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BODY TREATMENT


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BODY TREATMENT // LIPOSUCTION / LIPOSCULTURE

Liposuction is a procedure that can help sculpt the body by removing unwanted fat from specific areas, including the abdomen, hips, buttocks, thighs, knees, upper arms, chin and neck. During the past decade, liposuction, which is also known as "lipoplasty" or "suction lipectomy", has benefited from several new refinements. Today, a number of new techniques, including the tumescent technique, and the super-wet technique, are helping many plastic surgeons provide selected patients with more precise results and quicker recovery times. Although no type of liposuction is a substitute for dieting and exercise, liposuction can remove stubborn areas of fat that don't respond to traditional weight-loss methods.
If you're considering liposuction, this page will provide you with a basic understanding of the procedure – when it can help, how it is performed and how you might look and feel after surgery. You should know though that a lot depends on your individual circumstances. Therefore, please ask your doctor if there is anything about the procedure you don't understand.

THE BEST CANDIDATES FOR LIPOSUCTION
To be a good candidate for liposuction, you must have realistic expectations about what the procedure can do for you. It is important to understand that liposuction can enhance your appearance and self-confidence, but it won't necessarily change your looks to match your ideal or cause other people to treat you differently. Before you decide to have surgery, think carefully about your expectations and discuss them with Dr. Makram.
The best candidates for liposuction are normal-weight people with firm, elastic skin who have pockets of excess fat in certain areas. You should be physically healthy, psychologically stable and realistic in your expectations. Your 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.
Liposuction carries greater risk for individuals with medical problems such as diabetes, significant heart or lung disease, poor blood circulation, or those who have recently had surgery near the area to be contoured.

PLANNING YOUR SURGERY
In your initial consultation, Dr. Makram evaluates your health, determines where your fat deposits lie and assesses the condition of your skin. Dr. Makram will explain the body-contouring methods that may be most appropriate for you. For example, if you believe you want liposuction in the abdominal area, you may learn that an abdominoplasty or "tummy tuck" may meet your goals more effectively; or that a combination of traditional liposuction and UAL would be the best choice for you.
Be frank in discussing your expectations with Dr. Makram, as he will be equally frank with you, describing the procedure in detail and explaining its risks and limitations.

GETTING THE ANSWERS YOU NEED
Individuals considering liposuction often feel a bit overwhelmed by the number of options and techniques being promoted today. However, your plastic surgeon can help. In order to decide which is the right treatment approach for you, your doctor will consider effectiveness, safety, cost and appropriateness for your needs. This is called surgical judgment, a skill that is developed through surgical training and experience. Your doctor will use the same judgment to prevent complications, to handle unexpected occurrences during surgery, and to treat complications when they occur.
Dr. Makram's education and training have helped form his surgical judgment, so please take the time to do some background checking.

PREPARING FOR YOUR SURGERY
Dr. Makram will give you specific instructions on how to prepare for surgery, including guidelines on eating and drinking, smoking, and taking or avoiding vitamins, iron tablets and certain medications. If you develop a cold or an infection of any kind, especially a skin infection, your surgery may have to be postponed.
Also, while you are making preparations, make sure you arrange for someone to drive you home after the procedure and, if needed, to help you at home for a day or two.

WHERE YOUR SURGERY WILL BE PERFORMED
Liposuction may be performed in an outpatient surgery center or in a hospital. Smaller-volume liposuction is usually done on an outpatient basis for reasons of cost and convenience. However, if a large volume of fat is to be removed, or if the liposuction is being performed in conjunction with other procedures, an overnight stay at a hospital or a nursing facility may be required.

ANESTHESIA FOR LIPOSUCTION
Various types of anesthesia can be used for liposuction procedures. Together, you and Dr. Makram can select the type of anesthesia that provides the most safe and effective level of comfort for your surgery.
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, the local can be 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.
However, some patients prefer general anesthesia, particularly if a large volume of fat is being removed. If this is the case, a nurse anesthetist or anesthesiologist will be called in to make sure you are completely asleep during the procedure.

THE SURGERY
The time required to perform liposuction may vary considerably, depending on the size of the area, the amount of fat being removed, the type of anesthesia and the technique used.
There are several liposuction techniques that can be used to improve the ease of the procedure and to enhance the outcome.
Liposuction is a procedure in which localized deposits of fat are removed to recontour one or more areas of the body. Through a tiny incision, a narrow tube or cannula is inserted and used to vacuum the fat layer that lies deep beneath the skin. 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. If many sites are being treated, Dr. Makram will then move on to the next area, working to keep the incisions as inconspicuous as possible.
Fluid is lost along with the fat, and it's crucial that this fluid be replaced during the procedure to prevent shock. For this reason, patients need to be carefully monitored and receive intravenous fluids during and immediately after surgery.

TECHNIQUE VARIATIONS
The basic technique of liposuction, as described above, is used in all patients undergoing this procedure. However, as the procedure has been developed and refined, several variations have been introduced.
Fluid Injection, a technique in which a medicated solution is injected into fatty areas before the fat is removed. The fluid – a mixture of intravenous salt solution, lidocaine (a local anesthetic) and epinephrine (a drug that contracts blood vessels) – helps the fat to be removed more easily, reduces blood loss and provides anesthesia during and after surgery. Fluid injection also helps reduce the amount of bruising after surgery.
The amount of fluid injected varies depending on the preference of the surgeon.
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 (sometimes as long as 4 to 5 hours). 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.

AFTER YOUR SURGERY
After surgery, you will likely experience some fluid drainage from the incisions. To control swelling and help your skin better fit its new contours, you may be fitted with a snug elastic garment to wear over the treated area for a few weeks. Your doctor may also prescribe antibiotics to prevent infection.
Don't expect to look or feel great right after surgery. Even though the newer techniques are believed to reduce some post-operative discomforts, you may still experience some pain, burning, swelling, bleeding and temporary numbness. Pain can be controlled with medications prescribed by Dr. Makram, though you may still feel stiff and sore for a few days.
It is normal to feel a bit anxious or depressed in the days or weeks following surgery. However, this feeling will subside as you begin to look and feel better.

GETTING BACK TO NORMAL
Healing is a gradual process. Dr. Makram will probably ask you to start walking around as soon as possible to reduce swelling and to help prevent blood clots from forming in your legs. You will begin to feel better after about a week or two and you should be back at work within a few days following your surgery. The stitches are removed or dissolve on their own within the first week to 10 days.
Activity that is more strenuous should be avoided for about a month as your body continues to heal. Although most of the bruising and swelling usually disappears within three weeks, some swelling may remain for six months or more.
Dr. Makram will schedule follow-up visits to monitor your progress and to see if any additional procedures are needed.
If you have any unusual symptoms between visits – for example, heavy bleeding or a sudden increase in pain – or any questions about what you can and can't do, call your doctor.

YOUR NEW LOOK
You will see a noticeable difference in the shape of your body quite soon after surgery. However, improvement will become even more apparent after about four to six weeks, when most of the swelling will have subsided. After about three to six months, any persistent mild swelling usually disappears and the final contour becomes visible.
If your expectations are realistic, you will probably be very pleased with the results of your surgery. 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 maintain your new shape.

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