Published on : 01 July 202120 min reading time
What is Liposuction?
Liposuction is a procedure which removes localized fat deposits to shape one or more places on your body. Liposuction improves your body’s shape by intrusion and removal of subcutaneous fat using metal cannula connected to a vacuum device through a tube. It enables to suck the fat from the required areas. The suction cannula is inserted in the body through short incisions, maximum several centimeters in size, which are located in the natural skin folds to be as little visible as possible when healed up. Liposuction can help sculpt the body mainly in the abdomen, hips, buttocks, thighs, knees, upper arms, chin, cheeks and neck. Liposuction is suitable if you have fat deposits in so-called problematic parts of your body and exercise and diet do not help. It cannot be used to treat extreme overweight or obesity!
Why Liposuction Prague?
Prague has many attractive features for those considering liposuction abroad. Its location in Central Europe is easy to access; its mild climate is conducive to healing and its experienced clinics and liposuction surgeons ensure you’ll receive the best possible care. Liposuction Prague costs are often much more affordable than in the UK or with the NHS. For more information about getting to and around the Czech Republic, please visit our handy cosmetic surgery Prague info guide.
The liposuction techniques are divided into dry and wet (fluid is not or is used). According to the device used and cannula type liposuction can be divided into classical, power-assisted, ultrasound-assisted and laser. They all use the same principle where the intruded fat tissue is removed through a narrow tube – cannula. The cannula is inserted under the skin and using the vacuum it removes the excessive fat tissue. The methods of liposuction and anesthesia maybe combined in various ways. The final result depends on how much tissue is removed, how experienced the surgeon performing the procedure is and, of course, on the technique and anesthesia used.
Dry technique: The technique does not use any fluid injection – therefore the name Dry Technique. A higher suction must be used in this method which may lead to higher blood loss or tissue damage resulting in more significant unevenness. The method is considered as obsolete and is seldom used today.
Wet techniques: The fluid is injected under the skin. The wet techniques differ according to the amount of used fluid. The fluid is a mixture of saline solution (solution of sodium chloride), adrenaline (substance contracting blood vessels) and it may also contain an anesthetic. The technique facilitates the removal of fat, reduces blood loss and if an anesthetic is included it also provides anesthesia during and after the surgery. The injected fluid also helps to reduce bruising.
- wet technique (simple wet technique)
The volume of injected fluid is lower than the expected volume of removed fat. Usually 200 – 300 ml of the fluid for the treated area.
- super-wet technique
The volume of injected fluid approximately equals to the expected volume of removed fat. The technique is similar to the tumescent technique, except that a local anesthetic is not usually contained in the fluid or only in small amounts.
If the tumescent liposuction technique is used, large volumes of fluid are injected into the treated area through a 12cm-long needle which is tubed to a bag with the diluted solution. The fluid is infused slowly using a pump operated by a foot, which enables the surgeon to control the flow easily. The tumescent fluid contains a local anesthetic, usually lidocaine, to provide local anesthesia in the treated area. It enables to perform the procedure without the necessity of general anesthesia. The procedure performed under local anesthesia takes more time than liposuction under general anesthesia. It is necessary to wait for the effect of the local anesthetic and thus inject the fluid into each area just before the suction. The amount of the anesthetic and thereby the amount of the fluid is determined by the weight of the patient. The volume of fluid is usually 2-3 times higher than the volume of the sucked fat. It results in a solid swelling – tumescence, the skin in the treated area becomes white and cold. When the tumescent solution has been applied the suction of fat tissue can start. The liposuction is performed through a cannula tubed to a device which uses vacuum to suck. Different types of cannulas may be used with this technique. The biggest advantage is the possibility to position the patient as the procedure is performed under local anesthesia. The patient is conscious he/she can turn as needed, lift limbs or stand up. Some fat may be after a palpative and visual check removed when the patient stands.
Power-assisted liposuction – PAL
Power assisted liposuction utilizes a so-called vibration cannula that gently vibrates in quick micro-movements within 0,5 – 1 mm back and forth. The cannula is connected to a special device which produces the necessary power. It carefully penetrates fibrous fat tissue – e. g. in buttocks or back. At the end of the procedure it helps to smooth irregularities in the sucked area and its borders to make the transition from sucked to non-sucked area even and smooth. It is used for example in repeated interventions in the tissue. Most clinics use the advanced Vacuson LP 60 equipment which includes the vibration cannula, a device for solution infiltration and a sucking device. Presently, most experts consider the combination of tumescent liposuction, which is due to the contain of an anesthetic in the infiltration solution performed under local anesthesia, and vibration cannula as most advanced as well as most effective and sparing method.
Ultrasound-assisted liposuction uses a special cannula that produces ultrasonic energy. The energy bursts the walls of the fat cells and the fat is then liquefied. Ultrasound liposuction can be an effective tool for removing fat from fibrous body areas, such as the upper half of the back or enlarged male breasts. The advantage of ultrasound liposuction is the ability to penetrate the more fibrous tissues, e. g. fat tissues. It may be used in repeated liposuctions. Another advantage is a lower blood loss. There is a danger of skin burns unless the technique is performed correctly. The fat is removed in the same way as in other liposuction techniques. The combination of the tumescent method with ultrasound cannula is also a suitable however rare method due to the higher costs of the ultrasound device.
Under the term ultrasound liposuction we often encounter a non-invasive fat removal method where ultrasonic energy is applied to the fat tissue from outside the body. The fat cells are broken and purged by the natural metabolism of the body. Ultracontour and Ultrashape are devices using this advanced technology. The term non-invasive liposuction or E-UAL – external ultrasound-assisted liposuction may be rather misleading as it is not liposuction in the true sense of the word. No fat is sucked away.
Laser-assisted liposuction known also as ultrasound lipolysis uses a 1-2 mm wide cannula with a laser beam. With the forth and back movement of the cannula the energy is applied directly to fat cell, dissolves it and enables its removal. The laser beam also affects hypodermis, contracting collagen fibers. The liquefied fat tissue is not usually sucked in small localities. It is gradually absorbed during natural metabolism. In larger areas it is necessary to suck the fat tissue liquefied by laser. According to the laser type used we know SmartLipo and CoolLipo. Most clinics use a vibration cannula for the suction; it means they combine laser and power-assisted liposuction.
The liposuction cannula diameter is important in all liposuction technique. Wider cannulas suck more fat and save time and effort. However this type of cannulas leaves more empty space behind and therefore creates bigger irregularities on the skin surface. Presently, cannulas with smaller diameters are used more often as they are considered more delicate.
In out-patient liposuction under local anesthesia it is not advised to remove large amount of fat at a time but divide the procedure in several sessions. The suction of larger volume of fat, which also removes water, vitamins and other nutritious substances, can cause a state of collapse (shock). More extensive liposuctions (more than five litres of fat) should be performed by wet technique under general anesthesia. They require careful post-operative care including 1-2 days of hospitalization, replacement of lost liquids by infusions, pain relieving therapy.
Liposuction may be performed under local or general anesthesia or with tumescent technique.
- local anesthesia
Liposuction in small areas may be performed under local anesthesia, i. e. the treated area is filled with a solution of local anesthetic.
- tumescent technique
Tumescent technique uses a rather diluted solution of a local anesthetic. The anesthetic is absorbed from the tissue with contracted vessels (effect of adrenalin) to blood circulation slowly and the limits for the anesthetic contained in blood are not exceeded. There is another advantage as due to the slow absorption the local anesthetic operates in the target area on a long-term basis. The disadvantage is the toxic effect of lidocaine. With this technique you may feel discomfort when the fluid is being injected.
- general anesthesia
With a general anesthesia the patient sleeps through the entire procedure and all pain is eliminated. The pain is controlled only during the procedure; when the operation is over painkillers must be administered. The choice of analgesic depends on the scope of the procedure. It is necessary not to drink, eat and smoke for about six hours before general anesthesia. Note that general anesthesia is an interference with the organism and has some risks. Presently the liposuction under general anesthesia involves super wet or wet technique and the fluid usually does not contain an anesthetic.
Tools and equipment used for liposuction
Infiltration pump – is connected to a tube system. It is designed to infuse the infiltration fluid into hypodermis.
Suction device – is connected to the liposuction cannula through a tube system. It enables the suction of fat.
The suction device and infiltration pump may be included in one instrument (e. g. Vacuson LP 60 which produces also the energy for the vibration cannula).
Liposuction cannulas – have various diameters from 2 to 4 mm (sometimes 6 mm), various lengths, curvatures; the ends are either rounded or in the shape of a pointless chisel. Each type has its purpose.
There are also the aforementioned power-assisted cannulas, ultrasound cannulas, laser cannulas. Their equipment must include an ultrasound or laser device to produce the energy.
Containers for sucked fat – they are transparent to check the addition of blood and the amount of sucked fat, mainly to compare two sides.
Before liposuction surgery
During your initial consultation, your surgeon will explain the surgery in detail, discussing which liposuction techniques are most appropriate for you. You will together determine where your fat deposits lie and assess the condition of your skin. Be sure to discuss your expectations frankly with your surgeon. You should be realistic in your expectations. The surgeon should be equally frank with you, describing your alternatives and the risks and limitations of each liposuction technique. You should realize that general anesthesia is a significant risk and load for your organism, in particular in case of heart and vascular diseases. During the procedure unexpected complications occurred in some patients, e. g. heart failure due to the fluid overload, allergic reactions to the anesthetic or even death. It is necessary to consider especially following cases:
- high blood pressure
- heart and lung diseases
- diabetes mellitus
- drug allergy
- thrombotic tendency
- bleeding disorders (clotting disorders)
- endocrine disorders (e. g. thyroid)
Your surgeon shall give you instructions to prepare for the surgery, including guidelines on eating and drinking, smoking, and taking or avoiding certain vitamins and medications. You may be asked not to use any medications containing acetylsalicylic acid (such as Acylpyrin, Aspirin, Alnagon, Mironal, etc.) They can increase bleeding during and after surgery. It is assumed that no illnesses (viral illness, cold, etc.) will have occurred at least three weeks before the planned operation. Report any illness to your doctor. If you smoke, plan to quit at least one to two weeks before your surgery and not to resume for at least two weeks after your surgery.
The liposuction surgery
Liposuction surgery takes one, two or even five hours, depending on the scope of the procedure (size and number of the treated areas, amount of fat being removed, the type of anesthesia and the technique used.) Before the surgery the surgeon marks the area on the skin from which the fat should be removed. The marking should be performed in standing position as in lying position the locations of subcutaneous fat change and the anatomic relations may be distorted. Disinfection shall be applied on the marked place and its surroundings when in the operating theatre or surgery. The place is covered by sterile towels to prevent contamination of surgical tools and subsequent infection.
Depending on the liposuction technique used (except dry technique) the infiltration solution shall be infused in the marked area. Its content depends on the type of technique: with a local anesthetic for tumescent technique and without an anesthetic for wet techniques under general anesthesia. The solution is infused from an infusion bottle connected to a tube with a needle on the other end. The needle is punched into the hypodermis under the marked areas, usually through several punctures, to fill the whole area equally with the fluid. It is important to infuse the solution slowly to give the body time to adapt and in a sufficient amount to suck the fat totally. A pump is used to apply the solution. If the procedure is performed under local anesthesia it is necessary to wait circa 40 to 60 minutes until the anesthetic takes effect.
Then the most important stage, the suction of fat, is performed. It takes usually 40 minutes. The surgeon makes an incision with scalpel, usually 2 or 3 incisions for one treated area. The liposuction cannula (narrow tube) shall be applied into the hypodermis through the incision (circa 3- 6 mm) and the layer of fat shall be sucked. During the procedure the cannula moves from base to surface (up and down) to prevent any damage to the underlying muscle layer and upper skin cover. The movements must be gentle and even; it is an accurate job. During the liposuction it is possible to change cannulas with different diameters. The most difficult part is the suction of borderlines of the marked locality. The cannula is connected to a vacuum device and the fat is sucked through a tube to the collecting container. The sucked fat is mixed with blood and has peach-like color. The surgeon continuously checks the appearance of the sucked fat and according to the color of fat evaluates the extent of bleeding. In the end the incisions are sutured and dressed with a sterile cover. At some clinics these minor wounds are not sutured but the rims are brought together by a steri-strip which is permeable for the rest of effluent tumescent solution and tissue liquid, and covered. The patient is immediately after the liposuction dressed in a compression garment which may be even tailored at the clinic. Its supply is included in the liposuction procedure. It prevents swellings and hematomas (blood clotts) and enhances the healing process. The liquid keeps leaking for 8 – 10 hours after the procedure is over or even longer and therefore the patients are provided with absorbent mats which may be changed when at home. Corrective procedures or repeated liposuction are not recommended within six months following the initial procedure.
Are you a good candidate for liposuction?
To be a good candidate for liposuction, you must have realistic expectations about what the procedure can do for you. The best candidates for liposuction are normal weight people with firm, elastic skin who have pockets of excess fat in certain areas. You should be physically healthy and psychologically stable. Your age is not a major consideration; however, older patients may have diminished skin elasticity (around 40 years of age) and may not achieve the same results as a younger patient with tighter skin. The procedure then combines with plastic surgery which removes the excessive skin.
Not all areas are suitable for liposuction. There are so-called prohibited areas which include the lower part of buttocks. Some areas are not explicitly prohibited but the liposuction is not recommended due to the anatomic localization, e. g. back. Other unsuitable areas are those with excess skin or even an overhang.
Liposuction is a high-risk procedure for people with health disorders as diabetes mellitus, heart or lung diseases, blood circulation insufficiency (in particular in case of general anesthesia) or for those who have recently undergone an operation near the area to be treated.
After liposuction surgery
Some infiltration solution and tissular fluid shall outflow from the incisions after the operation. It is fluid which was not sucked and has not been absorbed by the organism yet. The fluid may be colored by blood – there is no need to worry. The outflow stops after approx. 10 hours. At some clinics a small drainage tube (so-called drain) may be inserted beneath the skin for a couple of days to prevent fluid build-up. To control swelling and to enhance your skin condition you will be fitted with a close compression garment. The garment cannot be taken off during first 24 hours after the operation. Than it can be taken off for 1-2 hours every day and perhaps washed. Most types of compression garment have a hole to enable toilet. The garment is worn for a period recommended by the surgeon; it depends on the practice at a clinic. Usually the period of 2 to 3 weeks (even at night) is recommended. The question of massages, so-called “rolling”, is rather discussed. Some surgeons advise not to roll and let the sucked areas quietly heal. Others recommend rolling – roll the sucked areas 3 times a day with a pastry rolling pin. You can go to work and do common activities after 2 or 3 days after the procedure performed by tumescent technique. Driving is not recommended immediately after the procedure; get somebody to drive you home. Sports are not recommended for 2 weeks. Wounds are covered by steri-strips for approx. 5-6 days and then the cover may be removed. The use of painkillers depends on every individual. Usually, it is not necessary or 1-2 tablets of Ibuprofen are sufficient. Tummy is a specific locality where rather strong sensitive nerves to innervate the tummy skin get out of rectus abdominis muscles. Note that during the liposuction under local anesthesia not only the fat but also the local anesthetic is sucked away, which means that the patient may feel pain of different intensity towards the end of the liposuction. Moreover in the tummy liposuction the cannula pulls these nerves which cannot be numbed as they run through the muscles and the pain may be really very unpleasant. The liposuction under general anesthesia is followed by a 1-2 day hospitalization and it is advised to wear the compression garment for 8 to 12 weeks. Sports should be avoided for 4 weeks. The period of wearing the compression garment depends in case of all liposuction techniques on skin conditions, amount of sucked fat, size of treated area and recommendation of the surgeon or clinic.
Shortly after the operation under general anesthesia you should start to exercise lower limbs, eventually stand up and make a short walk. It is a prevention of thromboembolic complications. The swellings and hematomas are individual, you are likely to feel stiffness, pain, burning or your sensitivity may be temporarily diminished. Your surgeon may also use antibiotics to prevent infection. It is not usual at every clinic. It is also suitable to use products for better healing as e. g. Wobenzym. The larger part of post-operative swelling disappears within 7 – 10 days. The stitches, provided the incisions are sutured, are usually removed within the week after surgery. Most of the burning and swelling usually disappears within 3 weeks. Healing is a long-term process and the recovery depends on your physical condition.
Don’t expect to look great right after liposuction surgery. New liposuction technique are more gentle than the old ones, despite, you shall experience some pain or itching for several weeks. The final result is apparent after 2 – 3 months, exceptionally after six months. At some clinics you will be checked regularly during the recovery to judge if you need any correction or you suffer from any complication. Some surgeons do not monitor you and you come only in case of complications. If you have bruises, sunbathing is not recommended. Sunbathing is also not advised for 3-6 months until the scars fade. During this period the scars may be covered by plasters or cream with a high sun protection factor.
As with any other surgery, complication may occur even after liposuction. Although it is not very often your surgeon should inform you on the risks. Complications may occur if your body has for example a reduced healing ability. Problems with recovery may occur if you do not observe surgeon’s instructions or you take unnecessary risk, for example when visiting solarium or doing sports. The skin may very rarely show:
- sensitivity disorder in damaged nerves
- skin relief irregularities
- skin pigmentation changes
- abnormal scar forming
- skin burns after laser liposuction
- subcutaneous seromas
- skin necrosis
Liposuction is a safe method of aesthetic surgery; however, you should follow all instructions of your surgeon and inform him/her on your health state. If the surgery is performed with precision by an experienced surgeon, the complications are minimal and the result is satisfactory. The liposuction of more than one area during one session is more complicated; eventually a combination of liposuction with other surgical interventions. It is performed rarely and mostly under general anesthesia.
Liposuction is always an aesthetic surgery paid by the client. The health insurance does not cover it as there is no health indication. The client cannot go on sickness leave and must plan holidays instead.
How long will liposuction results last?
You will see a noticeable difference in the shape of your body usually a week after the surgery. However, improvement will become even more apparent after about four to six weeks, when most of the swelling has subsided. If your expectations are realistic, you will probably be very pleased with the results of your liposuction surgery. You may find that you are more comfortable in a wide variety of clothes and more at ease with your body. By eating a healthy diet and getting regular exercise, you can help to maintain your new shape.