Liposuction involves sucking out the fat that lies just beneath the surface of the skin and is a relatively low risk procedure when carried out by a plastic surgeon. — HASAN BAHRI/The Star
You've tried all kinds of diet and exercise, but there are areas that simply refuse to tone or budge.
That last bit of lower belly or upper arm fat just clings on stubbornly.
Indeed, it’s unfair that body fat isn’t always distributed evenly, both in men and women.
Genetics, hormones, stress, pregnancy, and even past weight loss, can all play a role and leave behind disproportionate contours that no amount of clean eating or fitness workouts can erase.
If this “residue” is affecting your confidence, self-esteem or overall mental health, perhaps you might want to consider having liposuction.
This procedure can remove fat from specific areas of the body, such as the stomach, hips, thighs, buttocks, arms or neck – provided your wallet allows it, of course.
However, be aware that liposuction is not a substitute for diet and exercise, or even losing weight – it’s about giving you the shape you desire when all your lifestyle efforts have failed.
How it’s done
During the surgical procedure, the surgeon makes small incisions, injects a solution (originally just saline before a local anaesthetic was added to the mix later), and inserts a cannula to break up and suction out excess fat before closing up the incisions.
“Even though it sounds basic – using a huge straw to suck fat out through a small pinhole – the technology and devices have evolved over time.
“Initially, liposuction was very abusive and traumatic, then came the wet technique where you put fluid into the area you want to suck and once that space increases, you have more space to work in.
“Later, the super wet technique was introduced, where a smaller volume of fluid was used, typically with a 1:1 ratio of solution to the fat to be removed.
“And finally, we have the tumescent technique,” explains consultant plastic surgeon Dr Jagjeet Singh.
The tumescent technique involves injecting the saline and local anaesthetic solution and a blood vessel constrictor drug (to reduce bleeding) such as epinephrine, into the targeted areas of excessive fatty deposits.
The solution fills the fatty layer of the skin and causes it to swell and become firmer, allowing the surgeon to have better control when contouring the area.
Each surgeon has their own concoction of the solution and formula of how much to inject.
The main types of liposuction are traditional (suction-assisted), water-assisted, power-assisted, laser-assisted and ultrasound-assisted.
Each method differs in how it breaks up fat cells before removal.
The latest advancement is in ultrasound-assisted liposuction, where the most recent technology allows for more precise fat removal compared to traditional liposuction methods.
This device is designed to liquefy fat cells, making them easier to extract, while preserving surrounding tissues, which can lead to less bruising and a quicker recovery time.
It also has a skin-tightening effect.
There are three steps to this method.
Dr Jagjeet explains: “First, we use a smaller cannula to put the tumescent fluid.
“Based on how much fluid we have put in, we can make a rough estimate of how much time we have to melt the fat.
“When we melt fat using this device, the area needs lots of fluid surrounding it to prevent burns and overtrauma.
“The long device emits ultrasonic waves by making a hissing sound as it melts the fat.
“Lastly, we suck the fat out using the suction cannula.
“This device is low on effort (for the surgeon) and spares the blood vessels.”
The basics of liposuction
Fat disposal
International safety guidelines stipulate that the maximum fat that can be removed during one procedure is five litres.
“My cut off is three litres for daycare – anything more will require the patient to stay overnight for monitoring – but all procedures are done under general anaesthesia,” Dr Jagjeet says.
What is done with the extracted fat?
“We usually throw it away,” he says.
“But these days, the trend is to transplant it elsewhere to whichever body part the patient wants augmented and enhanced.
“The fat cells are actually alive, so we have to be as gentle as we can when sucking them out.
“Then we wash, prepare and put them back.
“Not all the fat cells will survive, so if we inject 100cc of fat and 50-70cc survives, then this is considered a successful fat-grafting procedure.
“The rest will be reabsorbed by the body,” he explains.
The fat that is successfully transferred receives blood supply from the area it is transplanted into.
The process for it to become alive takes about two weeks.
Interestingly, many people are unaware that fat cells do not multiply, but increase in size instead.
Dr Jagjeet shares: “If I have 10,000 fat cells in my adulthood, it stays with me; if I put on weight, these fat cells grow bigger in a process called hypertrophy.
“It’s only when you’re a child that fat cells can multiply, but once you hit puberty, whatever fat cells you have stay with you for life.
“It doesn’t regenerate again, although some studies say adipose-derived stem cells do have regenerative properties.”
Picking the right patient
This man had liposuction done to remove fat from his double chin. The procedure can be targeted at multiple areas of the body that contain fat. — 123rf
Men and women deposit fat differently.
Men deposit fat in visceral areas (i.e. around internal organs), hence their “tummies” can become big quickly.
“Their abdomen is very solid and round – you cannot liposuction that, but when they start to lose weight, it goes away fast.
“The male chest area also has a tendency to gain fat when testosterone levels drop.
“For women, fat tends to deposit in the inner/outer thighs, lower abdomen, arms, etc – areas that are easily accessible via liposuction,” he points out.
Liposuction leaves a 1-2cm scar at the incision site(s), which will eventually fade over time, hence patients need good healing capability.
Dr Jagjeet says: “With the new technology, I usually close it up with a stitch.
“Patients can go back to their daily activities in a few days, but full recovery can take up to three months.
“They are also advised to wear compression garments or something really tight for a minimum of three months.”
How does the surgeon know if the patient has indeed attempted to diet and exercise?
“I sort of know based on their physique.
“They’re not necessarily fat, but have certain areas that don’t want to go away.
“Anyone can have liposuction done, but whether they see the results they want is important.
“As long as the patient is healthy and has realistic expectations, age is not a barrier – my oldest patient was in their 60s and walked out fine.”
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He adds: “If we choose the wrong patient, then we need to manage their expectations.
“I turn down patients whose job description requires them to be below a certain weight.
“When I see the red flags going up, then the patient needs a mental assessment.
“But in our country, when you ask the patient to go for a mental assessment, most of the time they won’t return and will just find another surgeon!”
