“Liposuction” means the suction of fat through a vacuum, and consists of the suctioning of fat from different areas of the body by using specially designed cannulas connected to a vacuum pump. The techniques that are also called “Liposhaping, lipoplasty, liposculpture, suctionassisted body contouring, suctionlipectomy, liposhifting” consist basically of the removal of excess fat from certain areas of the body and the injection of that fat to areas where it is needed. The goal in all these procedures is to change the body contours, and all of them are based on the ‘liposuction’ technique.

Which techniques are used in the liposuction procedure?
Liposuction procedure can be performed through numerous different methods:
* Dry technique: This is the technique where excess fat is removed without the injection of serum to the areas from which fat will be suctioned. This technique is not frequently used anymore.
* Wet technique: Serum is injected to the areas where fat will be suctioned. The amount of serum injected is close to the amount that will be suctioned. This technique is also no longer popular.
* Tumescent technique: In this technique, a mixture of serum, some anesthetic drugs, adrenaline, and sometimes bicarbonate are given to areas where liposuction will be made. The amount injected is almost 2-3 times the amount of fat that is planned to be suctioned. Thus the injected areas are anesthesized. Although some argue that general anesthesia will not be necessary in this technique, injection of large quantities of fluid may cause discomfort for the patient. Therefore either the patients are kept asleep with drugs during the injection, or general anesthesia is applied. This technique is currently the most frequently used one. All the cannula types used during the procedure aspirate the fat tissue in the area to be liposuctioned, while at the same time destroying neighbouring fat cells as they pass. Therefore overaggressive liposuction should be avoided, otherwise dimples in the skin may occur.

Methods of liposuction (fat aspiration):
• Ultrasound Assisted Liposuction:
In this method, the fatty tissues that are to be removed are destroyed with ultrasonic waves, then they are suctioned and extracted with special vacuum systems. The harvested fatty tissues may be used to shape the body. This method is often combined with the tumescent technique. Most specialists see the ultrasound assisted liposuction method not as an alternative to normal liposuction, but as a complementary method that is useful in harder areas, decreasing the amount of effort used during the operation. Some experts, on the other hand, claim that the use of ultrasonic technique is useful in forming a more regular body contour.
• Power-AssistedLiposuction:
The fatty tissues are extracted with special vacuum systemsThe extracted fat can be used to shape the body by injections. This method is freqeuntly combined with the tumescent technique.
• Laser Assisted Liposuction:
The heat generated from lasers at different wavelengths is used to destroy the fat, which is then extracted with special vacuum systems. This method also is combined frequently with tumescent technique.
• Laser Lipolysis:
The laser lipolysis method is more commonly combined with tumescent liposuction. It is often used in small areas to melt the fat tissue before suctioning it with a vacuum. Because the molten fat tissue is in small quantities, it is naturally excreted from the body without any problems.
• Superficial Liposuction:
In the superficial liposuction method, suction of the fat immediately under the skin is essential, in combination with deeper fatty tissues. Thus, in people with a potential of sagging skin, a tighter skin can be achieved. However it should be kept in mind that trauma to the level immediately under the skin may injure the vessels that nourish the skin, eventually leading to a worse healing. Color changes on the skin is other potential problem. Superficial liposuction may be used much more safely in the face and neck due to the rich vascular network. In this method:
• The superficial fat tissue is removed with fine cannulas,
• There is a small amount of irritation under the skin,
• A contraction happens in the skin, therefore a tighter surface is enabled,
• Excess skin is removed, cellulite is erased to some degree.
When this technique is applied by people with insufficient experience, problems such as permanent skin injury, permanent skin discoloration, increased number of blood vessels near the skin surface, or even loss of skin viability in the operative area may occur.

Which body areas are suitable for liposuction?
Liposuction can be basically applied to almost anywhere in the body. In women the the most common areas are the abdomen, hips, thighs, and the knees, whereas in men these are the waist, abdomen, and the breast. In addition, the arms, ankles, neck, nape, and the face are among the areas treated with liposuction.

Who are suitable for liposuction?
Contrary to common misbelief, liposuction is not an ideal technique for those who aim losing weight. However, it may occasionally be applied to assist diet and exercises for people who wish to lose weight. Liposuction is actually used for the removal of fat masses in areas that appear to be nonresponsive to exercise or other methods, in those people at their ideal weight or close to it. The procedure is applicable for patients of all ages; however the skin needs to be elastic enough so that it can regain its former tension after being emptied underneath. Otherwise the skin may sag, which will require removal through additional procedures.

Liposuction is not a simple operation that can be performed in offices or clinics, instead it is a serious surgical procedure. The first prerequisite is that the person is be healthy. Therefore the medical history and current illnesses of the patient must be examined in detail. In the presence of a systemic illness, the patient’s physician and the anesthesiologist who will attend the operation should consult and decide on the feasilibity of the procedure and the necessary precautions.

What preparations are necessary before the operation?
Before the procedure, areas with fat accumulation and their structures are assessed, and the results are discussed in detail with the patient. If losing weight will be useful before the operation, the patient is informed. Also, if the skin elasticity is poor, LPG treatment before the operation may be beneficial. Drugs that interfere with blood coagulation must be discontinued at least 2 weeks prior to the operation, otherwise excessive blood loss, blood collection in the operative site, and excessive bleeding may occur. Although some of these are transient, accumulation of blood in the operative site (hematoma formation) may lead to undesired results and irregularities. Some herbal products, vitamin E, Coenzyme Q may also lead to a bleeding tendency. In such a condition, the patient should consult to his/her physician and if necessary, stop using these drugs.

Which procedures are performed during the operation?
The operation is performed under general anesthesia, local anesthesia with sedation, or only local anesthesia. The patient should take a shower the day before or on the day of the operation. Areas that will be treated are marked before the procedure, and some medications are given to make the patient feel more comfortable. A special fluid is injected to the areas which will be suctioned (tumescent technique). This fluid will anesthesize the operative site, decrease the amount of bleeding, and thereby facilitate the process of fat removal. Depending on the selected method, special small cannulas are inserted, and the fat that will be removed is destroyed via ultrasonic waves or laser beams. The destroyed fat is suctioned with syringes that create vacuum, or with suctioning motors. The operative time differs according to the area of application or the amount of fat that will be removed. When the procedure is completed, a special garment is put on the patient. The purpose of the garment is to limit the edema, which is inevitable because the procedure is carried out in a closed area, and to provide ease in the movement of the patient.

How is the recovery period after the operation?
• A slight oozing of fluid from the cannula entry sites is normal for the first 12-24 hours following the operation. This oozing progressively decreases, and stops completely after a time. During the first 48 hours after the procedure, there is a collection of fluid (edema) in the body and the operation area. This condition increases during the second day, and begins to decrease starting from the 3rd day. Therefore it is beneficial that the patient rests during the first 2 days following the operation.
• A feeling of lassitude and fatigue in the following few days is normal, especially during the day after surgery. Keeping the intake of liquids high may ease these complaints. The goal of fluid intake is drinking 2 liters of various liquids that contain electrolytes (salt-sugar), unless the patient has diabetes or hypertension.
• After the procedure, a loss in weight on the scale should not be expected. Depending on the edema and the fulids given to the patient, the patient’s weight after the operation may be equal to the measurement before the operation, or it may even be greater.
• Antibiotics are used both during and after the procedure as a precaution against infection. Although fat suction with vacuum is not a very painful procedure, it may differ according to the patient’s pain threshold. This pain is often similar to the pain felt after streneous exercising; although it is more intense during the first days, it decreases during the following days. The use of painkillers is recommended after the procedure to alleviate the complaints. Another method that can be applied to ease the pain is cold compression application for 10-15 minutes, to areas that are causing discomfort. This can be done by putting ice into a glove or plastic bags, with a towel between the bag and the body. Ice should not be in direct contact with the skin.
• Beginning from the 3rd day following the procedure, the patient is free to walk around wearing a corset, and they can perform daily tasks without too much exertion.
• The patient is allowed to take a shower starting from the second day.
• Wearing the corset at all times during the first week is beneficial to the patient. The web part of the garment is designed to allow going to the bathroom without taking it off. After the first week, the garment can be taken off during the night and worn during the day for at least 2 more weeks.
• One week after the procedure, initiating exercises and taking long walks is very beneficial. During the following days and weeks, more strenuous activities are allowed. Entering the sauna, solarium, steam bath, and sunbathing should be avoided during the first 6 weeks after the operation. These result in the swelling of the tissues that are still healing.
• It generally takes 6 weeks for resolution of the swelling in the tissues, and for the body to attain the desired shape. Better results can be achieved if this period is supported by diets and exercises. If the patient has poor skin elasticity, then methods such as LPG application, ultrasound, and manual massage may be utilized. Especially in the presence of poor skin elasticity, irregularities in the form of dimples and bumps may be seen. These are more common during the early period after the operation, and wither away as the edema fades. However, they may be permanent in some conditions. At least 6 months should pass after the initial operation before attempting their correction.
• Although a decent wound healing is expected in general, abnormal scars may occur in the skin and deeper tissues. These scars are different in color than the surrounding tissues. Additional procedures, including surgery, are applied in their treatment.
• If the skin is lax and sagging, then the removal of fat with vacuum will not be enough. Surgical procedures that tighten the skin may be needed. If, despite the recommendations, the patient does not accept an additional procedure then problems related to sagging and excess skin may occur.
• When fat removal with vacuum is performed very close to the surface of the skin, some permanent color changes may occur. This condition may arise especially when the same area undergoes multiple procedures of vacuum fat removal.

Can lipid accumulation come back after liposuction?
It is generally assumed that the number of fat cells in the body remain constant after puberty. It is also claimed that the fat which is accumulated in certain areas is rich in the number of fat cells and is also resistant to diet and exercise. The increase of weight in adults often does not result in formation of new cells, but rather leads to the enlargement of those already present. Removal of a fat cell by aspirating it with liposuction results in the total destruction of this cell. However, if no attention is paid to the diet, the remaining cells may accumulate fat and enlarge. Therefore maintaining a balanced diet and exercising are crucial after liposuction. Also, skin elasticity is very important. Age is not the only effective factor for this. Although it is considered that most of the people between ages 16-80 will benefit from liposuction, the operation should not be performed in those younger than age 18, because the metabolic balance has not matured and the patient’s body dimensions have not yet been stabilized. At advanced ages, although liposuction is beneficial, our experience has shown that removal of excess tissue will often require additional procedures for the removal of excess skin.