Liposuction - Body contouring, fat removal, fat suction and liposculpture

1. A bit of history

In the late 70’s, the French surgeon Illouz developed an operating method which made it possible to remove fat tissue. As opposed to slimming by exercise and dieting, the fat didn’t come back using this method. The method was named liposuction (lipo=fat). For a long period, French doctors were the only ones to offer the treatment. It was not until 1982 the method became known in the US. Short after, the method was acknowledged in most parts of the world.

In Norway – as the first clinic in Northern Europe – we began performing liposuctions in 1983, and we called the method fat suction or body contouring. Over the last few years, liposuction has become the common expression to use again. In the mid-80’s, new and improved instruments were developed, both in the USA and in Norway. These instruments were more gentle to the surrounding tissue, and thanks to them, the problem with unevenness on the skin surface became rare after liposuction – contrary to earlier, when it was more likely to occur.

From 1987-1988, the anesthetic techniques were improved. A diluted solution of local anesthesia was injected into the tissue of fat without recording any side effects. Thus, general anesthesia became redundant and the patient was able to go straight home after the operation. Also, time off from work after treatment was no longer necessary. Due to this new anesthetic technique, the so-called ”traditional liposuction technique” was abandoned by most clinics in 1988-1989.

In the mid-90’s, it became popular to remove fat by the means of ultrasound. Six years of experience with this method has given us considerable insights of its pros and cons.

In Norway, we estimate that more than thirty thousand women and men have undergone liposuction in the period from 1983 until 2004. In this same period, Fornebuklinikken - Center of Cosmetic Surgery - have performed more than 8000 operations. We keep ourselves up to date on new, and possibly better, methods and instruments at all times.

Fat removal, fat suction, body contouring, liposculpture, liposuction – they are all names for the same procedure.

2. Which areas are suited for body contouring?

You may have noticed how the fat in certain parts of the body simply can not be slimmed off. No matter how hard you try to diet and exercise, you just never reach your goal. Whether you are overweight or slim, the problem of too much fat in some areas persists. This is the type of fat accumulation we treat with liposuction.

Typical examples of areas of the body suited for this type of treatment are the chin, chest, stomach, hips and buttocks, outside of the thighs, inside of the knees, ankles and back. In women the hips, thighs and lower part of the stomach are typical areas. In men, the fat often accumulates above the chest, under the chin and on the hips. Injuries and surgical intervention may leave the fat tissue deformed. Certain medications, such as hormones, may cause a peculiar, abnormal distribution of fat tissue in the body. A few rare diseases can also cause the fat tissue to form into special shapes. We have treated all of these conditions successfully with liposuction.

In cases where there is too much fat tissue in the area of the plastic surgery, liposuction can be performed simultaneously with the main procedure. Examples are, face lifts, breast reductions and abdominoplasties.

3. Who will benefit from a liposuction?

Every healthy person with realistic expectations about the result can be treated. The decision as to whether the procedure is necessary is yours to make. There is no actual age limit upwards or downwards, but you should be fully developed and not pregnant. It is best to wait six months after a pregnancy. By then the body weight has usually stabilized. The skin on the stomach also need time to stretch back.

If you have diseases or take medication which cause you to bleed more than normal (for instance Dispril or Albyl), we treat smaller areas than we normally do. Should you have wounds or acne on the body part in question, we prefer to postpone the operation. If you have a psychological disorder or an eating disorder, you must receive an approval from your regular physician. Also, you must have no allergies to anesthetics.

Treating patients with weight problems is possible, but because of the remaining fat the changes can be less noticeable than in slim patients. As a result, these patients are not always completely satisfied with the result. Due to the risk of complications, we must be careful not to remove too much fat from extremely overweight patients. Thus, we recommend that patients with severe weight problems lose weight before treatment.

Moderately overweight patients do not need to lose weight before a liposuction. Have you made up your mind to start losing weight, you may just as well start your diet some time after your liposuction.

4. The day of the operation

The operation will take place in an operating room A surgeon, nurse, anesthetic nurse, and occasionally also an anesthetist, will be present. At first, you will be given a sedative, followed by sleeping medication. Then the local anesthetics are injected in the fat tissue which is about to be removed. Only in rare cases is epidural or general anesthesia used.

The fat cells are sucked out through one or two holes on the skin with the help of a thin, steel tube, a cannula. The cannula is hooked up to a pump or a syringe which both make a vacuum in the cannula. The pump is better when large amounts of fat tissue will be removed, while a syringe is best when the amounts are smaller. If the fat tissue is fixed, as is often the case with the fat on the chest in men, we ”soften” the fat with ultrasound.

Ultrasonic technique is often used before the removal of the fat cells. This method is especially useful when the fat cells is fixed to the surrounding tissue. Examples - among other locations are: "Love handles, hip rolls, belly and breast fat in men. We review every case and use the method we consider best for you. The results are equally good whether we use a pump or a syringe. See the illustrations in the Photo series Liposuction (Body Contouring).

With well-administered anesthesia, the treatment will feel more like a rough massage. The operation ends when the hole on the skin is sutured with one stitch, covered with a tight bandage, girdle or compression stocking. You can go straight home after the treatment, but most of our patients prefer to rest for a few hours in one of the clinic’s resting rooms for day patients.

A panty and elastic bandage are available at the clinic. Support stockings, which are used for below the hips, need to be ordered in a special store for health supplies. One of our nurses will give you advice about this during the first consultation.

Some clinics claim to use new and improved methods, instruments that are more sophisticated, and better surgeons. The fact is that there are 20 or so surgeons in Norway who have years of experience with liposuction and with good results. Nowadays, liposuction is performed in more or less the same way all over the world. All liposuction treatment in Norway is done by hand and by surgeons. The methods are well established and most common in practice everywhere. Of importance to you, are the routines of the clinic and the surgeon’s experience.

5. Before the operation

Call us: (+47) 67115420, or write to us by email, if you want to schedule for a consultation or have any questions.

We recommend that you come to us for a consultation first. The areas, from which you want to remove fat, will then be evaluated by a surgeon with many years of experience in liposuction. In Fornebuklinikken, you will not meet any consultants who will attempt to sell you procedures. However, if you wish, you are welcome to have a casual chat with a special nurse before the consultation. During the conversation you will be given advice and answers to any question you may have. Unless there are medical reasons that speak against an operation, it is up to you to decide whether you would like to go through with the treatment or not.

After the consultation, you may need to take some time to consider whether you want to go ahead with the treatment or not. If or when you decide, you will be scheduled for operation and asked for a deposit. The rest of the amount is paid later – but no later than on arrival the day of the operation.

If you live far away from the clinic or for other reasons are unable to come for the first consultation, you may send us photos of the body part or body parts in question. The photos will then be evaluated by a surgeon, before the ”consultation” is carried out by phone. Whether you come to our clinic or send photos, we need you to fill in a so-called personal statement of health, with information about your health condition; whether you have had any diseases, allergies, use of medication, and so on.

6. After the operation

The effect of the anesthetics will gradually wear off within the first 24 hours. At the same time, the treated area will become somewhat swollen. The day after, you will feel a bit tender and sore. Rest is the best medicine during this phase. You will be sent home with pain relieving medicine, but in many cases, they are not needed. You may experience that a mixture of blood and anesthetic fluid is leaking from the holes on the skin during the first 24 hours. The fluid may go through your clothes and make it seem like you are bleeding. This is quite normal and not dangerous. If you are in a line of work that involves manual labor, you will probably prefer to take a few days off from work after the treatment. Liposuction of large areas will also require that you spend a few extra days resting. If your job does not involve any manual labor, going to work as soon as the day after treatment should not be a problem. Moving about may feel uncomfortable, but it will not effect the result of the liposuction.

After two or three weeks, you can start some light exercise, while weight training, aerobics and running should wait about three to four weeks. The issue of training and other physical activities needs to be considered individually, and it depends on which parts of your body have undergone treatment. Alcohol can increase swelling and bruising, and should be avoided both a few days prior to treatment as well as the first week after the operation. As a rule, the elastic bandages, panty or stockings, are supposed to be left untouched for one week. They can be taken off during the night the following three weeks. The stitches are removed after one week.

7. What kind of results can I expect?

The result will depend on the elasticity of the skin, your age, and the amount of fat tissue removed. Patients of normal weight and skin elasticity will usually have good results. The skin will contract itself after the treatment.

Some patients are prone to have looser and less elastic skin, often with irregularities (”cellulite”). These patients are typically 45-50 years and older, and whose weight might have varied over the years, for instance due to pregnancies. In our experience, the liposuction may improve the ”cellulite” appearance in some cases, while it gets worse in a few patients. More often, we see no change at all on the surface of the skin after liposuction. If too much fat is removed from a patient who already have loose and uneven skin, it may result in increased unevenness. Usually though, those few patients with increased unevenness of the skin, tolerate it well – they prefer the slim figure. Unfortunately, no available methods of liposuction guarantee that unevenness of the skin will not be part of the result.

Right after treatment, it will very apparent that the fat has been removed. However, a few days later the treated area starts to swell, sometimes with a blue discoloration of the skin. This is completely normal – and the swelling will decrease in a few weeks. That said, it will be a month or two before the swelling is completely gone. In a few, rare cases it may take several months for the swelling to go down and the skin to contract completely.

Occasionally patients will think that we have removed too little fat. This does not mean that the operation wasn’t a success. It is better to remove too little than too much, and repeat the procedure later instead.

With treatments on both sides at the same time, there will sometimes be a visible difference between the right and the left side, even though the exact same amount of fat have been removed on both sides of the body. Such differences are common and may be corrected with an operation later in time (”an adjustment”), under local anesthesia and without any extra costs.

Your expectations are also important. If your perception of your own body is realistic, chances are that you will be satisfied with the result.

8. What about the bodyweight?

Most of the time there will be no visible loss of weight after a liposuction – neither is this the goal. The goal is a nicer figure.

The fat cells that have been removed are gone for good. Not all the fat cells are removed, however, and the few that are left, may increase in size in cases of major weight increase. If you gain weight later, most of the fat gain will be in other places. In some patients, this is wanted: In order to get thinner thighs some patients may have been dieting to such an extent that that their faces and upper bodies have gotten too thin. Once the fat has been removed from the ”critical” areas, they can safely gain a few kilos again – until they reach their ”ideal weight”: So, the result is permanent, provided that the bodyweight isn’t increased considerably.

9. Possible complications

Liposuction performed correctly, seldom have side effects. As mentioned earlier, skin irregularities occasionally occur, but very seldom. In addition, numbness and tenderness in the treated area might occur. The tenderness will disappear after about a month, but the numbness may last up to one year. In a very few cases we can see weak bluish discolorations of the skin. They are caused by minor bleeding underneath the surface of the skin like small tattoos. You can avoid this by keeping away from the sun as long as the area of treatment is blue and swollen. Nausea and fatigue are side effects that may be caused by the anesthetics, just like with any operation where anesthetics are used.

In addition, there may be complications associated with any type of operation, and liposuction is no exception. However, our experience from more than eight thousand cases of treatment shows that this is extremely rare. If all the basic rules are followed when it comes to the pre-examination, as well as sterility and anesthetics during the operation, patients also run these risks at the dentist or during childbirth. Statistically, though, driving a car is even more risky!

In the case of complications, we will provide the proper treatment and check-ups to ensure that the result is not ruined. Overall, liposuction is characterized as a very safe method of treatment .

The different areas

10. Face and neck

Liposuction of a double chin can usually be done without tightening the skin at the same time. During the consultation prior to the procedure, we will find out whether the skin has enough elasticity. The result will usually be satisfying when it comes to improving the profile. After the treatment, an elastic bandage needs to be worn for at least one week – preferably two. Many experience having to wear the bandage to be socially bothersome, and they prefer to stay inside during this period. When the bandage comes off, the area of treatment will be swollen. You can perform some gentle massaging of these areas on your own.

Liposuction of the face is usually performed along with a facelift. If you are younger than 40-50 years of age, some parts of the face may be treated without a facelift with good results. Large cheeks (a round baby face) and fat cushions above the jaw line may be good areas for liposuction. See the photos in the Photo series liposuction (Body Contouring).

11. Breasts in men

Most of the time, disfiguring breasts in men consists mainly of fat tissue that can be efficiently removed with liposuction. The condition is usually related to being overweight. The treated area can become quite swollen afterwards. Thus, it is necessary to wear a rather tight bandage or elastic vest for about four weeks after surgery. Most patients should receive physiotherapy as soon as the stitches are removed, which is about one week after the operation.

Men also have a breast gland. It is usually too small to show. Sometimes though, the chest will not become completely flat after treatment because of a large gland, which cannot not be sucked out like with the fat tissue. In such cases, it may be necessary to remove the gland with an operation later. Fortunately, this is seldom necessary because we use ultrasonic liposuction. If we know beforehand that the gland is large, we will remove it at the same time as we perform the liposuction. See the photos in the Photo series liposuction (Body Contouring).

12. The back

In grown women it is quite common to have a fat fold that runs from the shoulder blade and over to the side of the chest – about on the level of the bra-strap. This may be embarrassing when wearing a tight top or bathing suit. Liposuction alone can often give good results, but sometimes the fat fold is surrounded by so much loose skin that it will not disappear completely.

13. The thighs

Unwanted depots of fat on the thighs is quite common in women. The so-called ”riding breeches” are the most common and will be described in its own section. High up, on the inside of the thighs, there are often bothersome depots of fat. The skin is usually thin, and having the inside of the thighs constantly rubbing against one another, may cause skin irritation and eczema. Many also experience that the fabric on the inside of their pants wear out quickly. However, as the skin on the inside of the thighs is thinner and less elastic, we need to be cautious. If too much fat is removed, it may result in disfiguring irregularities of the skin. Thus, only small amounts of fat are usually removed from this area. Occasionally, liposuction is combined with a thighplasty or a thighlift in patients with very loose skin on the inside of their thighs.

Many women also think that they have too much fat on the front part of the thighs. The case though, is often that large muscles and a heavy bone structure – rather than fat – cause the large thighs. Liposuction of this area, often result in skin unevenness, so it is seldom used.

14. Riding breeches

Riding breeches are characterized by fat accumulations on the outside and lateral parts of the upper thighs towards the buttocks. In women, this is the most common liposuction procedure. The cause for riding breeches in otherwise healthy and slim women is unknown. They show up a few years after puberty and continue to increase in size, especially during pregnancies. Riding breeches are almost impossible to get rid of with slimming. Weight reductions in these women usually result only in a thinner upper body. Neither are there any exercises, massage methods or medications that can take care of this problem. The only effective treatment against riding breeches is to remove the fat.

After the operation, the patient is helped into a tight panty, which will prevent swelling and roughness. The panty is supposed to be so tight that it is almost uncomfortable to wear, and it must be left on, untouched, every night and day for one week. Then the next three weeks, it only needs to be worn during the days. In order to prevent swelling of the legs, one also needs to use elastic, support stockings the first week after the operation. You can purchase these from measure in a special health supply store. We provide you with the panty.

Should the area of treatment become blue and swollen, it is best to see a physical therapist for treatment about a week after the operation. The result will be just as good if you do the massage yourself, but it may take longer for the swollenness to disappear. /P>

15. The hips

Fat on the hips is about equally common in men as in women, and it isn’t always a result of being overweight. The skin on the hips is quite elastic and able to contract after a liposuction, and unevenness of the skin is seldom a problem in this area.

Other than that, the same principles and guidelines as for operating ”riding breeches” apply to operations of the hips. In women, fat on the hips is often removed at the same time as the ”riding breeches” are treated. Swelling, in the form of ”sore” lumps, may last from four to six weeks. Thus, physiotherapy or massaging on one’s own is recommended. A panty needs to be worn for four weeks.

16. The stomach

Sometimes the stomach has a combination of excess fat and loose, excess skin. Loose skin or scars from previous abdominal operations, sometimes need to be corrected with a plastic operation of the stomach in addition to the liposuction. Liposuction alone will usually be sufficient in younger patients with elastic skin.

In most cases, we do a liposuction of the lower part of the stomach, below and around the navel. The fat in this area, in both slim and overweight patients, may have accumulated as a ”bump” which is difficult to lose by dieting. Fat in the upper part of the stomach, above the navel, is often seen in combination with loose skin. The risk of unevenness is higher in this part of the stomach. It is also more difficult to remove as much fat as wanted from this area. The swelling may take longer to go down on the stomach than in other parts on the body. The need of adjustments is also more common in the stomach than it is, for instance, on the thighs.

17. The knees

In women, fat cushions on the inside of the knees are common, and often appear along with ”riding breeches”. The fat can be removed relatively easy via a small incision behind the knee in a skin crease. Tight support stockings are worn day and night the first week. After that it is sufficient to wear ”knee pads” during the days for a few weeks. With the ”knee pads”, it is important to make sure that no skin folds are created over the treated area. A few patients experience pain when walking in stairways the first week after the operation. Physical treatment is recommendable if the operating site gets swollen.

Many are also bothered by depots of fat on the front side of the knee, where it accumulates as cushions above and below the kneecap. Because the knee joints are in constant movement, the skin is stretched. This means that these cushions are often combined with loose skin. Thus, one must be cautious not to suck out too much fat from the front side of the knee.

18. Ankles and calves

Liposuction of large ankles is more common than one may think, and most of the time the difference is remarkable. Many also feel that their calves are too large. The reason for this, though, is often that the muscles are well developed, and that cannot be treated with liposuction. You can check this by standing on your toes. If your calf is getting hard, it is mostly muscles. Fat cushions are often seen on the upper part of the calf. These can be removed successfully.

Sometimes, swollen ankles are a result of disease or fluids, and liposuction may help reduce the swelling.

Like with the stomach, the ankles and calves are areas that may be swollen for several weeks after the operation. There is often also more pain involved with treatment of this area than of others. Tight support stockings are needed for a long time afterwards. You must be careful about standing up or sitting with your feet hanging down for too long periods. It is recommended that you walk around or sit with your legs elevated. Physiotherapy is usually needed after liposuction of the ankles and calves.

The results of liposuction of the ankles are usually very good. The difference between before and after is very noticeable, and many actually feel that the blood circulation of their feet is improved after the operation. Many also feel an improvement of their general endurance. The result after having the calves done, especially the thicker part, varies some. Some had hoped that more fat would be removed.