Nip? Tuck? …Or Suck?

The quest for the “body-beautiful” has had people going to great lengths. Common complaints I hear in my clinic are “My butt’s too big!”, “This tummy has got to go!”, “I’ve got jiggly thighs!”. People are also concerned about chubby cheeks, baggy eyes and double chins. Options available include Liposuction and its non-invasive alternatives.


Liposuction is an invasive surgical procedure where unwanted fat is vacuumed out from its subcutaneous deposits. It is the most commonly performed as well as the most dangerous of all cosmetic surgical procedures having the highest fatality rate of 3 in 100,000. The procedure is performed under general anaesthesia and besides the side effects of general anaesthesia it also has its associated risks. Surrounding connective tissue and blood vessels may be damaged in addition to the fat cells. A fatal fat embolism may occur if fat cells leak into these damaged vessels and are carried to the lungs and brain. Tight bandages are applied afterwards to help prevent this potential hazard.

The technique involves the use of a small stainless steel tube called a cannula. This cannula is connected to a powerful vacuum suction pump and is inserted into fat deposits through small incisions in the skin. The most common areas for liposuction in women are the thighs, hips, buttocks, abdomen, arms and knees. In men, the abdomen, love handles (or “spare tires”), chest and chin are the areas most commonly treated. Specialized abdominal liposuction known as abdominal etching may be used to enhance the definition of abdominal muscles giving the coveted “6-pack of abs”.
Liposuction may also be used for non cosmetic applications such as treating Iipomas (benign fatty tumours) and gynaecomastia (fatty breasts in males).  Liposuction is used to contour the body by removing stubborn fat deposits that diet cannot remove and should not be seen as a treatment for cellulite nor a means to become thinner and more toned which require diet and exercise. Facial and neck liposuction are used to contour the face and treat a double chin which is great since chubby cheeks and a double chin hardly respond to diet and exercise.

Available Liposuction Techniques
In addition to the traditional method of liposuction that employs the use of a cannula, there are newer techniques available such as the Ultrasound assisted liposuction (UAL) Power assisted liposuction (PAL) and the Tumescent technique. The technique used depends on the types of anaesthesia used, amount of tumescent fluid and the type of cannula used.

Ultrasound assisted liposuction (UAL): Ultrasonic liposuction was invented in the early 1990’s in Europe by an Italian surgeon. In this procedure a sound wave generator delivers energy by means of a probe to fat tissue liquefying the fat thus making it easier to remove. This liquefies the fat so well that only low pressure suction is needed to remove it making it a gentler procedure.

Power Assisted Liposuction (PAL): A relatively new technique approved for use in 1998 uses a motorized cannula that oscillates and reciprocates (moves back and forth) a few millimetres up to 8,000 times per minute. These vibrations allow the cannula to penetrate the tissue with less effort on the part of the surgeon.

Tumescent Technique: To help reduce blood loss and facilitate fat removal during this procedure wet liposuction was introduced as an advantage over dry liposuction. This involved injecting a fluid (tumescent fluid) containing a mixture of intravenous solution, an anaesthetic (lidocaine) and a vasoconstrictor (epinephrine) into the areas to be suctioned before the procedure itself.

Risks associated with liposuction include

  • Pulmonary embolism
  • Fluid imbalance
  • Lidocaine overdose
  • Infection
  • Traumatic organ damage
  • Burns from ultrasonic liposuction
  • Irregular contours
  • Scars
  • Swelling
  • Excess loose skin that may need lifting
  • Death

Alternatives to Liposuction
Two minimally invasive alternatives are now available and have obtained a welcoming response in the field of Aesthetic Medicine. The first is Injection Lipolysis (a form of Mesotherapy) where phosphatidylcholine, a phospholipid that dissolves fat, also known as ‘Lipodissolve’ and ‘Lipostabil’  is injected directly into fat deposits melting it away over a period of time by breaking down the cell membrane and releasing the fat which is subsequently metabolised by the body. Injection Lipolysis was developed in 1995 by a South African dermatologist to remove bags under the eyes. The procedure was further developed by an Austrian dermatologist to treat wider areas such as the chin, abdomen, arms, thighs and buttocks. It has been very useful in the treatment of cellulite.

Results are visible in six to eight weeks for the body and four weeks for the face. Between three and six treatments are needed and fat loss is permanent.  There are minimal side effects such as bruising and itching. Alcohol should be avoided for up to four weeks after the injection as the release of fat puts the liver under stress. This procedure is not a cure for obesity but targets fat removal from areas that exercise and diet have failed to remove. The face and abdomen show better results than the thighs and buttocks.

The second procedure uses high frequency ultrasound waves to break down fat deposits and the machine is known as UltraShape. This is a much newer technique developed in Israel. It is completely non-invasive and fat cells are destroyed with focused ultrasound. The body clears the destroyed fat cells in six to eight weeks via the lymphatic and venous drainage systems. This procedure does not put additional stress on the kidneys or liver and cholesterol levels are not affected. Fortunately, the skin doesn’t collapse as seen after liposuction. There is no downtime and the procedure can be performed in a Doctor’s office. Treatment is usually at one month intervals and it successfully treats the problem areas such as the arms, thighs, abdomen and buttocks.

It is important to do your homework before getting any procedure done. Find out about the physician and results of patients who have been treated by him or her. Please keep in mind that trends are leaning towards non-invasive procedures.

Thanks for reading my article. Get Glowing!


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