1st Step- When you come to me asking for liposuction, I will ask you following questions?
What areas are bothering you most?
This will help me understand your main concerning areas so I can focus on that and achieve a desired result. This is called Targeted Liposuction. Often people who come asking for liposuction all over the body fail to understand that Liposuction is to improve the shape of the body and safety guidelines does not allow all areas of treatment in one session.
I will be happy if you say Doc, I have tried hard working out and managing my diet and that I have reduced in weight but a certain area fails to respond well. If you say you want it because you don’t want to try by exercise and diet management, I will have to sadly refuse the procedure.
What is your Maximum and Minimum weight?
This will allow me to understand your weight fluctuation pattern, possibly reasons for fluctuation and the condition of your skin. If there is not much fluctuation, I can except a better and long lasting result. A significant fluctuation will tell em that your skin may not retract well after liposuction.
What is your medical history?
In terms of past surgeries, pregnancies, medical illnesses, allergies, ongoing medications etc I will than grade you according to ASA (American Society of Anesthesiologists) physical status classification system. This will help me assess your fitness for surgery.
The levels are as follows; ASA type
- Healthy person.
- Mild systemic disease.
- Severe systemic disease.
- Severe systemic disease that is a constant threat to life.
- A moribund person who is not expected to survive without the operation.
What are your expectations?
This will help me understand your desire and expectations. I will than analyze if they are realistic or unrealistic. I will explain to you what to expect and whether or not I will be able to meet your expectations. I will do liposuction to remove the fat from the desired areas to improve the shape and contour. It will be done either at an accredited Day Care surgical facility such as Cocoona or a hospital depending upon patient choice.
What anaesthesia is used?
The procedure involves some form of anaesthesia. Mostly it can be done under local anaesthesia with IV sedation. After IV sedation, I inject local anaesesia at few sites using smallest possible needle. Then I make a small hole to insert a blunt fine cannulae. This will allow me to perform Tumescent Anaesthsia.
Tumescent Anaesthesia is a cocktail of Normal saline, Lidocaine, Adrenaline and Sodium Bicarbonate. This will provide local anaesthesia that lasts for four to six hours, sometimes even longer to minimize post operative discomfort. It also helps to prevent bleeding and soften the fat for easier removal.
During this part of anaesthesia you will feel mild pressure, it can take about 10-20 minutes to complete the anaesthesia. In some patients who do not prefer to feel anything at all we can administer General anaesthetic.
Then incisions are small about 3-4mm and are placed in hidden areas such as belly button, bikini line, under the breast etc. If incisions are required in a visible area it is made very small and staggered to prevent a surgical look. There are no sutures placed to prevent stitch marks.
How do I Melt/ Liquify the fat?
The tumescent technique itself helps to soften the fat and most often it works very well.
- RFAL (Radiofrequency assisted Liposculpturing): I use this device if I feel your skin needs a lot of tightening. Bipolar radiofrequency helps in breaking down the fat and also heating the dermis to a controlled temperature that allows good skin retraction.
- Ultrasonic Lipo Z Lipo- Ultrasonic energy is used to liquefy large volume of fat. It is particularly useful for secondary/ correction liposuction, tough areas such as abdomen, back, chest and particularly in Men. Z lipo is helps more skin retraction than laser lipo. It is also very useful for High Definition Liposculpturing in men and Women. “Six –pack” and “Chiseled Chest” in Men and “Turtle Tummy “ in women can be achieved using Ultrasonic assisted liposuction.
- Laser Lipolysis: I use laser for selected patients where there is small pocket of fat such as chin, arms, flanks, thighs, knees, ankles etc. laser lipolysis has some advantage of skin tightening, but that is limited to 15 to 20% only. I do not recommend laser lipo for large areas where more than 2 liters of fat need to be removed or where we need more skin tightening.
- Vaser Lipo section: Vibration Amplification of Sound Energy at Resonance, It is performed using a high energy ultrasonic device. It is much more powerful than the previous Z lipo. So it is useful in selected individuals looking for atheletic and toned looks. It does carry some risks of Burns, excessive internal scarring hence it is used with caution.
- Power assisted Lipo / Vibro Lipo: I use this device when I feel I need mechanical advantage in breaking down the fat. This is mainly to improve my efficiency and reduce tiredness. The effect for the patient in my view is nothing different than Ultrasonic lipo or even Conventional Liposuction.
- Water Jet Liposuction: I will use only if I am confident it is safe and will give us more advantages than all other equipments that we are already using.
How is fat removed?
The fat is than removed by a vacuum device with small diameter cannuals. This process is called “Liposuction”. You will now understand that Liposuction is an integral part of the procedure and that it means removal of fat. Enough fat is removed to achieve the desired result yet prevent excessive removal. It is best left to surgeons expertise. There are various guidelines for fat removal-
I follow below rules-
- Less than 8% of total body weight: Average ranges from 5-10 %. Anything more can alter the hemodynamics of the body requiring IV fluid therapy, blood transfusion or worst ICU support.
- Less than 25% of the total body surface area: I limit number of areas as well. Multiple areas of liposuction can cause more discomfort and delays the recovery. More importantly as an Artist, I say “I cannot build a masterpiece in one day”
- Achieving the contour: It is never about volume it is about achieving a desired outcome. Once the shape is achieved I stop the liposuction.
- Respect the Skin: One more important guideline is skin laxity, I stop when I feel the skin will not contract any more. So I can prevent skin wrinkling, skin folds and irregularity.
What is the recovery immediately after the procedure?
After completing the procedure the wounds are left open without stitches. This allows complete drainage of fluid from inside the body. Because of this I never had any Seroma in any of my patients of Liposuction. The areas are covered with gauze padding and bandage. The drainage stops within 12-18 hours. You can than remove the dressing, have a quick shower and apply pressure garment. If there is any ooze from any of the site, please apply small pads until it dries. I do not recommend covering the wounds completely as moisture retention can cause redness and discoloration of the scars.
When can I start my activities?
You will be up and about the next day, I recommend one to three days of rest at home depending upon the areas treated. After three days most of the patient start going out of the home, attend work, drive etc. After 6-7 days I recommend you to start walking around with mild exercises of other areas. This will improve the metabolism and prevent weight gain in early recovery period. Exercises such as jogging, cycling, hand paddling can be started in two to three weeks. Most of the patient returns to complete exercises within 6 -8 weeks. Bottom-line is listen to your body, do what it allows without much discomfort and stop when it hurts or swells.
What can I do post surgery to improve the results?
Pressure garment is the key to best results. A properly fitting garment needs to be worn for approximately one month. During this time I recommend Foam paddings to achieve a better result. Subsequently second stage tight cotton wears for few weeks help to support the skin while it is retracting. Starting early controlled exercises improve drainage, muscle toning and better skin retraction. Watching your Diet will help you achieve better result for long period of time.
When do I expect the result?
- In many cases you can see some improvement the day you remove the bandage. After that you will be swollen. The swelling is fluctuating in the first week and than it gradually starts going down.
- If the skin is elastic the results start showing within a month, though it continues improvement every month.
- If the skin is flaccid, it may take good four to six months to see the result. Interestingly some areas show result much earlier than others such as Waist line, arms and ankles.
What are the risks?
Any surgery carries some risks, but at this stage of my experience I have been successful in eliminating following risks-
- Life-threatening risks such as Thromboembolism, lung complications etc
- Infections of any kind
- Excessive Bleeding
- Skin Necrosis
Some of the risks that I have been able to reduce significantly are-
- Scars of the port
- Skin unevenness
- Skin laxity
- Contour deformities
- Over correction
- Under correction
There are some risks that are unpredictable and out of my control-
- Skin retraction
- Perfect result
- Recurrence of fat
How do I proceed from here?
Before you leave my office you will get a handbook that explains the details of before and after care, medications to avoid, risks and complications, financial agreement, consent and permission forms, medical history form etc. Please spend some time reading the booklet completely. My patient coordinator will get back to you with details of cost and booking protocol. Then a preoperative appointment will be arranged where we will do complete medical checkup, measurements, surgical planning, photographic documentation and other necessary documentations.
People who come asking for liposuction all over the body fail to understand that Liposuction is to improve the shape of the body and safety guidelines does not allow all areas of treatment in one session.