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Smoking seriously constricts blood vessels and therefore decreases blood flow to a given area resulting in poor healing. Aspirin and certain anti-inflammatory drugs and other medications can cause increased bleeding, so you must avoid these.
Determining your suitability will partly be defined by the quality of your skin. In most cases the skin being a dynamic organ, is able to shrink and reaccomodate to the new body contour after liposuction. In the some cases however, patients may have decreased skin elasticity as witnessed by loose, hanging, or creepy skin in the affected area. In these cases liposuction alone will not produce the desired result and you may therefore require some form of skin removal/reduction instead (i.e. tummy tuck) or perhaps in combination with liposuction.
The best patients for liposuction are those individuals who are active and healthy, of average or near average weight (within 12-15% of their ideal weight), and have reasonably good skin tone and elasticity. Age by itself is not a significant factor and in fact patients from age 16 - 65 have benefited from liposuction.
 You should also understand that liposuction by itself will not improve the dimpled skin condition known as cellulite.
What is Liposuction with the Tumescent Technique?
The most significant refinement in liposuction over the last decade has probably been the development of the Tumescent Technique. The tumescent technique of liposuction involves the injection of relatively large volumes of a saline solution containing dilute local anesthesia and adrenaline into the fatty tissues, thus forming a safety cushion on which the cannulas can slide.
More importantly, these elements contribute to the loosening of bonds between the fatty cells, thereby facilitating their removal. As a result of the adrenaline there is a decrease in the bleeding from blood vessels thus allowing us to remove larger quantities of fat more safely. Less bleeding also means less bruising. The infiltration of large volumes of dilute an anesthesia also allows the procedure to be performed under local anesthesia with or without sedation if desired.
What does the operation involve?
The following is a description of the classic liposuction method utilizing the tumescent technique.
To begin the operation a number of tiny incisions (about 3-4mm) are made in the skin in the areas to be treated. These slit incisions are made, when possible in inconspicuous places. Subsequently the areas are injected with the tumescent solution mentioned previously. The solution is then allowed to diffuse and take effect (about 10-15mins) throughout the target fat. As mentioned the solution will numb the areas as well as reduce bleeding by temporarily closing down the capillaries. The appropriate cannulaes are inserted into the fat, and then through backward and forward stroking motions the fat is loosened and drawn off by a strong vacuum pump.
Since the fat is removed by suctioning small "tunnels" through the fat, the skin remains intimately connected to the underlying muscles by multiple attachments called fibrous septa. These can be described as being the body's "Velcro". It is this process and these structures, which assures that the skin will not hang in loose folds after Liposuction. The fat is removed by doing as little damage to the septa, which also contain blood vessels, nerves and lymph vessels. For this fat to be removed without serious damage requires an excellent knowledge of the anatomy, an appreciation of body proportions and of course, surgical and mental stamina.
Throughout this procedure Dr Skarparis is always conscious of leaving a smooth layered thin blanket of fat attached to the underside of the skin, in order to minimize the possibility of any irregularities or rippling of the skin.
Because you'll also lose some fluid along with the fat during liposuction, it is normal practice for the anesthetist to give intravenous fluids to replace those lost in the procedure.
What type of anesthetic is used?
Liposuction can be performed successfully either with a local anesthetic alone, local anesthesia with mild sedation (twilight anesthesia) or with a General anesthetic (completely asleep). If you decide to have it done with a local anesthetic, you will probably feel some vibration and friction during the procedure. You may also occasionally feel a stinging sensation as the cannulae moves closer to the muscle. Obviously if you are put to sleep then you will not be aware of anything.
The decision very much depends on: the number of areas treated, the amount of fat to be removed, any pre-existing medical conditions or unique circumstances and of course the individual patients desires.
How long does the surgery take?
This depends on the number of areas treated and the amount of fat which will be removed. Therefore this can be anywhere from 30 minutes to 2 hours.
Do I need to stay in overnight?
This very much depends on the number of areas treated and the amount of fat that is removed. It also depends on the individual's preference and circumstances. Some people prefer day surgery so that they can recover at home whilst others prefer the reassurance of a hospital environment on the first night following surgery. Certainly when small areas, with less that 1.5 liters of fat are removed, day surgery can comfortably be undertaken. When the amount of fat exceeds this, it may then be preferable to decide on an overnight stay.
The decision for this can be made at the time of the consultation visit.
How much fat can you extract?
It is important to understand that there is a maximum safe limit to the amount of fat that can be extracted during any one operation. This is usually between 2.5 - 3 liters. In some instances therefore you may want to repeat or have more removed at another time. It is usually best to wait at least three months between procedures.
How much weight will I lose?
The answer is very little. In fact in the first few weeks after surgery you may notice a slight increase in weight due to water retention. The reason that you don't lose much weight is because taking out up to 2.5 or even 3 liters of fat (which is the safe maximum limit) is not enough for you to see a significant drop in your weight. This is because fat cells don't actually weigh that much. On the other hand however, depending on the treated area of course, you will notice a significant decrease in girth measurements.
Is it Painful?
There are very few forms of surgery that are completely painless. Discomfort is a euphemism for pain and many doctors use these interchangeably. In the case of liposuction, the degrees of pain vary from patient to patient but this can be controlled by analgesics, which will be prescribed. The initial pain lasts around 1 week however there may be residual soreness in the treated area, mainly upon palpation, for up to 4-5 weeks. Along with the soreness you may experience some stiffness, which usually abates, as your mobility increases.
Will the Fat come back?
The short answer to this is no. As fat cells have achieved their set number in any given part of the body by puberty, increased caloric intake will not lead to volume gains in the treated site. It is important nonetheless to maintain your weight afterwards by sensible eating and regular exercise. You must understand that if you do take in excess calories after surgery, you will then notice other areas of your body increasing in size. Of course if there is a massive weight gain then new fat cells will also be seen in the previously treated areas.
What happens immediately after the Operation?
After your surgery, depending on which area you've had treated, you will find that a snug elastic compression body stocking or garment will be in place. This must be worn over the treated area to control swelling and bleeding, and to help your skin shrink to fit your new contour. You will need to wear this garment compression continuously for one week (apart from taking it off for a shower) after surgery, then just in the daytime for a few weeks more.
For treatment of the abdominal region however application of a garment very much depends on how comfortable and snug the actual garment feels. The abdominal area is notoriously difficult to apply compression to, due to the lack of any underlying bony support. It certainly needs to be in place however for the first 72 hours. After this time, it depends on the individual. If the garment feels comfortable and you feel it is providing you with support then wear it for 7-10 days, taking it off for showering. If however, it feels as though the garment is digging into your abdomen it may be preferable to loosen it or not wear it. Ill fitting garments may lead to the development of undesired folds in the skin, which subsequently harden and form ridges, and which can last up to 3 months.
What kind of effects can I expect after Surgery?
After the surgery you will notice that you will be draining some fluid from your tiny incisions. This is because there is almost always some fluid build up (usually bloody) that develops in the treated area in the first 24-36 hours postoperatively. Your incision sites therefore will act as "drainage holes" in this instance and are therefore invaluable in reducing overall post operative swelling and bruising.
Drainage of the fluid is possible because, unlike traditional teaching, Dr Skarparis does not use stitches to close the small incisions. As the incisions are very small, these seal off and heal quite quickly on their own and the ensuing scar is no different, if not better, compared to the use of stitches. There is also the obvious advantage in that it negates the need for stitch removal. The down side of this practice is that during the first day or two, your dressings and clothing will usually get soaked quite quickly and therefore you will require regular changes. Thankfully all this usually stops by the end of the first 48 hours after surgery.
Despite wound drainage, you are still likely to experience swelling and bruising to varying degrees. Sometimes this bruising is quite spectacular. Bruising can take up to 3 weeks to disappear although very occasionally a light tinge of yellow can still be seen in the skin up to 2 months following treatment. Tissue swelling, while expected, can last up to 4 weeks. In fact because of this swelling you will probably not notice any change in your size immediately after surgery. It is important to remember that when the abdominal area is treated, the swelling and bruising can migrate downwards to the groin and genital region. In men this would mean substantial swelling, bruising and discomfort of the external genitalia. This usually lasts about 7-10 days, and one may benefit from the use of support underwear instead of boxer shorts, in this instance.
At around 2-3 weeks after surgery, you will discover that the areas treated will feel hard and irregular. This is part of the normal healing response. The body starts to lay down scar tissue (which is hard in nature) in response to surgery in an attempt to "heal" itself. This scar tissue can also block lymph drainage channels temporarily and occasionally cause the skin overlying the treated area to look dimpled or take on an "orange skin" appearance. Thankfully the scar build up ceases and eventually resolves completely, along with its manifestation. However this period of hardening and irregularity can take up to 4 months to resolve.
You will also experience sensory changes in the area treated. This may result in numbness of the skin or alternatively it may feel hypersensitive. Either way this is usually temporary and returns to normal in about 6-8 weeks.
Overall because of these effects, it's not unusual to feel depressed in the days or weeks following surgery. Try to keep in mind that this is normal and will subside as you begin to look and feel better.
What are the scars like?
Scars are not a complication but a normal event after any surgery. Thankfully scars in liposuction surgery are tiny. Depending on the area(s) needed to be treated, scars about 3-4 mm in length will form. These are usually placed in natural folds of the skin where possible. Generally about 2-3 incisions are required for any given area.
Thankfully the scars in Liposuction are short and generally heal quite well, gradually fading with time. However it is important to keep in mind that this may take up to two years to complete. If you are of a darker skin type however, then expect your scars to be darkly coloured for a longer period of time (about 3 years). Daily massage of the scars during this time period is advised to expedite and facilitate this process. You must understand however that no responsible surgeon will ever be in a position to predict any scars ultimate appearance.
What can go wrong?
All surgery carries some uncertainty and risk. When liposuction is performed by a qualified Plastic Surgeon, complications are infrequent and usually minor. Still, individuals vary greatly in their anatomy, their physical reactions, and their healing abilities, and the outcome is never completely predictable.
Thus complications that can occur include thickened, deeply coloured or unattractive scars at the site of the small incisions; irregularities of contour or dimpling of the area treated; unevenness or asymmetry between sides; prolonged numbness and swelling; haematoma or seroma formation (a collection of blood and fluid under the skin that must usually be drained by the surgeon), and infections. In extremely rare cases, skin loss resulting in permanent scarring has been reported.
Despite any surgeons best efforts, it is possible that a small number of patients may require a secondary tidy up procedure, usually after 9-12 months, to correct or improve any residual uneven contour or shape irregularity. This will be determined at the follow up checks.
How long before I Get back to normal?
The recovery time varies with how many areas are treated and the type of activity the patient intends to resume. It is important to realize that although only tiny incisions are made, liposuction creates a large wound hidden under the skin and therefore as healing is a gradual process, adequate rest in the days after surgery will be required. However you should start walking around as soon as possible to improve the circulation and avoid stagnation of blood, which could lead to the formation of blood clots. Most patients resume light activities within 2-3 days and depending on their work can be back between 5 -7 days. However because of variations in swelling and bruising, sometimes this may be delayed up to 7 -10 days. Exercise is usually recommenced at about 10 -14 days. Don't be depressed however if it takes you longer to resume your full activities. Remember every individual is different and great variations occur.
Summary
Liposuction is the most popular cosmetic surgery procedure .It is a highly effective technique for giving you a new body contour with minimal scarring. In most instances it improves body image by making you feel better and more comfortable about your body both with and without your clothes.
The results can be permanent, providing you eat sensibly, exercise regularly, and maintain your weight. As long as your expectations are realistic, and understand that the final results may take a few weeks before becoming apparent, you should be happy with your new shape.
These notes are for guidance but you must realize that every patient is different with a different healing capacity. You should contact your surgeon in case of any specific concerns.
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