Services

Liposuction

The operation called Liposuction (Suction Assisted Lipectomy and Liposculpture) can give you a better body contour with relatively little scarring. Areas of fatty tissue which are resistant to diet, exercise and weight loss may be suitable for treatment by this technique.

There are two basic types of fat. There is a dense or fibrous fat which is difficult to remove by this technique and there is a more loose padding fat which is softer in consistency and this is suitable for treatment by Liposuction. The proportion of these two types of fat varies from area to area and consequently some areas in the body are more amenable to Liposuction. The ability to suction the fat varies from individual to individual and generally it is easier to suction the fat from women than from men as the fat is softer and less fibrous.

Suitability For Operation

• Good health
• The deformity or fatty bulge is localised
• The deformity has not responded to a strict regime of diet, exercise and weight loss
• Good skin tone, with little or no tendency to sagginess
• Generally patients under forty years of age (not absolute)
• Little or no cellulite
• Few or no stretch marks
• Have realistic expectations about result

The best liposuction candidates tend to get the best results. During your consultation Dr Olbourne will discuss with you the areas of concern and those factors that will influence the outcome of liposuction surgery. It is important to have realistic expectations as to the outcome of your surgery.

As with any cosmetic surgery it is important to have clear objectives and realistic expectations.

Unrealistic Expectations

• Minor deformity to be corrected by major surgical procedure
• Understand that liposuction is not a cure for obesity or a substitute for weight loss
• Wants to have liposuction for themself, not to please someone else
• Don't expect liposuction to change their personal or professional lives dramatically

What Areas Are Suitable For Liposuction?

Please remember liposuction is not a substitute for weight loss or a cure of obesity. The following diagrams show suitable areas for liposuction.

Liposuction will reduce excessively stubborn localised fatty areas where dieting and exercise have failed. These areas are usually genetically determined areas of accumulated fat cells.

Liposuction can also be used in combination with other procedures such as abdominoplasty (tummy tuck) where specific fatty areas can also be contoured. Facelift can also be improved by liposuction by removing fat from under the chin and neck and to enhance the jawline.

How Is Liposuction Performed?

A small incision is made in the skin for each area to be treated. A narrow metal tube (cannula) is inserted through the incision into the fatty area and by working the tube back and forth, the fat is shaved off in tunnels and evacuated through attached tubing to a suction machine or suction syringe. The suctioned tunnels and spaces are then collapsed by the use of a compression garment to create the new contour.

Tumescent Technique

The Tumescent technique (or wet method) involves the injection into the tissues prior to commencing liposuction. A solution of saline, local anaesthetic and vasoconstrictor agents has been found to increase the amount of fat removed and decrease the amount of post-operative bruising.

Ultrasonic Assisted Liposculpture

This technique uses ultrasonic waves produced by a generator and introduced into the tissues by a small incision to disrupt the fat cells (Lipocytes) and release the fat. The free fat is then removed from the tissues by use of an aspiration cannula in much the same way as regular liposuction (known as Suction Assisted Liposculpture or SAL). Ultrosonic Assisted Liposculpture (UAL) facilitates removal of fat from areas previously inaccessible by SAL and by making the procedure less physically strenuous for the surgeon. It allows greater volumes of fat to be removed than was previously the case. UAL has specific indications and the relative merits of the two techniques will be covered in your consultation with Dr Olbourne.

How Much Scarring?

This procedure has been such an advance in surgery because it can alter the body contour significantly with minimal scarring. Generally there are few incisions less than 1cm long for each area treated. Given time the scars will fade. As far as possible, the skin incisions are placed in the natural body creases and folds.

Are The Results Permanent?

The effects of liposuction are permanent. This procedure sculpts away a number of fat cells from a particular region and the remaining fat cells do not multiply to take their place. Consequently, once the operation has been performed to change the body shape, the proportions remain the same even if there is weight gain subsequently.

Gaining weight after surgery may adversely affect the result. If you do gain weight, you will tend to gain it more uniformly, and not just at the former bulges. With weight gain, the remaining fat cells swell, but no new fat cells are created. With weight loss, those remaining fat cells shrink.

Cellulite

This uneven skin texture appears to be due to bands of fibrous tissue pulling on the skin so that fat accumulation is not even. This surface irregularity can not be camouflaged when the overlying skin is thin as is the case in many women. Liposuction alone cannot improve this, although there are additional techniques which are sometimes used with limited success - please ask Dr Olbourne for additional information. In short, "cellulite" is a name given to what is nothing more than the normal female appearance of the subcutaneous fat. Cellulite is not a disease entity in itself.

Cellulite

How Many Areas Can Be Treated At One Time?

A number of areas can be treated at the same time. Between two and three litres of fat can be aspirated without a need for a blood transfusion. If more than this volume needs to be aspirated, then the suction of fat is undertaken in two separate procedures. It is best to avoid transfusion in any cosmetic procedure. A routine blood check is normally undertaken to assess what volume of fat can be removed without transfusion.

Before The Operation

Dr Olbourne will discuss carefully with you the suitability of the procedure for the various areas of concern to you. Dr Olbourne will normally take "before" photos of the areas to be treated to help judge the final results. Prior to surgery you should not participate in any strenuous activity or consume alcohol. On the day prior to surgery you should eat a light diet and increase fluid intake. Showering with antiseptic soap is necessary the evening prior to surgery and again on the morning of the operation.

If a girdle is considered necessary, we will arrange its purchase for you and will ensure its delivery to the hospital. Two girdles will be necessary as they must be worn continuously for up to six weeks after the operation.

Style of Girdle to be worn after liposuction of the outer thighs. This gives continuous compression of the area treated.

Prior to the anaesthetic the areas to be treated will be "marked" with the patient in a standing position to more accurately locate where the liposuction is to be applied. Occasionally some shaving of the upper pubic hair may be necessary for liposuction to the abdomen. A careful contour diagram is developed on the areas to be treated as the shape and position of the troublesome fatty deposits changes when the patient is asleep and lying down.

The Operation

The operation is performed either under a local anaesthetic (for smaller areas) or under general anaesthetic in a hospital or day surgery centre. The surgery is performed through a tiny incision as previously described. The suction cannula is worked evenly under the skin over the area to be sculpted. Care is taken to make sure that the suction is as smooth as possible to avoid uneven contours. The operation can take from 30 minutes to several hours.

For each area treated the patient has to be specifically positioned and the operative site prepared. Therefore, when multiple areas are treated, it involves a series of procedures and repositionings. The length of time of the operation is therefore proportional to the number of areas treated.

After The Operation

When fat tissue is suctioned from under the skin, it leaves small tunnels and empty pockets. The purpose of a compressive dressing or girdle is to collapse these spaces to allow healing to take place.

The area treated with liposuction may be strapped with elastic tape or a girdle will be applied. This will minimise bruising and swelling and provide a degree of support for the skin which will be relatively loose after the operation, particularly when the swelling settles down. The elasticised material of the girdle helps to keep even pressure on the areas treated, minimise bruising and swelling and "even out the skin". This process will help the skin to redistribute itself more evenly and minimises the risk of skin sagging and irregularities.

Bruising and Swelling

Following surgery you may be quite bruised and the areas can be discoloured and even purple. Dr Olbourne can show you representative photographs of the healing process and the time taken for the result to develop.

There can be swelling of the ankles, particularly if liposuction has been carried out in the abdomen or legs and a girdle is worn. This can be aggravated by hot weather. Minimise standing if there is swelling of the ankles and elevate your legs on a foot stool when sitting. The bruising tends to track down the leg or the abdomen and in some cases the patient can experience some swelling of the labia or scrotum.

The bruising usually starts to settle after a week and is usually well faded by two weeks. It may, however, take six weeks for all the bruising to resolve. When a figure fault is sculpted away, the fullness in the area is temporarily replaced by swelling which resolves slowly. It is understandable, therefore, that the patient may underestimate the improvement in the first few weeks and wonder if the operation has been successful.

The fat cells that are suctioned away are gone forever and when the swelling settles the result will be noticeable particularly in previously tight clothing.

Will There Be Much Pain?

The amount of pain felt varies from individual to individual, depending on one's pain threshold. Generally, areas treated with liposuction are tender to pressure, but there is usually no excruciating pain when resting or in bed.

There may be a feeling of stiffness when moving about, but most of the pain subsides after a few days. It is not a particularly painful operation as the muscles are not disturbed except when suction is performed on large areas of the abdomen. It is then sometimes painful to sit up for the first few days. It is our impression that ultra sound assisted liposculpture (UAL) is attended by more pain and discomfort in the postoperative period than is suction assisted lipectomy (SAL). There is no scientific basis for this observation, but it appears to be so. It is our impression that the results obtained from UAL (where indicated) justify this increased discomfort.

CALL DR OLBOURNE IF YOU EXPERIENCE THE FOLLOWING:

• Excessive pain or bleeding
• Abnormal swelling
• Fever during the first 24 hours following discharge from hospital
• Concerns about your post-operative recovery

Wearing The Girdle

The girdle is normally worn continuously for one week. You should then attend Dr Olbourne's clinic for follow up where his staff will give you specific instructions regarding further use. The incisions for this operation are usually small and there are not many sutures to be removed. The girdle is reapplied after the first visit and then worn as much as possible to help the skin "even out" when it is settling for the next five to six weeks. It can be removed to shower after the first week. You can usually wear normal clothing over this elasticised garment.



How Much Time Off Work?

This varies with the number of areas treated and the nature of your work. If a single area is treated, you may be allowed to return to sedentary work within a few days.

However, liposuction of specific areas such as the ankles might need more bed rest and if your occupation involves a lot of standing, it may be two or three weeks before you can return to all normal duties.

How Long Before Exercise?

Again this depends on the areas treated and the type of exercise. However, we encourage immediate mobilisation following surgery as we believe this speeds up the resolution of the postoperative swelling.

Return to exercise will be a gradual process, beginning with slow walks to encourage circulation and aid healing, progressing to normal activities over a relatively short time.



Complications

There are few complications. Like any surgical procedure, there is a small risk attached to the anaesthetic.

Specific complications include:-

• Lumpiness
  For one week or two following the operation the areas treated may feel a bit lumpy as the tissues under the skin are starting to heal. This should be of no concern as it always resolves by six weeks. Dr Olbourne may suggest that gentle massage with a body lotion will help expedite the resolution of the lumpiness and occasionally ultrasound treatment which gently massages the deeper tissues may be prescribed.
• Skin Laxity, Waviness or Dimpling If the skin elasticity is not good or if a large volume of fat is removed from one area there may be some laxity or waviness of the skin. This is more common in older patients.
• Depressions Depressions or hollows can occur. These are different to dimpling found with skin laxity. Occasionally small areas can be over treated, but it is possible to reinject fat into these areas after adequate time has been allowed for settling. this will improve the result, but residual unevenness may persist.
• Numbness The area treated may feel "numb" when the initial tenderness has settled down. This is because the fine nerve endings of the skin are temporarily bruised, but the feeling usually returns to normal within a few weeks.
• Asymmetries People are rarely symmetrical from side to side. Frequently more fat will need to be removed from one side compared with the other. However, a degree of asymmetry can remain after surgery, even with careful pre-operative planning and marking.
• Infection Is a rare complication of liposuction. Antiseptic showers prior to surgery along with operative and post-operative antibiotics will help to minimise this problem. However, if redness, increasing tenderness or fever develops report this immediately to Dr Olbourne.
• Skin Loss Can very rarely occur, but it's more commonly associated with infection. It is also more likely to occur where the area suction is quite thin.
• Scarring The small incisions are hidden as far as possible in the skin creases and fade quickly. However, areas in the groin and lower limb where it is not possible to "hide" the scars easily will remain blue-purple in colour and noticeable for many months. These will eventually fade.
• Pigmentation of the Skin After the bruising has resolved, slight "staining" or pigmentation of the skin can remain on rare occasions. The main area affected is the inner thighs but occasionally other areas can be affected. It takes many months for this to fade but very occasionally it can remain as a permanent problem.
• DVT and PE Deep vein thrombosis means clotting of blood in the large veins of the leg. This is a very rare complication of any operation, but is more common after procedures where there is lengthy immobilisation. Although this is extremely rare, it is important to report related symptoms to Dr Olbourne. These include swelling of the leg, tenderness of the calf with redness and local heat. If this problem is left untreated clots can break off in the large veins and lodge in the lung (pulmonary embolus - PE).

lease report any suspicious symptoms to your doctor.

THIS CAN BE TREATED

Follow Up Treatment

Follow up visits allow Dr Olbourne to continue to monitor your progress. "After" photos may be taken. In some cases, doctor may discuss with you the advisability of a touch up procedure to refine the final result.

How Much Will The Procedure Cost?

The costs of this surgery relate to:

1. surgeon and assistant surgeon
2. anaesthetist
3. hospital
4. ancillary charge (pharmacy, etc)

Dr Olbourne can tell you his fee and give you some indication of the costs of the other people involved in your care.

You must appreciate that the ultimate cost to you will depend on where you choose to go for your procedure and what rebates you will receive from your medical fund and Medicare. This in turn depends on whom you may be insured with and what level of insurance you have chosen. Please advise Dr Olbourne if your insurance has a front- end deductible cost or "excess". With all the relevant information, doctor's office should be able to give you a very close approximation of what your final costs might be.

Private insurance including Medicare may pay the cost of part of the operation, but not the cosmetic part. If so, they would also contribute to the anaesthetic and hospital costs.

It is always preferable to arrange all your finance prior to surgery to avoid unnecessary stress afterwards which will detract from your enjoyment of having achieved your goal.

Further Information

For further information on this or any other cosmetic procedure, feel free to contact our office. Our staff are dedicated to assisting you and will do all they can to make your surgical experience as comfortable as possible.

You can also assist us by advising us of any aspect of your experience that has not been adequately covered in this brochure. We are always seeking to improve the information we give to patients. Your input will help us achieve that goal.

Contact: Dr. Norman A. Olbourne
MB BS (Hon), BSc(Med), MHL, FACLM,
FRCS, FRCSEd, FRACS


Sydney Institute of Plastic Surgery
7 Help Street
Chatswood NSW 2067
PO Box 5010
Chatswood West NSW 1515

Phone: (02) 9411 - 3177
Fax: (02) 9411 - 3380

Email: info@sydneyplasticsurgery.org
Web: www.sydneyplasticsurgery.org