In some cases, fat tends to accumulate as adipose pads, whose volume increases, slowly, but progressively. Such pads, which are often inappropriately called cellulites, can alter the silhouette of a person in a way that can be very evident and unpleasant. With liposuction (or lipoaspiration), microlipoaspiration and with liposculpture, it is possible to remove exceeding fat, which is present in well defined body areas, such as hips, double chin, stomach, knees, buttocks, etc. in order to bring the body back to a more harmonious and pleasant profile. The modern concept of the remodelling of the body adipose tissue – through liposuction, microliposuction and liposculpture – consists in the regularization, as much as possible, of the body outline, bringing the shapes of a specific area back to the appropriate proportions.
Liposuction, microliposuction and liposculpture are methodologies used to produce better proportions among the several elements of the body, a better ratio between the concavities and convexities of the profile, with more proportionate volumes. Excessively protruding buttocks can be reduced in volume, while flat buttocks can be better highlighted with a liposuction or lipoaspiration reducing the adipose tissue of the small of the back and of the hips, conferring to the buttocks an aesthetic effect of a greater projection. To better highlight flat glutei, it is also possible to increase their volume following a technique of self-transplant of autologous fat that has been drawn with lipoaspiration from other areas of the same person (see lipofilling – liporestructuring). Even in other sunken areas it is possible to implant fat that has been drawn from areas in which it is exceeding.
During the operation on a person, it is possible to use several liposuction (or lipoaspiration), microlipoaspiration and liposculpture methods, combining the several techniques, according to the cases and to the body area that needs to be treated. The best results are obtained on patients with localized adipose deposits, which resist the loss of weight and physical activity. It is important not to consider liposuction as an alternative to a diet: while a diet is needed to reduce the adipose mass in a uniform way, all over the body, both at a subcutaneous as well as at a deeper level, lipoaspiration is needed to reduce the adipose tissue only in the parts undergoing the aspiration. Therefore, in a situation of general obesity, the patient will have to undergo a slimming diet, while in the presence of exceeding adipose tumefactions localized in specific areas of the body (for ex. hips, glutei, thighs, shoulders, ankles, double chin, etc.) liposuction, microliposuction and liposculpture are suitable to improve the body outline.
Liposuction, microliposuction and liposculpture are surgeries in every respect. They have to be performed in a sterile operating room, by an experienced Aesthetic Plastic Surgeon, who thoroughly knows the principles of surgery and the surgical anatomy of the area to be treated. The general and local conditions of the person who wishes to undergo liposuction must be checked before surgery, discarding – after a careful assessment – the subjects presenting contraindication to the operation, such as disorders in coagulation, heart diseases, varicose veins, hypertension, uncontrolled diabetes, etc. Correct patient selections, as well as an accurate execution of the surgery, make liposuction a reliable operation. The number of lipoaspiration operations carried out in Italy and in the world every year is enormous (in the USA only, the number of liposuction operations exceeds 300.000 operation per year!). Liposuction is a surgical operation in every respect and, as such, it has to be performed by and expert surgeon, assisted by a group of specialists, in a sterile, equipped and suitable environment.
To aspirate adipose tissue, a tiny cutaneous incision of a few millimetres is performed at the end of a skin fold, next to the “pad” to be removed or in hidden areas. A thin cannula with one or more aspirating fissures is introduced through such incision. Inside the cannula is hollow: through a sterile and flexible tube, it is connected to a device aspiring fat (lipoaspirator). This equipment retains the fat that is aspired to assess the amount of the mass that has been removed. Under the ongoing control of the surgeon, the surgical tool moves forward in the adipose tissue to be removed with a continuous forward-backward movement. The reduction of the adipose tissue removed through liposuction, microliposuction and liposculpture is definitive, because the adipose tissue that has been taken away cannot form again. With surgery, it is possible to remove as many as three litres of adipose tissue – made of cell clusters with all their fat content (adipocites), grouped in masses of adipose lobules – in a definitive way. Each adipose lobule contains many adipose cells, full of the fat gained through food. Therefore, the result of lipoaspiration is to be considered a definitive correction. Should the same person, in the future, gain weight, it is intuitive that fat can deposit again on the residual adipose tissue that has been left on the aspirated spot (it is reduced to bring it back to standard, but it is never removed completely), given that the same spot increases in volume. But this happens in a harmonious way, as in other areas that did not undergo surgery. Obviously, the volume will increase starting from a mass that has been definitely reduced, compared to whatever was there previously, therefore fattening will be more harmonious with the rest of the body.
Liposuction, microliposuction and liposculpture do not directly solve the problem of the so-called “orange peal” look that is typical of cellulites, but indirectly they can improve it, reducing the compression and the turgidity exercised by the subcutaneous adipose tissue on the overlapping skin.
Immediately after the operation, the appearance of ecchymoses on the areas which underwent surgery is quite frequent; generally they are of modest entity and they reabsorb spontaneously after a few days. In expert and scrupulous hands, complications as a consequence of liposuction, microliposuction and liposculpture occur seldom and, anyway they are solvable. In time, it is infrequent that a slight cutaneous irregularity or an asymmetry of the body outline occurs: anyhow, it is possible to correct it with a readjustment. According to the amount of fat that needs to be aspirated, the liposuction, microliposuction and liposculpture operation can be performed in local anaesthesia, without hospitalization, or in local anaesthesia together with a mild general sedation, administered by an anaesthetist, or in general anaesthesia with one day hospitalization.
After the surgery, it is necessary to wear a suitable elastic-compressive garment directly in contact with the skin, for as long as 2-4 weeks; it can be slipped off to have a shower or to wash it.