purpose is, in almost all situations, to improve the contour or shape of the body. In this sense, the term can be considered to encompass all the following operations:- Liposculpture Liposculpture is a more modern refinement of conventional liposuction. It uses far smaller cannula and involves the plastic surgeon suctioning fat from much nearer the surface of the skin. As a result, it leaves far less fat behind, and in experienced hands produces much more smooth aesthetically pleasing results. Further, by producing such thin skin flaps, skin tightening is much more effective and predictable. The suction may be applied either by a machine or in a much gentler fashion by a simple hand-held syringe (so-called superficial syringe liposculpture). By using such small instruments, the plastic surgeon really is able to sculpt the body in a gentle controlled way. Liposuction This was the original form of fat removal, and is the technique used by the majority of plastic surgeons. 2

3 It usually involves the use of much larger cannula and conventional suction machines. The aim is generally to remove only the deeper layer of fat. As a result, it is often associated with residual fat deposits. In conventional liposuction a vacuum machine is used to help the plastic surgeon remove the fat. In liposculpture, a hand-held syringe is used. The plastic surgeon uses whichever technique, or combination of techniques, that he is experienced with. It is entirely wrong to say that liposculpture requires a day case local anaesthetic, whilst liposuction requires a general anaesthetic and an overnight stay. Both, in certain circumstances, may require general anaesthetic and an overnight stay. Ultrasound-Assisted Liposuction In this technique, much discussed recently, the probe that is used consists of two parts. The outer sheath and tip is an ultrasound producing device that fires ultrasound waves into the fat, helping to break it down. The inner part is a conventional suctioning cannula attached to a suction machine. External Ultrasound Assisted Liposuction In this technique, an ultrasound probe is used on the outside of the skin to attempt to soften the fat prior to the surgeon undertaking liposuction or liposculpture. Technical Considerations Our specialist surgeons will advise you on the most appropriate Lipoplasty technique for your particular requirements. Some patients may undergo a combination of techniques during the same operation. Your procedure will be tailor-made to meet your personal needs. Suction-assisted Lipoplasty may be performed under either local anaesthetic; local anaesthetic with sedation; or general anaesthetic. In almost all cases, the procedure will be performed as a day case. This means that you will almost certainly be allowed to go home on the same day (often a few hours after the procedure). In a small group of patients (probably about 10%), patients may be kept in overnight. This group of patients might be summarised as: Most patients having general anaesthetic Patients having the largest volumes of fat removed Patients with certain medical conditions Patients who live alone Patients who live a long distance from the clinic Patients requesting an overnight stay from the outset Patients who take some time to recover from the local anaesthetic and sedation 3

4 Small (5mm) stab incisions are made in the skin, anaesthetic fluid is injected throughout the area to be operated upon. Subsequently the fat is aspirated through fine cannula. The operation takes anything from 30 minutes to three hours or more depending on the volume of fat to be removed. Patients should wear tight support dressing for several weeks. If your work is not physical, expect to return to work after 7 to 10 days. You must understand that Lipoplasty is most definitely not a treatment for weight loss or obesity. Generally, we advise patients that they should not be looking for significant results within the first few weeks. In larger cases, there will be some size difference; and most patients should see an improved shape. By approximately eight weeks or so, most patients have achieved about half of their ultimate visible outcome. However, it is vital to note that, whilst the size and shape have improved; the areas will still feel far from normal. Generally, they feel somewhat uneven; still tender in some areas; perhaps numb in some areas; with odd sensation in other areas. In most patients, by (at most) six months they usually have the final visible result. However, areas may still not feel 100% back to normal. In most cases these areas will appear, to all intents and purposes, normal. Some patients do relate that, at this time, various areas continue to feel a little numb; or a little too sensitive. In almost all cases, this will settle over the ensuing months. As with almost all surgical wounds, the wounds related to Lipoplasty continue to heal for more than one year. It is important to remember that the wounds in question relate to the whole area operated upon; and not to the small incision sites. Therefore, most of these odd sensations will settle over this period. The result is permanent, since the removed fat cells will not regenerate and by maintaining a sensible weight, and preferably also exercising, the result will last and even improve. Any fluctuation in weight will lead to deposition of fat to other areas, and also proportionately to the liposucted areas. Feeling of itching; skin tightening; occasionally almost of skin shearing are often described. These are entirely normal. To view before and after photographs, please visit the Photo Gallery page on our website. 4

5 Considering Lipoplasty- What Next? You have now read general information about your desired procedure, next step would be to discuss your specific wishes and receive personalised advice from Dr Allen Rezai. When it comes to plastic surgery, every person is different in their hopes, expectations and fears. And so it is essential that every patient has their own personal consultation. Consultation At your consultation, Dr Rezai will fully discuss with you all aspects of your aesthetic goals. Your particular concerns will also be addressed, in addition to being fully informed about all of your options. Dr Rezai gives utmost importance to providing you with the necessary education and information, ensuring that each individual arrives at a decision that is best for them, taking all factors into account. In addition Dr Rezai will: - Discuss your medical history and any pre-operative tests that will need to be conducted. - Make a detailed and thorough physical examination of your area of concern. - Explain the surgical options available and which would be most suited to you. - Talk you through in details all aspects of the procedure such as where and how each incision will be made, an overview of the procedure and what s involved, likely complications and possible conditions, recovery and healing times and stages, dressing and after care, pain and where it is likely to be felt and specific care details. - Assess your feelings and expectations, providing a realistic account of the likely results and what can be achieved. - Confirm how long the procedure will take from surgery to recovery and establish if any postoperative treatments are necessary. Following this consultation it is possible that Dr Rezai may decide that surgery is not in your best interest and might recommend not proceeding any further. Please note that you are absolutely under no obligation to take this consultation any further. 5

6 All patients are encouraged to return for a second consultation with Dr Rezai, should they desire. This is provided at no additional charge. Our consultation process is designed with the needs of the patient in mind. Making the leap from thinking about plastic surgery to actually having plastic surgery is actually the hardest part of the whole process. We at Dr Rezai s practice are here to provide you with a comfortable, easy and confidential environment in which to do just that. Time for Reflection All aesthetic cosmetic procedures are elective operations. Following your consultation we recommend that you take a period of at least fourteen days to consider all the benefits and risks of the procedures, and seek more information if necessary, before you decide. Your Procedure Should you decide that a procedure is right for you, we will arrange a date with you for your procedure. Dr Rezai and his team will support and guide you throughout the entire process. Informed Consent Patients have a fundamental legal and ethical right to determine what happens to their own bodies. Valid consent to treatment is therefore absolutely central Prior to any cosmetic treatment or surgical operation being performed. Seeking consent is also a matter of common courtesy between health professionals and patients. Age Limit The minimum age for any consultation or surgical procedure is 18 years. Dr Allen Rezai and his team are delighted to be able to offer you compassionate care you can trust. 6

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