Liposuction, a technique used to remove fat from certain areas of the body, is one of the most performed surgical procedures in the world, including in Brazil where, according to the Brazilian Society of Plastic Surgery, about 300 thousand of these operations are performed per year.
Lipo appeared in 1977 because of a love story. French surgeon Yves Gerard Illouz invented liposuction to solve the problem of the girlfriend, who could not use a neckline because of a lipoma, a benign tumor formed by fat cells. By normal surgery to remove the lipoma, she would have a very large scar on her back, which would continue to prevent her from using her necklines. Illouz then had the idea of placing a cannula attached to a vacuum cleaner to end the problem without leaving marks
According to Dr. Rodrigo Mangaravite the technique of liposuction has reached enormous development in recent years, becoming increasingly safe and less aggressive. It gained fame of dangerous with the divulgation of unsuccessful cases, but it has excellent results and a lot of security, since that realized by specialist and in suitable hospital environment.
Liposuction is not a weight-loss technique, as many people think. It is made to remove excess localized fat, improving the harmony of the curves and modeling and defining the body contour. The irregularities and depressions caused by cellulite may not be eliminated by liposuction, but it improves the aesthetic appearance of the affected region.
According to Dr. Rodrigo Mangaravite, who attends his clinic in Ipanema, Rio de Janeiro and in São Paulo, the ideal candidates for liposuction are young patients with localized fat, who are at or near the ideal weight. This is because liposuction does not remove excess skin and the retraction of the leftover skin after surgery will depend on the elasticity of the skin and its retraction ability.
Liposuction can be done on the abdomen, flank, back, legs, arms and face. In women, estrogen causes accumulation of fat in the buttocks and especially culotas. In men, hormones favor increased fat mainly in the abdomen and waist.
According to Dr. Rodrigo Mangaravite, who attends his clinic in Rio de Janeiro and São Paulo, it can be local, local with sedation, epidural or general, depending on the region to be operated on and the volume of fat to be liposuction. The Brazilian Society of Plastic Surgery establishes a safety limit of fat removal around 5% to 7% of the total weight of the person.
From one to three hours, depending on the area and amount of fat to be removed. It is worth mentioning that Dr. Rodrigo performs all his surgeries with all possible attention and calmness. Following an individualized surgical plan minutely for each patient, using all their technical capacity and resources to arrive at the best possible result, and only then, the surgery can be finished. Dr. Rodrigo only leaves the surgical center when he is sure that he has reached the maximum, the desired result.
The incision site is left with a small dressing of micropore and gauze to protect the stitches. Must be changed after bathing. It is normal for a bleeding fluid to leak in the region of the dots within the first 48 hours. The stitches are removed seven to ten days after liposuction.
Externally, there are bumps (edemas) and purple spots (bruises), which usually disappear in a maximum of one month. Internally, healing or fibrosis causes hardening in the operated region lasting one to two months. The final result, with the retraction of the leftover skin, appears within two to six months.
Wear elastic band 24 hours a day for 30 days. Although it is uncomfortable, its use helps to heal, reduce edema and retraction of the skin. The strap can only be withdrawn to the bath and should not be cramped in order not to impair the circulation, cause even greater discomfort and even delay healing.
Do lymphatic drainage to decrease swelling and stiffness. The lymphatic drainage brings much comfort. It is not mandatory, but it helps a lot in its recovery, accelerating the reduction of edema, ecchymoses and pain in the postoperative period.
The lymphatic system drains excess fluid from our body through ducts and ganglions into the bloodstream to be eliminated through the urine. When run efficiently, the flow rate of these liquids increases. Manual drainage provides the experienced practitioner to visualize nodules, ripples, fluid accumulations and work best in the affected site and can be started from the first week. Drainage with appliances is recommended after 15 days and also greatly helps in the removal of fibrosis.
For the first two days after liposuction, just take a hygienic bath. In the following days, you can take a shower normally, but it is recommended to ask for help the first few times. When dizziness is removed for the first time, dizziness and fainting are very common.
So do it in stages. Remove the strap, sit down and take a deep breath. If you are feeling well, stand up and breathe again. If you feel safe, you can start the bath. But remember: it’s always good to have someone around, not lock the door and at the first sign of weakness or dizziness call for help. Do not expect it to get better. Normally, it will only improve when you lie down. When this occurs, reinsert the strap and leave the bath for the next day.
Hyperprotein feeding, rich in meat, eggs and milk, combined with fruit consumption, is recommended in the postoperative period. Then it is important to do a food re-education to prevent the cause of liposuction.
Do not make strict regimes during this period. You may get compromised immune system, impairing healing. Drink about three liters of fluids a day the first week. Isotonic drinks, fruit juices and coconut water are great for replenishing the liquid loss.
Do not drink alcohol for a week after liposuction. Alcohol can increase edema. It is normal for the gut to be slow in the first few weeks, but it is important to regularize it. If it does not work after the third day, the use of bowel regulators (under medical supervision) is recommended.
In the first week you should sleep on your stomach. This is one of the points of greatest discomfort for the patient. If you turn around at night, sleeping, no problem.
Do not take sun for two months after liposuction to prevent dark spots and scars. If there are purple spots, it is essential to apply the sun block. Avoid intercourse in the first two weeks because of the risk of trauma to the area and increased pain.
Physical exercise should be avoided for at least a month, but the patient can resume normal activities immediately after the operation, in small liposuction, and up to two weeks in the larger ones.
The most common, although rare, is the seroma, accumulation of fluid in the liposuction area, which can be avoided by using drains in more extensive liposuction and solved with punctures for emptying.
The occurrence of dizziness and weakness is common in the first week due to fluid loss during liposuction. Avoid getting up quickly because this can cause a pressure drop, leading to fainting. When you get up or make some significant effort, machete slowly. Take a deep breath, and just get up when you’re feeling fine. If you begin to feel dizzy, it is best to ask for help, sit or lie down until the circulation recurs.
In the first week, the site will be swollen and with some bruising areas. This swelling will regress from the first week. It can occur on one side becoming more swollen and purple than the other. But it is important to remember that this is temporary and does not interfere with the final result.
In many cases, the swelling reaches regions that have not been manipulated. It is very common for the genital region to become swollen and bruised in the liposuction of the abdomen. Ecchymosis peaks within five days, ranging from a slight redness to totally black. They tend to disappear completely in up to four weeks.
From the second week, with the help of lymphatic drainage, there is a progressive improvement of the swelling, providing greater comfort each day.
It depends on the sensitivity of each patient. Some people are more resistant to pain and may feel only mild discomfort in the area, regardless of the area or volume aspirated.
Usually liposuction hurts at the aspirated site. Some areas are more sensitive and hurt more (eg, abdomen and flanks), others hurt less (eg, breeches and legs). The pain is more intense in the first few days and gradually decreases. Numbness and tingling are also common and may come with or without pain.
It is important to remember that the pain is not related to the amount of fat removed. The prescribed analgesic medication will be important to bring relief. Usually, a strong analgesic associated with an anti-inflammatory is used.
There are three types of liposuction all for the same purpose, removing fat: traditional liposuction, which are cannulas attached to an aspiration apparatus; Liposuction with a syringe, cannulas connected to a syringe in which a vacuum is made and aspirates the fat with the syringe; And vibrolipoaspiration, cannulae attached to an apparatus that makes a back and forth movement and is connected to a vacuum cleaner.
In traditional liposuction, aspiration of the fat through the cannulas is done. The cannulae have a support for the hands, making the withdrawal of the fat with movement of coming and going, entering and leaving the fat of the tissue that one wants to liposuction.
The technique is very good as long as performed by experienced surgeon. Still the most used. Most surgeons do liposuction this way because it is the oldest, most publicized, and least cost technique.
The cannulas are reused, without risk of contamination, since they are washed and sterilized like all surgical materials. But the trend is that it falls into disuse due to the evolution of the handsets.
Liposuction with syringe is also good, especially for removal of material for grafting. The best way to collect fat is with a syringe. The cannula is connected in a syringe, a vacuum is made in this syringe, it is entered in the fat, with movement of comes and goes the fat is removed and with the same syringe puts itself in the desired place.
There are surgeons who only do liposuction with a syringe. It requires a little more experience because, by not having the help of the aspiration device, the surgeon has to have greater control of the vacuum that is doing in the place.
Vibrolipoaspiration can be done with several devices, among them the vibrolipo and the micro-air. The micro-air is a modern device that uses technology to assist the surgeon in performing liposuction. It produces a back and forth movement, reducing the trauma in the tissues.
Due to this movement, the vibrolipoaspiration is performed with less physical effort to the surgeon. With this, it can perform a less aggressive liposuction, with less trauma in the blood vessels and in the dermis, leading to a more accurate fat removal.
Due to the trauma being smaller, the vibrolipoaspiration greatly diminishes the discomfort, the pain, the edema and the ecchymoses (purple spots) very common in the postoperative period. Thus, the patient presents a better recovery and the return to normal activities is in a shorter time.
All liposuction done with due caution provides excellent results. The great advantages of traditional liposuction are the lower cost and easy learning. The material is more accessible and, as many people do, it is easier to follow the surgeon and begin to learn how it is done.
The main disadvantage of this method is the surgeon’s physical exertion, which is greater, and the trauma of the tissues, which is also greater because, as the surgeon is making more force, he traumatizes the tissues more.
The main advantage of liposuction with a syringe is to be a great way to collect material for grafting. The main disadvantage is that it requires a great amount of learning time, mainly to do the refinement.
The main advantage of vibrolipoaspiration is the less trauma to the patient and the lesser wear to the doctor. The main disadvantages are the cost of the device and the longer learning time.
There are new liposuction devices being launched, such as SlimLipo, a laser device recently approved by the FDA. The process is similar to that of conventional surgery, but it is not yet widely used because it is in the learning phase.
The two remove the localized fat, but only liposculpture restores or grafts part of the fat aspirated into other areas that need filling, such as glutes, creases face, mouth, areas of depression in the body. Popularly, the term liposculpture is used to refer to liposuction done in several areas in the same surgery.
There is liposuction and fat grafting. The fat graft consists of removing the fat from one area and putting in another. The term liposculpture began with this. It is often said that a liposculpture is done when liposuction fat is injected from another region of the body.
The liposuction removes only the fat, does not remove the skin and does not solve the sagging, and in some cases even make it worse. It is therefore only indicated for cases of localized fat accumulation in patients close to the ideal weight, without excess skin.
The abdominoplasty removes excess skin and stretches the excess. It only removes the fat that comes along with the skin and is indicated for patients with excess skin or sagging, with or without excess fat.
For patients with both problems, fat and sagging, lipoabdominoplasty is recommended, association of liposuction for fat removal and abdominoplasty for removal of the skin, in the same surgery.