Liposuction of the pubic mound

Liposuction is the removal of adipose tissue from places of excessive accumulation. It allows you to shape the figure by reducing subcutaneous fat. Most often it is performed around the hips, thighs and abdomen.

Characteristics of liposuction

The first liposuction procedure was described by the French doctor Dujarrier in 1920, it was made using a teaspoon to clean the uterus and ended badly due to damage to the femoral artery. In the 1970s, Yves-Gerard Illouz performed the procedure using a blunt probe and vacuum. He published his achievements in 1982. In 1987 Klein injected it with saline solution, adrenaline, lidocaine and sodium bicarbonate before removing body fat. In the nineties, liposuction becomes a safe and commonly performed procedure. In 2006, liposuction was the most frequently performed plastic surgery procedure, according to the American Society of Aesthetic Plastic Surgery.

The benefits of liposuction

- the treatment is used primarily to shape the silhouette,
- reduction of the circumference of the body at the place of the procedure,
- reducing the amount of fat on the stomach,
- correction of skin irregularities caused by local fat accumulation (to a small extent).

Indications for liposuction

The best candidates for liposuction are patients who have normal or close to normal body mass and only fat accumulation in some places. These people can achieve the most spectacular results. It is common to say that liposuction can not be used as a method of weight loss. Nevertheless, for many people liposuction is a very good motivation to lose weight before surgery and to take care of the figure after the treatment.

In women, liposuction is most often performed around the hips, buttocks and thighs. This is due to the typical gynoidal silhouette (pear shape) in which fat accumulation occurs in the above-mentioned areas.

In men, liposuction is more often performed on the abdomen. This is caused by an android figure, in which fat accumulation occurs in the abdomen.

This treatment is also performed in many other places, for example for underlining the waist, for slimming the medial part of the knees, reducing fat on the shoulders, neck / chin (to reduce the so-called second chin). Liposuction is used because of overly developed breasts in men (gynecomastia).

It should be remembered that liposuction will not replace proper nutrition and regular physical activity. What's more, a healthy diet and movement are necessary to maintain a correct figure.

Most researchers agree that liposuction does not improve physical performance and fitness, does not reduce the risk of heart disease and blood vessels associated with obesity, does not improve the level of sugar and cholesterol in the blood.

Contraindications for liposuction

Liposuction is not a curative and life-saving treatment, and should not be carried out at any price. If the patient has a large number of other diseases and low physical capacity then the risk of surgery is too high.

A patient applying for liposuction should not be during or shortly after respiratory infection or herpes infection.

Liposuction should not be subjected to persons whose goal is slimming.

There is local skin infection - bacterial or fungal.

Patients with chronic diseases that increase the risk of surgery may be disqualified or asked to perform additional consultations and preparation with a specialist in a given field.

Caution should be exercised in patients who have scars in the area that is to undergo liposuction.

First, the hernia should be plastered, and then the liposuction of the area of the body should be performed. Because there is a risk of damage to the contents of the hernia sac.

Do not perform liposuction instead of the plasticity of a given area of the body. In some situations, abdominoplasty or shoulder surgery will produce a better result than liposuction. It is possible to combine both techniques.

Before liposuction surgery

Before the surgery, you should report to a doctor who performs the liposuction procedure. It is good to prepare for consultations. It is worth to write down on a sheet of paper:

• other diseases - current and past
• completed operations
• cosmetic and aesthetic medicine treatments performed in a given region of the body
• list of medicines (including those without a prescription) including dosing. e.g., Piramil 2.5mg 1-0-1 (morning and evening after one tablet). You can also deliver packaging from the medicines you are taking.

During this consultation, the patient is examined and qualified for surgery. The plan and range of liposuction are presented. If necessary, the doctor will commission additional tests and consultations if necessary. This is a very good time to ask questions and raise concerns.

Consultation with the doctor performing the procedure should take place several days to a few weeks before the procedure. The interval between consultation and treatment is beneficial, because at that time the patient "calmly" can rethink everything, talk to family or friends.

Pre-liposuction should stabilize body weight. The patient should not be in the process of slimming or shortly after slimming.

Smoking should be reduced or ceased.

Reporting to the operation:
• the patient should provide the results of the tests commissioned during the consultation. In some clinics, tests carried out on the spot, after the patient has applied to the clinic, however, it extends the time from coming to the surgery.
• between the last meal and surgery should be 6 hours or more. Most often you can eat a light meal before leaving the house. This applies in particular to general anaesthesia (narcosis).
• in the morning you should take medications taken permanently (unless the doctor recommends otherwise during consultations)
• you should go without applying a cream or lotion to the area to be treated or wash it after reporting to the clinic.
• 2 weeks before surgery, avoid sunbathing and tanning
• it is good to remove hair from a given area (shaving with a razor blade is not recommended, because it damages the epidermis, it is better to use a depilatory cream, classical epilation should be done earlier, in order to avoid irritation).

After coming to the clinic:
• it's good to take a shower,
• take off the jewelry,
• just before the operation it is good to use the toilet.
The next medical consultation takes place on the day of the surgery. During the consultation, the patient is examined, the treatment is discussed in detail. The body of the patient is marked with areas that will undergo liposuction. The patient should report to the doctor the areas on which he is most interested. Photographic documentation is made. This is a very good time to ask questions. During this consultation, the patient should sign a consent for liposuction.

Type of anaesthesia for liposuction

After applying to the clinic for abdominal liposuction, in addition to consultation with a plastic surgeon, you should consult an anesthetist (doctor performing anaesthesia). During this consultation the patient will be examined. Anaesthesia and period after anaesthesia will be discussed. This is a very good time to ask questions about anaesthesia. The patient should sign a consent for anaesthesia. If the procedure is performed under local anaesthesia, consultation with an anaesthesiologist may not be necessary.

The operation can be performed in: general anaesthesia (anaesthesia), ductal (spinal anaesthesia - injection into the spine), analgosedation combined with local anaesthesia, only local anaesthesia. The type of anaesthesia depends primarily on the extent of the procedure and the experience of the team working in the clinic. The most commonly used anaesthesia is anaesthesia or spinal anaesthesia.

The procedure is performed under general anaesthesia (narcosis). This means that the patient will sleep during the procedure and will not be aware of what is going on around him. A plastic tube (intubation) will be inserted through the mouth into the trachea, through which air will flow (a mixture of respiratory and anesthetic gases). This tube will be connected to the machine (respirator), which will give the right amount of gases to breathe. During the course of anaesthesia, the anesthetist and anaesthesiologist nurse supervises the patient's safety.

The procedure is performed under spinal anaesthesia (injection into the spine). This means that before the operation the anesthetist will ask you, the patient will sit on the operating table with his head bent forward, or lie down on his side with knees bent to the chest. A needle and a given medication will be inserted into the lumbar spine. The subarachnoid anaesthesia covers the body parts below the navel, although anaesthesia can be carried out to include the abdomen. During the procedure the patient is aware, breathes independently and remembers the course of the procedure. (you can ask an anaesthesiologist for an additional medication to sleep and not to remember the procedure).

Abdominal liposuction performed in the analgosedation with the addition of local anaesthesia. During this anaesthesia, the patient is not intubated - he breathes on his own. The patient is hypnotic, confused and usually does not remember the course of the operation. During the procedure, the surgeon soaks fat tissue with the liquid, which facilitates later suction of fat and reduces bleeding. You can add a local anesthetic to this fluid.

What liposuction looks like

After the anaesthesia (general, subarachnoid anglobate) by the anesthetist, the patient's skin is disinfected. The surgeon soaks the liquid swab to disinfect and rubs the abdominal skin in the place where he will perform the surgery (operating field). Most often, this activity is repeated three times. Next, sterile surgical sheets are placed around the operating field.

The surgeon makes small (about 4-5mm) incisions on the skin. The incisions are located on the edges of the area to be liposucated. In individual clinics, the location of incisions may vary, certainly they should be in places less visible, but providing good access to the sucked adipose tissue. The number of incisions for one area is 2-3. Scars after cuts are usually not visible.

Then a probe is injected through the skin incisions to inject fat tissue. The probe is a thin metal tube (about 2 - 3 mm in diameter), about 20 cm long. There are holes on the sides of the probe through which the liquid is delivered to adipose tissue.

The composition of the fluid is different in individual clinics. It most often contains 0.9% sodium chloride (saline) and adrenaline. It may also contain other substances such as lignocaine and sodium bicarbonate. The amount of injection fluid to be injected is 0.5 - 3 ml per 1 ml of aspirate obtained during suction, depending on the technique used. The purpose of saline is to hydrate body fat which facilitates its subsequent suctioning. The goal of adrenaline is to shrink the blood vessels, which limits bleeding. The goal of lignocaine is to reduce pain in the postoperative period. Lignocaine works for 1 - 4 hours, also if the procedure is performed under a spinal or general anaesthesia, it can be dispensed with because the anaesthesia is sufficient.

After the injection of adipose tissue, wait a few minutes for the adrenaline to start working. During this time, you can inject a different area.
Then the surgeon inserts a suction probe through the incisions on the skin. The surgeon vigorously moves the probe forward and backward to reach any place in the marked area. This is to break down fat, which will facilitate its subsequent suctioning. The probe is connected with a rubber hose to a vacuum generating mammal. Negative pressure causes suction of adipose tissue.

There are many types of liposuction probes, so there are many types of liposuction. It is difficult to clearly say which type is the best, it is important for the surgeon to have experience in using a given type of probe.

Suction liposuction (SAL) - the probe itself does not produce energy, fat tissue is broken down during movements performed by the surgeon.

Vibrating liposuction (PAL) - the probe makes small movements within a few millimeters. They can be circular movements, sideways, forward and backward. It facilitates the breaking of fat tissue.

Laser assisted liposuction (LAL) - laser energy helps break up fat tissue.

Liposuction with ultrasound (UAL) - energy from ultrasound waves helps break up fat tissue.

Other liposuction techniques are less frequently used, there are many of them, the choice of technique should be the surgeon's experience.

The suction is carried out so long as to achieve a reduction in tissue thickness and tension in a given area. The amount of sucked fat should be symmetrical in the appropriate area of the body (eg on both hips). If the patient's body was unbalanced before surgery (ie if there was more fat on one side than on the other), take this into account during liposuction and suck out more from the side.

After suction, the treatment of cutaneous incisions may vary from clinic to clinic. They can be sewn together with a thin thread, they can be stuck together with a special patch (Steri-Strip), they can be left without sewing for one day. Small dressings are then applied to the incisions.

After the surgery, the patient is dressed in pressure clothes. It is similar to cycling shorts. It reaches from the lower leg to the abdomen and lower back, it has braces (straps) put on the shoulders. Pressure clothes reduce the risk of bleeding and thrombosis after surgery, smooths out irregularities and shapes the figure. If the treatment was performed around the arms or chin, a flexible bandage may be used.

The treatment lasts from one to several hours.

After the surgery, the patient is transported to the post-operative room (especially if the procedure was performed under general anaesthesia).

Time and course of convalescence after liposuction

Immediately after the liposuction surgery (in the post-operative room), the patient stays under supervision and receives painkillers. Postoperative supervision may vary in individual clinics. It is smaller after analgosedation and subarachnoid anaesthesia and larger after anaesthesia. An example of a course in the post-operative room is described below.

Life parameters are usually displayed on the cardiomonitor. Electrodes are stuck on the chest, thanks to which the heart is visible on the monitor. A cuff, periodically filled with air, is placed on the arm to measure blood pressure. A pulse oximeter is placed on the finger to measure the saturation of blood (oxygen content in the blood). The patient receives a pilot, whom he can call staff. There is a nurse in the post-surgery room.

In the postoperative room, the patient stays for a few to a dozen or so hours.

If the scope of the procedure was small, it can be discharged the same day.

Most often, the next morning, the patient is transported to another (normal) room and stays there for discharge from the clinic. On the first day you can move freely around the clinic and eat light meals. The patient receives painkillers. The dressing is changed. The patient can look in the mirror. The body is swollen, bruises or small hematomas can be seen. Sills and small hematomas are normal. A dressing and compression garment is again put on. Depending on the extent of the treatment, it is possible to leave the clinic the day after the surgery.

If liposuction was subjected to many areas of the body, the patient remains 1 - 2 days in the clinic. It requires less and less painkillers. Motor fitness improves. Dressings are changed daily. The maximum swelling is possible on the 3rd - 5th day of the procedure.

On the day of discharge, the patient receives recommendations, instructions on how to proceed, dates of the inspection.

In the second week after surgery the bruses disappear.

At week 4 - 6 the swelling subsides.

The effects of liposuction

The effects after the treatment are not fully visible immediately. The first results are visible after 3-4 weeks, it is about 1/4 of the final effect. After 6-7 weeks, about 1/2 of the final effect is visible. 95% of the final effect is visible after 3 months. The final effect after 6 months.

The effects of the treatment are modelling, slimming, reducing the circumference of the area of the body.

To obtain the desired effect, a healthy lifestyle should be maintained and the body weight should be stabilized.

Recommendations after liposuction

Recommendations given by surgeons vary and depend on the scope of the procedure, the course of the procedure, the course of the period after surgery and the experience of the operator. Recommendations should be followed and not modified without contacting the clinic.

Examples of recommendations:

• pressure clothing received after the procedure should be worn for 3 - 4 weeks, 24 hours a day,
• you can remove pressure clothes for a short shower,
• after shower, the skin should be oiled with cream or balm,
• pressure clothes should be washed regularly, so it's worth having two sets,
• after 3 - 4 weeks, wear clothing to wear 12 hours a day (eg at night),
• painkillers may be needed for a few days after surgery,
• seams removed 7 days after surgery, applying for control,
• perform lymphatic massage, indicated by a physiotherapist every 1 - 2 days for 2 - 4 weeks (reduce swelling, facilitate shaping the figure),
• you can return to work after a few days, move without effort is recommended,
• you can come back to sport after 4 - 6 weeks,
• for 6 weeks to give up the sauna and solarium,
• in doubtful situations, contact the clinic.

How long do the effects of a given area of liposuction last?

The effect after the treatment is permanent, while maintaining a healthy lifestyle (diet and physical exercise), the effect lasts until the end of life. If you increase your weight, you may need further liposuction treatments.

In areas undergoing liposuction a "subcutaneous scar" is formed which is not visible; some fat cells are also sucked away. Therefore, in the case of a large increase in body weight, in the first place fat may accumulate in the area of non-liposuction.

How to avoid complications after liposuction surgery

Completely avoiding complications (in all patients) is not possible. It is important that in such a situation the doctor should take special care of the patient.

From the patient's point of view, to avoid complications, two basic principles must be observed:

1. Say everything about your health before surgery.
2. Follow the instructions after surgery.
You should stop smoking.
You should report to designated inspections.
Keep your body weight stable.
Perform regular physical activity.
Do not use liposuction instead of slimming.
Do not perform liposuction in a situation where it is necessary to perform a surgical operation of a given area.
It is important not to modify the recommendations without contacting the clinic.

Possible complications after liposuction

During each surgery and surgery, complications are possible. They happen rarely, it is worth asking a doctor who performs the procedure, for which we are more susceptible to exposure, and for which less.

Possible complications due to liposuction include: vascular embolism, hematomas, haemorrhages, infections of the treated area, delayed wound healing, overgrown scars and keloids, local skin necrosis, skin discoloration, unevenness of the area undergoing liposuction, flaccid skin, need for another treatment.

It should be remembered that it is not possible to predict and list all possible complications.

Recommended additional treatments

It is often good to perform liposuction with simultaneous plastic surgery of the area. Especially during gynecomastia, liposuction of the abdomen or arms.

Lymphatic massage after liposuction is recommended.

dr n. med. Norbert Czapla

Literature:
Aesthetic Plastic Surgery; 2009; Sherrell J. Aston, Douglas S. Steinbrech, Jennifer L. Walden
Essentials of Plastic Surgery, 2014, Jeffrey E. Janis,
http://pl.wikipedia.org/wiki/Liposukcja