Liposuction, or with a grand word, liposculpture, has constantly been refined since it was introduced 30 years ago. Nowadays it constitutes an important part of the activities of our clinic. Depending on the magnitude of the operation, the surgery is performed under local anaesthesia (rarely), intra-venous anaesthesia or under general anaesthesia. This part is carried out either by an anaesthetist nurse or by an anaestheologist doctor. After more than 20 years’ experience, we find that the results are long-lasting and complications are rare. Patients, on whom we performed sub-mental and neck liposuction more than 20 years’ ago have never developed the large excess of skin and fat common in the previous generation.
Liposuction is performed in many areas, such as on the neck and sub-mental area and – rarely – of the cheeks. Common areas are the abdomen, hips, saccrum and bulges of fat below the bra on the sides. Fat also accumulates laterally in the breast (sometimes remaining after breast-surgery) and especially in front of the armpits. Liposuction is an excellent tool by which to remove excess fat. However, in large collections of fat an excessive skin envelope will remain afterwards. The skin can then create unevenness and even bulging, often mistaken for remaining fat. The clue is to remove the excess skin in an appropriate area, for example on the inner sides of the thighs.
In abdominoplasty, we do remove fat by using liposuction, and we also stretch the skin by excising large excess areas.
We are frequently asked to perform liposuction of the abdomen only. This can be successful, but only in young men or women who have good elasticity in the skin. Many of these cases need to have a complete tummy tuck later, due to the excess skin creating unevenness on the trunk/abdomen.
Other popular areas for liposuction are the trochanteric area (the outer side of the hip), the inside of the thigh, the medial side of the knees and finally the lower leg. Knees and lower legs will present true liposculpture. In the lower leg, a convex contour of the inner aspect of the leg must be created in order to achieve an elegant shape (see the Photo Gallery). The inner aspect of the knee is a great fold area to change.
In conclusion, all areas bordered by flat surfaces are difficult, while areas bordered by convex or concave profiles are much more forgiving.
Liposuction of the behind (gluteal area) is possible in young people, but an excess of skin is often created and this has to be removed by skin excision, preferably in the gluteal fold (see the Photo Gallery). We now have the tools to create harmonious and happy buttocks.
There is a great demand for these procedures, which involve liposuction, and the operations are performed at the Institute of Plastic Surgery, Western Harbour, Malmö, Sweden.
There is a new innovation to liposculpture: Liposuction means to remove fat, and the new method, called lipoaugmentation, can be used to add fat, for example to the breast. Considerable augmentations can be performed in the breast, but this requires considerable access to fat. Liposculpture is particularly useful for the correction of breast asymmetry, but it is not at all as efficient as implants.
Over the last few years, there has been an increasing demand for gluteal (behind) augmentation, using autologous fat. This technique is successful and fulfils the expectation of the women. As in all fat augmentation, one can expect 1-2-3 sessions.
A new combined liposuction and vibration technique has made the procedures more efficient.
Today liposuction is normally carried out by the use of a tumescent (wet) technique, which makes the procedure both safer and quicker. Only at the borders, between flat and bulging areas, do we have to be restrictive with fluid addition in the tissues. This precaution is made in order to avoid postoperastive unevenness.
Liposuction is a safe procedure when you remove less than three (3) litres of material and it can be acceptable for removal of up to five (5) litres. When removing larger amounts, the change of balance between fluid and water can seriously harm the patient’s circulation.
Ultrasound came as an innovation in liposuction, but it has virtually disappeared due to several disadvantages, such as pain, increased cost and increasing risks of serious complications. This technique is not used at the Institute of Plastic Surgery, Malmö, Sweden.
Today we can replace tissues with autologous fat. Usually 1-2-3 sessions are required. Liposculpture is popular in the malar area and the lips. For some years now we also augmented breasts and the gluteal area with autologous fat. Please note that fat is excellent for correcting contour defects.
These procedures are also performed at the Institute of Plastic Surgery, Western Harbour, Malmö, Sweden.