It was the 70’s and Dr. Schruddle faced a new challenge in his career: how to extract a fatty tumor from a patient without leaving the mark of an extensive scar? And the light bulb came on: cure it from a small scar. Liposuction had begun to take shape. Since then, advances have been made to make this procedure more and more reliable and safe.
Liposculpture, Liposuction, Liposuction or Lipoplasty?
It is all the same: remove fat from the body and wait for the skin to mold and retract to achieve the best possible result. Different words for the same procedure: a matter of how they want to sell you the idea.
At this point I would like to make several ideas clear: Liposuction, liposculpture or whatever you want to call it is not a procedure to lose weight. After the surgery there are three basic recommendations to follow:
- Do not take salt
- Drink plenty of liquids.
- To walk at least one hour daily.
Complying with these three simple recommendations, during three months, will make you lose weight, not the surgery itself. It is not an intervention to eliminate cellulite either. Something will improve after the surgery, but it will inevitably reappear after a short time.
What does the surgery consist of?
This surgery consists of introducing a lot of water (saline solution with anesthesia) into the fat, and then aspirate this and part of the liquid that we have introduced. It is impossible to remove all the liquid, so part of it will remain after the procedure and it will be the patient who will have to eliminate it little by little as I said: walking, drinking and leaving the salt.
Lymphatic drainage plays an important role in this process, which is very important so that the elimination of liquid does not take too long, but we must never forget that a good drainage cannot be done by just anyone: it is essential to have a good professional.
Another decisive factor is the post-surgical massage to eliminate the residual water before the small openings through which the cannulas are introduced are closed. This massage should not be painful or aggressive. Often patients come to my office complaining about how bad they have had it after receiving some of these massages that have recently become popular in Central America. They are very dangerous: several of these patients have suffered convulsions and even loss of consciousness. I repeat: this massage must be bearable.
How long will it take to eliminate the edema and fluid?
Swanson did some studies with Magnetic Resonance Imaging where he proved that 66% of the edema is resolved in one month. Eighty-seven percent at 3.3 months and at 9.3 months it has completely disappeared; and he also showed that there is a significant drop in triglycerides, which prevents cardiovascular diseases. The girdle is another element to take into account. It should be worn for a month and a half to two months. There are patients who find it difficult to get rid of it after that time.
What type of girdle should be used?
During the first few days, a simple abdominal girdle that can be fastened with Velcro, easy to put on and take off for showering and washing, or a pair of medium compression pantyhose is sufficient. After the second week and once the edema and swelling have disappeared, more complete or full body girdles can be used.
What is the postoperative period like?
The recovery from this procedure is quite simple although a little “scandalous”. You will see, during the first 48 hours you will get a reddish liquid as when washing meat in the sink because the incisions are not usually closed for this purpose. Do not panic, it is normal, the more it comes out the better: it is liquid that you will not have to eliminate yourself through urine, sweat, breathing, etc.
This surgery is not very painful. When the patient is sitting or lying down there is no pain. When you get up you will feel a stiffness type discomfort, like when you go to the gym, but during the first 48 hours you will be so tired and you will feel as if you had been run over by a truck. So the important thing during the first week is to recover properly without weird diets: you should eat proteins and little or no carbohydrates. That is to say, it is necessary to eat meat, fruits, vegetables and legumes and to abandon pasta, rice, bread and potatoes.
Results of the surgery
The expectations of a liposculpture must be realistic, both before and after the surgery. We will never obtain the same result when liposculpting the body of a young person who comes for a high definition, than if we do it with the body of a woman who has already had children or has gained and lost several times of weight. It is not worth gaining weight before the operation thinking that “since I am going to have surgery, I’ll eat first”. This is a mistake that the body will later show in the form of stretch marks, flaccidity and poor tissue retraction.
The same in the postoperative period, it is necessary to maintain a healthy life to keep the type and try not to gain weight: if you gain a couple of kilos you will still keep the line, but if you gain more, there is no surgery that can resist it and new adipocytes will be created.
In which areas of the body can liposculpture be performed?
The areas of the body candidates for liposuction are the abdomen, flanks, back, armpits, arms, double chin, inner and outer thighs and the inner part of the knees, as well as the breasts in males, called gynecomastia.
Which liposculpture technique is more effective?
There is a lot of talk about the techniques used in the liposculpture intervention. Every now and then a new device appears. From the conventional aspiration to the modern and very expensive micro-air devices, passing through the laser, the water jet and the ultrasound – cavitation (now called Vaser). Well, it has not been demonstrated that any of these modern devices have any advantage over conventional Liposculpture! In fact, some of them can even produce important burns. They can reduce a little the surgeon’s fatigue (in the case of the laser it lengthens the surgery in one more hour) but nothing more.
Little has compared the results between techniques, taking as a basis the standard criteria of conventional liposuction, and, as he indicates in these studies he has published, he did not find any basis to demonstrate the superiority of any of them. Prado et al. published another double-blind controlled study between lipolaser and conventional lipo which also showed no clinical differences in terms of final results (Therapeutic Evidence Level II). Regarding Vaser, Nagy and Vanek also compared it with conventional liposculpture looking at skin retraction, blood loss and patient and physician satisfaction and were not able to demonstrate differences between the two systems.
What complications can occur in Liposculpture?
And now we would have to talk about the complications in Liposculpture, since, according to the device we use, we can have a different sequel or complication. For example, the laser ultrasound produces a lot of ecchymosis (bruises) and both this technique and the laser assisted one can burn the skin if they are not well used and the vibrating handles produce a lot of seroma (accumulation of lymph liquid) as they are more aggressive with the tissues. Anyway, in any procedure sequelae or complications may occur; the difference is that complications are rare (great blood loss, fat embolism, necrosis) and however, sequelae are inevitable (irregularities, paresthesias, bruises).
I have used all these procedures: Ultrasonic liposuction (now Vaser) at Clínica Robles, in Argentina, between 2000 and 2002. Laser assisted liposuction at Compañía Dermoestética, until 2008. And lately the vibrating handles. Believe me: beyond the device used, what is really important in Liposuction are the surgeon’s hands and ethics.