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b_250_250_16777215_00_images_stories_cosmetics_lipo2.jpgLiposuction is a surgical method for the removal of fatty tissue on places where it cannot be achieved in any other way. The term liposculpture describes the “sculpturing of the body” and the main goal will be nicer body contour and proportions. Liposuction does not resolve overall obesity, but it has been observed that weight is easier to lose after this procedure.
The treated body areas can be reduced even by two clothes size numbers. Liposuction can be performed on all parts of the body where subcutaneous fatty tissue is accessible and by whose removal better physical appearance is achieved, including:

Cheeks
Chin
Neck
Upper arms
Above the breasts
Breasts
Waist
Abdomen
Back
Hips
Buttocks
Thighs
Knees
Calves
Ankles.


According to the American Society of Aesthetic Plastic Surgeons (ASPS,) the number of liposuction procedures performed in the United States was 456,828 during 2007, being the most popular cosmetic surgery procedure (the most current year for which statistics exist). This figure represents 4 percent of the 11.7 million plastic surgery procedures done in 2007 and an increase of 13.2 percent over liposuction cases performed in 2006.
Special cases in which liposuction is needed for the treatment are lipodystrophies, which comprise several syndromes with abnormal fat tissue distribution. This situation can be congenital, ruled by genetic factors or acquired later in life due to several conditions. Also there are other situations where liposuction and fat tissue injection can be used to resolve defects in the fat tissue layer, such as depressed scars after surgery or lipoatrophies.


Adipose or fat tissue is a form of connective tissue that can be found in many parts of the body, under the skin, organs or around them. The main role of this tissue is to store energy in the form of fat, which accounts also for the excessive weight and change in body shape when being overweight.  The type of cell that contains fat is called adipocyte and participates in the energy metabolism releasing or capturing fatty acids that are converted to another form of fat called triglycerides inside them. It is important to notice that the total number of adipose cells is rather constant in adulthood, most of the new cells are born during childhood and adolescence and weight loss can diminish the size of the cells but not their amount.   After liposuction and body sculpture the cells and fat tissue that are taken out cannot regenerate again in the same place. This doesn’t mean that you can’t increase weight if you don’t follow a healthy diet, but the distribution of fat tissue will be different, more proportionate.

The fat tissue is located in compartments throughout the human body, liposuction act exclusively in the subcutaneous compartment, which also has a different composition depending in the anatomic area, for example, in the abdomen we can observe a superficial fat layer (Fascia of Camper), a middle fibrous layer and a deep fat layer (Fascia of Scarpa), instead, in the thighs there is only one thick layer of fat tissue. The arranging of adipose tissue changes in extremities, torso, neck and other regions and also has particular attachments to other structures as skin or membranes covering muscles or bone.

Sexual hormones have a very important influence in fat distribution, especially in adolescence, in women more fat is stored in the buttocks, thighs and hip and in men excessive fat tissue is more likely be stored in the belly.   The fat compartments have different properties in relation to how they behave under weight loss, after liposuction and other surgeries and that’s why this should be managed by an specialist with the proper knowledge on the field.

The final aspect after liposuction will depend in the form of suctioning the fat tissue, the type of instruments used and the expected scarring inside the fat tissue that will tighten the skin after some weeks.

The concept of liposculpture is to modify the shape and volume of these fat compartments to reach more pleasant esthetic lines, not all people have the same distribution and not always this will be esthetically nice, and this procedure can be of great help to achieve this objective.


Cellulite corresponds to a change in the skin that usually occurs in young adult women after puberty, where can be observed skin dimpling and nodularity, especially in the pelvic region, legs and abdomen.

Histological analysis of the skin shows that the fat tissue is located in small chambers of 0,5 to 1 cm surrounded by fibrous tissue (retinacula cutis). This fibrous tissue in the woman is arranged in arches with vertical or oblique direction and attaches the skin to deeper tissues and in spite of being elastic they have “memory” and try to come back to their original stretch. When an increase of the amount of fat tissue inside the chamber happens, naturally the skin tries to expand outside but the pull of the fibrous tissue causes the dimpling giving the aspect of orange skin (peau d’orange).

This condition is not a disease or inflammation but affects the skin esthetically as a result of the mechanical pull of the retinacula cutis after an increase of fat content in the chambers. It’s important to notice that cellulite occurs in almost 90% of women and is rarely seen in men because the distribution of the retinacula cutis is different.  Certain conditions can facilitate the appearance of cellulite due to retention of lymphatic fluid that increase the distention of the fat chambers, like the use of tight clothes and high stress lifestyle with an increase in catecholamine hormones for example.

The treatment for this condition is very discussed and you will see an impressive amount of different solutions that include exercises, cosmetic products, laser treatment and medication, none of which work in the practice because the problem is anatomic: You would have to cut each one of the retinacula cutis to solve it. Even dieting has mixed results, though in some cases diet can improve the look of the skin with cellulite.

Liposuction for the treatment of cellulite is a point in discussion, as the problem locates in the most superficial area of the fat compartment this is not the first tool in the treatment, some patients benefit of it when diminishing the deeper layers of fat tissue, achieving modeling of areas that are abnormally overstretched because of an increased deep component of fat, but the utility of the procedure must be evaluated case to case in a clinic evaluation and will be recommended when is thought to be useful due to added anatomic characteristics.


Patients considering a procedure of body sculpturing or a localized liposuction can be evaluated in Arcadia Clinic or consultation offices. In this moment, with the evaluation and demarcation of the areas to treat, also are thoroughly discussed the patient’s desires, goals and expectations in mind. Not all expectations can be accomplished with surgery and it is important that these issues are carefully discussed before surgery. Photographs can be helpful in this regard to analyze all areas in question and facilitate the patient the viewing of those with difficult reach to own eye like the back,  buttocks and posterior part of the legs.


According to the patient age and medical antecedents different tests can be taken in our clinic such as hemogram (blood analysis), coagulation tests, metabolic and urine tests, electrocardiogram, and Internal medicine evaluation when needed. If you are a young patient without clinical history of diseases only the basic tests are taken with minimal discomfort for you.

Medication such as aspirin and analgesics must be avoided 2 weeks prior the surgery and smoking suspended 3 weeks before, as both conditions can interfere with coagulation and oxygen delivery to the manipulated tissues. If you are taking any medication or you are allergic to any medication, material or food please notice it to the surgeon and staff people when arriving to our clinic.

Admittance to Arcadia Clinic for Plastic and Aesthetic Surgery should be arranged in advance by telephone or electronic mail. The patient can arrive early the same day or the previous day of the surgery. After accommodating in the room, vital signs, tests and medical history and examination are taken, as well as record photographs if not available beforehand.


The surgical technique varies depending in the anatomical area to work, in relation to fluid, instruments and postoperative elastic garment used.
Generally, in the beginning of the surgery fluid injection is used in all the areas to be liposuctioned, a mixture of saline fluid, lidocaine (an anesthetic) and adrenaline (a drug that contracts blood vessels) is prepared and applied and help to perform the procedure easier and with minimal bleeding. Fluid injection also helps to reduce the amount of bruising after surgery and provides anesthesia during and after the procedure.

The amount of fluid that is injected varies depending on the individual needs of each patient the specific area being liposuctioned.

Large volumes of fluid - sometimes as much as three times the amount of fat to be removed - are injected in the tumescent technique. Tumescent liposuction, typically performed on patients who need only a local anesthetic, usually takes significantly longer than traditional liposuction.   However, because the injected fluid contains an adequate amount of anesthetic, additional anesthesia may not be necessary. The name of this technique refers to the swollen and firm or "tumesced" state of the fatty tissues when they are filled with solution.

The super-wet technique is similar to the tumescent technique, except that lesser amounts of fluid are used. Usually the amount of fluid injected is equal to the amount of fat to be removed. This technique often requires IV sedation or general anesthesia and typically takes one to two hours of surgery time.

Power Assisted Liposuction (PAL). This is the newest technique of liposuction. In this technique a power source is used to rapidly oscillate the liposuction cannula 3 or 4 millimeters at a frequency of several hundred cycles per second. This allows the fat to be removed with less force thus decreasing trauma to the patient. The fat is removed more quickly, more evenly and with less bleeding. This means that patients have less bruising and can recover more quickly following surgery.


Liposuction is not a classical surgical procedure and it requires special instruments to perform it. Before the procedure, parts of the body on which liposuction is to be performed should be precisely outlined. The procedure begins by meticulous surgical washing and covering the body with sterile compresses, through very small incisions liposuction fluid in injected in the fat tissue compartment. This is followed by tunneling, i.e. undermining of the fatty tissue, and its suction under negative pressure into separately graded transparent containers.

The suction is performed using thin perforated probes or cannulae through 0.4-0.5 cm incisions on the skin that are located in inconspicuous areas. The duration of the surgery depends on the number of zones to be treated by liposuction and the extent of the fatty tissue. On average, liposuction takes from 1 to 3 hours but can be longer if bigger areas need treatment.

At the end of the procedure the small holes on the skin are covered with sterile compresses. The patient is then dressed in a special elastic garment, which helps the skin to return to the desired position as soon as possible and it also puts pressure on the vessels to avoid postoperative bleeding and hematomas.


The patient is dressed with an elastic compressive garment immediately after surgery. The dress is first removed the next morning after surgery when the patient showers in lukewarm water. A cream with salicilates is applied on the skin to accelerate the resorption of any hematoma or bruising and the elastic garment is applied again. During the first 10 days the garment is taken off only when showering, otherwise it is worn permanently.

After that it is worn only during day for the next 4 weeks. 5 days after surgery, manual massage and lymphatic drainage of the treated area are recommended. 24 hours after the procedure the patient is discharged home with written instructions to follow at home and arranged date for control.


Liposuction is most frequently performed under the general anesthesia.

If only a small amount of fat and a limited number of body sites are involved, liposuction can be performed under local anesthesia, which numbs only the affected areas. However, if you prefer, the local is usually used along with intravenous sedation to keep you more relaxed during the procedure. Regional anesthesia can be a good choice for more extensive procedures. One type of regional anesthesia is the epidural block, the same type of anesthesia commonly used in childbirth.


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Pre-operative picturePost-operative picture

 

 

 

 

 

 

 

Pre-operative picturePost-operative picture (Liposuction of abdomen and flanks

 

 

 

 

 

 

 

 

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If liposuction is performed by an experienced team and a motivated surgeon, with the patient following all instructions and recommendations and at the same time has realistic expectations that liposuction will improve his/her appearance, the results are very good. You may find that you are more comfortable in a wide variety of clothes and more at ease with your body. And, by eating a healthy diet and getting regular exercise, you can help to maintain your new shape.

Most of the associated bruising and swelling should subside within the first weeks. To expedite the healing process, liposuction patients may be encouraged to begin light activity as soon as possible.
Patients should be able to return to work within a few days if the job is fairly sedentary. Regardless, liposuction patients should avoid strenuous activities for several weeks while the body naturally heals. Compression garments are easily concealed under regular clothing.
A permanently new body image (appearance of the body) is apparent within 4 to 6 weeks after liposuction, when you are also ready for the most vigorous physical and sports activities.    After about three months, any persistent mild swelling usually disappears and the final contour will be visible. The full result in few cases can take longer to be seen, up to 6 months.
The more fat removed, the longer it takes to achieve optimal results because the skin has to adapt to a more radical change in shape. It is important to note that liposuction will not alter skin quality or muscle tone. Furthermore, liposuction is not designed as a means of weight control or as a substitute for regular exercise and a balanced diet.
Because the cells that hold and store fat are permanently removed by liposuction, future weight gain will not occur in the treated areas. If you do gain weight, you will gain it somewhere else in the body. Also, since the aging process directly affects the firmness and elasticity of the skin, older patients may not achieve the same results as younger patients.
Liposuction is often done in connection with other cosmetic plastic surgery procedures, such as abdominoplasty, face lift, breast reduction, thigh lift and other forms of fat injections, a procedure which is also known as fat grafting.


Liposuction is normally safe, as long as patients are carefully selected, the operating facility is properly equipped and the physician is adequately trained.

As a minimum, your surgeon should have basic (core) accredited surgical training with special training in body contouring.
However, it's important to keep in mind that even though a well-trained surgeon and a state-of-the art facility can improve your chance of having a good result, there are no guarantees. Though they are rare, complications can occur. Risks increase if a greater number of areas are treated at the same time, or if the operative sites are larger in size. Removal of a large amount of fat and fluid may require longer operating times than may be required for smaller operations.
Below are some of them with symptoms the patient should pay attention to:

Early complications
Bleeding  and hematoma: Normally is observed a small amount of bleeding trough the skin incisions used in the procedure, colored light red, this is expectable and can happen up to 36h after surgery. The main component of this is the fluid used for the liposuction. In case this situation prolongs or the bleeding is active (a rare situation), you should contact immediately your surgeon. Most of any kind of bleeding occur during the time of recovery in the clinic and most only need close observation and proper use of the elastic garment or some additional measure for local compression by the clinic staff. Hematomas (a local collection of blood under the skin) are infrequent in our experience, the treatment can be observation, suction with a needle or drainage.
Skin and subcutaneous infection: Very infrequent, we take all preventive measures to avoid any microscopic contamination and add extra protection with the use of antibiotics. If present, an infection can develop after 24 to 72h with local swelling, redness and temperature or fever. The treatment consists in the use of antibiotics for few days.

Late complications
The scars from liposuction are small and strategically placed to be hidden from view. However, imperfections in the final appearance can occur. 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.
Insufficiently removed fatty tissue: The correction is possible within 4 to 6 months after surgery.
Excessively removed fatty tissue: The correction possible within 4 to 6 months after surgery.
These cases are infrequent and generally can be solved with local anesthesia and you then you can return home the same day of the procedure.


Lipodystrophy is  a medical condition characterized by abnormal or degenerative conditions of the body's adipose tissue. ("Lipo" is Greek for "fat" and "dystrophy" is Greek for "abnormal or degenerative condition") A more specific term, lipoatrophy is used when describing the loss of fat from one area (usually the face).
Lipodystrophy may be divided into the following types:

 

  • Congenital lipodystrophies
    Congenital generalized lipodystrophy (Beradinelli-Seip syndrome)
    Familial partial lipodystrophy
  • Acquired lipodystrophy
    Acquired partial lipodystrophy (Barraquer-Simons syndrome)
    Acquired generalized lipodystrophy
    Centrifugal abdominal lipodystrophy (Lipodystrophia centrifugalis abdominalis infantilis)
    Lipoatrophia annularis (Ferreira-Marques lipoatrophia)
    Localized Lipodystrophy

The treatment of lipodystrophies vary, for example, if corresponds to a local increase accumulation of fat tissue in the body surface, then liposuction is a very good alternative, if is a local reduction of fat tissue then the treatment will include liposuction from other area and the use of this fat tissue for a fat injection in the affected area. In this latter case, the amount to be injected is more than needed because occurs some degree of reabsorption in the following months.

Extensive areas with fat tissue loss are more difficult to treat and each case is carefully evaluated by the plastic surgeon.

Depressed scars can be treated through resection or if esthetically acceptable, through local injection of fat tissue.


Patients considering liposuction should be of normal or increased body weight but constant in the last months, without a sudden gain or loss, physically healthy and realistic in their expectations. Liposuction is recommended to patients up to the age of 45 if they have firm and elastic skin. Persons of older age, whose skin elasticity is reduced, must be warned that liposuction should be combined with another procedure, primarily with lifting (For tightening of the skin of the treated area).

Women most frequently undergo liposuction on the hips, thighs, knees and abdomen. Apart from these areas, liposuction is also performed on cheeks, double chin, upper arms, breasts, calves and knees.

In men, it is most frequently performed on the double chin, abdomen and waist, as well as on breasts (Gynecomastia), which sometimes can be completely resolved by liposuction or a surgical procedure is added removing the glandule under the areola.

Liposuction also may eliminate lipomas (benign tumors containing fatty tissue). The material obtained is sent to histopathologic analysis for study.
Poor candidates for this procedure are those patients with diabetes, circulatory, lung or cardiac disease.


Lipoatrophy: This is the term describing the localized loss of fat tissue. This may occur as a result of subcutaneous injections of insulin in the treatment of diabetes, or from subcutaneous injections of Copaxone used for the treatment of multiple sclerosis. In the latter case, an injection may produce a small dent at the injection site.  Lipoatrophy is also an adverse drug reaction that is to different medications.

Lipodystrophy:
Corresponds to a medical condition characterized by abnormal or degenerative conditions of the body's adipose tissue. ("Lipo" is Greek for "fat" and "dystrophy" is Greek for "abnormal or degenerative condition".) A more specific term, lipoatrophy is used when describing the loss of fat from one area (usually the face).

 

 

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