People, by heredity, fall into one of three categories. There are patients who are very thin, and these are patients who we call ektomorphs. The patients who are very muscular, these are patients who are called mesomorphs. Other patients who have a hereditary deposit of excess fat are referred to as endomorphs.
Endomorphs have a hereditary predisposition to excess deposits of fatty tissue throughout the body, whether it’s the face, neck, arms, trunk, abdomen, or legs. This condition is not only heredity but also dietary and these patients have a propensity to deposit excess fat in a variety of anatomical areas.
The body basically consists of a muscle framework that is covered by skin. In between the skin and the muscle there is a varying degree of fatty tissue. At times, patients have excess fat deposits throughout their body and are considered obese. Sometimes patients have excess fatty tissue in selected anatomic areas of their body, for example in their neck, arm, midsection, or thighs.
Regardless of where the excess fat is deposited, the basic principle is that the body is a muscle framework surrounded by skin and in between the skin and the muscle there is a deposit of undesirable fat. If a patient has relatively tight skin and excess fat in a certain part of their body, they are ideal candidates for what is termed, liposuction, or lip contouring. If a patient has excess skin, in addition to the excess fat, which is very common in women who have children and it is also common in patients who have rapid growth spurts, where the elasticity of the skin is disrupted and these patients have an inherent handicap in attempting to eliminate the excess fat and to achieve a desired body shape.
Normal skin has microscopic elastic fibers that simulate an entire cross network of rubber bands that allow the skin to stretch and shrink, as long as that occurs over a reasonable period of time. But if a patient has a rapid growth spurt or if a patient is pregnant and has rapid expansion of the skin of the abdomen or the skin of the breasts, the rapid stretching of the skin actually creates breaks in the elastic network of the skin and this results in what we refer to as stretch marks or striae. Patients who have stretch marks and who have lost their basic elastic integrity of the skin, are not as likely to have skin shrinkage if the excess fatty tissue is removed.
Ideally, the patient has good muscle framework and tight skin that has maintained its elastic integrity. These candidates are ideal for what is known as liposuction.
Liposuction is a technique where very tiny incisions are made throughout the body, regardless of where the excess fat exists and then very modern sculpting instruments are inserted through these tiny incision and the excess fat is literally released and suctioned away from the area under the skin. Liposuction is not intended for weight reduction, it is more intended for body contouring. Prior to removing the fatty tissue, the area in question is filled with a certain type of medicine that bulges the fatty tissue. This technique is what we refer to as the tumescent technique of lipo contouring. This technique facilitates removal of the fatty tissue and minimized blood loss during the procedure.
There is no doubt that the skin, even if it has stretch marks, will shrink, but depending upon how elastic the skin is, will determine how well the skin is going to shrink and conform to the underlying muscle framework. At times we see absolutely miraculous shrinkage of the skin that yields very dramatic results of liposuction, but patients have to realize that there are four essential elements to successful liposuction:
The procedure itself
The patient has to maintain a normal, low fat diet
The patient has to engage in physical activity to maintain good muscle tone
Most importantly, the shrinkage factor of the skin. If the skin happens to shrink and conform to the underlying muscle framework, the patient has a remarkable improvement using this tumescent liposuction technique.
If the skin does not shrink completely, then the patient first of all has to know beforehand and realize that that may occur. If it occurs, and that patient is unhappy with the excess skin and is happy with the general shape of the body having removed the fatty tissue, then the patient can elect to have the residual excess skin removed from that part of the body that bothers the patient.
Tumescent liposuction is an extremely safe procedure and is probably, if not the most common form of cosmetic surgery. It is extremely popular. The procedure is performed at Newport Beach Center for Surgery usually under a general type of anesthesia but the anesthesia is extremely safe and statistically the patient is safer under that type of anesthesia then in their car driving either to or from the outpatient surgical center. Once the contouring is complete, a light pressure garment is placed over the area that was contoured. There are surgical, safe limits of the volume of fat that can be removed on any given day. That volume is 5 liters of fat but in reality, 5 liters of fat is an enormous amount of fat so it is very unlikely, except in the morbidly obese patient, to approach levels of the safe limits of liposuction manly 5 liters. Once the garment is placed in position, the patient is transferred to the recovery room and after a short recovery period, is then discharged to a responsible adult who then cares for them overnight. The patient usually is extremely comfortable, even the evening of surgery, is able to have dinner, is alert, is ambulatory, is able to use a bathroom facilities, and enjoys a comfortable nights sleep.
The patient routinely is seen in the office the following morning where the elastic garments are removed, the skin is checked for good circulation. The patient generally is astounded by the remarkable new body contour. The patient is aloud to engage in normal physical hygiene. So they are able to shower the very next day after the procedure. They are then advised to use the elastic garment to encourage the skin to shrink and conform to the underlying muscle framework. The duration of wearing these garments might be as much as 6 weeks but could actually be longer. The idea is to use the elastic garments to encourage the skin to shirt and conform to the underlying muscle framework. Complications in this type of surgery are extremely rare and usually limited to minimal bruising or swelling but serious complications are extremely unusual and unheard of in performing liposuction. Most patients are extremely pleased with the results of liposuction and a great majority of patients have ideal skin shrinkage and are extremely happy with the results.
In patients where they are pleased with the general contour improvement but are not happy with complete shrinkage of the excess skin, they can have the option of having very simple, open body contouring by making skin incisions and removing and tailoring the excess skin. This is, although unusual, is very successful surgery and usually results in minimal or highly inconspicuous scaring.