Fat Removal

     Though it is a fact that the body tends to put on weight after forty years of age, in today's health-conscious society, many people, young and old, are maintaining a slender form. Many times leanness is not uniform over all parts of the body; many patients have problems with unwanted fat deposits that persist in spite of dieting, exercise, and treatment to decrease "cellulite." Liposuction may be a solution.
     Until the 1980s surgical fat removal was primarily surgical excision of fat. The procedure involved making large, conspicuous incisions in areas of the body, which resulted in obvious, often unfavorable, s cars. Liposuction is a more recent procedure that requires only small incisions, one-quarter to one- half inch in length, to enter the area under the skin where fat deposit bulge in the body. It was a procedure introduced in Europe by French surgeons during the mid-1970s and taught around the world by the mid- I 980s. At first the procedure was popularly called "lipolysis," and in some quarters it still is. Now its most common name is a term called "liposuction."
     The procedure has swept the country as one solution to unwanted fat deposits. It is now one of the most frequently performed procedures in the nation. As enthusiasm for liposuction spread quickly, the procedure was renamed. Now most people interested in eliminating fat deposits know of its usefulness.
     Liposuction involves removal of fat cells by suction through a metal tube-no bigger around than a pencil-called a cannula. Fat cells can be removed quickly by suction. When fatty tissue under the skin is removed, there needs to be sufficient elasticity of the skin for it to smoothly contract into place, rather than wrinkling and sagging. A support garment may be worn to support the skin for several weeks. For most patients this is not a serious consideration, though surgeons look for potential lack of skin elasticity and warn against removing too much fat.
     The same is true in weight loss in older patients. Too much fat removal either by diet or lipoplasty may result in redundancy or wrinkling of skin, whereas the skin of younger patients will usually tighten without sagging. However, older patients with less elasticity are often good candidates since their improved appearance in clothing and their sense of well being offsets any local skin irregularities. Even those with sagging skin around the middle enjoy slipping into smaller dresses and pants. The sagging of skin can, of course, be corrected by tucking the skin (removing excess skin).
     Liposuction can be performed on many areas of the body, including fat deposits under the chin, in the neck, the abdomen, the chest and upper arms, the hips, thighs, knees, and ankles. In some cases liposuction may be combined with customary surgical procedures that stretch and remove excess skin and fatty tissue, such as a tummy tuck (abdominoplasty). This often permits achievement of improved results in face-lift surgery by combining safe removal of fatty tissue with skin tightening. Suction of the neck can be helpful. However, suction of the face is not recommended.
     Liposuction surgery can be performed on any person in reasonably good physical condition who may have localized, unwanted fat. It may have a role in the removal of fat from the obese patient, though full investigation of this area of the field is not complete.
     Questions frequently asked are "Will the fat return again if I put on weight after surgery?" and "Will I look out of proportion to the rest of my body?" It appears that in children fat cells increase until they reach puberty, and thereafter the number of fat cells in the body remains fixed or constant throughout life. With weight gain or loss, the fat cells change size. They store fat and expand or contract like a balloon. With liposuction, fat cells are removed, thereby decreasing the number of cells and excess fatty deposits in the surgically auctioned area.
     Since most patients are generally "post pubertal," the return of fat cells does not occur, and fat deposits should therefore not return in the treated area, This is not to say that the remaining fat cells will not enlarge if the patient gains weight. Researchers know that fat cells can dramatically increase in size if the body takes in too many calories.