Liposuction technique

The technique of liposuction involves the observance of certain rules and has its own peculiarities depending on the forms of fat deposits and their localization. Immediately before the operation, the surgeon marks the liposuction zones with the help of a marker, with the patient's vertical position. A small operation (liposuction in two or four zones) can be performed under local anesthesia. In this case, adipose tissue is infiltrated with a 0.25% solution of lidocaine with adrenaline in a ratio of 1: 200,000. With liposuction of a larger number of zones, general anesthesia is required in combination with tissue infiltration with isotonic sodium chloride solution with epinephrine.

The amount of solution going to infiltration is different in each case and should provide a stable spasm of the vessels of the treated area.

This effect, manifested by a uniform pallor of the skin, is usually achieved in 10-15 minutes. Evidence of a good level of tissue infiltration and achieved vasoconstriction is the light color of the aspiration content, represented in this case by a fatty tissue without a blood admixture. With minor violations of body contours that spread over a small area, fat extraction can be performed without tissue infiltration.

The vacuum system for liposuction includes a set of cannulae with a diameter of 4.6, 3.7, 2.4 and 2 m, lengths of 10, 14 and 30 cm. Their end part can have one or three lateral holes arranged in a circle. The kit also includes a fat tissue receiver and a vacuum pump, which provides a constant air depression of up to -1 atm.

Evacuation of fat is carried out through skin incisions of 1-1.5 cm in length, placed symmetrically, mainly in areas of natural folds, as well as in places most hidden by clothing.

Smaller incisions can lead to unnecessary traumatization of the edges of wounds by cannulas. A consequence of this may be the development of suppuration, as well as the formation of prominent, retracted scars.

Collective experience allows us to formulate the following basic principles of liposuction.

• The cut of the skin should be positioned in such a way that the end of the cannula can reach all points of the treated area.
• The movements of the cannula must be parallel to the skin, thus avoiding damage to the muscular aponeurotic frame.
• For more effective removal of adipose tissue, each zone needs to be processed from two incisions in two mutually intersecting directions. Treatment of relatively small fat "traps" can be carried out from a single cut.
• To obtain after the liposuction of the uniform contour of the treated zone (without depressions and elevations, with a smooth transition to the surrounding tissues), the intensity of processing the cannulas of fat trap tissues decreases in the direction from its center to the periphery.
• In patients with a good elasticity of the skin with a relatively small postoperative relaxation, the main part of the fat trap should be treated with cannulas 4.6 m in diameter. Remove fat in the transitional zones of the traps, and also in places with a small thickness of adipose tissue (including for locally diffuse forms of obesity), preferably using a cannula of smaller diameter (3.7-2.4 m).
• When treating fat "traps" fat tissue is removed at a depth of at least 0.5-1 cm, which allows you to maximize the blood supply to the skin. To do this, the opening of the cannula must be directed away from the surface of the skin.
• The treatment of each zone should be carried out until the extraction of fatty tissue sharply slows down (practically stops) and the color of the aspiration content changes due to the content of more blood. Continuation of treatment in this case only increases the mechanical trauma of the tissues, not yielding significant benefits.
• The volume of surgical treatment of large fat "traps" should be limited to prevent subsequent sagging of the skin. In this case, the patient should be informed about the planned limitation of liposuction.
• With a significant reduction in skin elasticity, the presence of stretch bands, as well as a finely contoured contour, additional extraction of adipose tissue in the subdermal layer is necessary with the help of a cannula with a diameter no more than-2 mm.
• Liposuction on the face is performed by cannulas of medium and small diameter (3.7-2.4 mm). In this case, the cannula opening can be turned to the skin, which is due to the superficial location of fat deposits with an extremely developed subcutaneous capillary system.
• The operation ends with the application of cosmetic sutures without draining, wound closure with bactericidal labels and putting on compression tights that carry out pressure up to 30-40 mm Hg. Art.

During liposuction, the surgeon must remember the so-called forbidden zones, where the superficial fascia connects with the deep fascia and there is only superficially located fat.

Potentially "forbidden" is, in fact, any zone containing only sub-dermal fat of relatively small thickness. Within this zone, only extremely careful liposuction is possible using the thinnest cannulae (up to 2 mm in diameter) with an opening facing the fascia.

The use of a larger diameter cannula results in excessive removal of subcutaneous fat, which causes the formation of well-marked depressions, long-lasting gray and even necrosis of the skin. The most likely occurrence of these complications in the area of the wide fascia of the thigh, above the gastrocnemius muscle, heel tendon, over the patella and sacrum.

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