The preparation

1. Taking aspirin or medications that contain aspirin in the two weeks prior to the operation are forbidden, as these can inhibit blood clotting.
2. If you take medication regularly, you must discuss this with your doctor in advance.
3. You should be in good health before the operation takes place.
4. Restrict your intake of alcohol and cut back smoking to a minimum several days before the operation.
5. Plan to take off a week for rest after the operation. The first few days after the operation you will have to reduce physical activity.
6. Before surgery, take care of all open questions.

The Surgery - liposuction

Depending on how extensive the surgery is, liposuction can be performed on an outpatient basis, or, for the removal of larger deposits, under general anesthesia. Staying overnight in the facility offers the benefit of being carefully attended to by trained personnel. Operations vary in time depending on the extent and number of fat deposits as well as on the type of anesthesia and technique chosen. For example, the removal of “saddlebags” takes approximately 60 to 90 minutes.

Techniques

There are various methods of liposuction. We prefer the tumescent technique where the deep-lying fat deposits are injected with fluid before suctioning begins, so that the fat cells can be removed more easily. A mixture of intravenous salt solution, a local anesthetic and a drug that contracts blood vessels provides the advantage of applying anesthesia and arresting bleeding at the same time. When sufficient time is taken, the connections between the fat cells themselves are loosened and the suspension apparatus consisting of connective tissue is treated more gently. For this method, the amount of fluid injected is roughly equivalent to that of the fatty tissue to be removed. After surgery, it is easier for the skin to contract.

This technique offers the advantage that it can be performed under local anesthesia combined with a sedative when removing smaller amounts of fat.

In order to protect the tissue structure to which the fat cells are attached, there are two further procedures possible. They are particularly suitable when fat is to be removed from areas with lots of connective tissue, for example in the upper back or male breast. For ultrasound-assisted lipoplasty (UAL), the surgeon uses a special cannula that releases ultrasonic energy in the fatty tissue. The energy explodes the walls of the fat cells, enabling the liquefied fat to be suctioned off. The second procedure, the power-assisted liposuction (PAL) is based on the physical inertia of the skin. A dull metal cannula starts to vibrate. The suction created only draws away the fatty tissue that was loosened, but not the connective tissue structures. Because the connective tissue is handled more gently, the skin over the wound can heal better. We use all common methods depending on the existing physical conditions and the skin of the patient.
The tumescent solution is infiltrated through the inconspicuously placed minute incisions. After waiting approximately 45 minutes, the surgeon inserts the thin cannula to remove the fatty tissue. A vacuum pump generates the necessary negative pressure. In general, a somewhat larger cannula is used in deeper layers to remove larger amounts of “deep fat”.
Only thin cannulas are used closer to the skin’s surface, enabling/allowing the skin to contract after the operation and to reduce the risk of “forming dimples”. Afterwards the incision is sewn and a snugly fitting bandage or compression garment is applied in order to keep swelling down to a minimum. The fluid that is lost when suctioning off the fat is replaced through an infusion during and after surgery,

The Anaesthesia

Depending on how many and what size areas are to be operated on and which method is used, liposuction can be performed under general anaesthesia or with a local anaesthetic. General anaesthesia has the advantage of drastically reducing the stress on the patient. The anaesthetist decides after a thorough examination whether or not a patient can undergo general anaesthesia.. The anaesthetist is present during the complete operation and monitors the anaesthesia.

For certain types of operating techniques, liposuction can also be performed under local anaesthesia. In addition to an anaesthetic, the patient also receives a sedative to make the patient drowsy. When awake and relaxed, a slight tugging, pulling or drilling sensation can be felt during surgery – however no pain. The sedative can be taken as a pill, or injected into a vein in the arm.