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Liposuction

PREOPERATIVE MEASURES, POSTOPERATIVE MEASURES AND COMPLICATIONS

Liposuction is aimed at removing excess fatty cells from specific regions of the body. With the improvement in surgical techniques and instruments and its effective results, this type of cosmetic surgery has become one of the most widespread and performed procedures in the world. Liposuction is a surgical technique that requires a qualified professional, a thorough preoperative examination and specific instruments.

Liposuction can be performed on several regions of the body, depending on the necessity and technical conditions for the procedure to be carried out, which will be assessed by both the surgeon and the patient. Liposuction is most suitably indicated when the skin presents good quality, without flaccidity. The surgery shows a good result when properly indicated and when the patient is completely aware of the cautions and auxiliary procedures that may help in his/her postoperative recovery.

The end results are seen after the 6th month. It is indicated for correcting small and large abdominal deformities and contours of the body; it must be performed on people with bodyweight close to normal, with localized fat and good skin elasticity. It is not a method for losing weight and should not be performed on overweight patients. The fat removed during the procedure can be used for filling depressions or areas needing projection: face, buttocks, thighs, legs and even the breast.

Almost all professionals use the tumescent approach, this means that a physiological solution with vasoconstrictor agent is injected into the site to be treated, so that the aspired material contains minimum blood. The areas to be treated are marked with the patient standing up, so that an accurate perception of the contour to be corrected can be achieved. In order to ensure greater safety, the aspired volume must not exceed 5% of the bodyweight. When the volume to be treated exceeds safety rates, the procedure will be completed in a second stage.

ANESTHESIA

The type of anesthesia depends on the preoperative evaluation:

  • Local with sedation for minor procedures
  • peridural, when there are several sites to be subjected to liposuction
  • general

PREOPERATIVE MEASURES:

Preoperative preparation by the patient is also crucial for successful surgery:

  1. For at least 30 days prior to the surgery, the patient must not use non-prescribed medications nor abuse alcoholic beverages.
  2. Similarly, the patient must completely abstain from tobacco (cigarettes, cigars, pipes, etc.) for at least 2 months prior to the procedure.
  3. Diabetic and hypertensive patients need to have their clinical conditions managed.
  4. In some cases we recommend that the patient undergo lymphatic draining sessions before surgery to detoxify the organism and activate blood circulation (a detoxified organism responds better to the procedure).
  5. Em alguns casos, recomenda-se uma dieta balanceada e ginástica adequada, para preparar o corpo para um lipoaspiração.
  6. The surgeon must be told about the use of any medication.
  7. Some medications may contribute to the risk of hemorrhage: acetylsalicylic acid (aspirin), non-steroidal anti-inflammatory drugs, anticoagulant agents, vitamin E, vitamin C, ginkgo biloba, ginseng, garlic, alcoholic beverage, and some homeopathic medications used on a regular basis.

POSTOPERATIVE MEASURES:

As important as the surgery itself are the postoperative measures, which, if not observed, may prevent the surgery from achieving the desired results. This is true for all types of surgical procedures. Different factors influence postoperative recovery, such as race, sex, age, liposuction extension, the sites subjected to liposuction, individual scarring characteristics, physical ability of recovery, sensitivity to pain, genetics, etc.

  1. Stitch removal: they are removed on average 7-14 days after the procedure.
  2. Shaping elastic belt: its use is immediate, after the completion of the surgery, before leaving the operating room. It will be used for approximately 30-40 days and may be taken off only when the patient takes a bath. The elastic belt has a shaping role, reducing the edema (swelling) through mild compression and keeping the site subjected to liposuction immobilized while the skin and areas subjected to liposuction undergo a progressive retraction of tissues until they adapt to the new shape. Thus, after the period of utilization indicated, it can be used at night only, for sleeping, during a period ranging from 30 to 60 days, depending on the patient’s progress. The belt model indicated will depend on the liposuctioned area.
  3. Dressings are replaced upon stitch removal.
  4. Rest: only mild activities during the first days, it is recommended that the patient walk at his/her home, lying down all the time is not recommended. Physical efforts and lifting weights are strictly forbidden.
  5. Lymphatic drainage: useful for reducing swelling and avoiding fluid accumulation under the skin, as well as for the prevention of eventual irregularities; several sessions may be necessary in the first month. In general, the edema begins 5 days after the surgery. Most of the edema will be resolved in two months. Residual edema may persist for 6 months and, in a few cases, for up to a year.
  6. Ultrasound: Helps organize internal scarring after liposuction and is quite useful for minimizing irregularities and nodes postoperatively.
  7. Return to activities: the patient can resume his/her professional activities in around 5-7 days (on average), but any physical effort is forbidden. The return to daily activities will depend on the procedure extension; 2-4 weeks may be needed for this. After this period, the patient can take mild walks of at most 2 km. More demanding physical activities will be gradually allowed after one month, depending on the doctor’s evaluation of the patient’s general status. After 45 days, the patient can practice sports such as jogging and bodybuilding.
  8. Diet: drinking water (at least 2.5 liters) and natural juices is fundamental due to the need for fluid replacement as a result of fasting and due to the loss of fluids in the surgery. All foods are allowed, there are no dietary restrictions. The patient should not forget to consume healthy foods, rich in fibers, and fruit, vegetables and greens. No alcohol should be drunk until at least 14 days after the surgery in order to accelerate the edema absorption.
  9. Sun exposure: sunbathing is forbidden for the first 3 months. Sunscreen with a protection factor 30 or higher should be applied to the scars in order to prevent them from darkening from sun exposure.

COMPLICATIONS

  1. Infections: these may occur after any surgical procedure. In general, they are caused by Streptococcus pyogenes or by synergy with anaerobic bacteria. Proper antiseptic measures, care in the transoperative period and antibiotic therapy for at least 7 days can prevent infections in liposuction.
  2. Deep venous thrombosis and pulmonary embolism are severe complications to this type of surgery and can even be fatal. For prevention, a preoperative evaluation is necessary for identifying risk factors for thrombosis, in addition to using elastic compression stockings, intermittent pneumatic system for the lower limbs in the transoperative and immediate postoperative periods, and good hydration and early immobilization postoperatively. These measures help prevent these severe complications. Symptoms are shortness of breath and difficulty breathing. If these symptoms appear the patient must first talk to his/her surgeon immediately and, if necessary, seek medical emergency care.
  3. Cardiorespiratory arrest: many cases do not have any apparent reason and it may take place in any kind of surgery, cosmetic or not; hence the importance of carrying out the surgical procedures in a hospital.
  4. Skin necrosis: the death of the skin above the liposuctioned area may occur. This can occur especially when liposuction is carried out on a very superficial layer, causing damage to vessels in the subdermal plexus. The compressive mesh can also lead to necrosis in view of the ischemia that may be caused by excess compression, especially in the skin folder area.
  5. HSkin hyperpigmentation: typically occurs at the aspirated sites due to deposits and fixation of hemosiderin by ultraviolet rays, derived from the breakdown of hemoglobin present in surface ecchymoses. For prevention, it is fundamental to avoid sun exposure and to apply sunscreen to the operated areas. Depigmenting agents can be used if necessary.
  6. Visceral perforations: can occur when the liposuction cannula causes damage to internal organs, especially to abdominal wall herniae that had not been previously detected.
  7. Unaesthetic scars.
  8. Hematoma: the accumulation of blood accumulation that may occur in the immediate postoperative period (first days).
  9. Seroma: is the accumulation of serohematic fluid that may take place at a liposuctioned site in the late postoperative period (many days or weeks after the surgery). These can usually be aspirated with syringes at the office. The compression meshes worn postoperatively help prevent seromas and minimize pain.

More and more people have posture problems and abdominal muscle weakness and this is one of the key points to be worked on with guided physical activity and/or electrostimulation (physiotherapy) to increase muscle strength in the abdomen and improve posture and body image. This is an important factor to be remembered by all patients undergoing a cosmetic surgery and who want to improve their body image.

Liposuction ALONE will not provide the desired resultS. Patients must carry out a physical conditioning program before and after the procedure in order to work on their muscles and body posture. In liposuction, the surgeon works on a fat (adipose) layer and it is also necessary to treat the quality of the skin. THE COMBINATION OF MEASURES LEADS TO BETTER END RESULTS.

REMEMBER YOU MUST TREAT YOUR NEW BODY SHAPE PROPERLY AND FOR THIS IT IS IMPORTANT TO STICK TO A HEALTHY DIET AND TO EXERCISE REGULARLY.

BE WISE WHEN YOU CHOOSE A SURGEON. Just like in all other professions (lawyers, teachers, politicians, masons, cabinetmakers, baby-sitters, plumbers, etc.), there’s also a significant difference in the quality of the medical work provided.

Remember that different surgeons have different medical BACKGROUNDS, follow different procedures, have different esthetic views and obtain significantly different surgical results.