.Liposuction is a procedure that can help sculpt the body by removing unwanted
fat from specific areas, including the abdomen[2,12,13], hips,
buttocks[2,13,4,5,10,11], thighs, knees, upper arms[6], chin, cheeks and neck.
The problem of localized fatty deposits affects women [sometimes men
also] of all ages, body types, and fitness levels.
The best candidates for liposuction are normal/near normal-weight people
with firm, elastic skin who have pockets of excess fat in certain areas &
physically healthy, psychologically stable and realistic in expectations. Age
is not a major consideration; however, older patients may have diminished
skin elasticity and may not achieve the same results as a younger patient
with tighter skin.
More recently liposuction has been used for circumferential treatment of
multiple anatomic areas, resulting in more comprehensive reshaping &
reduction of the body. For those who are slightly or moderately overweight,
liposuction can provide incentive for weight loss[10,11]. Permanent weight
loss requires modification of diet and permanent change in eating habits.

Speckles indicate areas that are best suited to liposuction.
Crosshatches indicate areas where liposuction results vary.

Procedure- Liposuction is the surgical aspiration of subcutaneous fat by use of a
cannula attached to a vaccum pump or syringe. The size of cannulas used varies
from 2 mm to 5 mm [In past 6 mm to 10 mm cannulas were used which
increases the chances of all complications]. In all patients tumescent fluid
[1000ml of R.L./N.S. + 1ml of 1:1000 Adrenaline +/- 20ml of Xylocaine 2 % ] is
first injected in the areas of interest to reduce blood loss & facilitate the
procedure . Then liposuction is done either conventionally or with PAL- power
assisted liposuction. Through a tiny incision, cannula is inserted and used to
vacuum the subcutaneous fat. The cannula is pushed then pulled through the
fat layer, breaking up the fat cells and suctioning them out. The suction
action is provided by a vacuum pump or a large syringe, depending on the
surgeon's preference[ 1 ].

Ultrasound assisted liposuction-UAL can also be used in fibrous areas. In
UAL ultrasonic energy is delivered from the tip of cannula to break adipocytes &
then suction is done.
External Ultrasound Assisted liposuction [EUAL]- In ESAL ultrasonic energy
is delivered from outside to break adipocytes & then suction is done.
Liposuction can be used exclusively or as an adjuvant for the treatment of
gynecomastia[ 12, 13 ].

Fat can be injected in certain areas to give the contour[ 8,9 ].

8. Post-operative(excision of sebaceous cyst) depression on left cheek-before & after
injection of fat. 9. Mild variant of hemi-facial atrophy- before & after injection of fat.
Anaesthesia :
Various types of anesthesia can be used for liposuction procedures.
If only a small amount of fat and a limited number of body sites are
involved, liposuction can be performed under local anesthesia, with
intravenous sedation to keep the patient more relaxed during the procedure.
Regional anesthesia can be a good choice for more extensive procedures e.g.
epidural block. General anesthesia, particularly if a large volume of fat is
being removed from different areas.

Complications :
Liposuction is normally safe, as long as patients are carefully selected, the
operating facility is properly equipped and the plastic surgeon is adequately
trained & experienced. One can remove up to 10% of the body weight in a
single seating. Risks increase if >10% of weight is removed. The
combination of these factors can create greater hazards for infection; delays
in healing; hematoma formation, excessive fluid &/or blood loss leading to
shock, sometimes fat embolism, friction burns or other damage to the skin or
nerves. The skin surface may be irregular, asymmetric or even "baggy,"
especially in the older patient. Numbness and pigmentation changes may
occur. Sometimes, additional surgery may be recommended.

Pressure Garments
In order to achieve maximum results after surgery, it is essential to wear a
pressure garment for several weeks following surgery. Pressure gar-
ments provide firm pressure and support to suctioned areas, facilitate skin retraction, and optimize final contour.

Post-operative care : Pressure garment for 3 to 6 weeks.
Normal routine work may be commenced within a week.
Avoid strenuous exercise for 3 to 6 weeks.

6& 7. Befor & after 1.8 liters of fat aspiration & liposuction

3. Bilateral gluteal , trochanteric areas & love handles before liposuction 4. After 7
liters of aspiration from gluteal & trochanteric regions. Remaining marked areas treated
after 6 months with liposuction [5].

10. Bilateral gluteal, trochanteric fat [saddle bags] Before Liposuction 11.After 4 weeks
of liposuction[7.2 liters fat aspirated]. She lost total 11 kg in 4 weeks time (Liposuction +
Dieting). 12. Bilateral gynecomastia + Abdominal fat before. 13.After Liposuction

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