liposuction – lipoplasty
Definition and principles
Liposuction is used to remove excess localised fat. Liposuction is not an alternative to a weight loss programme; it aims at improving the silhouette by acting on localised adipose excess that cannot be eliminated by diets or physical exercise. As such, liposuction does not treat obesity and does not permit the neglect of health behaviour (exercise and calorie control).
There are three ways to aesthetically correct body shape:
- Liposuction can be performed when the skin is toned and when there is a moderate and localised surplus of fat between the skin and the muscle.
- Surgery can be performed when there is an excess of skin and / or a slack muscle wall with or without excess fat. Liposuction alone is not appropriate in this case since it would leave a residue of excess skin that would be completely inharmonious.
- Regular exercise coupled with a calorie-controlled diet when there is a general excess of fat that obviously can be removed by liposuction. In exceptional cases, liposuction can be recommended by a psychotherapist for overweight patients to kick start better health behaviour and to initiate a slimming regime, but this remains an exceptional case (with limited achieved goals due to inherent risks of liposuctions that are unrealistic in terms of the amount of fat to be removed).
Liposuction removes fatty deposits by suctioning it away with the aid of a cannula inserted through a small incision in the hypodermis. The technique can be used on many zones of the body such as the stomach, saddlebags, thighs, knees, calves, ankles, arms and face: oval and double-chinned. When the fat removed during liposuction is injected to fill another part of the body or face, the process is known as lipofilling, fat transfer, lipostructure or Coleman.
Every adult has a fixed number of fat cells that do not regenerate. When weight is gained, the volume and not the number of cells increases. Liposuction used since 1977 by Dr Illouz suctions inharmonious fat, thus reducing the number of excess fat cells to reduce the volume. Since the remaining fat cells cannot multiply, there will be no recidivism provided weight remains stable. In the case of considerable weight gain, the zones that have been treated with liposuction could develop again, but they will do so much less than if the liposuction had not been performed since there will be a reduced number of cells to increase in volume.
Different body areas where liposuction can be performed
Cannula tubes are inserted under the skin through small incisions (3 or 4 mm) that are discreet as possible: hidden in the belly button for the stomach or in the buttock crease for saddlebags.
The fat is suctioned in such a way as to respect vessels and nerves. Deep fat (near muscle) and surface fat (near the skin) can be treated, but it should be noted that a certain amount of fat will be preserved in function of the state of the skin and its redraping capacity to avoid creating waves or skin impairment.
The surgeon can suction the fat away using:
– a vacuum of cannula tubes: this is a classic liposuction technique invented by Dr ILLOUZ. Fine cannula tubes enable liposuction to be performed much nearer the surface – Dr GASPAROTTI’s technique.
– an ultrasound apparatus: created by Dr ZOCCHI. This technique is used less and less because it substantially increases the duration of surgery and has risks specific to lymphangitis phlebitis in the case of burning of veins and lymphatics. Better skin retraction has never really been recognised.
– a syringe: this micro-suction gives good results on reduced and localised excess, but is fully ill-adapted on taut surfaces.
– rotating cannula tubes and / or alternate cannula movement: this technique allows the surgeon to perform a much easier operation in certain cases.
Alternative non-surgical treatments:
You will find here all some general information on the latest techniques to induce « fat melting » without surgery. However, it is impossible to list each equipment or product available on the market, and nothing can replace the advice of an experienced practitioner.
Non effractive ultrasounds
UltraShape and related techniques promise to destruct localised lump of fat without surgery nor pain by means of focused ultrasounds targeting fat in depth without damaging tissues aside.
Without being as efficient as liposuction, the technique is recommended for light fat excesses localised on tummy, thighs, saddle bag and waist. Ergonomic hand-treatment devices are now under investigation in order to be able to treat narrower areas (arms, thighs, knees…).
This technique is contra-indicated in persons who are too skinny (there should be at least 3 cm of fat) or overweight (BMI greater than 29), in pregnant women, people with chronic hepatitis, abdominal hernia, as well as in pace-marker fitted carriers.
It is mandatory that this procedure should be performed by an experienced doctor given the « strength » of ultrasounds that are used.
Overall, it is a good option for patients who wish to avoid surgery and are ready to accept a moderate effect as well as the potential cost of repeated sessions.
Lipodissolve, Lipolysis, Libostabyl, Phosphatidylcholine injections…
Called by various name including Lipodissolve, Lipolysis, Lipomelt, Phosphatidylcholine injections, Lipostabil, Lipotomie (France)… is a controversial procedure in which some drug mixture is injected into patients’ local fat excess in order to dissolve /breaking down the fat by creating necrosis.
Most often the mixture is based on Phosphatidylcholine and Deoxycholate (PCDC). The idea is derived from the use of solution called Lipostabil. It contains5% PC and 4.75% deoxycholate (DC) and was approved in Germany for the treatment of fat embolism, dyslipidemia, and alcohol-induced liver cirrhosis.
The idea is very attractive, but unfortunately the technique has not been proven innocuous:
– It is said that this technique has been banned in Brazil due to non-specified problems.
– In 2004 EQUAM (the European Committee for the Quality of Medical Technologies and Devices) pointed out the lack of any established medical data and reminded that clinical studies should precede the actual use of this esthetic technique.
– In May 2007 the American Society of Aesthetic Plastic Surgery (ASAPS) issued a warning recommending that the use of injection fat loss treatment for aesthetic purposes should be renounced for the time being. In September 2007, the ASAPS announced through a press release that they had obtained the FDA agreement for a clinical study on fat loss product injections.
– Australian doctors report numerous cases of bacterial infections, chronically inflamed tissues and necrosis linked to the technique were found.
– One of the biggest providers in the US, Go Fig Inc., filed for bankruptcy after clients asked for refunds totalling $ US 4.3 millions. Complaints against this company included improper billing, difficulty getting a refund and basically that the procedure didn’t work.
– The french society SOFCPRE issued on March 4th 2008 a warning against lipotomie (lipo-dissolve) it reports complications and stated the technique as scientifically unapproved and as such ethically blameworthy.
To conclude, Dr Le Louarn does not recommend that his patients undergo any kind of lipo-dissolve treatments: there is no objective data on how these treatments produce ‘fat dissolving’ effects and there are numerous reports of complications documented in the medical literature, including bacterial infection, granulomas (masses of chronically inflamed tissue) and necrosis (localized tissue death). He will quoted Foad NAHAI, President of the American Society for Aesthetic Plastic Surgery (ASAPS) “The bottom line for patients is this: Don’t allow yourself to be injected with an unknown and untested substance.”
Practical recommendations prior to the operation
Do not arrive too morally or physically tired to the operation. Let us know about any change in your state of physical or mental health and do not forget that there is never any urgency to carry out an aesthetic operation.
Medicines that cause bleeding are prohibited during the days leading up to the operation : Aspirin, Anti-inflammatory medicines, Anticoagulants, Vitamin E….
It is imperative that all aesthetic operations be foregone if you are ill or, for women, if you are pregnant on the day of the operation.
It is imperative that you neither drink nor eat for the 6 hours prior to the operation.
The operation will be cancelled if preoperative advices are not adhered to : fast, assessment. not smoking…
When preparing your belongings DO NOT FORGET YOUR MEDICAL FILE.
Where possible, do not bring any valuable jewellery with you (or put it in the safe at the clinic with your other valuables during the operation.)
Have a shower or bath before coming to the clinic and make sure your hair is clean; women should obviously not wear nail varnish or make-up. Do not shave your pubis before coming to the operation (risk of germs if there are micro cuts, thus risk of infection during the operation.)
Prior to the anaesthetic contact lenses, dentures and hearing aids must imperatively be removed.
Anaesthetic and hospitalisation
The operation is performed at the clinic and can be carried out:
- under assisted local anaesthetic in most cases
- under general anaesthetic if the volume to be removed is considerable
- under local anaesthetic for very limited and localised action
Without hospitalisation (in ambulatory), if a small volume of fat is to be removed and few areas are to be treated.
With a hospitalisation (of 1 to 2 nights), if a more important amount is removed or if liposuction is performed on more areas.
The duration of the intervention varies in function of the number of zones to be treated and the quantity of fat to be removed. It can vary from 20 minutes (for one sole zone) to 3 hours, but lasts on average 1.5 hours.
When the operation is carried out without hospitalisation
You will usually leave a few hours after the operation. However, in certain cases (nausea, stress..) it can be preferable to spend the night at the hospital. Ask an ABLE-BODIED AND RESPONSIBLE person to take you home. Since anaesthetics are euphoriants do not make any plans to do anything requiring concentration or the use of potentially dangerous equipment. If you are going home by car YOU WILL NOT BE ABLE TO DRIVE UNDER ANY CIRCUMSTANCES.
You should arrange for someone be with you at home. You should not get up during the night following the operation without being accompanied, even to go to the toilet and even if you feel perfectly fine (anaesthetic products can produce effects identical to those of alcohol abuse).
Before leaving home prior to the operation, ensure that you have prepared everything for your return:
– Prepare a light meal
– Put Arnica 5CH, paracetamol-based painkillers (Dafalgan, Doliprane..) and a bottle of mineral water on your bedside table.
When the operation is performed with hospitalisation
Bring with you comfortable clothing that is easy to put on for when you leave the hospital. You will usually be discharged the day after the operation.
You should be aware that the time needed to recuperate from liposuction (fatigue, pain) is proportional to the amount of fat removed and the number of areas treated.
For the first few days at home you must relax as much as possible and avoid any over exertion. However, you should walk a little several times a day to prevent the risk of embolisms and should eat enough to enable healing.
Note down the telephone number of the office (01 45 53 27 17 for France, 33 1 45 53 27 17 for international call) and the number of the clinic near your home telephone and in your mobile phone. Do not hesitate to call us if you are worried. Call us if you have a temperature, experience weeping, pain or other symptoms that give you cause to worry.
Leave from work: 3 to 4 days depending on your professional activity
Girdles and support tights: day and night for 8 days, then 10/15 days only during the daytime
Stitches: absorbable or removed 15 to 20 days after the operation
Bruises: 15 days to 20 days
Swelling: at its height on 3 rd / 4 th day post-op and then fades progressively
Scars : 6 to 9 months before whitening
Exercise: resume 3 weeks to one month after the operation
In most cases, operations run smoothly and patients are happy with the result. However, before deciding to go ahead with an operation, you should be aware of the risks and possible complications.
General risks of all surgical operations : infections, haematomas, healing problems and risks from anaesthetics
Serious infections are rare when the operation is carried out under normal conditions and when post-op care and advice are respected. You will notably be asked to wash yourself everyday initially to keep scars clean and to respect oral antiseptic and antibiotic prescriptions.
Haematomas are very rare complications in liposuction apart from particular pathologies or use of medicines that provoke bleeding during the pre- and post-op periods. Bleeding is rarely serious, other than due to associated coagulation problems.
Immediately after the operation a scar can inflame or weep, requiring specific local treatments that can often be long. In the mid-term, a scar may develop poorly: thicken, expand, form keloids. This principally depends on the type of skin (red or black skins experience more problems) and health behaviour (cigarettes and the contraceptive pill increase this risk.)
However, scars from liposuction are very small and usually strategically placed; as such, this risk is much reduced.
Risks from anaesthetics
Anaesthetic techniques and monitoring methods have improved immensely and safety is high when an operation is performed in non-emergency conditions on a person in good health, when the anaesthetist is competent and working in a recognised establishment. However, the effect of anaesthetics on the body can be difficult to predict and treat. Therefore there are still risks and hazards inherent to all anaesthetics before and after the operation. This is why it is imperative that you consult the anaesthetist prior to the operation and fully inform him of the state of your health. In function of your health and the planned operation, he will assess the risks related to anaesthetics and tell you of any potential precautions to take. If the anaesthetist objects to the operation, this decision is final.
(see in chapter ” Before surgery ” section “Check up and anaesthetic consultation“)
Risks during any aesthetic operation: asymmetry, a result judged as insufficient or excessive, need to touch up results, sensitivity issues
The way in which tissues react to an operation is always specific and, to a certain extent, unpredictable. It depends on the patient correctly following the doctor’s recommendations, but luck also plays a role. This is why all risks of asymmetry, unsatisfactory or excessive results and the need to touch up are evoked prior to any aesthetic operation.
In liposuction, as well as the fat cells directly suctioned during the operation, damaged but non-suctioned cells evacuate themselves after the operation. This secondary loss of volume, specific to the reaction of each patient, requires a certain safety margin during the operation to avoid excessive results. Furthermore, the retraction of the skin can lead to irregularity reactions on the surface. It follows that localised imperfections can sometimes appear without causing veritable complications: residual asymmetry, insufficient correction, surface irregularities. Usually these can be touched up under local anaesthetic in a further session as of the 6 th month.
Imperfections of the result
Waves are the most common problem. They are due to a bad skin reaction or liposuction too near the skin. The best method of prevention is to be conservative in the quantities removed. If the skin quality is poor, a second operation should be organised.
Burning of lymphatic tissue and vessels can occur solely when the operation is performed using ultrasound. Since this technique does not present any proven advantage, other than being more comfortable for the surgeon, it is not recommended by Dr Le Louarn.
Eiderdown (quilt) effects are typical of lipostructure when performed using a syringe on inappropriate surfaces.
Possible liposuction complications
Accidents are the most dreaded complications, even if they remain extremely rare.. The phlebitis can sometimes lead to pulmonary embolisms which can be fatal ( 1 in 10 000).This risk increases with long haul flights too soon after the operation and by certain pathologies. This is why an anaesthetic consultation and the respect of preventative measures will be decisive: anti-thrombosis supports, respect of potential anticoagulant prescriptions, halt of all progestin treatment etc. Furthermore, if the anaesthetist feels that the patient should be rejected his decision is definitive. If in doubt, during the post-operative period a blood test can be performed to measure the DDimères and research impending thrombo-embolic problems.
– Serious metabolic problems
Have been reported from excessive liposuction. The pre-op anaesthetic consultations are key in order to avoid finding oneself in this situation.
– Lymphatic effusions and necroses
Are very rare complications when the operation is performed correctly, but it is important to be aware that the risk of necroses is heightened if a patient smokes.
Initially the volumes treated experience oedema (post-op swelling) that can make the area look even more swollen than before the operation. After three weeks / one month, the appearance is close to the original appearance and it is not until the second month that the result begins to appear. It is necessary to wait 6 to 9 months to be able to judge the definitive result, since as well as the fat cells suctioned, damaged cells that are not suctioned evacuate themselves. This secondary loss of volume, specific to the reaction of each patient, requires a safety margin during the operation to avoid excessive results.
An appreciable aesthetic effect is usually achieved together with a real psychological benefit.
The longevity of the result of liposuction depends essentially on health behaviour. The effect will be long lasting provided that significant weight changes are avoided.
By way of conclusion, we remind you that precise and detailed information, an in-depth analysis of the reasons for the operation, teamwork between the patient and the surgeon during the preparatory phase, the search for surgical excellence coupled with a good analysis of benefits and risks, the respect of pre-op and post-op advice and regular monitoring of the patient are all key elements for aesthetic surgery to be a success.
Information regarding liposuction is available in english in the « Liposuction » page of the ISAPS’website (International Society of Aesthetic plastic Surgery) chapter: « Info for patients ».
You will also find information in french in the section « Lipoaspiration » of SOFCPRE’s website (French Society of Reconstructive and Aesthetic Plastic Surgery).
It is Doctor Yves Gérard Illouz (France) that was the first to have had the idea of aspirating excess fat to reshape the body.
Illouz Y.G.: Une nouvelle technique pour les lipodystrophies localisées
(La Revue de Chirurgie Esthétique de Langue Française Numéro19, Tome VI, April 80.).
All the specific information delivered on this site is derived on Dr Le Louarn’s practice.
In this field, the following publications and works can also be listed ( this list is obviously not exhaustive and may be amended) :
FDA Statement on Lipo-Dissolve 02/01/08 : Lipo-Dissolve is not FDA approved for any use. In fact, there are no FDA-approved drugs with an indication to dissolve fat
1 – ASAPS (American Society for Aesthetic Plastic Surgery) :
Investigational New Drug Application for “Fat Melting” Injections Cleared by the FDA
Clinical trial on injection lipolysis treatment to begin soon September 4, 2007
2 – ASAPS (American Society for Aesthetic Plastic Surgery) :
Patient Safety Warning to Steer Clear of Injection Fat Loss Treatments 2007 May 14th http://www.surgery.org/public/consumer/trends/patient_safety_warning_to_steer_clear_of_injection_fat_treatments
3 – ILLOUZ I.G. : Complications of liposuction
Clin Plast Surg. 2006 Jan;33(1):129-63, VII
4 – ILLOUZ I.G. : Complications de la lipoaspiration – Liposuction’s complications.
Ann Chir Plast Esthét. 2004 ;49(6) : 614-629
5 – EQUAM : consensus declaration 26 June 2004
www.secpre.org/pdf/EQUAMConsDec 14-7-04 FINAL.pdf
6 – COLEMAN S.R. : Facial recontouring with lipostructure
Clin. Plast. Surg. 1997 Apr ; 24(2):347-6
7 – ZOCCHI M.L. : Ultrasonic assisted lipoplasty. Technical refinements and clinical evaluations
Clin. Plast. Surg. 1996 Oct ; 23(4):575-98
Le Docteur Michel ZOCCHI (Italie) a initié et développé la liposuccion assistée par ultrasons.
8 – COLEMAN SR. : Long-term survival of fat transplants: controlled demonstrations
Aesthetic Plast Surg. 1995 Sep-Oct;19(5):421-5
Le Docteur Sydney COLEMAN (USA) a développé l’utilisation de la graisse autologue liposuccée en réinjection pour rajeunir le visage.
9 – WOOD W.G., GRAZER F.M. : Body Contour Surgery
Chapter 11 in Complications and Problems in Aesthetic Plastic Surgery
Edited by George C. PECK – Gower Medical Publishing 1992 : ISBN 0-397-44613-6
10 – GASPAROTTI M. : Superficial liposuction: a new application of the technique for aged and flaccid skin.
Aesthetic Plast Surg. 1992 Spring;16(2):141-53.
Le Docteur Marco GASPAROTTI (Italie) a fait connaître les lipoaspirations superficielles de graisse.
11 – TOLEDO L.S. : Syringe liposculpture: a two-year experience
Aesthetic Plast. Surg. 1991 Fall ; 15(4):321-6
12 – ILLOUZ I.G. : Remodelage chirurgical de la silhouette par lipolyse-aspiration ou lipolictomie selective – Surgical modeling of the silhouette by lipolysis-aspiration or selective lipectomy
Ann Chir Plast Esthet. 1984;29(2):162-79.
13 – ILLOUZ I.G. : Body contouring by lipolysis: a 5-year experience with over 3000 cases.
Plast Reconstr Surg. 1983 Nov;72(5):591-7.