Liposuction is one of the top five most commonly performed cosmetic procedures in the entire
world, and in today's video, with the help of the cadavers here in the lab, we're going
to see exactly what's happening to the body as the fat is being removed and then in some
cases, placed somewhere else in the body.
It's going to be an oily one.
Let's do this!
[Intro]
Liposuction is the method of removing adipose tissue from the body with the use of a suction
device in an effort to correct deep and superficial fat accumulations and thereby remodeling the
body's contour or shape.
You could think of a classical liposuction as being a more broad and massive removal
of fatty tissue.
Liposculpture on the other hand is seen as a more artistic variation of liposuction where
the surgeon can take very small or large amounts of adipose tissue out of the body and even
insert it elsewhere in the body if so desired such as the buttocks for example.
So, while general liposuction definitely alters the contour of the body, liposculpture is
where highly specific contouring can happen just as if the body was being sculpted from
stone.
Most people are aware of liposuction being used in the abdomen.
However, there are plenty of other options available.
Some of the most common are going to be the buttocks or the gluteal region, the love handles
or the waistline, the hip and thighs are very, very popular as well as the neck is a highly
desired option by many.
However, depending on the surgeon and the specific technique being used, it's possible
to perform liposuction anywhere there's adipose tissue including the face and even the ankles.
Although, some areas come with far more risk and pain than others which is why many plastic
surgeons elect not to perform liposuction in those areas at all.
Liposuction isn't only for cosmetic purposes.
It actually can be highly effective in treating several medical conditions, including the
removal of lipomas which are fatty non-cancerous tumors as well as treating lipedema which
is an excessive amount of body fat that's accumulated in the lower body.
The psychological benefit of liposuction also shouldn't be glossed over, for many that struggle
with body image, liposuction can play a huge part in improving their overall mental health.
However, cosmetically, it's important to note that liposuction isn't a weight loss procedure.
Now, obviously the patient is going to lose weight considering your literal vacuuming
fatty tissue out of their body but in order to qualify for liposuction, the patient must
clearly demonstrate a deviation from normal body contour as well as be within 30% of their
normal Body Mass Index or BMI.
They shouldn't be obese, they should have minimal skin looseness, and they need to be
at a stable weight for six to 12 months prior to the surgery.
Now, granted this is up to the specific surgeon and exceptions to apply but it's best to understand
that liposuction isn't the answer for quick weight loss.
In fact, unless dietary and exercise habits are altered, the patient isn't expected to
lose much weight if any at all and that's because they'll have a disproportionate distribution
of fat in the remaining fatty tissue after the procedure.
This is because when adipose tissue is removed, it doesn't come back or if it does, it's to
a much lesser extent.
When you gain weight, it's not as though you create more adipose cells.
Instead, the preexisting cells will increase in size.
So, when you remove them, the vast majority of them are gone forever.
This is why it's so important to come into the procedure with a healthy lifestyle and
mindset already in place as well as having realistic expectations as to the outcome of
the procedure and I know this can be difficult for many which is probably a massive understatement,
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Alright, let's get back to it.
When it comes to performing liposuction, there are several different procedures that can
be done each with their own techniques, equipment, complications, recovery time, and associated
cost.
So, let's just go ahead and assume that someone's getting a classical liposuction.
First, the surgeon will mark the area typically with circles to indicate areas that will be
suctioned and then hash marks that will indicate areas to avoid such as what are called the
Zones of Adherence which are areas where the fatty tissue is strongly connected to the
underlying fascial tissue.
If they're to perform liposuction in the zones of adherence, that area will lose its contour
which is obviously a bad thing.
Depending on the exact procedure as well as the opinion of the surgeon performing the
liposuction, the patient could be given a local, regional, or a general anesthetic.
Now, it's my understanding that the vast majority of these procedures are extraordinarily painful
in the moment, given the fact again that you are literally sucking fatty tissue through
a tube while narrowly missing nerves and blood vessels and in some cases actually hitting
nerves and blood vessels which is why I believe that most board-certified plastic surgeons
prefer to do liposuctions under general anesthesia.
You know, that way the patient is unconscious.
Again, as their fatty tissue is literally being sucked out of their body.
The most fat that could be at one time in an outpatient setting is five liters which
equates to ten pounds worth of fat.
However, most individuals don't get this much done in one time and instead hover around
three to four liters at maximum.
If you want to go above five liters, you'll need to do so in a hospital setting.
That way they can monitor you given how much blood loss that can occur during the procedure.
When under anesthesia, the surgeon will begin the process and again, depending on the specific
procedure, this can look pretty different.
In some cases, they'll use an ultrasound or even a laser to help liquefy the fat before
sucking it out but in the most popular form of liposuction called Tumescent Liposuction,
they'll inject saline, lidocaine, and epinephrine into the fatty tissue which will cause the
area to become numb while also causing it to firm and stiffen up and at the same time
constricting blood vessels to prevent blood loss.
They'll then insert a Cannula which will be attached to either a syringe or a vacuum and
the tip of the cannula is blunt.
This helps to prevent damage to the surrounding areas but following their markings, they'll
then traverse back and forth even going in a crisscross direction ensuring they get as
much fat as possible.
Again, depending on the type of procedure, many different types of cannulas can be used
including micro-cannulas or cannulas that vibrate back and forth making it easier to
break up the fatty tissue and then suck it in.
In what's called a high-definition liposculpture, they'll strategically leave fat behind in
order to give it a more sculpted and muscular appearance, again, leaning on the skill and
creativity of the surgeon.
When they're all done with the liposuction procedure, they may or may not choose to use
sutures on the incision depending on a variety of factors.
So, the benefit of not suturing the incision is that the tumescent fluid can actually drain
out of the body.
However, for certain individuals, you may have a less visible scar by suturing and just
have an overall better healing experience.
So, it really just depends on the surgeon to decide what's best.
Either way, they'll place pressure bandages on the incisions which will allow the remaining
fat to help close the wound up from the inside.
They'll also provide the patient with compression garments to wear which will assist with tissue
adhesion as well as limiting swelling.
As with every surgical procedure in existence, there are bound to be complications.
I mean, the body is not meant to be cut into without having some consequences.
Now, the most common complication is going to be swelling and bruising and I mean, this
is a direct product of the cannula literally scraping the fat out from the body.
Now, the swelling and bruising tends to last for about a week or two and then once all
the broken down fat and fluid that is still inside is absorbed by the body, the area will
become very hardened and after about four weeks, it'll start to soften and then after
about eight weeks in total, the entire area will feel relatively normal.
Another potential complication are what are called Seromas which are serous fluid collections.
Now, this is typically a product of over suctioning in the area and breaking down a lot of the
fibrous tissue so there's not a lot of adherence with the tissues after the surgery.
So, what will happen is fluid will start to fill into that space but it also can occur
if a patient is repeatedly taking off their compression garment - again, the tissues then
start to create space and fluid will go in there.
So, what they'll do is provide some more bandages that can kind of be placed under the compression
garment and just squeeze the area closed and typically this will result after about a week
or so.
Another potential complication is just surgical error in the form of over or under correcting
or maybe there's asymmetry or even surface irregularity.
So, essentially, either too much fat was taken or not enough fat was taken or it was taken
in an uneven format.
So, in order to fix this though, you're going to have to wait about six months post op.
That way the body can heal up enough to then undergo the knife again but essentially what
you'll do is liposculpture to fix the problem.
So, if it was an over correction, well, then you are going to place fat in that area.
If it was an under correction, you're going to perform liposuction.
So, liposculpture will be the answer.
Now, it is also possible for penetrating injuries to occur.
This is where the cannula goes too far or too deep or maybe breaks nerves or blood vessels.
There's been cases where the cannula has actually penetrated into the abdominal cavity which
is absolutely frightened.
And this is why it's so important to go to a board-certified plastic surgeon because
they're going to be trained in understanding in the underlying anatomy and are far less
likely to make those mistakes.
Now that we've discussed liposuction in some detail, I want to pose an important question
to you - are there physiological consequences to removing adipose tissue from the body?
Now, for most of medical or modern medical history, I should say, adipose tissue has
been considered to only have two functions and that's going to be storing calories or
excess calories and then insulating the body.
However, in recent decades, adipose tissue has been discovered to be metabolically dynamic
- participating in functions such as coagulation, appetite regulation, immunity, and even body
weight homeostasis and plenty others.
Now, look, I am not here to say liposuction is bad or shame anyone for receiving it.
As I mentioned earlier, there are clear benefits to liposuction but when you study and inspect
the body the way that Jonathan and I do here in the Cadaver Lab, you begin to wonder just
how much we don't know yet and also start to ponder what potential consequences might
be on the horizon due to our ignorance.
Thanks again to Noom for sponsoring today's video.
Be sure to click the link in the description below to take your free Noom evaluation today.
As always, be sure to like, comment, subscribe if you feel so inclined and I'll see you in
the next video.