Liposuction And Bariatric Plastic SurgeryNovember 6, 2012
Liposuction And Bariatric Plastic Surgery: Liposuction was first introduced in the United States in the 1980s and is one of the most popular plastic surgeries performed today. It’s a procedure that can safely, effectively, and permanently remove fat from the body. The procedure is best suited to removing stubborn, localized fat deposits that have been resistant to diet and exercise. With liposuction, a surgeon can sculpt or reshape areas of the body, producing a smoother, more proportional figure.
Understandably, liposuction can be an important component of bariatric plastic surgery procedures. Keep in mind however, that because liposuction removes only fat, it can actually worsen the appearance of loose skin. Therefore, liposuction is used only as a complementary treatment to the removal of excess skin.
If liposuction is performed as part of staged procedures, the liposuction is typically the first procedure with other procedures performed at a later date. For instance, if the initial procedure involves liposuction on the thighs, then a thigh lift would follow during a subsequent procedure. In other cases, minimal liposuction performed at the same time as a skin removal procedure is a way to fine-tune results.
How Liposuction Is Performed
In a typical liposuction procedure, the plastic surgeon makes small incisions, usually measuring only one-eighth to one-half inch each. The number of incisions made
depends on the number of areas to be treated and the amount of fat to be removed. Whenever possible, incisions are hidden under the pubic hair, in convenient folds, or skin creases, such as under the fold of the buttocks or in the belly button. When incisions can’t be hidden, the resulting scars are usually inconspicuous.
To perform liposuction, the surgeon typically prepares the fat cells for removal by injecting tumescent fluid, a solution containing Lidocaine, epinephrine, and other fluids. An ultrasonic probe liquefies the fat cells, facilitating their removal. After this, the surgeon inserts a narrow metal tube called a cannula, which is attached to a vacuum. The cannula is passed back and forth beneath the skin to suction out the fat cells. The surgeon continues suctioning fat until achieving the desired contours.
Liposuction as Part of Bariatric Plastic Surgery Procedures
Now, to better understand the role of liposuction with bariatric plastic surgery, let’s take a look at the basics of popular post-weight loss procedures and see how liposuction is used.
A tummy tuck, or abdominoplasty, is the most common surgical procedure performed to restore the shape and appearance of the abdomen. This popular procedure can help achieve a flatter midsection by addressing several problems associated with significant weight loss to include excess skin, lax abdominal muscles, and stubborn pockets of fat. Tummy tucks can also correct excess skin present in the pubic area. In addition to removing loose skin, tummy tucks tighten loose abdominal muscles, which help to reshape the abdomen. In most cases, only minimal liposuction is performed during a tummy tuck to fine-tune the shape of the waist and abdomen.
During a breast reduction, the surgeon uses one of several types of incisions to perform the operation. Once the incisions have been made, the surgeon lifts the skin away from the underlying breast tissue and removes tissue until achieving the desired size. Minor liposuction performed at the side of the breast or near the underarm can remove fat and provide better contouring.
Outer Thigh Lift
A thigh lift is a surgical procedure that involves the trimming and tightening of excess thigh skin. In most cases, the inner and the outer thighs are treated separately in staged procedures with outer thighs typically addressed first. An outer thigh lift is usually performed in combination with a buttock lift or as part of a lower body lift. The thighs also may be contoured as part of a combined abdomen, thigh, and buttock procedure.
An outer thigh lift involves removing skin that hangs down the sides of the legs. Depending on the situation, liposuction can improve the contours of the outer thighs. The liposuction procedure occurs either during the outer thigh lift or staged later. In some cases, concurrent or subsequent liposuction of the inner thigh area can achieve the best results possible with an inner thigh lift to follow as needed.
Inner Thigh Lift
An inner thigh lift involves the removal of loose skin from the inner thighs. As just mentioned, liposuction of the inner thighs may be performed at the time of
an outer thigh lift, with the inner thigh lift following later. To perform an inner thigh lift, the surgeon makes the incisions and then lifts away the skin from the underlying tissues, trimming it away. If liposuction was not performed earlier, it may be performed at this time. Once the excess skin has been removed, the surgeon will close the incision using layers of sutures.
Lower Body Lift
A lower body lift, also called a body lift, improves the contours of the abdomen, thighs, and buttocks. This surgical procedure typically combines a tummy tuck, thigh lift, buttock lift, and pubic lift (removal of loose or bulging skin in the pubic area) into a single operation. During a lower body lift, liposuction can fine-tune the contours of the body by removing, for instance, pockets of fat from the abdomen, outer thighs, or buttocks. In most cases, however, fat removal is not considered a primary objective for a lower body lift. Any liposuction performed is usually minor.
A buttock lift is a surgical procedure designed to improve the contours of the buttocks. In most cases, a buttock lift is combined with an outer thigh lift. The primary purpose of a buttock lift is removal of excess skin hanging from the backside. Once the incision is made, the excess skin and fat is lifted away from the thigh and buttock area. Minor liposuction performed at this time on the flanks can remove small pockets of fat.
Once sagging skin has been trimmed and tightened, the contour of the buttocks will be smoother, but also may appear flatter. For most post–weight loss patients, a flatter buttocks is an acceptable outcome. However, if more volume in the buttocks is preferred, there are additional procedures that can help. For instance, liposuction can remove fat from elsewhere on the body, such as the abdomen, hips, or outer thighs and then injected into the buttocks. This will give the buttocks a more rounded contour. Another option involves the placement of a silicone implant into the buttocks to provide shape.
An arm lift is a surgical procedure that redefines the contours of the arms from the elbow to the underarm. This procedure permanently removes drooping skin often due to massive weight loss, the natural aging process, or simple heredity. The procedure begins with an incision along the inner arm or the back of the arm. After the incision has been made, liposuction can remove fat deposits. Then excess skin and tissue is removed until achieving satisfactory contours. A surgical drain may be placed in the arm, and the incision is closed using layers of sutures. The process is repeated on the other arm, with great care taken to maintain symmetry in the size of the arms.
Upper Body Lifts
There is no standard guideline for procedures included in an upper body lift, but this procedure often includes any combination of the arms, breasts, chest, back, or sides. For instance, depending on patient needs and the surgeon’s preferred surgical technique, an upper body lift may involve only an arm lift and a breast lift. In other cases, it also includes the removal of loose skin from the back and the sides of the chest. In the course of these procedures, the surgeon removes the loose skin and may perform minimal liposuction to achieve the best shape.
Neck Lifts and Facelifts
Neck lifts and facelifts are often performed at the same time, with the neck addressed first. The surgeon begins by making a small incision below the chin. Liposuction can remove small deposits of fat in the neck area. If necessary, sutures will tighten the thin sheet of muscle covering the neck area.
For a facelift, after the surgeon makes incisions, he or she gently lifts the skin away from the underlying fat and muscle. The surgeon may adjust the distribution of fat below the skin either by performing liposuction or by performing fat grafts. Liposuction removes fat deposits; fat tissue or grafts are injected into areas of the face that need softening or that appear hollow. If fat grafts are necessary, fat suctioned from the neck or another part
of the body is injected into the cheeks or other areas of the face. Next, sutures tighten the layer of tissues under the facial skin, the skin is re-draped over the underlying tissues, and excess skin is trimmed away. Great care is used not to pull the skin too tight, and the incisions are closed without tension.
ABOUT THE AUTHORThomas McNemar, MD, FACS, is a noted cosmetic plastic surgeon and author. His offices are located in Tracy & San Ramon, CA. For more information visit www. mcnemarcosmeticsurgery. com or www.bariatricplasticsurgeon.com.