Liposuction is a procedure whereby fat deposits in certain parts of the body are removed to achieve a more pleasing appearance and contour. This procedure is in demand by both men and women. Liposuction became very popular in the 1980’s thanks to the pioneering work of French Plastic Surgeon Illouz.
Areas where liposuction is done include the enlarged male breast (gynecomastia), the under chin fat, excess cheek fat, abdomen, thighs, the back (so called love handles) the calves, medial knees, arms, the hips and buttocks. In women, a common complaint is the ‘saddle bag’ deformity which is usually resistant to weight loss. In the abdomen an important observation for the surgeon to make is the presence of loose skin and lax muscles which indicates that a tummy tuck is needed, wherein loose skin is removed and muscles are tightened, repairing any hernia if present.
Who is a candidate for liposuction? Any medically fit individual. If the person is contemplating weight loss then target weight should be reached prior to surgery. The patient is cautioned to maintain the same weight after surgery as any weight gain will result in reaccumulation of fat.
Temporary bruising is common. Decreased sensation in the overlying skin occurs with a benumbed feeling as the nerves are stretched, which lasts for about one year. Over liposuctioning one area can lead to contour deformities. Removing more than three litres of fat in the absence of adequate fluid replacement can lead to shock. Intra abdominal penetration is a disastrous side effect of liposuction.
How is liposuction done?
With cannulas from 1.5 to 4 mm diameter, via tiny incisions in the skin. Fat is aspirated with a suction machine.
Another technique used at Apollo Bramwell Hospital is syringe liposuction where fat aspirated into a syringe. This fat is viable and can be injected to correct contour deformities in the face, such as for lip augmentation , for the ageing face and in diseases such as Romberg’s facial trophy.
Dermabrasion is a surgical technique wherein superficial layers of the skin are abraded away leaving a bed of raw dermis from which new skin is reformed. This results in the scar becoming shallow and less visible. Another pleasing effect is a tightening of the skin due to collagen regeneration. This is a very effective technique for deep acne scars. Three to four sittings at six month intervals may be required. New skin is formed in 5 days and a regime of sun protection and moisturizers is started to protect the new skin from hyperpigmentation.
Keloid is a scar in the skin which has outgrown its normal boundaries with continued rate of growth. This distressing problem is peculiar to persons of African and Asian. It is non-cancerous. The exact cause is not known. It can occur after heart surgery, with a scar in the mid sternal area, after ear piercing, after an infective episode such as a boil or after accidental injury or surgery. Common sites are the sternum, deltoid area (outer upper arm) breast, the back of the shoulder and the ears. Besides the unsightly appearance patients may suffer pain, itching, burning sensation and abscess formation due to infection of underlying glands.
The problem can be treated by a procedure called intralesional excision, followed by a course of steroid injections into the scar after surgery. Ancillary treatments are pressure and silicon gel sheeting. Cancer of the upper lip in a case of Epidermolysis Bullosa - a report of a case treated at Apollo Bramwell Hospital. Epidermolysis bullosa is a genetic disease in which the primary feature is formation of bullae in the skin or mucous membrane, either spontaneously, or in response to trauma. A 31 year old male with epidermolysis bullosa presented with a squamous cell carcinoma of the upper lip.
Excision of the lesion and reconstruction was planned. However several anesthesia related problems need to be addressed in such patients. Use of the face mask can cause bullae on the chin, nose and cheek.
Poor eyelid retraction can lead to corneal damage. Use of the laryngoscope or oral airway can cause bullae in the mouth that can bleed. However there are no reports of laryngeal or tracheal bullae. The patient was successfully intubated and a nasotracheal tube was inserted with the guidance of a fibreoptic bronchoscope.
The eyelids were sutured to protect the eyes and intravenous line fixed with sutures. All instruments are lubricated with petroleum jelly. It is important not to use any adhesive tape on the face as blisters can result. The lesion in the lip was resected and resection margins were confirmed negative with frozen section.
Reconstruction of the defect was done using a Zisser Madden flap and a perialar crescentic excision was also done. The flap healed uneventfully and patient had adequate mouth opening postoperatively.
Jane and I wanted to thank you so much for the care you and your colleagues took of Jane whist in Mauritius. Everything went well and Prakash did a great job of getting us to your clinic and back over the 6 dialysis days. We had a wonderful holiday and our children and grandchildren plus the other family all enjoyed it enormously. Best wishes to you all
Andrew and Jane Stewart