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Dr Ömer Özkan

Liposuction

Appropriate diet and exercise and a regular lifestyle are essential in order to lose surplus weight. However, even people who do these may have stubborn accumulations of fat that refuse to disappear. The stomach, waist, hips and inner and outer thighs are areas of diet and exercise-resistant fat. Although excess fat in these areas can be overcome to some extent with diet and exercise, this may end in impairment of the general metabolism rather than in these regions becoming thinner.
What is liposuction?
Liposuction is an operation in which accumulated fat in specific parts of the body is dissolved and removed from the body using a special vacuum device or special injectors. This is definitely not a slimming operation, but a body contour correction procedure. Increased fatty tissue resistant to diet and exercise is removed from the body, while the number of existing fat cells id reduced.

In liposuction surgery the stubborn fatty area is inflated with a special fluid injection. A number of incisions a few millimeters long are then made to or near the region. Depending on the patient’s status, metal tubes known as cannulae 2-6 mm in diameter are then inserted beneath the skin through these incisions and the tubes are attached to the vacuum device by transparent pipes.

The vacuum device is turned on, and the process whereby the cannulae set the fat at an appropriate depth in motion, thus removing the excess fat. The process of removing fat by means of vacuuming continues until the desired body contour, and a smooth skin surface, has been achieved. Use has recently begun being made of ultrasound energy. In this technique, excess fatty tissues are broken down by ultrasound waves and then removed by vacuum in a similar manner.

Excess and stubborn fat in deep layers is removed through liposuction, while the fatty collections that cause contour irregularity can be overcome using the technique known as superficial liposuction or liposculpture, developed in the last 10 years. Liposculpture has also become a technique giving good results in overcoming sagging skin and eliminating stubborn cellulite.
When classical liposuction first appeared in the 1970s the cannulae used were quite wide and sharp, and the vacuum devices employed were not up to the job, so serious problems resulted. The procedure could lead to a significant loss of fluid and electrolyte in the body. Some patients even died after the operation. But these problems are now a thing of the past. With the techniques applied over the last 10 years, liposuction has acquired an essential place in body contour correction. So long as the aim is contour correction, not slimming, it is an operation with no risks if performed properly on well-chosen patients in a hospital environment, and so long as safety limits are not exceeded. The safety limit today is cited as 2.5-4.5 liters in various reference sources today. There are areas from which more fat can be taken. But precautions are then taken to maintain the patient’s fluid and electrolyte balance, and blood transfusions may sometimes be necessary. In cases of extreme excess weight, known as morbid obesity, it has become possible to remove more than 10 liters of fat in a single session.

The Operation
The operation is performed in an operating theater under hospital conditions, under the observation of an expert anesthetist. A combination of local anesthesia and sedation is preferred. Local anesthesia alone can be administered in small area with many nerves. The operation lasts between one and five hours, depending on the regions to be vacuumed. The entry holes for the cannulae are usually left unsutured, or else just 1-2 stitches are used. Sometimes the cannulae holes are used to insert special thin tubes (drains), which help empty out the accumulated solution. Depending on the scale of the operation, the patient can leave hospital the same day or after 24 hours.

The period after surgery is generally comfortable. Pain is quite minimal and can be overcome with drugs. After surgery a special bandage is applied to the vacuumed area and the patient is given a special corset to wear. The patient wears this for 5-6 weeks. Purplish color changes may occur in the vacuumed areas, and swelling, itching and burning sensations may also arise. These disappear of their own accord within three weeks. The scars become unnoticeable in 2-6 months.


Which Areas Are Suitable for Liposuction?
It is now possible to vacuum out accumulated fat from beneath the jaw, the cheeks, neck, the upper inner surface of the arms, the breasts, chest, stomach, waist, hips, thighs, the inner surface of the knees and the back of the legs. It is also used as a complementary procedure in other body contour correction operations (such a stomach lift and breast reduction).

Is There Any Scarring after Liposuction?
The holes through which the cannulae (metal tubes through which liposuction is performed) are generally 2-4 mm in size. Any scars remaining from these are not noticeable. Scars from this operation are negligible.

How Many Liters of Fat Can Be Removed in One Session? Can Liposuction Be Repeated?
A maximum of 4-5 liters of fat can be removed without damaging the patient’s equilibrium and body functions. But there are areas that can release more by taking fluid and blood. Your surgeon’s preference is the important thing here. If the areas are quite wide, the operation can be repeated at 3-6 month intervals.

Can You Replace the Fat Removed to Reshape the Body?
In the same way that many women have regional surplus fat, some have contour problems stemming from regional fat deficiency. These two conditions are generally seen together. These conditions are corrected by transferring surplus fat from one region to another where there is not enough fat. This technique is known as “liposculpturing” or “liposhaping,” meaning fat shaping. Fat removed by liposuction from areas with excess fat is inserted in areas with fat deficiency, again using similar cannulae. These areas are generally those between the stomach and waist, the upper part of the bottom, the inner part of the mid-thigh and the calves. The amount inserted depends on the quantity removed, but is in the region of one liter. Even if some 40%-60% of the fat inserted is absorbed by the body inside a few months, the remaining amount will still please the patient.


Can We Regard Liposuction As a Weight-Loss Technique?
Of course, liposuction has become a “weight loss” method successfully administered to people with specific levels of excess weight and who have failed to achieve the desired results through dieting and exercise. These people are generally 10-30 kilos overweight. Following the procedure, approximately 80% of patients are easily able to comply with diet and exercise programs, and build on the outcome achieved. These people generally drop two or three sizes a few months after surgery.

What Serious Problems Are Involved with Liposuction, and Can These Be Prevented?
The main reason for problems has been that both the surgeon performing the procedure and the patient fail to fully grasp the serious nature of liposuction. In many countries, doctors who are not plastic surgeons are authorized to perform liposuction after attending very brief courses. Looking back on these problems arising after liposuction, the majority of procedures were performed by inexperienced doctors. The procedure has been performed on people it should not have, from a failure to determine their general health before surgery or from an existing health condition being missed. The result is the serious problems we sometimes see after surgery.