Liposuction is a surgical procedure in aesthetic surgery in which the subcutaneous fatty tissue (subcutaneous fatty tissue) is removed or sucked out by vacuum with the help of an aspiration cannula. The term liposculpture refers to the regular shaping of the body silhouette through targeted removal of fatty tissue. In principle, every region of the body is a potential treatment area, with both cosmetic and medical indications determining the use of the method. Liposuction is one of the most common aesthetic surgical procedures today and is performed worldwide. Men and women have different problem areas where disturbing fat pads negatively influence the aesthetic perception of one’s own body. The cause for this already lies in the human genetic makeup and cannot be influenced by conventional medicine. Men tend to store fatty tissue in the abdominal region (synonyms: abdominal obesity; android body fat distribution; abdominal fat), while women, on the other hand, usually suffer from fat deposits in the buttocks, hips and thighs. Excess fatty tissue is deposited here and leads to unpleasant dimples known as cellulite. Often the thighs widen to the side to form so-called riding pants. Neither diets nor sports can remedy this. Diets usually lead to the fact that after their end the double of the lost weight is added again. The body reacts to the deprivation of food. As soon as more food is taken in again, the body begins to build up reserves to ensure that in the next hunger period, sufficient reserves are available. This reaction is completely natural, but it leads to a body shape that does not conform to the ideal of beauty. Liposuction can solve this problem. Fat cells do not regenerate in adulthood, so excessive fat storage no longer occurs in the treated areas because the fat cells have been removed. Problem areas that form a cosmetic indication for liposuction:
- Outer thigh (breeches).
- Inner thigh
- Chest
- Flanks
- Gluteal region (buttock region)
- Neck
- Inside knees
- Neck (bull neck)
- Upper arms
- Upper abdomen (upper abdomen)
- Lower abdomen (lower abdomen)
- Lower leg
Indications (areas of application)
- Adipositas dolorosa (synonyms: Dercum’s disease; lipomatosis dolorosa; adipose tissue rheumatism, neurolipomatosis, lipalgia) is the name of a disease of adipose tissue; severe pain in the area of adipose tissue deposits is typical. These occur preferentially on the elbow, abdomen, knee, buttocks, and the sides of the upper arms and thighs.
- Degreasing after flap plastic surgeries (flap plastic surgeries are surgical plastic surgery techniques that transfer tissue from one (dispensable) site of the same patient to a new desired site).
- Lipomas – benign (benign) adipose tissue neoplasm that grows slowly.
- Lipomastia – form of pseudogynecomastia in men, a hormonally-induced increase in fatty tissue in the breast area.
- Lipodystrophy – fat distribution disorder of unknown cause.
- Lipomatosis benigna symmetrica (Launois-Bensaude syndrome) – symmetrical adipose tissue hyperplasia in the subcutis (subcutaneous tissue) in the neck, neck, shoulders, upper arm and chest.
This article summarily highlights the basics of the procedure of liposuction. Specific areas such as liposuction of the upper arm, thigh or abdomen are described in more detail in a separate text in the following subsection:
- Liposuction of the upper arm
- Liposuction of the thigh
- Liposuction of the abdomen
Contraindications
Absolute contraindications (contraindications)
- Known allergy to anesthetics or local anesthetics of tumescent anesthesia.
Relative contraindications (contraindications).
- Known tendency to convulsions (epilepsy)
- Taking anticoagulants (anticoagulant medications).
- Too high expectations of the patient for the outcome of the operation
- Severe heart disease
- Severe lung disease
- Severe liver damage
- Severe kidney damage
- Thrombosis tendency (thrombophilia)
Before surgery
Before surgery, an intensive medical history discussion should be conducted that includes the patient’s medical history and motivation for the procedure. The procedure, any side effects, and the consequences of the surgery should be discussed in detail. Note: The requirements of the explanation are stricter than usual, since courts in the field of aesthetic surgery demand a “relentless” explanation. Furthermore, you should not take acetylsalicylic acid (ASA), sleeping pills or alcohol for a period of seven to ten days before liposuction. Both acetylsalicylic acid and other pain relievers delay blood clotting and can cause unwanted bleeding. Smokers should severely limit their nicotine consumption as early as four weeks before the procedure to avoid jeopardizing wound healing.
The surgical procedures
At the beginning of the performance of liposuction in the 70-ies, the so-called “dry technique” was predominant. Here, the non-pretreated fatty tissue was simply aspirated, but this technique was accompanied by severe bleeding complications. The further development was the “wet technique”, in which the suction was facilitated by injecting saline solution and the bleeding complications were reduced. In 1987, liposuction using tumescent local anesthesia (TLA) was performed for the first time by the American dermatologist Jeffrey Klein. In the first step, one and a half to several liters of a mixture of sterile, isotonic water, sodium bicarbonate, a local anesthetic (drug for local anesthesia) and often also some cortisone are infused into the subcutaneous fat tissue. After a 30-minute waiting period, the infused fluid is evenly distributed in the fatty tissue. A kind of emulsion of fat cells and tumescent solution is formed, which makes the actual liposuction much easier. Liposuction is performed under local anesthesia (local anesthesia) for minor procedures and under general anesthesia otherwise. As already mentioned, the most commonly used method is tumescent anesthesia. Depending on the extent of the operation, a hospital stay of one to eight days is required. Before the procedure begins, the patient is shown exactly what is to be suctioned out and how the result is to be achieved. The patient is informed in detail about the procedure, risks and complications. There are several techniques available for performing liposuction:
- Manual liposuction – The suction is performed here by means of hollow steel cannulas.
- Vibration-assisted liposuction (VAL; Power-assisted Liposuction) – Suction is performed using an oscillating suction cannula.
- Ultrasound-assisted liposuction (UAL) – The ultrasound selectively destroys the adipocytes (fat cells).
The fat is usually suctioned out with the help of a vacuum pump. If autologous fat grafting is planned, the fat tissue is collected sterile. Then the emulsion is removed from the fatty tissue with a light suction using special cannulas. Not all fat cells are suctioned out in the process. The fat layer is reduced until a harmonious result is created. The skin contracts and adapts to the new body shape. Following liposuction, the small incisions required for the procedure are dressed and the treated area is supported by bandages or compression girdles for about four to six weeks.
After the operation
During the first few days, the patient may experience a sensation similar to sore muscles. Sports activities should be refrained from for a few weeks at first, so as not to negatively affect the surgical result. The small scars of the skin incisions fade with time and the final result can be admired after six to nine months.
Possible complications
- Allergic reactions – e.g., to the anesthetic.
- Hematomas (bruises)
- Keloids – increased scarring
- Edema – swelling
- Pain, feeling of tension
- Sensory disturbances in the surgical area
- Thrombosis – vascular disease in which a blood clot (thrombus) forms in a vessel.
- Wound healing disorders due to circulatory problems.
- Wound infections
Note on the legal basis of the recognition of liposuction as a therapeutic measure by the statutory health insurance (SHI): since January 2020, the service is covered by the SHI for stage 3 b lipedema. In addition, proof of successful conservative therapy over 6 months must be provided. The same applies to patients with obesity grade II (BMI: 35-39.9).
