Arm- and leg lifting
Large losses of body weight and also in patients with a disposition to skin sagging, tissue surplus on arms and legs arise which are disturbing aesthetically and functionally. The largest deformations occur on the inner side (towards the body) of upper arms and thighs. For tightening these areas one tries to place the skin incision into skin folds in the axilla or groin so that resulting scars become hidden. With larger skin surplus on upper arms excisions often require being placed vertically so that the resulting scar is on the inner side of the arms. Ideally, only a little fat tissue should be present at the time of operation so that tightening of the skin carries the least risk and delivers optimal results. If larger fat pads are present, liposuction should precede tightening by several weeks. After leg lifting tissue becomes subjected to considerable tension because of gravity on the one hand, and through motion of legs and pelvis, on the other hand.
Therefore, especially strong suture threads are needed to anchor the lifted tissue on to the bone surface (periost) at the lower part of the pelvis. One attempts by this to prevent sagging of scars. Otherwise scars would become visible. If leg lifting should be combined with lifting of hips and belly, the so-called body-lifting is done, which results in better scar appearance, especially on the legs. This comes from mutual compensation of pull of scars so that scars are left where they were initiated by the primary incisions. All these operations demand full anesthetic and hospitalization for several days.
Liposuction serves to reduce fat pads. This is one of the most frequently used procedures in plastic and aesthetic surgery. A very tissue-sparing technique uses only very thin and blunt needles. On the other hand, an old conventional technique still relies on suction of fat through thick and sharp needles which often results in damage to blood vessels causing local bleeding and tissue hematomas. Here also nerve injuries with loss of skin sensation are common.
Our sparing and very successful method is as follows: First, fat pads are marked with a water resistant colored pen; it is important to mark on with the patient standing upright, because liposuction is done on the patient in supine position when fat pads possibly may change their presentation. Liposuction on the patient standing is feasible only when fat pads are small and on legs and/or hips with local anesthetic being sufficient. Usually, a combination anesthetic is given. One hour before surgery the patient takes one pain relieving tablet. Then two additional medications, one for sedation and one for pain relief, are administered intravenously. Only then the patient lies down, and in local superficial anesthesia a water solution is injected through small fine needles into the marked fat pads. This solution also contains an anesthetic to numb the tissue on site. Now it is important to let the water solution act for some 20 to 30 minutes. During this time fat cells in the tissue take up water and swell and release free fat that one can suck out through fine needles. These have at their tips small openings like in a sieve and are connected to a tube that is linked to a vacuum machine pump. The fat cells burst under the vacuum and deliver free fat for being sucked out. This method preserves tissue optimally, since there are no lacerations to blood vessels or injury to nerves, and it can be applied to any body region. Very obese patients should reduce weight generally since otherwise long term satisfying results are in jeopardy or unlikely. After liposuction the patient must control their body weight and thus prevent fat from seeking body sites to accumulate and again develop deposits.
Surgery ends by applying compression dressing to the treated tissue and stockings to the treated legs and hips. This is crucially important in view of the persisting varying extent of post-surgical excess of skin. The compression helps the skin to attach better on to the underlying muscle and thus become tightened. Only rarely is it necessary later to renew skin tightening. The patients are made aware of this possibility already at the first meeting with the surgeon. Rather large fat deposits may require several liposuction sessions so that the skin may adapt in successively. If a single session were used to take on a larger fat deposit, the skin would not adapt well anymore and a special tightening operation would be required.
Good to know:
- Liposuction, also called lipo-sculpture, is performed on an ambulatory basis in the day clinic of the surgery of Plastic, Reconstructive and Aesthetic Surgery in Zollikon or upon request in the hospital in Zürich.
- Liposuction (lip sculpture) is the most frequent operation of aesthetic surgery in Switzerland.
- Liposuction is a lasting therapy which when done right and when met with proper compliance by the patient is without side effects or danger.
- Liposuction serves first to reshape the body and not to lose weight.
- Liposuction uses the most modern micro-suction needles.
- If the skin is not sufficiently elastic anymore, for instance, after a large weight loss, a single liposuction is not enough for reshaping the body. In this case it is necessary to continue after liposuction with a technique called dermolipidectomy to remove surplus skin and fat.
- The patient may resume his normal daily activities about one week after normal liposuction. There is no further need for special care.
- It may take 6 months until the result of liposuction has settled fully.
- Liposuction may increase substantially the feeling of wellbeing and self-esteem.