Methods – Fat away
There are several methods of liposuction. Originally, the “Basic suction” was developed. It has been used since the late 1970s and other techniques have developed from it.
The Basic method is suitable for smaller operations where the fat deposits are easily accessible. A maximum of three liters of fat is removed per session. It is less expensive than other methods because it is comparatively less complex.
During the operation, a liquid is first injected into the subcutaneous fatty tissue. This fluid causes the blood vessels to contract – which prevents bleeding – and also contains a local anesthetic and is intended to prevent swelling. The surgeon inserts fine cannulas through small skin incisions to loosen the fatty tissue and then uses a vacuum pump to suction it out along with the fluid.
Manual suction syringes can also be used. This manual procedure is called liposculpture. According to advocates of this method, it is more tissue-friendly than mechanical suction because of the weaker suction.
The skin incisions are then sutured or glued. A variation of the basic method is the tumescent technique. It is currently the most frequently used technique.
The difference to the Basic method is that a significantly larger amount of liquid is injected into the tissue, namely three times the volume of the fat to be removed. The tumescent fluid consists of an isotonic saline solution, a local anaesthetic, adrenaline to constrict the blood vessels and cortisone, which has an anti-inflammatory effect. The liquid causes an anesthesia of the affected body part for up to 18 hours, so that a general anesthesia is usually no longer necessary.
The fat cells soak up the mixture, which makes it easier to detach them from the connective tissue afterwards. The softened tissue swells considerably at this point, hence the name (tumescere: Latin for swelling). After an application time of 30 – 60 minutes, the mixture of fat cells and the liquid is sucked off, as in the Basic method, by means of fine cannulas under the suction of the vacuum pump or manually.
Veins, vessels and nerves are not injured because of the loosening of the tissue. With the tumescent method, up to four liters of fat can be removed in one session. Since the patient does not require general anesthesia, he or she can change position during the operation to ensure that the surgeon has good access to the affected areas.
A third method of liposuction is the “super wet method”. Here – contrary to what the name suggests – less fluid is injected into the tissue than in the tumescent technique. The ratio of liquid to the fat to be suctioned is about 1:1, and because of the lower dose of anesthetic, the patient is put under general anesthesia.
The procedure takes about two to three hours, during which large amounts of fat – up to five liters – can be removed. This technique is therefore suitable for liposuction of the thighs or abdomen. In the various methods, so-called microcannulas can be used instead of the conventional cannulas with a diameter of 3 – 8 mm.
They have a diameter of only 1 – 2.5 mm, which allows for more precise and tissue-friendly suctioning and therefore minimal skin incisions are sufficient. Furthermore, there are various modifications of the technique in liposuction. Different adapters on the cannulas support the liposuction in this way.A distinction is made between vibration assisted, water jet assisted, ultrasound and laser assisted liposuction.
The ultrasound is intended to liquefy the fat cells before suction, the laser is intended to transfer thermal energy into the tissue. Liposuction must be distinguished from so-called lipolysis (“fat dissolution”). Here the fat cells are not completely removed, as in liposuction, but only emptied.
In this process, the tissue is supplied with energy (for example ultrasound) or cold from outside. A further distinction is made between injection lipolysis, which is only used in the case of localized fat accumulations. Here, a substance not approved for this use in Germany is injected into the tissue, which causes the fat cells under the skin to die. This method is criticized for possible side effects and is prohibited in some countries.
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