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May 31, 2018 | Feature Article

Liposuction, Know About Liposuction

Liposuction, Know About Liposuction

LIPOSUCTION
Since 1977, plastic surgeons have used blunt-tipped hollow cannulas, connected to a closed suction system, to tunnel and remove 'target' fat with the aim to improve the body contours and desired proportions. This avoids making large incisions and subsequent prolonged recovery.

Pathophysiology
White fat is the storage forms of triglycerides and fatty acids.

In females, fat is stored in the Outer thigh, Buttocks, Hips and Trunk.

In men, fat is stored in the truncal and abdominal areas.

As we age, our subcutaneous fat decreases, and intra-abdominal fat content increases

Obesity is due to either an increase in fat content of cells or an increase in fat-cell numbers.

The latter is resistant to diet and exercise regimens.

Procedure:
Before surgery, the surgeon would make markings, while the patient is in standing position,

using surgical markers to indicate the areas to be treated,

During liposuction, fluid containing epinephrine and lidocaine (wetting solution) is infiltrated into the fatty tissue, using blunt-tipped cannulas, making the area turgid.

The purpose of this fluid infiltration is to reduce bleeding associated with fat removal/aspiration.

The deeper fat layers are suctioned first, before the superficial fat layers.

After suctioning, drainage ports are left in place to drain the site of excess fluid.

Major complications usually occur within the first 24 hours, so most physicians recommend evaluation of patients, a day after surgery to assess for major complications.

Liposuction is a relatively, safe procedure, if the amount of fat aspirated is small. Complications are associated with large fat aspirations in excess of 4 liters of fat or 5 liters of fat and wetting solution.

Good Candidates for Liposuction :
. Nonsmoker
. Healthy individual with healthy lungs and healthy heart that may not be overburdened with the large volume of wetting solutions, during liposuction.

. Candidates must have no medical conditions or must have adequately controlled medical conditions.

. Candidates must not be on blood thinner medications and must stop over the counter, herbal and prescription medications for at least 2-3 weeks, prior to surgery.

NB: Very obese and people with sleep apnea are at risk for fatal complications during the post-operative period.

Contraindications:
Persons who cannot discontinue their "blood thinner" medications, especially those with Atrial Fibrillation, Heart valve replacements and those being treated for deep vein thrombosis or pulmonary embolism.

When properly trained surgeons perform large volume liposuction, under ideal conditions, it is a safe procedure with low complications and morbidity rates.

It is relatively easy for inadequately trained and inexperienced physicians to encounter disastrous complications or even deaths when performing large volume liposuction.

For Large volume liposuction, the following 5 safety pillars must be strictly observed.

  1. Properly trained and knowledgeable physician with experience in large volume liposuction.

  1. An anesthesiologist who knows about large volume liposuction and understand the physiology of fluid management, in large volume liposuction.

  1. A well-equipped medical facility that can deal with complications that may occur during and after the procedure.

  1. A supporting operating room staff, thoroughly trained and familiar with the procedure, care and patient recovery

  1. Proper selection of patients appropriate, for the procedure.

COMPLICATIONS
Low body temperature: during surgery, because of the cold operating room temperature, and large surface area of body exposure, together with infusion of large volume of wetting fluid, the body temperature, usually drops below 36 degrees centigrade.

Heart: Cardiac arrhythmia: lidocaine, epinephrine

Lungs: pulmonary edema and pulmonary embolism

Fluids and Electrolyte imbalance, including hypovolemic shock.

Bleeding and Hematoma
Deep vein thrombosis
Fat emboli into major arteries
Infections.
Post-Operative Care:
A well trained and competent post-operative recovery room staff is essential for the close monitoring of circulation, heart and lung functions, as well fluids balance, for about 2 hours.

When patients are stable and voiding urine freely, they may either be sent to an overnight care facility or discharged home.

Major complications occur within the first 24 hours, so most physicians recommend evaluation of patients, a day after surgery to assess for major complications.

Patient may return to work after a week. They should avoid lifting heavy objects for 2-3 weeks.

In advanced communities. Mortality rate for large volume liposuction is 20 per 100,000.

Pulmonary embolism, fluid imbalances are major causes of death.

OUTCOME
. 80% of persons who undergo liposuction are satisfied with liposuction results.

. 53% rate their post liposuction appearance as excellent or very good.

. Weight gain and recurrence of abdominal fat is seen in 43% of patients.

Reference: https://emedicine.medscape.com/1272642-treatment#d14

Alex Sarkodie MD
Alex Sarkodie MD

The author has authored 48 publications on Modern Ghana.
Author's column: AlexSarkodie

Disclaimer: "The views/contents expressed in this article are the sole responsibility of Alex Sarkodie MD and do not neccessarily reflect those of Modern Ghana. Modern Ghana will not be responsible or liable for any inaccurate or incorrect statements contained in this article."

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