Indmedica - India's Premier Medical Portal - Cyber Lectures


Micro-Vascular Surgery

Dr. Ashok K. Gupta

Page 2


Can you describe the procedure of Suction Assisted Lipolysis?

Suction Assisted Lipolysis is a simple, less traumatizing procedure with minimum hospitalization. Results are immediate and definite. With the patient in standing position, fatty deposits to be contoured are outlined and the amount of fat to be removed is estimated roughly by using “Pinch Test” both pre and intra-operatively. The skin is pinched between the Index finger and the Thumb and the width of the skin fold is measured. This is a very useful method of assessing the thickness of the fold of the fat to be treated with Suction Assisted Lipolysis. During the process of suction, surgeons invariably uses this simple test to confirm and to compare various areas for sameness of the amount of fat suctioned and the layer of the fat left behind under the skin.

What type of instruments / apparatus are used in Suction Lipolysis?

Hollow Metal Canula, connected to a strong negative suction apparatus using non-collapsible Silicon Tubes are used in this technique. Through a small (1/2 cm) incision, the suction Metal Canula are inserted in the area and with backward and forward motion in a fan shaped manner, the liquefied fatty tissue is first disconnected (Pre-suction) and aspirated thereafter. By doing the same procedure using either single or multiple small incisions, a honeycomb type of lipolysis is performed, leaving bridges of normal fat and blood vessels attached to the skin. 4 to 6 mm. Canula is preferably used for large fatty deposits such as “saddle bags” or “buttocks” , 4 mm. size Canula for arms, abdomen, knee and ankle, while 2 mm. Canula is preferred for face and sub-mandibular area.

Can the entire fat be removed together?

It is possible to remove up to 3000 gms of fat safely in a patient with enormous saddle bags. More then 3000 gms of fat suction at one attempt may lead to some complication. It is advisable to remove about 2000 gms to 2500 gms at each stage, but never more than 4000 gms under any circumstances.

What is the postoperative care after Suction Assisted Lipolysis?

After the Suction Assisted Lipolysis , the treated area is well supported with compression dressing for about seven to ten days. Locally there may be bruises, which usually disappear by two week’s time. To avoid subcutaneous fibrosis and hardness, it is often recommended to wear Elastic Pressure Support and to massage the areas for about three to six months. This helps the skin to shrink in size.

What is the procedure for removal of Abdominal fat?

Procedures like Abdominoplasty, Abdominal Lipectomy, Riding Breeches, Seat lift etc. are often combined with suction lipolysis. Frequent or multiple pregnancies, neurectomy in surgical operations on the abdomen may cause muscular flaccidity, diastases of rectus muscles and / or ventral hernia. Skin deformities due to striae or intertrigo (skin disorder) or previous surgical scars, call for a combined procedure. Using a ‘W’ incision in the pubic area, the excess skin is pulled down and excised. The umbilicus (belly button) is freed by a separate incision and repositioned to a new location. Suction assisted lipolysis is used to remove the fat from flanks, upper and lower abdominal flaps.

Which is the easier surgical operation for removal of such fat?

Surgical excision of excess skin with fat to correct riding breeches or saddle bags are no more popular. Suction lipolysis has offered excellent results in these cases. Even a new gluteal fold (for the buttocks) can be created by this technique.

How the method of Suction Assisted Lipolysis was evolved?

The technique of Suction Assisted lipolysis was first used by a French Plastic Surgeon Dr. Illuze to remove extra fat at and around hips, calves and ankles. Initially, Canula used for abortion, were used, but over a period of time, these Canula have been specially designed for different areas.

Is the method of Suction Assisted Lipolysis Standardized?

The method of Suction Assisted Lipolysis, has been universally accepted. Over 1,00,000 such procedures are being undertaken every year all over the world. There are two distinct types of Suction Assisted lipolysis . i.e. Dry and Wet method . In the wet method, which is a popular method, a solution of fat dissolving enzyme and adrenaline in normal saline is injected prior to the Suction . This allows an easier suction with a minimum blood loss. Relatively large areas with practically no notable complications can be attended by this method. The dry method is useful in very large pad of fat or for a small and limited area of suction. No fluid or enzyme is injected before the Suction Assisted lipolysis .

Are there some serious complications of SAL?

Theoretically speaking, there is a potential risk of Fat Embolism following Suction Assisted lipolysis , which could be fatal, but the clinical incidence of such a complication is practically nil. If the suction exceeds 4.0 Liters of fat, there are chances of fall in blood pressure and oxygenation and may require a blood transfusion.

What are other minor complications of SAL?

Complication like bruises in the area of SAL is part of the procedure, which normally disappear by two weeks. Whenever a larger Canula is being used or a satisfactory quantity of subcutaneous fat is not maintained, localized waves and daves may develop and may be unacceptable aesthetically and may require revision surgery.

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