Liposuction technique

The liposuction technique requires compliance with certain rules and has its own characteristics depending on the forms of fat deposits and their localization. Immediately before the operation, the surgeon marks the liposuction zones with a felt-tip pen while the patient is in an upright position. Small operations (liposuction in two to four zones) can be performed under local anesthesia. In this case, the fatty tissue is infiltrated with a 0.25% solution of lidocaine with adrenaline in a ratio of 1:200,000. When liposuction of a larger number of zones, general anesthesia is necessary in combination with tissue infiltration with an isotonic solution of sodium chloride with adrenaline.

The amount of solution used for infiltration is different in each case and should ensure a persistent spasm of the vessels in the treated area.

This effect, manifested by 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 aspirated contents, represented in this case by fatty tissue without blood admixture. In case of minor violations of body contours, spreading over a small area, fat extraction can be performed without tissue infiltration.

The vacuum system for liposuction includes a set of cannulas with a diameter of 4.6, 3.7, 2.4 and 2 mm, 10, 14 and 30 cm in length. Their end part can have one or three side openings located around the circumference. The kit also includes a receiver of fatty tissue and a vacuum pump that provides constant air vacuum down to -1 atm.

Fat evacuation is performed through skin incisions 1-1.5 cm long, placed symmetrically, mainly in areas of natural folds, as well as in places that are maximally hidden by clothing.

Smaller incisions may lead to excessive trauma to the edges of the wounds with cannulas. This may result in the development of suppuration, as well as the formation of noticeable, retracted scars.

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

• The skin incision should be positioned so that the end of the cannula can reach all points of the treatment area.
• The movements of the cannula should be directed parallel to the skin, which avoids damage to the muscular-aponeurotic framework.
• For more effective removal of fatty tissue, each area should be treated from two incisions in two mutually intersecting directions. Relatively small fat "traps" can be treated from one incision.
• To obtain a uniform contour of the treated area after liposuction (without depressions and elevations, with a smooth transition to the surrounding tissues), the intensity of cannula treatment of the fat "trap" tissues is reduced in the direction from its center to the periphery.
• In patients with good skin elasticity and relatively little postoperative relaxation, it is advisable to treat the main part of the fat "trap" with cannulas of 4.6 mm in diameter. It is preferable to remove fat in the transition zones of the "traps", as well as in areas with a small thickness of adipose tissue (including locally diffuse forms of obesity) using cannulas of a smaller diameter (3.7-2.4 mm).
• When treating fat "traps", the fatty tissue is removed at a depth of at least 0.5-1 cm, which allows for maximum preservation of the skin's blood supply. To do this, the cannula opening should be directed away from the skin surface.
• Each zone should be treated until the extraction of adipose tissue slows down sharply (almost stops) and the color of the aspirated contents changes due to the presence of a larger amount of blood. Continuing treatment in this case only increases the mechanical trauma to the tissues without providing any significant benefit.
• 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 the scale of liposuction.
• In case of significant decrease in skin elasticity, presence of stretch marks, and finely lumpy contour, additional extraction of adipose tissue in the subdermal layer is necessary using a cannula with a diameter of no more than 2 mm.
• Liposuction on the face is performed using cannulas of medium and small diameter (3.7-2.4 mm). In this case, the cannula opening can be facing 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 drainage, closing the wounds with bactericidal stickers and putting on compression stockings that exert pressure up to 30-40 mm Hg.

During liposuction, the surgeon must be aware of the so-called no-go zones, where the superficial fascia connects to the deep fascia and there is only superficial fat.

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

The use of larger diameter cannulas results in excessive removal of subcutaneous fat, which causes the formation of clearly visible depressions, long-term seromas and even skin necrosis. These complications are most likely to occur in the area of the broad fascia of the thigh, above the gastrocnemius muscle, Achilles tendon, above the patella and sacrum.

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