Northern Plastic Surgery (NT)
Liposuction
In some people where there are localized fat deposits, liposuction may be a mechanism to remove these areas and contour the body to a better shape. It may be done in isolation or combined with other procedures. Liposuction is never a weight loss mechanism. It is a reshaping mechanism. Areas that are most suitable for liposuction include the outer and inner thighs, sides or upper parts of the abdomen, under the chin. Occasionally it is used to remove other fatty growths like lipoma. Liposuction does not deal with skin excesses where other surgical procedures are needed. Nor is liposuction is a solution for cellulite which is due to fibrous tissue that anchors the skin to deeper tissue and this results in skin dimples.
When to have the surgery Dr Mahajani will see you for a consultation and it is best that your weight is within normal limits and there are no other significant other medical problem. After pregnancy, you should wait 12 months from the delivery and with massive weight loss, have achived your ideal body weight ( but discuss this with Dr Mahajani). The patient usually feels fat pockets that they are not happy with and cause bulges that despite exercise, they cannot remove with exercise. If you are trying to lose weight, try exercises that concentrate on removing fat in the areas that are of concern with a gym trainer. If you can avoid an operation, you should. Liposuction also may not the most suitable procedure for you and Dr Mahajani will help you discuss this.
Before the operation
Discuss any queries regarding the operation and post operation procedures with Dr Mahajani and his staff. Any fee enquiries please discuss with the practice administration. Please note that liposuction is not a rebateable item unless the fat has been caused by trauma. Therefore you are liable for all fees including surgeon, anaesthetist, hospital etc and there is no rebate from the health fund. Small amounts of liposuction can be done in the day surgery but we tend to perform most liposuction at the Darwin Private Hospital. Do not smoke 2 weeks before the operation to 3 months after the operation. Stop any medications you have been advised to by the anaesthetist. Go to your anaesthetic appointment. We will give you the name of your anaesthetist so you can make contact with them. We will give you your operation date and time. The day before operation you will come for a mark up where the incisions are marked and the operation is discussed. Please bring the completed consent form with you. You will also need to purchase support garments.
The operation
The operation is done under general anaesthetic very occasionally under sedation, we make an incision where the liposuction canula needs to be placed in order to remove the fat. Before we remove the fat, the area is injected with a solution that consists of lignocaine ( a local anaesthetic ) and adrenalin ( to decrease bleeding) . The canula is inserted and the fat is removed. The canula may be a manual canula or a canula with some vibration to assist removal. At this point we do not use ultrasound assisted liposuction. All liposuction involves the canula making tunnels in the fat and removing the fat until a smoother contour is achieved in the skin. Once the fat is removed, the skin incisions are closed and the dressing ( and or garments ) placed.
After the surgery
You are admitted to the ward for 1-2 days. You have calf stimulators on the legs during the operation to prevent deep vein thrombosis or clots in the legs and these are removed. There will be iv fluid therapy over the forst 1-2 days. You are discharged from hospital after 1-2 days with antibiotics and pain relief. Go home and rest, but you will come to the clinic for dressings and stitch removal at 1-2 weeks. We will ask you to wear garments for at least 12 weeks and come back for dressings. You can start driving after 1 week sooner if the liposuctio is smaller. Walking as an exercise is possible after 1 week and we would really encourage this. At 4 weeks you can commence exercise but build this slowly. At about 3 months, final post operative photos are taken. Sometimes if you are a day surgery patient, then make sure you have a responsible adult with you.
At any time after the operation, report if you have increased pain, fever temperature, vomiting, signs of an infection.
Time off work
Most people take 1-2 weeks on average off work. It can be 1 week with a mostly sit down job. It depends on your health and amount of tissue removed.
Surgery Expectations, Risks and Complications
For most people liposuction is a safe and straightforward procedure. We would however like you inform you of what to expect along with risks and complications.
Scar
The canula ports can produce a scar . This scar is red up to 12 months but then settles down. In some people the scar may thicken or stretch. Some form of scar treatment or surgery may be needed ( see scar managment) . Whislt we attempt to make scars as fine as possible, scars in these areas can thicken and we cannot predict how scars will manifest. Sometimes there are pigmentation issues where the incisions are hyperpigmented. In some cases this can be permanent.
Wounds
Generally heal over 1-2 weeks but can take longer. These can get infected and usually only requires antibiotics to treat. Occasionally stitches that infect need removal. We will help manage your dressings. Rarely some wounds break down and the patient needs a revision of this. Infections that require more than antibiotics like severe necrotic infections requiring surgery are very rare. In the thighs it is the upper thigh that tends to break down and the same in the upper inner arm. These may require dressings for several weeks.
Asymmetry
There may be some asymmetry between side to side. if opposite sides are being done. Mostly this is not significant or noticeable and may needs correction.
Bleeding seroma and swelling
It is unusual to have significant bleeding but if you do bleed, we may be required to stop the bleeding and or give a transfusion. There are drains which help indicate this. After the operation, more commonly people get a seroma (wound fluid) or small lymphatic collection that collects and doesnt absorb. This may require draining in the rooms. The wounds takes usually 6 weeks to 3 months to completely settle.
Injury to deeper structures of lymphatics
In the event these structures are injured, although so far in this practice it has not been seen, lymphoedema may occur. This is a fluid swelling in the arms or legs and may need garments to control. This in theory should resolve but it could be permanent. More commonly but less serious is small lymphatic collection that has been explained in the previous paragraph.
Injury to the skin
If the skin is traumatized or loses its blood supply then there may be some skin loss. It is very rare to encounter this problem and so far has not been experienced by Dr Mahajani.
Numbness and pain
In the scars, numbness may occur. This usually resolves over weeks or months. Occasionally it is permanent but doesnt interfere with function. In the arms it can go beyond the scars in the inner arm and in the legs in the skin under the incisions. Pain lasts 1-2 weeks and settles down after this over a 6 week period in most people but can take longer. In some patients, nerves can be irritated and cause pain that is very severe or longer to resolve. This is unexpected but occasionally occurs. If this happens, our practice will help you to manage this where we can.
Other complications
General complications from any anaesthetic include, sore throat, chest infection, deep vein thrombosis, irritation from dressings, rare complications from anaesthetic ( your anaesthetist will discuss ) .
Contour abnormalities
Liposuction is an imprecise art and there are times that too much fat is removed and leaves depressions in the skin or insufficient fat is removed and leave bulges. Sometimes time massage, wearing garments and the way skin redrapes will correct this itself, at other times another procedure is needed. No guarantee can be given to create a perfectly smooth contour although every attempt is made to try and achieve this.
Liposuction can produce rare complications that are rare but can be serious and in sporadic instances can cause significant morbidiy or even death. These are few and isolated cases but their seriousness warrants us to explain these. The first is local anaesthetic toxicity where the body absorbes the lignocaine liposuction fluid and can cause symptoms like nausea, nervous system disturbance, changes to the pulse and blood pressure and convulsions. It will require emergency intervention. Fat globules which are meant to be sucked out could seed into the blood stream. This is very rare also but can cause a fat embolus. This is a serious medical condition and work into the
Realistic expectations from a body contouring operation
It is important for your expectations to be realistic. It is not infrequent that a minor adjustment may be needed. Complications are uncommon but if they occur, we will do our best to help you. We will try as far as possible , within the constraints of your physical health and the state of the ears and your wishes to help you achieve your goals. The surgeon cannot guarantee all expectations and nor can guarantee the longlasting effect as the ageing process continues and there may be other variations. Also for a longlasting effect your weight should be stable and weight gains or losses will affect the outcome. Sometimes other procedures are required, and infrequently sometimes severe complications are encountered. We will endeavour to the best of our ability to help you where possible. Rarely, it may be required to seek the help of other specialists. If you however have any concerns at any time please feel free to contact the practice. You are always entitled to second opinions at any stage and we are happy to help facilitate this for you if you so desired.