Liposuction (Fat Removal)
Everything you need to knowLiposuction (Fat Removal)
Although liposuction basically provides reduction in subcutaneous fat tissue, its main goal is surface correction.
Fat tissue, which is widely found in the human body, gains its general character as the number of fat cells stabilizes in adulthood. The areas where fat is predominantly distributed in the body vary from person to person and are actually proportional to the number of fat cells in that area. For example, in men, fat gain is more evident mainly around the abdomen and between the intra-abdominal organs (intra-abdominal fat), whereas in women, weight gain is evident mostly in the hips, hips and thighs. Another factor that causes this distribution is hormonal activity.
When people gain weight, what is basically expected is an increase in the amount of fat stored within the cells rather than an increase in the number of fat cells. Therefore, the majority of fat removal techniques aim to destroy these cells.
Contrary to popular belief, liposuction is not a surgery that causes bleeding and is extremely painful afterwards. Postoperative swelling and bruising may occur.
Liposuction (fat removal surgery) techniques have improved greatly over the years. Although the first applications regarding the necessity of breaking and vacuuming the fat were initiated by the French surgeon Charles Dujaer in the 1920s, serious problems were observed in patients in the applications until the 1970s. The main reason for this was the use of sharp-edged curettes used in abortion during the procedure. In 1974, the Fischer family, Italian father and son surgeons, carried out their first experiments on breaking down and vacuuming fat using blunt-tipped cannulas without damaging the surrounding vessels and nerves.
In 1978, Paris physicians Yves-Gerard Illouz and Pierre Fournier improved the Fischers' technique and defined what is called the wet technique . With this technique, a special serum solution was first injected into the fatty tissue to reduce blood loss and pain in the patient, and after waiting for a while, the fat was broken down and vacuumed with cannulas. Fournier later showed that more ideal results could be obtained by making passes in different axes from the same area with the cross fat removal technique.
The concept of liposuction , which means fat suction, was put forward by Narins, Newman and Dolsky, who organized a course on it in the 1980s.
In 1982, the tumescent technique, which minimized pain and bleeding, was described by the US dermatologist Klein as an important development for liposuction. In this technique, a much more balanced solution containing adrenaline and lidocaine was injected into the fatty tissue. The application could now be performed with thinner cannulas and without anesthetizing the patient.
In 1992, Zocchi in Italy developed the ultrasound-mediated fat removal technique . This technique, which did not receive support for a long time, was later developed with new technologies. It is among the methods frequently used today.
We do not expect any serious bleeding or pain with today's techniques. However, swelling and bruising may still occur. We apply corsets to patients to minimize these.
Some of my patients ask how much weight they can lose with liposuction. However, it should not be forgotten that this surgery is not a weight loss surgery and only aims to correct the body surface.
Although liposuction basically provides reduction in subcutaneous fat tissue, its main goal is surface correction. Some patients may wish to have excessive amounts of fat removed. However, if the amount of fat removed exceeds critical levels based on the patient's weight, fluid support is required. Despite this, serious problems such as clot formation in deep veins, fat clot passing into the vein and entering the circulation and reaching the brain or lungs are not uncommon. Therefore, it would be more appropriate for our patients who are candidates for liposuction to have moderate amounts of fat removed in more than one session, rather than removing excessive amounts of fat at once. In addition, I recommend my patients to pay attention to the nutrients they consume by getting support from a dietitian in the pre- and post-operative period. Because success in such surgeries requires the patient to contribute in this way.
Laser liposuction can also create a shrinkage effect on the skin and provide more satisfactory results for patients with possible sagging skin. Likewise, more satisfactory results can be achieved with ultrasonic liposuction devices such as VASER.
Traditional liposuction is still one of the most commonly performed plastic surgery surgeries in the world. Many new technology products have been developed especially to reduce the time and effort spent. The main goal of those involving ultrasound (such as VASER) or laser technologies is to burst the fat cells, allowing the fat to come out and then sucking it with the aspirator device. In fact, some of the oil, as needed, can be taken into closed systems and prepared for injection. All of these technologies can provide some increase in skin tension. They cause less swelling and bruising. The patient's return to daily life is faster.
The use of fat removed by liposuction to shape various parts of the body has given rise to the concept of "liposculpture". In fact, liposculpture can be thought of as a combination of fat suction and fat injection procedures.
Disposal of a substance obtained from the body in plastic surgery is something we do not want. In this sense, the tissue obtained most frequently and in the largest amount is fat tissue. Adipose tissue has the potential to provide relative improvement in the areas where it is injected with adult-type stem cells and various substances called growth factors. After the fat tissue is removed, it can be further purified by going through various processes. This is followed by injection of the harvested tissue. 20-40% of the injected volume remains after one year. However, what is actually left is the connective tissue formed in place of the part that melts with the fat. Each injection will provide some additional volume. The particle diameters of the injected oil are reduced to millimetric levels by being thinned as much as possible during the processing process. After this, injection and shaping will be easier. Liposculpture is not a device or method. It only involves removing fat and then injecting it into the desired areas.
Returning home after liposuction is quick. However, it takes 1-2 weeks for the swelling and bruising to subside, although it varies from person to person.
Many patients apply with the hope that they can return to work the day after surgery. While this is possible in limited liposuction surgeries, I recommend my patients to rest for at least 1 week, as a surgery involving the entire body, arms and legs will also require fluid and painkiller support. No matter what technique is used, there will be some bruising and swelling. In fact, in full body corsets, the genital area generally remains open to relieve the need to go to the toilet, and edema and bruising may cause severe swelling in this area. Therefore, rest and fluid intake are important.
Not everyone may be a suitable candidate for liposuction. In order for this to be evaluated, you must be examined and inform your doctor about your height and weight during the examination.
Liposuction, which is a surgery that does not satisfy patients in terms of weight loss, is ideal for removing fat that cannot be eliminated by exercise in patients who do not have a significant internal organ disease, whose skin tone (elasticity) is sufficient to prevent sagging, who do not smoke, who have reached the required weight and have been able to stabilize this weight. I have heard of oil intakes reaching up to 10 liters in a single session, and these can cause serious systemic problems. I always evaluate the body mass index (BMI, your weight / height squared) in patients who apply to me . Patients with a BMI of 25 kg/m2 and above are in the overweight category and I recommend that they return to their ideal weight before liposuction.
Liposuction is one of the most ideal methods in cellulite treatment. However, the main problem in cellulite is not the accumulation of fat under the skin, but rather the connective tissue compartments called septum, which separate the fat masses from each other, causing dimples.
Excessive fatty tissue may not create a bad skin appearance in everyone. The appearance of surface irregularities, dimples and an orange peel appearance on the skin is generally called cellulite .
Image Note: Normally, the thickness of subcutaneous fat tissue does not exceed the connective tissue septa. However, when the fatty tissue thickens, the septums remain short and dimples begin to appear on the skin. Liposuction reduces the thickness by absorbing this fat tissue in the deep layer.
In fact, the concept of cellulite is an incorrect definition and corresponds to the infection of the subcutaneous tissue, and the problem in question is called lipodystrophy , that is, "defective development of fatty tissue" in plastic surgery.
There are connective tissue compartments called septum that connect our skin to the muscle tissue at the base. Inside these septums are the blood vessels and nerves that feed the skin. Septums create small chambers under the skin and fatty tissue is located in these chambers. If the thickness of the fat tissue exceeds the length of the septum, the fat tissue bulges outwards, creating a dimple with the septum in the center. This condition is known as cellulite. A person does not have to be overweight to have cellulite. Cellulite may also occur in thin people whose septums may be short in length. At this point, liposuction surgery, which also breaks down the septums, provides an ideal treatment.
Image Note: The cannulas used in liposuction surgery can be advanced through millimetric incisions and fat removal can be performed in a 360-degree area.
In laser, ultrasound and power assisted liposuction techniques, septums are easier to break down and the likelihood of remaining dimples is lower.
Power-assisted liposuction is basically a technology that has its own fat breaking and suction system.
In liposuction surgery, there is a cannula inserted through millimetric incisions in the skin and a hose attached to the back of this cannula.
Image Note: Cannulas and probes of different liposuct and ion technologies.
This hose is connected to the aspirator that performs high pressure suction. By entering through the hole with a cannula, the fat tissue is broken down with back and forth movements, and the broken fat is drawn into the aspirator in the cannula. This dissection process is a very tiring process. The energy and time spent especially in liposuction performed on the whole body is quite high. To eliminate this problem , power-assisted liposuction has been developed , which breaks down the fat tissue with high-frequency reciprocating movements and significantly reduces the number of movements of the surgeon .
With power-mediated liposuction, surgery time is reduced by one third. Pain and edema are slightly less. However, in this technology, which has a certain learning curve for the surgeon, the skin may be damaged in applications close to the surface. Especially in patients who will undergo liposuction for gynecomastia, force-mediated liposuction technology provides much more effective tissue disintegration. The care and recovery process after power-mediated liposuction is the same as in classical liposuction.
VASER is not a laser technology as it is thought. It is a liposuction method based on the effect of ultrasound waves on breaking down fat tissue.
It is VASER (Vibration Amplification of Sound Energy at Resonance) ultrasound-mediated fat removal process, which is frequently mentioned by my patients but the technology involved is misidentified . It separates the fat tissue more selectively from the surrounding connective tissue septa with the vibration created by sound waves and allows it to be absorbed by cannulas. It is effective without damaging tissues other than fat in the area, such as vessels, nerves and muscles. The surgery takes between 2-5 hours, depending on the width of the area to be treated. After the surgery, a corset is needed again and patients get rid of their swelling in an average of 10-15 days. Massage over the corset is recommended.
Laser liposuction devices work with Nd:YAG or diode type laser technologies. Return to daily life is faster after surgery. Bruising and swelling are more limited and short-term.
Laser technologies have been used in plastic surgery for a long time, as in many areas of life. It is especially successful in regenerating the skin and stimulating the increase of collagen synthesis in the subcutaneous tissue. In fact, it is more accurate to call it laser lipolysis instead of laser liposuction. Because the laser device actually has the effect of melting only the fat tissues and septums. If the surgeon removes the melted fat with cannulas, then laser liposuction can be mentioned, since liposuction is also involved. There are publications claiming that this technology, which is commonly known as laser lipo and is based on navigating the skin with a laser probe, provides better skin tightening than ultrasound and other liposuction techniques. In the right hands, laser lipo technologies can provide very good results. Lipotherme, Smartlipo and Slimlipo are examples of frequently preferred laser lipo devices. When only lipolysis is performed, that is, when suction is not done with a cannula, the metabolism is expected to melt the broken down fat. In this case, it is recommended to consume plenty of water, especially in patients who undergo extensive lipolysis. However, personally, I am in favor of removing the melted fat. It is observed that the unextracted fat can rarely cause cyst formation in the area. Another risk is that the fat may somehow pass into the systemic bloodstream and travel to organs such as the lungs and brain in the form of a fat clot.
Healing in the laser liposuction technique is generally faster than in classical liposuction, and the bruises disappear faster. Patients with limited application can be sent home on the same day. I recommend corset application for at least 3 weeks.
Liposuction is a surgery and its risks should not be ignored. Our patients often come to me thinking that liposuction is a very innocent surgery.
As with any surgery, local wound infections may occur at the points where the cannulas enter after liposuction. Most of the time, they are easily controlled. Very rarely, more common soft tissue infections can be observed in patients with metabolic problems such as diabetes.
In cases of excessive fat removal (massive liposuction), if fluid therapy is not properly regulated, the possibility of the blood in the patient's veins clotting and settling in the deep veins increases. This clot can dissolve and travel to important organs such as the lungs, brain and heart, causing vascular occlusion (venous thromboembolism) . For this reason, I definitely do not recommend excessive fat removal.
Another frequently encountered problem is the inability to achieve the desired aesthetic improvement. In superficial applications, depressions may remain on the skin. In fact, the main purpose is to prevent the septums from dimpled by absorbing the deeper fat. Therefore, choose physicians who have completed the learning curve of the liposuction procedure and have only a plastic reconstructive and aesthetic surgery specialty diploma.
Cold lipolysis is the process of thinning fat tissue with periodic cold applications and is one of the liposuction alternatives that can be used in the treatment of cellulite.
Various studies have shown that fat tissue thins (atrophy) when periodically exposed to low temperatures. Based on this, cold lipolysis devices have been developed that adapt to the body surface and allow cold application to the fat tissue . In practice, there is no instrument penetrating the skin as in liposuction. The effects of the application appear after 2 weeks and better results can be obtained with periodic repetitions. Low temperature causes regression in fat tissue. The most common side effect observed in patients is numbness in the application area, which can last for a long time. It can be applied to patients who do not want to undergo surgery and who say that they can wait even if the effect appears late.
High Intensity Focal Ultrasound (HIFU) technology is a technology that targets the subcutaneous fat tissue and connective tissue from the outside and provides both melting of the fat tissue and tightening of the connective tissue.
After observing the advantages of ultrasonic liposuction and radiofrequency on fat tissue and skin, technologies that apply external ultrasound have also been developed to offer a non-surgical solution. Cavitation , the most well-known of these, mainly targets fat tissue and can provide a significant slimming in fat tissue with repeated sessions (please see the cavitation page for more detailed information.)
In high-intensity focal ultrasound technology, unlike cavitation, ultrasound energy is concentrated on a certain focus and does not cause excessive heat increases. It has been claimed that it can cause melting of fat tissue and tightening of connective tissue without opening it. It may be possible to achieve such a result, especially in the face area, with repeated sessions.
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