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Liposuction
Understanding
How Liposuction Works
Liposuction,
after 25 years since its introduction in the United States in
1981, remains one of the most popular plastic surgeries for
both men and women. How it works seems simple enough...'stick
a tube and suck it out' to paraphrase what many patients say.
And while it is conceptually simple mechanical process, there
is more to it than meets the eye.S
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At
its most basic level, liposuction is a simple two-stage process
for removing fat. A hollow tube (cannula) is put under the skin,
the tube is moved back and forth until the fat is dislodged,
and the attached vacuum source draws the fat back through the
cannula into the tubing and finally into the plastic bottle.
Despite
this apparent simplicity, there is more science to it than that.
There are three interesting components about liposuction, all
of which contribute to its safety and effectiveness. These include
tumescent fluid infiltration, vacuum pressure, and cannula size
and design.
The
placing of fluid during the liposuction operation before doing
the suctioning is an integral part of the operation. I frequently
get asked by patients if I do tumescent liposuction. Patients
think that this is a special method of liposuction, when in
fact, it is used in every liposuction procedure. Putting large
amounts of fluid into the fat areas to be suctioned beforehand
is known as tumescent infiltration. This achieves two fundamental
things, substantially reduces bleeding (from the fat being broken
up by the liposuction tube and it distends the fat compartments
which make the tube easier to pass through the fat being suctioned.
Without tumescent infiltration, liposuction would quite bloody,
give patients more pain, and have them bruised for a month,
if not longer.
The
amount of suction generated by the liposuction machine, in short,
makes liposuction possible. At the accepted amount of suction
needed for liposuction (-20 cms of water or -1 atmosphere of
pressure), the pulling of fat through the tubing certainly occurs.
But it also causes the vaporization of water. If you have ever
witnessed an actual liposuction procedure, you may have seen
bubbles in the fat or bubbling in the plastic cannister. To
some degree, this is actually water boiling....or the pressure
in the system falling to the vapor pressure of the water in
the fat being removed. It is this vaporization that makes the
viscosity (how thick it is) of fat, which is actually a combination
of fat, blood, and infiltration fluid, less to improve its ease
of flow through the tubing. From a flow standpoint, water that
is vaporized ( a gas) flows 100 times faster than liquid water.
This is also why liposuction done at higher altitudes, where
the water vapor of pressure is less, is somewhat easier to do.
(takes less suction from the machine)
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The
tube (cannula) that is actually used under the skin differs
in diameter and the holes at the tip. In days gone by, the cannulas
were quite large but left a lot of depressions in the overlying
skin after due to removing too much fat too fast and in large
pieces. Today, small cannulas are used which removes fat more
carefully and in smaller pieces, decreasing the problem of skin
irregularities after surgery. The tip of the cannula is rounded
so that it travels through the fat easier with less chance of
penetrating something you shouldn't. The holes at the tip are
where fat sticks to and then gets sucked into the cannula. The
more holes there are at the tip achieves two effects; increases
the shearing effect (like a blade) on fat and makes more cross-sectional
area through which fat can be suctioned.
Currently,
there are newer methods of liposuction or to be accurate, methods
of loosening up the fat. These include ultrasonic and laser-assisted.
While they sound quite advanced (and they are), there is no
convincing evidence at this time that they are actually better
than traditional liposuction. Better meaning....you get more
fat removed, smoother results, and recover faster with less
bruising and pain. They are marketed by the manufactures as
such but there is no solid science to prove it. And they still
require suction to pull out much of the loosened or liquefied
fat.
--------------------------------------------------------------------------------
Dr Barry Eppley is a board-certified plastic surgeon in private
practice at Clarian Health in Indianapolis, Indiana. He writes
a daily blog on trends in plastic surgery at http://www.exploreplasticsurgery.com
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