The word “lipoplasty” (‘lipo’ = fat, ‘plasty’ = shape or mould) covers all the procedures that designed to shape or mould body fat, and includes liposuction (fat removal through suction) and lipo-filling (otherwise known as fat grafting) to gain the desired contour. Liposuction is a very popular, safe procedure for removing stubborn, diet-resistant localised fatty deposits (most often tummy, saddlebags, thighs and neck).
Patients of normal weight for height, with good skin and muscle tone, and localised fatty deposits that are diet resistant. The presence of loose, saggy skin with stretch marks would usually indicate poor skin tone, and hence a poor candidate for the procedure. Remember that we rely on the skin being elastic enough to “redrape” (shrink) once the underlying fat has been removed, so good skin elasticity is very important in ensuring a good result. Liposuction is NOT an alternative to dieting, nor a treatment for obesity. I do not perform liposuction on patients with a BMI over 30.
Assuming the patient is a good candidate, surgery is performed as a day case (most often no overnight stay is needed) under local anaesthetic with IV sedation – twilight anaesthesia (usually done by a certified anaesthesiologist).
The areas to be suctioned are marked in the standing position before surgery. At the start of the operation and after suitable sedation, large volumes of fluid containing dilute local anaesthetic and adrenaline (epinephrine) are injected into the tissues to be suctioned. This is called the “tumescent technique” and serves several important functions including fluid replacement, prolonged local anaesthesia, and vasoconstriction (minimises bleeding). Via small incisions that are well hidden, the fat is then suctioned out using small diameter (3&4mm), blunt tipped rods, until the desired contour is achieved. The surgeries vary from about 1 hour up to 3 hours, depending on the extent of the problem.
A pressure garment is strongly advised for use in the 3-6 weeks post op. These are commercially available and are purchased separately. For smaller localised areas (like saddlebags) one can often get away with using cycling shorts as a PG – I will advise at consultation. It needs to be worn for 6 weeks after the surgery – 3 weeks day and night, and 3 weeks day OR night, to ensure a good result. (helps the skin to shrink)
Liposuction is very safe, provided the surgeon is familiar with the procedure, and the patient is a suitable candidate. If one adheres to the recommendations, by not removing too much fat, or doing too many body areas at once, it is an extremely safe and well tolerated procedure, with only minor post operative discomfort. Most of the serious complications arise from inadequately trained individuals removing vast quantities of fat in unsuitable candidates.
It is always better to remove a little too little fat, rather than to overdo it. One can always go back and remove more if necessary, but it is quite difficult to correct areas that have been over-suctioned, since fat graft survival may be erratic. Although a significant improvement should be seen within a week of the surgery, the final result may take several weeks / months to manifest, as the healing process continues for up to a year.
A stay in Cape Town of a week to 10 days post op is optimal.