Patient Information - Liposuction

The desire to remove unsightly, undesired fat build-up by means of operational procedure is by no means new. Accounts are available of such attempts in the Ancient World. Until late in the twentieth century, undesired fatty tissue could only be removed via enormous incisions. Besides being associated with tremendous operative risk due to a high rate of blood loss and other complications, this technique produced extremely unsatisfactory and unaesthetic results.

In the 1960s, the first attempts were made at removing fat with curettes or aspirators with the objective of sparing patients the large incisions. Two Italians actually initiated the start of modern liposuction in the 1970s. In the thirty years since then, there have been numerous advances in the operation technique and anaesthesia as well as the instruments and equipment used. These changes have made today’s level of success and high degree of safety possible.

In the following, you will find answers to the most frequently asked questions. For further information, we recommend: G. Sattler, B. Sommer, Liposuktion - Wege zu einem schönen Körper, (The Way to a More Beautiful Body) mednova Verlag ISBN 3-9808510-0-1.
As well as the following for professional colleagues: G. Sattler, B. Sommer, C.W. Hanke, Lehrbuch der Liposuktion, (Liposcution Textbook) Thieme Verlag 2003 ISBN 3-13-138141-8.

What can liposuction surgery accomplish?

Today, liposuction can remove any undesired deposits of fat that are located directly under the skin, from the cheeks to the ankles. Since, in many cases, the fat deposits that are to be removed may not be located directly under the skin, as is often the case with stomach areas in men, one of the first things to discuss is whether the affected area is accessible for liposuction. With liposuction, the surgeon can correct proportions, remodelling the area into a more pleasing, lasting form. Today, we speak of body contouring or liposculpture. Successful liposuction produces treated areas that look attractively proportioned and lend the whole body a pleasantly shaped figure.

Liposuction is neither the “cure” for obesity nor a weight reduction procedure for people who have general weight problems. Rather, it is a method that enables the targeted removal of fat from the most unpleasant, disturbing areas. Without question, in most cases, the individual feels much more positive about him or herself as a result of the new, invigorated appearance. This, in turn, usually leads to lasting changes in the person’s life and nutritional habits and subsequently to the overall loss of weight.

But isn’t it possible to get rid of the fat by means of committed, consistent dieting and exercise?

Dieting and exercise are the ideal activities for reducing and regulating the overall body weight and staying in shape. However, even with implementation of the strictest exercise and nutritional programmes, it usually is not possible to achieve an ideal figure. This is because our genetic makeup often determines the locations of the fat deposits. How our bodies react to dieting and exercise is in large part determined by our sex as well as the surface receptors and character of the specific body area. Fat deposits on the thighs and hips in women, for example, are characteristically resistant to diet. Since the fat cells in these areas serve as emergency reserves for offspring, they are usually unreceptive to weight loss attempts. Thus, dieting causes the body to lose weight in areas where the person doesn’t want to lose weight. The actual, unpleasant areas of excess fat remain.

Are different liposuction techniques available?

Yes, there are different methods of liposuction and different types of anesthetization. Which techniques are best suited for the individual patient should be decided in pre-operation consultation with the surgeon.

  • Vibration assisted liposuction
  • Laser assisted liposuction
  • Liposuction under general anaesthesia — inpatient treatment
  • Liposuction with local anaesthesia — outpatient treatment
  • Liposuction with tumescent local anaesthesia

Tumescent local anaesthesia was specifically developed for liposuction. It involves the injection of a dilute solution containing a local anaesthetic directly into the subcutaneous fat that is to be removed. This technique serves at least two purposes: it delivers the necessary anaesthesia where it is needed and facilitates removal of the fat, slowly penetrating and preparing the fat cells for suction.

Tumescent liposuction is considered by the leading American and European professional associations to be the safest and the best technique currently available. It is the most frequently used method of liposuction throughout the world with an annual average of 400,000 procedures. In recent years, tumescent liposuction has been combined with vibrating, aspirating cannulae to vibrate the macerated fatty tissue from the connective tissue fibres. There are different names for this procedure. Dr. Sommer is one of the first surgeons to use it in Germany and calls it Vibration Assisted Liposuction.

In certain isolated cases, laser assisted liposuction offers distinct advantages. The laser is very gentle and applied as an additional treatment to the fat tissue.

How is the tumescent liposuction different from other liposuction techniques?

Tumescent liposuction has established itself as the most frequently used technique, because it offers many advantages, including:

  1. It eliminates the need for general anaesthesia and the preliminary examinations and risks that are associated with it.
  2. The patient remains awake while the surgeon is performing the procedure, enabling him to respond and cooperate with the physician. For example, the patient can change positions, so that the surgeon can extract the fat from different angles, something that is imperative to the achievement of optimum operation results.
  3. The tumescent solution penetrates the fatty tissue, easing, simplifying and expediting the uniform aspiration of fat via much thinner thin cannulae for faster healing and more uniform overall postoperative appearance. Use of thin cannulae helps preserve the connective tissue apparatus of the fat tissue that is decisive to the retractive function of the skin during the healing process and a key to achieving superior aesthetic results.
  4. Reduced loss of blood.
  5. Less bruising because the procedure is more gentle on the blood vessels and less damaging to the lymphatic vessels.

Dr. Sommer is a joint editor of the only textbook available in the German language on this procedure: B. Sommer, G. Sattler, C.W. Hanke, Tumeszenz-Lokalanästhesie, Springer Verlag ISBN 3-540-64573-x. It is also available in English under the title Tumescent Local Anaesthesia ISBN 0-540-66544-7.

Which complications can occur as the result of a liposuction procedure?

  • Medical complications, such as haematoma or numbness caused by irritated small skin nerves may occur. In certain isolated cases, thrombosis may develop.
  • Cosmetic or aesthetic complications, for example, irregularities or other unsatisfactory results, occur very seldom if an experienced surgeon performs the procedure and if the physician uses modern equipment and instruments. Any unsatisfactory results that do occur can be corrected via LipoRepair.

Thrombosis occurs very rarely with tumescent liposuction. Still, to protect patients, small injections of a blood thinner may be administered during the first days after the operation. Also recommended is the taking of antibiotics for several days after the operation to prevent infection. 

In your preoperational consultation talk, other rare complications that could occur will be explained to you, and any personal risk factors that need to be taken into consideration will be discussed and taken into consideration in the procedure.

What happens to the excess skin that remains once the fat has been removed?

Following tumescent liposuction with vibration, the skin is able to recover and retract in the course of the healing process due to the retained connective tissue. Just how well the skin is able to retract is naturally dependant on the operational technique, general condition of the individual’s skin and the magnitude of the aspirated fat deposits. Patients with very soft skin and weak connective tissue should not expect their skin to react as well as patients with a tauter tissue structure.

An experienced surgeon is capable of providing patients with a realistic prognosis before the operation and suitably incorporating the data obtained in the initial examination into the operational procedure.

Are traces of the liposuction visible following the procedure?

In the first two to three weeks, haematoma (bruises) are visible. During this time, the tiny punctures heal, appear like small mosquito bites and disappear for the most part within several months. Immediately after the operation, slight swelling may occur and last for several weeks. The overall healing process that takes place under the skin actually lasts for months. During this time, the tissue stabilizes and reaches its final, new shape. For this reason, corrective procedures should be avoided during this time.

Do fat cells redevelop to take the place of those that were removed?

No, fat cells begin to form in childhood. New formation of fat cells in adults rarely takes place. The remaining fat cells, however, can increase to a certain extent in volume. To achieve and maintain a well-balanced postoperative appearance, a thin layer of fat between the skin and muscles must be left. Therefore, the fat cells from a specific area are never entirely removed. As a result, the patient can gain weight with a diet that facilitates weight increase, but with limitations. If, following liposuction, more calories are consumed than required by the body, the surplus of fat will have to be stored somewhere. Since its usual place of accumulation has been removed or at least drastically limited, it may build up in areas that were previously never predisposed to fat deposition. It is therefore always best for patients who are prone to being overweight to work together with the doctor in developing a comprehensive programme with suitable nutritional guidelines in addition to the liposuction procedure.

When can I return to my usual activities after liposuction?

It depends on the magnitude of the procedure. Following tumescent liposuction, the patient can and should walk around. The effects of the local anaesthesia diminish approximately six to eight hours after the operation. The patient may then experience pain, similar to a muscle ache, in the areas that were treated. A mild analgesic is usually sufficient to alleviate the pain. Patients whose work and daily activities involve minimum physical activity can theoretically return to their usual activities on the same day the procedure is performed. In general, however, patients should allow the body two to four days to recover. Based on desire and how the patient feels, he or she may exercise when the four days have passed. At first, the patient should wear the compression garment. To prevent the small punctures from becoming brown, exposure to the sun should be avoided until they have healed and the bruises have completely disappeared. With the expiration of four weeks, the patient can use a sauna.