Modern liposuction, which should rather be called liposculpture, is a surgical technique that allows transforming the silhouette by acting on fatty tissue. Some call it contour surgery. Indeed, the silhouette, apart from a few bony ridges, is determined by subcutaneous fat, which in some cases can reach a considerable thickness and completely ruin this silhouette. If you can remove fat where there is too much, and sometimes even add it where it is lacking, well, you are witnessing a true transformation: a dream of balance and harmony becoming reality.
After infiltrating the area to be treated with Klein’s solution, the surgeon makes very small incisions not exceeding 4 mm, which will leave very little trace, if any, when made, for example, in the pubic hair, the navel, or the infragluteal fold. Through these mini-incisions, a cannula is introduced, that is, a stainless steel tube with a rounded tip and one or more holes. The cannula is connected by a transparent, very flexible plastic tube to a kind of vacuum. The surgeon moves this cannula in a piston-like motion, that is, a back-and-forth movement, creating tunnels in the fatty tissue just under the skin.
These fatty tunnels empty into the tube and are suctioned into a graduated bottle. Thus, the fatty tissue will gradually collapse, and the mass causing the disfigurement, for example, a large belly or saddlebags, will eventually be completely suctioned and flattened.
Since these cannulas are of a very small diameter, 2 or 3 mm, sometimes 4 for a large belly, performed by an experienced hand, the work will leave smooth skin and, depending on the extent of the liposuction, the silhouette can be completely transformed.
Tumescent outpatient liposuction, as practiced today, allows removing excess fat almost anywhere on the body, fat masses that are particularly resistant to diet and exercise. Tumescent liposuction avoids general anesthesia and especially the risks associated with this type of anesthesia. The tumescent technique, as described by Klein, is extremely safe thanks to local anesthesia and much more delicate cannulas.
Moreover, it causes fewer bruises and blood loss, and allows for a much faster and more comfortable recovery. It produces far superior results to what was known in the past with liposuction, which Klein calls “antediluvian.”
This technique allows extracting 2 to 4 liters of fat (4 to 8 pounds) per procedure, without general anesthesia, and with very little blood loss.
Exceptionally, up to 5 liters can be removed when circumstances allow. To work safely, the volume of fat that can be removed depends on the total body weight. Thus, in a single procedure, 4% to 6% of the patient’s total weight can be removed. For example, in a 65 kg patient, this gives a volume of approximately 3 liters of fat.
While not exceptional, a harvest of 3 liters does not happen every day in a liposuction clinic. Remember that before the discovery of tumescence, barely a liter (2.2 pounds) could be removed per procedure, often requiring blood transfusion, a long convalescence, and a difficult awakening due to general anesthesia.
All this explains why liposuction has become the most performed procedure in the world of aesthetic surgery.
It can also be added that it causes very little interruption in social life. For example, saddlebags operated on Friday will allow a return to work the following Monday. The largest liposuction, for example, a trunk where 5 liters of fat are removed (which is very rare), would not require more than a week of convalescence for a patient whose work is not too physical.
I sometimes train doctors in liposuction. Here are the two pieces of advice I give them when introducing them to the world of liposuction.
To ensure your patients are truly satisfied:
You must remove as much fat as possible;
You must never remove too much.
Obviously, this is said with humor, but it is the pure truth. Our patients have a visceral hatred of fat and repeat to us: “Please doctor, remove as much as possible, remove all this bad fat.”
But removing it all would be a disaster, as a layer must be left to shape the body, to soften the contours, because it is the fat left behind that will be beautiful to look at, the fat removed goes to the incinerator. The goal is to create harmony, not a gaunt appearance. There are no flat surfaces on the human body, only concave or convex.
Sometimes, with liposuction, we make concave from convex, for example, at the love handles.
Moreover, removing too much or all of it would lead to skin adhesions, which would give a “bumpy” effect, similar to repoussé leather. I tell my students: Not enough will lead you to purgatory, too much will lead you to hell; but if you show judgment and balance as I teach you, it will be heaven for you and your patients.
The greater the experience of the liposculptor, the greater the amount of fat that can be removed while staying within acceptable limits without creating unnecessary risks. An inexperienced liposculptor will be afraid to remove too much and will prefer to measure their intervention with exaggerated caution, leading to disappointing results.
The greater the experience of the liposculptor, the greater the amount of fat that can be removed while staying within acceptable limits without creating unnecessary risks. An inexperienced liposculptor will be afraid to remove too much and will prefer to measure their intervention with exaggerated caution, leading to disappointing results.
Beware of the many misconceptions that circulate and are very persistent about liposuction.
It is better to lose weight beforehand. This is a big mistake, as the results will be mixed and the skin will drape less well;
General anesthesia does a better job. On the contrary, under local anesthesia, the patient moves much more easily on the table, and it is easier to reach the smallest corners with the cannula. Moreover, the patient can be stood up after the procedure to check the work and make immediate adjustments;
Leaving the incisions open can cause infections. This has no basis, as the fluid flow is from the inside out and not the other way around. Moreover, keeping this excess fluid mixed with blood inside is an excellent breeding ground for microbes;
A surgeon makes a better liposculptor. Surgery involves cutting, sewing, dissecting, exploring, whereas in liposuction, we sculpt with completely different instruments. These are two specific disciplines. Who would seriously claim that plumbers make better electricians?
At the abdomen, if the skin is questionable, a lipectomy should be done immediately. This is a gross error, as in 95% of cases, even with uncertain skin, skin redraping is not needed after liposuction.
Your profile can take different shapes:
These different shapes, some more than others, with poor diet and lack of exercise, can become more pronounced and unsightly. The good news is that there is a solution: liposuction!
Source: LIPOSUCTION | Everything you need to know before, during, and after – Dr. André Dupuy
