Body contouring / liposuction

Liposuction in tumescent local anaesthesia, and vibration-assisted technique with fine cannulas is the gold standard in liposuction surgery. My experience is based on personally performing about 150 liposuctions per year and this in the last 20 years of my practice. The Hirslanden Klinki St. Anna in Meggen offers the optimal facilities for performing the procedure in state-of-the-art operating rooms, excellent care during and immediately after surgery by the anaesthesia team, and comfortable all-round care during the first two nights at the clinic. Safety for the patient is always the top priority here.

Tumescent local anaesthesia

Tumescent local anaesthesia (lat. tumescere: to swell) is a special form of local anaesthesia that is very suitable for preparing fatty tissue for liposuction. Here, the fatty tissue to be treated is swollen and homogenized with a highly diluted local anaesthetic saline solution. Anaesthesia or twilight sleep are not required for liposuction. For relaxation, of course, sedative and analgesic medications can be administered through the vein before, and also during the infiltration phase. At the end of the infiltration phase, and about 30 – 60 min later, the tissue feels very plump and firm. After the tumescent local anaesthetic solution has been left to act for about half an hour, the treatment zones are pain-free. The patient is able to actively position himself on the operating table and tense up the muscles during the subsequent suctioning as needed. These are the best conditions for an effective, pain-free treatment and excellent aesthetic results.

Liposuction procedure

The fat is removed using thin (2 – 4 mm Ø), 15 – 30 cm long, hollow cannulas, which are driven by an electric motor to vibrate at a high frequency. This vibration-assisted liposuction technique under tumescent local anaesthesia makes gentle and uniform removal of the excessive fat cells possible. The cannulas are passed through the skin via some small incisions (3-5 mm) and then pushed forward and back, parallel to the skin surface in a fan-like pattern. The suction separates the fat cells from the adjacent tissue and removes the fatty tissue through a tube. The fat cells are collected in a sterile container with some of the anaesthetic solution. In one session, up to 85% of the fat cells or as much as 5 liters of pure fat can be removed. The connective tissue fibers remain in place and are instrumental in the process of tissue shrinkage during the healing phase. During liposuction the patient experiences a rubbing or scratching sensation under the skin; this is caused by the vibration of the cannula and the tugging on the connective tissue fibers. Some patients also describe an almost pleasant feeling of an „internal massage“. If any of the sensations become too unpleasant, it is possible to administer intravenous medications to relieve the symptoms. In any case the entire procedure, which lasts 30-60 minutes, is well-tolerated by almost every patient.

After the procedure

Immediately after the liposuction, the tiny skin incisions are not sutured, but only covered with sterile dressings. The remaining tumescent local anaesthetic solution leaks out precisely through these incisions; to a greater extent in the following hours and to a lesser extent in the following 4-6 days. This “post-operative drainage time” is somewhat unpleasant, but highly desirable. The tissue is almost completely pain-free in the first hours after liposuction. The saline solution plus drugs are not completely resorbed by the body but drained out, and the liver has not to metabolize. Furtheron bruises are much less common after liposuction in tumescent local anaesthesia, as compared to other techniques.

Highly absorbant diapers used under special compression garments keep the patients dry. The compression causes that the excessive fluid flows outwards, and at the same time insures close contact of the loose skin and the underlying tissue layers. The adhesion of the multiple tissue layers in the right position is one of the critical factors in making liposuction procedure a success. The compression garments should be worn all around the clock for one week, and then during daytime for another 2-3 weeks. However, it is allowed to take a shower already on the first day after surgery, – without the compression garment! When the neck is treated by liposuction, patients are advised to wear a collar-like compression dressing for a short period of time – one day all around the clock – and then for the rest of a week only at home and during nighttime.

Immediately after surgery and also in the next few days, the patient should be active and drink a lot (3-4 liters a day). This is good for blood circulation and the best prophylaxis of thrombosis. Additionally antithrombotic injections (low molecular weight heparin) and an oral antibiotic (cephalosporin) are prescribed for 5-7 days. An analgesic (ibuprofen) may be taken as needed, recommended due to its beneficial anti-inflammatory and decongestant effects. The discomfort after liposuction is most comparable to severe “muscle soreness” and is usually well tolerated.

A two night stay at the Hirslanden Klinik St. Anna in Meggen is from a medical point of view advisable for larger liposuction procedures, or if you have to travel a long way to the clinic, and is also very comfortable. The nurses take care of the frequent changes of the absorbant dressings, required initially. After a shower in the morning, a medical check-up and a new dressing change, the patient can travel home relaxed and “well packed”. An emergency cell phone number ensures that I can be reached anytime by phone, if anything is unclear or disturbing.

Follow-up Care

The first follow-up exam takes place on the morning after surgery. After some check-up the dressings will be changed. In those incision sites where drainage has already stopped, steristrips are applied for wound adaptation. They should be left in place for up to 10 days. The normal wound healing process leads to a slight collection of fluids and swelling during the first 4-6 weeks after liposuction. Although this process is somehow frustrating, it is inevitable and necessary for normal healing processes. Usually patients can return to work after 7 days, depending on occupation and physical exertion. Sports should be avoided for 2 weeks, while tub baths, swimming, and sauna should be avoided for 4 weeks. Taking a shower is allowed immediately, on the first day after surgery.

A next medical follow-up exam is advisable after 10-14 days. Manual lymphatic drainage is recommended, performed by an experienced physical therapist or masseur, supporting a rapid reduction of swelling and bruising. Regular massage of the treatment areas is also very helpful, using a gentle body cream or lotion.

The results

The cosmetic results can first be evaluated after 4, better after 6 months. This healing time is really needed before you can discuss the changes actually. Even after 12 months further improvements in body contours, as well as in smooth- and skin tightness are obvious. After 6 months photodocumentation will clearly show the difference and the improvement – and  before and after pictures will cause happiness not only for the patient, but also for the doctor.