"Diets and exercise don't work". True or false? Unfortunately, all too true when it comes to saddle bags, love handles, spare tires and those other well-known trouble spots that resist every lifestyle-change method to whittle them down.
The trail is a familiar one : you follow a scientific, medically-supervised weight-loss regimen, and you do lose weight. Your scales, your measure tape, your waist-to-hip ratio all tell you so. But at the end of it all, you're still left with those bulges that just won't budge : may be that apron of flesh around your abdomen, or the side pouches of flab in your upper thighs, may be even your double chin - suspiciously similar to the one your mother has. The reason is that, these localised areas of resistant fat are genetically pre-determined - which is what makes them hang in there so stubbornly.
Just a decade ago, the only solution that cosmetic surgeons could offer for these fat traps was the old snip-and-trim option : cut away the excess flab (skin and underlying fat) and suture the rest back in place - thus tightening and improving the surface skin contour while getting rid of the pudge below. The procedure, known as lipectomy, found its greatest use in the case of abdominal overhangs, which can sometimes be so gross that they do not merely pose a cosmetic problem but are also a cause of discomfort and unease - the apron being sometimes so extensive that it completely covers the genitals, resulting in constant irritation, weeping and itching in the skin folds. Lipectomy re-shaped the area, giving the procedure its popular name, "the tummy tuck".
Apart from the abdomen, lipectomy was earlier also the only available solution to excise flab in the upper arms ("batwing arms"), thighs ("thunder thighs") and buttocks. To some extent, the surgeon was able to conceal the incision, e.g. in the natural bikini line, or in the inside of the thigh. But this was not always possible; in reducing heavy buttocks,and upper thighs, for instance, the surgeon had to cut away large melon slices of fat and skin, leaving long scars on each side, extending from the buttock crease to the hip bone.
The scarring left behind by lipectomy was its biggest drawback. By its very nature this was also major surgery, requiring several days stay in hospital and posing a long list of potential complications.
In an attempt to bypass these problems, cosmetic surgeons began to look at other ways of removing body fat. One of the earliest of these used a device that looked like a long-handled ladle to literally scoop out fat from the thighs or buttocks; sometimes the surgeon would first thin the fat, using a sterilised whisk to churn up the thick lumps, thus making it easier to remove. Unfortunately, along with the fat, blood vessels and nerves were also often removed. The procedure had to be hastily abandoned.
Then, about ten years ago, American surgeons took a closer, harder look at a method of spot reduction in which fat was first broken up and then suctioned out under negative pressure. In various forms, this approach had been tried out in Germany, Switzerland and France. The French method, developed in Paris by Yves-Gerard Illouz, is the one that the American surgeons studied, employed and, in the process, popularised to its current international status. It was called liposuction (lipos = Greek for "fat"), and since it involves only a small incision through which the fat is aspirated out of the body, it minimises scarring, hospital stay and post-operative complications. Over the last decade, liposuction has been used with such spectacular success that it has become the most in-demand cosmetic surgery procedure in the United States. Refinements in the method have also widened its scope to include more body areas, older patients, smaller incisions.
Not that lipectomy has been totally abandoned. Liposuction can remove fat, but it cannot remove skin that has stretched and become wrinkled and loose in the process of accommodating a great excess of fat. Such skin needs to be trimmed and then sutured into a flatter, tauter look. In other words, lipectomy. But liposuction has transformed the traditional approach to lipectomy as well. In the case of the tummy tuck, for instance, the fat is today first sucked out and the excess skin then trimmed (in contrast to the lipectomy-only method in which both, fat and skin, had to be excised.) The result : surgery that's simpler, safer and virtually scarless compared to the older version.
A combination of liposuction and lipectomy is also used in the case of batwing arms, characterised by a gross overhang of upper-arm flab.
Or, a face-lift might be simplified by first suctioning out redundant fat from a double chin and jowls, and then trimming and tightening the face and neck skin.
And, it seems the possibilities inherent in liposuction can only increase as technical advances (e.g. the use of laser) further minimise blood loss and other complications of surgery.
- How Liposuction is done
Under light, general anaesthesia (or, in some cases, under local anaesthesia combined with a sedative), the surgeon makes a small incision in your skin ( between 1/4" to 1/2" ), through which he introduces a thin, blunt-nosed metal tube into the fat layer that lies deep inside, below the skin. Manipulating the tube (called a "cannula") back and forth, he loosens and breaks up the fat into globules. A suction device attached to the tube then "sucks out" the fat globules, which make their exit through an opening in the tube near its outer end.
Essentially, by creating a number of tunnels within the fat layer, the surgeon undermines its integrity, reducing its fullness and compactness; the result is a kind of sponge that, after surgery, shrinks, causing a less fleshy look and an improved surface contour.
Why create tunnels? Why not just remove all that unwanted fat and give you a better slimming effect? Simply because it is necessary to preserve the blood vessels and nerves that lie in the fat tissue but nourish the layer of skin that lies just above it. Getting rid of them along with the fat could result in loss of skin, scarring, infection, deformity - all of these did, in fact, occur when excessive fat removal was carried out in the earliest attempts at liposuction.
Removing all the fat would also cause the skin to adhere to the muscle layer (located immediately below the fat), resulting in unevenness or a depression in the surface contour.
Because no skin is removed, liposuction does not leave conspicuous scars. However, the incision made to allow entry to the cannula will result in a small scar; with time, this will fade to the colour of the surrounding skin, though it will never entirely disappear. Surgeons try to locate the incision in a natural body crease or in a concealed spot to enhance the aesthetics of the final result: just behind the base of the ear for chin liposuction; near the navel for abdominal liposuction, in the buttock crease for the inner thighs.
The surgery can take from 30 minutes to several hours, depending on which areas are being suctioned, and whether the liposuction procedure is being combined with another one, e.g. liposuction of jowls, combined with a face-lift.
- Fat Suction Works For
- Cheeks
- Jowls
- Neck and Chin
- Upper outer breasts (skin folds extending into the underarm area)
- Breasts (in women; suction may be used as an accessory procedure to breast reduction surgery, enabling the surgeon to minimise the surgical cuts - and therefore the scarring - resulting from the classical procedure)
- Upper arm (Suction often has to be combined with lipectomy to encise hanging skin folds)
- (Enlarged) breasts in men (gynecomastia)
- Abdomen (where there is a gross abdominal overhang, suction may need to be combined with the classical 'abdominal lipectomy' in which excess, loose skin is trimmed off)
- Upper waist ('love handles')
- Upper hips
- Buttocks
- Outer thighs ("saddle bags")
- Inner thighs
- Inner knees
- Calves
- Ankles
- Other areas of localised fat deposits e.g. the elbow area; or areas in which surface contours have been distorted due to injury/trauma to fat tissue.
- The Ideal Candidate For Liposuction
- Is not looking for a cure for overall obesity, i.e. for a 'weight-loss treatment'. General obesity is best treated by diet and exercise.
- Has specific areas of localised fat that are disproportionate to the rest of the body. Has tried both, dieting and exercise, and is still left with these areas of stubborn fat. Once removed, fat doesn't re-form and liposuction therefore implies a permanent treatment for areas of disproportionate fat. In women, these tend to lie below the waistline - the hips, buttocks and outer thighs ("saddle bags"). In men, they tend to lie above the waistline-on the abdomen and at the sides of the waist (" love handles"). The body areas in which you are likely to put on excessive weight are genetically determined - and these are the areas that liposuction is best suited for.
- Has good skin elasticity in the area to be liposuctioned. On the whole, this is a far more important consideration than age per se. A 35-year-old with lax, wrinkled skin is not as good a candidate as a 50-year-old with firm and elastic skin. The reason: skin that is lax simply can't snap back tautly enough over a newly-slimmed area: after the fat has been vacuumed out, such skin will hang in loose, sometimes redundant folds. To get rid of these festoons of fat would require surgery with a scalpel - the very procedure that you wanted to avoid in the first place.
- Does not require too much fat to be removed from one area in a single procedure. At a time, not more than 3 kg of fat can be liposuctioned. This is because, along with the fat, some blood is also lost, so the surgeon needs to proceed with caution. (If necessary, a second liposuction can be done a few months down the line).
- Is not grossly overweight (10 % above your ideal weight is considered the maximum upper limit); and does not suffer from hormonal problems.
- Has realistic expectations from the procedure : knows, for instance, that cellulite (wavy, dimpled skin) cannot be eliminated through liposuction, although the surface unevenness can be improved. Similarly, the slightly flaccid, post-pregnancy abdomen, with a few stretch marks, will achieve a new grace of form, but to expect a return to the taut, flat-as-a-washboard abdomen of your teenage years is clearly unrealistic.
- The Post Op Period
A nurse will monitor your condition during the immediate post-operative period. Your surgeon will also drop by during the day on one or two check-up rounds. You will be given medication to control the pain.
Possible complications during this period include some that are common to all surgical procedures: bleeding, infection and pulmonary embolism (a rare but life-threatening condition in which a blood clot escapes into the circulation and travels to the lungs). Fortunately, recent innovations in technology, such as smaller suction tubes and special injectable chemicals, have greatly reduced these risks.
Depending on how much fat has been suctioned out (and, correspondingly, how much blood loss has occurred), and depending also on the general health status of the patient, liposuction may be done as a daycare procedure or may require a brief hospital stay. Fat and blood loss are greater, for instance, in the case of abdominal liposuction than in liposuction of the thighs.
After the Surgery
Your recovery time depends on the extent of your surgery. If you've had a lot of fat removed, you'll be able to lie down, but you might not be able to sleep for the first night.
If you've just had a few bulges whittled away, you may be back at work within a few days. Ambitious re-shaping could keep you home for a week or more.
The liposuctioned areas will be bruised for a few weeks and swollen for upto a few months. The swelling is the result of fluid build-up in the area: your body's natural response to the suctioning of fat is to rush blood and fluid into the newly-created spaces. You'll need to wear a tight elastic dressing (a pressure bandage) for a few weeks to keep swelling down and to help your skin shrink to its new contours. (In some cases, if the fluid accumulation is excessive, a temporary drain may be used immediately after surgery or even some time later).
Don't discount the discomfort factor, either. You'll feel sore for up to a week after your surgery. But the discomfort should never be as extreme as, say, getting a facial chemical peel. If it is, or if it worsens, call your doctor. Also, call him if you develop a fever, or have a sudden increase in the swelling or bruising: you may have developed complications.
Even if there are no complications, follow-up visits will enable your surgeon to monitor your progress, advise you on how you can speed along the healing process, and also guide you on the resumption of routine activities, commuting and physical exercise.
In the long-term
Some surface waviness may persist, depending chiefly on the area liposuctioned, the elasticity of the skin and the amount of fat sucked out. It's better for a surgeon to err on the side of conservativeness and suction out less rather than too much : it's always possible to do a follow-up liposuction, but to put fat back is a far more dicey proposition.
Since small nerve fibres are always injured during liposuction, temporary numbness as well as tingling/burning sensations in the area may be expected while they heal. Sometimes, a limited amount of numbness may be permanent.
Most of the improvement - in swelling, bruising, discoloration - will occur during the first six weeks. But the "final look" may take as long as 9 months to a year to settle in.
