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Fat reduction procedures

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This chart shows the progression of obesity in the U.S.

Fat reduction procedures are cosmetic surgeries aimed at either reducing localized fat deposits or restricting intake. For some people cosmetic surgery is a pleasure and/or luxury, but for others it is a necessity. Morbid obesity has been ever increasing throughout the years and for some the choice is between surgery or suffer a premature death. There are now various ways to lose fat cells that hold all those extra pounds. Some procedures cut away the fat completely and leave it up to the patient to keep it off, other procedures help the patient create a new way of life by restricting their eating habits.

Lipoplasty

Lipoplasty is a common procedure, better known as liposuction. It is one of the most popular cosmetic surgeries available. This procedure is such a hot commodity because when fat cells are removed, they generally cannot be regained. This operation uses a cannula to break up and remove fat. It also re-sculpts the body by reducing the fat deposits that the patient can't remove through other regiments such as diet and exercise. The best candidates for this particular procedure are those that are at least 18 years old, are in good physical health, and are psychologically stable. There are different types of liposuction available, a few being body-sculpting liposuction, conventional liposuction, large volume liposuction, tumescent liposuction, and ultrasonic liposuction. [1]

Procedure

The liposuction operation is done under either local or general anesthesia. Conventional or tumescent liposuction requires a time period of 1-2 hours. Larger, more complex procedures need a longer time frame and may even require several separate operations. [1] The procedure itself requires the assistance of a hollow metal tube called a cannula. This tube is responsible for removing the fat from the body. There are different techniques used to perform liposuction. One is called suction assisted liposuction, or SAL. It uses a pump that acts as a vacuum to suck out the excess fat from the body. Another technique uses a motor with the cannula. This motor provides continuous, steady movement for the cannula. This particular procedure is called power assisted liposuction, or PAL. A surgeon may also call for a laser to aid in breaking down the fat cells. Sometimes an ultrasonic generator is used for high frequency sound waves to break down fat cells. When this is used the cells are then removed by using the suction assisted liposuction technique. These variations of liposuction may be used together in different combinations. While they all provide different benefits they also carry their own set of risks. These different methods will be discussed with the patient prior to the surgery during a consultation. [2]

The recovery time varies depending on the severity of the procedure and the individual patient. The swelling produced from the operation takes approximately 3 weeks to decrease and return to normal. For faster results and healing it is highly suggested that the patient resume light activities immediately or as soon as possible. For more hard activities, or those necessary for normal life, it takes more time to be able to gain the strength to do, around 4-6 weeks. A patient can normally return to work within 3-21 days. While most procedures are successful there are many various side effects such as post-surgical dimpling, lumpiness, numbness, scarring or discoloration, and because of these a follow-up surgery may be necessary. [1]

Risks

Liposuction is a high risk operation that can produce a multitude of complications. A couple very minor complications are simply bruises, some scars, and slight numbness. A little more severe, but still within the normality range, are some changes in the pigmentation in the patient's skin. The major complications include problems such as reaction to the anesthesia, cardiac arrest, cardiac arrhythmia, internal blood clots, excessive bleeding, severe drug interactions, an allergic reaction to the provided medication, permanent nerve damage, seizures, and brain damage due to the anesthesia. For those who participate in liposuction frequently, and over excessively, they risk skin damage such as dents, lumps, and sagging. This is due to the removal of too much fat from one centralized area. It may also be caused by too much of one procedure within a short time period. Procedures, especially larger projects, should be taken in stages over several days with rest periods in between. To minimize the risk of complications the patient can take several precautionary measures such as presenting their full medical history to their physician, providing the surgeon with the knowledge of all their current drug use, being fully aware and knowledgeable of the procedure taking place, following the instructions for pre and post operative care, and sustaining from smoking two weeks prior and following the surgery. The best way to prevent complications for the patient is to choose a surgeon who has had extensive training, maintains a strong recommended facility, and holds a good name within his or her area of expertise. This surgeon should provide the patient with all the knowledge of the procedure by explaining the side effects and risks. [3]

Benefits

This is a picture of a woman's legs with severe cellulite and with less cellulite.

While the risks may be high for a procedure such as this, the benefits can also be just as high. For example, not only can it remove excess fat, improve health, and remove cellulite, but it can provide new life to the patient. The operation can remove up to 10 lbs. of fat from a single area. Not only can it improve the health of a person in the general sense of removing fat cells, but it can bring relief through operations such as breast reductions. When a patient has disproportionately large breasts it can result in severe back pain, neck pain, headaches, and migraines. Because the area at which the body stores its fat is generally determined through genetics liposuction can remove the fat deposits that have gathered disproportionately. Cellulite is created when the fat cells push through the collagen connective tissue beneath the surface of the skin. This is what causes the dimpled appearance on the surface. Cellulite is not based off of the amount of fat a person has, a healthy or underweight person is just as susceptible. Because genetics also plays a role in cellulite, the procedure does not always guarantee its removal. Moreover the greatest benefit to this procedure would be the greater amount of abilities capable for performance and the self-confidence obtained. [4]

Laser Lipoplasty

Laser lipoplasty is most commonly referred to as laser liposuction. Some of the benefits of this particular type of cosmetic surgery include skin tightening, smooth skin, less bleeding, less trauma, and a shorter recovery period. [5] This procedure operates with the use of a laser that is adjusted to a specifically high frequency. This powerful beam of light liquefies excess deposits of fat, which is then removed. Laser lipoplasty is a less invasive procedure that requires less time, provides fast results, and fewer severe complications. [6]

Procedure

First the surgeon uses a local anesthesia on the patient so that they remain conscious during the procedure. This will provide the patient with a faster recovery time because they will be awake. [6] Once under the anesthesia, the surgeon creates a small incision that the cannula slides through. The cannula possesses the laser that is able to liquefy fat cells and coagulate small blood vessels. The higher the wattage on the laser the faster the procedure is able to go. Not only does the laser liquefy fat cells, but it also acts as a visual guide for the surgeon. This allows more precise movements and thereby less complications. A hollow cannula also pulls out the liquefied fat cells, removing them from the body entirely. [7] The laser itself is set to a specific and high frequency range. By rupturing the fat cells it creates an oily liquid substance that can be easily drained from the body. Most of the fat cells targeted are located within the top layers of the skin. By sealing blood vessels it decreases the amount of swelling, bleeding, and bruising. [6]

Because it is a less invasive procedure and the patient is only on a localized anesthesia the patient may return home within a couple hours following the surgery. The only post-operative care that the patient may find necessary is some pain medication and bandages. The patient is provided with compression bandages that help prevent blood clots and help stabilize tissues. The substances that a patient would be wise to abstain from are anti-inflammatories, blood thinners, and smoking. The little bruising and numbness that may appear disappears anywhere from outside a couple hours to a few days. The swelling also decreases within a week following the operation. At this time the patient should also be able to resume normal activities. Follow-up visits are mandatory and by the end of three months the patient's skin should have returned to its original state. [8]

Risks

The best way to avoid major complications during laser lipoplasty is to hire a well trained and experienced surgeon who has perfected his or her technique. While some sources may say that there are less complications and it is a variably safe procedure, there are still serious risks that should be taken into consideration. Because a laser is the main source of treatment within this procedure, skin burns are a risk. When one specific area is treated too harshly or too close to the skin for a proportionally long period of time, the patient is at risk for thermal injuries. Skin loss is also a problem when the overlying skin becomes damaged by a burn and as a result is lost. To avoid infection sterility and antibiotics are necessary. In this procedure, and those like it, bleeding and anesthetic reactions are always a factor. One of the major complications that may arise is contour deformity. This includes lines, depressions, lumps, and bumps that arise in around 20% of liposuction patients. They are caused by the removal of fat that is either too close to the surface of the skin or irregularly removed. [5]

Gastric Bypass

The woman in this photo is severely obese and could benefit well from a fat reduction procedure.

Gastric bypass surgery is a procedure for people who suffer from severe obesity. It requires its patients to be very prepared for not only the operation, but the results that it brings and the effect it plays on their bodies both physically and mentally. The patient must be both well informed and highly motivated, otherwise the outcome could be more negative than positive. The best candidates for this operation are those who have a BMI (body mass index) of 40 and above. Exceptions are those who have a BMI within the 35-40 range who suffer other co-morbidities such as medical conditions like diabetes or heart disease. They also should have attempted other weight loss regiments that haven't produced the desired results. Preparation for the procedure is immense. The patient must, first and foremost, meet with a surgeon to discuss the risks, instructions, and what to expect during and after the surgery. They must meet with a psychologist to make sure they are mentally and emotionally prepared to endure the changes that take place and to set up a support group. A nutritionist helps the patient after the surgery to stay healthy, keep hydrated immediately following the surgery, and maintain a strong diet. The patient must also meet the nurse practitioner, financial specialist, and bariatric coordinator. [9]

Procedure

The Roux-en-Y gastric bypass procedure is primarily minimally invasive. There is only a series of small incisions made in order to proceed with the operation. It is a form of laparoscopic surgery. Through the incisions the surgeon is able to insert long, tube like instruments that carry out the procedure. The surgeon also admits a type of gas in the abdomen that increases the cavity size, allowing greater visibility and thus better working conditions. One of the tubes previously stated holds a camera that displays images of the abdomen on a screen within the operation room. This camera allows the surgeon to work efficiently without creating large incisions. The actual procedure entails the creation of a smaller stomach pouch and the division of the small intestine. The stomach pouch then attaches to the divided small intestine. Through this connection it allows the food taken in by the patient to bypass a large portion of the small intestine. Because the small intestine is responsible for absorbing nutrients and calories from the food eaten by the body, this adjustment makes it so that when the patient eats food, less of it is absorbed by the body. In the end it reduces the amount of calories the patient intakes per day. [9]

This picture shows the incisions that were made during a gastric bypass procedure. Notice the staples used to close up and the bruising around the incisions that result.

The first day after the operation the patient endures an upper GI to make sure that there were no resulting complications from the surgery. Once everything is cleared the patient is able to drink liquids. Although the patient is discharged on the second postoperative day, they have to return for a follow-up visit a week later and every several months later to ensure everything is working smoothly. Once at home light activity can resume and normal activity capability should begin within days. The patient can return to work within 2-4 weeks. It is specified that there can be no driving if the patient remains under the influence of any narcotic medication administered for pain. [9]

Risks

As advancements and technology increases within the medical field the health risks involved in a gastric bypass surgery decreases. While the benefits to a procedure such as this can be substantial and/or necessary for a patient's health, for example the improvement of comorbidities such as heart disease, blood pressure, type 2 diabetes, lung function, and some cancers, there are always the other negative factors to consider. The higher or lower risk factors are based off of different key components such as the weight and co-morbid conditions of the patient post surgery, the patient's physical health, the procedure itself and its extensiveness and difficulty, and most importantly the experience and skill of the surgeon. During a laparoscopic surgery, although it may be less painful and require only a few incisions thus reducing the risk of incisional hernias, it is more complex for the surgeon. If the surgeon is less experienced using this method, the risk of complications increases in the patient's perioperative and post-operative state. [10]

The most common complications that arise from this procedure are abdominal hernias. It is normal for patients to have a follow-up surgery to fix some complications; 10-20% submit to another surgery. Gallstones are also a common problem that comes up in over 1/3 of patients. [10] Because the small intestine no longer absorbs as much, what it does absorb must be healthy; there is risk for nutritional deficiencies such as anemia. A reaction to the anesthesia is also a factor to consider. [9] Complications that take affect early on include: infection, dehiscence, leaks from staple breakage, stomal stenosis, ulcers, and deep thrombo-phlebitis in over 10%. Some long term complications include 40% who suffer from vitamin B12 deficiency, 23.9% suffer incisional hernias, 23.7% suffer depression, 15% suffer staple line failure, gastritis, cholecystitis, anastomotic problems, dehydration, malnutrition, and dilated pouch. The death rate for the operation is at .2-1%, but for obese patients who require this for their health lower their risk of premature death by 89% than those who live untreated. [10]

For those who suffer from severe obesity and it is necessary for their survival to have this surgery, they put themselves at high risk for depression. Depression is caused through the emotional tie that they have with food and the role it plays within their lives. When the surgery requires them to maintain a healthy diet it puts an emotional strain on them. The procedure no longer allows these certain people to make food their emotional support. This disruption and imbalance causes the muscles to weaken and fatigue to set in months following the operation and results in lower protein intake. While these emotional side effects should wear off, some constantly struggle with the monumental change in their lives.[10]

Abdominoplasty

Abdominoplasty is a common cosmetic procedure better known as a tummy tuck. The procedure deals with incisions, skin and fat removal, and muscle manipulation. The results can be extraordinary by creating a flat and firm abdomen. These benefits not only help the appearance of the patient, but increases their self-confidence. Because of the incisions scarring is unavoidable, but speaking with your surgeon first, the incisions are most likely planned to be minimally visible. Paying close attention to pre and post operative instructions can help immensely with the recovery of the body and the healing of the scars. [11]

Types

Mini (partial) tummy tuck is a less invasive procedure that only requires one small incision inferior to the navel.[11]


Circumferential abdominoplasty is a procedure that removes excess skin from the hip and back area. It requires a large incision that takes up the entire waistline. It is a type of body lift that is routine for a patient of a gastric bypass surgery who has lost a great amount of weight and now has large quantities of loose skin. If untreated a fungus is likely to grow within the folds of skin and become a health risk. Scars are most likely going to be large and prominent.[11]


Traiditional tummy tuck requires only a single incision that goes across the stomach extending from each hip bone.[11]


Endoscopic tummy tuck is a procedure that many men sign up for. It is for patients who, although don't have a lot of fat or an excessive amount of loose skin, have weakened muscles. The procedure requires the use of an endoscope, camera attached to a tube. Because the surgery is not very extensive the scarring is very minimal.[11]


Extended tummy tuck takes care of those ever annoying 'love handles' and also the excess fat and skin from the abdomen. It generally requires the use of a circumferential tummy tuck.[11]

Procedure

The procedure itself varies in time depending on the extensiveness of the surgery. For example, a partial tummy tuck requires 1 1/2 hours while others require anywhere from 2-5 hours. During the surgery the patient is put under a general or localized anesthesia. Most of the time the surgeon uses general anesthesia where the patient is unconscious rather than localized where the patient would be awake. General anesthesia provides a faster and easier surgery for the doctor because the abdominal muscles are relaxed and there won't be any unexpected movements. [11]

The procedure requires incisions to be made across the abdomen. Depending on the desired results a specific procedure requires different incisions. These incisions are created in a manner that shows minimal appearance. The surgeon tries to cut where the scar can be hidden from plain sight. The procedure most likely requires the detachment of the navel by a vertical incision. Nearing the end of the surgery another incision is needed to either reattach the navel in a more natural position or the recreation of a brand new one. It is best to speak with your surgeon about this situation specifically to prior to so that you may get the best results. [11]

The purpose of the procedure is to tighten the abdominal muscles by removing extra pockets of fat and skin. In order for this to happen the skin is removed from the muscle while the surgeon pulls the muscles together and stitches them into place to create a better physical appearance. This new positioning of muscles creates a narrower waistline. Once the muscles are tightened into place the skin is stretched back down over the muscles. Once pulled down the excess skin is removed from the body. The tightening of the skin allows stretch marks to be eliminated or decreased because the depth of each dimple is lessened. In association with abdominoplasty, liposuction may also play a part in the removal of fat deposits within the area before the skin has been pulled into place. [11]

The last step in the surgery is to suture the skin with the use of surgical stitches. Before the stitches are set into place a surgical drain is inserted into the body through the incision. This drain is used to prevent fluids from building up underneath the skin. Fluid buildup is a very common complication that arise in patients. The drain also helps during the healing process as the body tries to repair the surrounding cells and the skin cells coalesce at the incision. The drain is removed prior to the removal of stitches after about one week following the surgery. The stitches follow, coming out in stages over a period of two weeks. [11]

Risks

Risks in abdominoplasty procedures include infection and blood clots which, although are normally rare, can cause serious problems. If an infection arises hospitalization is prolonged, but drainage and antibiotics should help. To prevent blood clots the patient is suggested to begin moving around as soon as possible. Blood clots form during immobilization in the legs and can eventually break apart and head up the body until reaching the lungs and getting inside. Scarring is inevitable, but paying attention to the instructions given by your doctor can quicken the healing process. Anesthesia reactions are also a risk factor. Nicotine intake is requested to halt during the weeks prior and after surgery because smoking increases the risk of tissue loss and delays the healing process. When the nerves in the abdomen are divided and/or stretched during the operation it results in numbness of the area. While most patients regain feeling there is possible risk of permanent damage. [12]

Vertical Banded Gastroplasty

Vertical banded gastroplasty is more commonly known as stomach stapling. It is generally used for those patients who obtain a BMI of 35 or higher who are considered morbidly obese. Developed in 1982, the procedure entails the sectioning off of the stomach by means of staples. It also involves a plastic band that limits how much food a person eats and holds at one time. Although this procedure also involves the manipulation of the digestive system, it differs in that it does not limit what food is absorbed, but what is ingested. After the procedure weight loss occurs within the first six months. By 18-24 months the patient should have lost about 50% of their extra weight. Problems such as diabetes, high blood pressure, urinary stress, incontinence, and other complications should have decreased and improved also. [13]

Procedure

This diagram of the body cavity shows the stomach and esophagus that will be reconfigured during the vertical banded gastroplasty procedure.

A regular open vertical banded gastroplasty operation takes, on average, 1-2 hours. While under anesthesia the surgeon creates a long incision along the upper abdomen. Next, a hole is then cut a little below the esophagus in the upper stomach. He then designs a small pocket on the upper stomach that now suffices as storage for food. This results by creating a surgical staple line headed towards the esophagus to hold the newly generated stomach. This pocket is only able to hold a tablespoon of solid food because it is a mere 10% size of a normal stomach. Because polypropylene doesn't stretch it is used to hold the food within the stomach longer, which thus keeps the patient feeling full. The band of polypropylene plastic is stitched into place through the hole that was formed around the outlet of the stomach pocket. The final step in the operation is to sterilize everything and close up the incision. This particular type of stomach stapling requires 4-5 days of hospitalization post-operative. [13]

A newer technique devised for this operation is a laparoscopic vertical banded gastroplasty. This operation requires more time in the operating room, but less post-operative hospitalization. The patient needs a total of four, small incisions. Three of them are on the left side of the abdomen and are a gateway for the laparoscope. The fourth is about 2 1/2 inches on the opposite side of the abdomen. Once the incisions are made the surgeon uses a 10mm(diameter) hollow tube holding a fiberoptic cable called a bariatric laparoscope. The laparoscope feeds a screen within the operating room with images of the abdomen. The operation take 2-4s hours long, but the patient can be released from the hospital after 2-3 days. [13]

Because the procedure is very long and arduous the patient must remain on a PCA (patient controlled anesthesia), which is a pump that provides the patient with a dose of medication through an IV unit. As their stomach recovers they keep on a strict liquid only diet for 2 weeks. During this time they have to regain their lung strength and keep changing their surgical dressings. After the first couple weeks they may begin eating regular foods, but they must remember to chew thoroughly and eat cautiously because they aren't used to the change within their body yet. Because they don't know how much food their stomachs can now handle eating to fast or to big of substances can cause nausea and vomiting. Five years minimum of regular follow-up visits are required to make sure that the patient continues to stay healthy. After recovery they begin an exercise program, support groups for both the physical and psychological toll the change takes, and a new diet that strays from sweet and soft foods to help reduce weight gain. [13]

Risks

Both forms of lateral banded gastroplasty have approximately an equal balance of risks involved with the procedures. Some of these risks include blood clots in the legs, infection, pulmonary embolism, and death. There is a 5% mortality rate and a 6% chance of getting an infection due to a leakage, which can be fixed through another operation. Infections are common within any operation that involves incisions, but for patients who suffer from severe obesity, they have a 10% higher risk rate. When an incision is reopened and a piece of tissue pushes through it is called an incisional hernia. These occur when there is a great amount of stress put on the stitches that are keeping the incisions closed. Because the spleen lies fairly close to the stomach it is not unusual for it to suffer from damages too. Dehiscence may result when the staples holding the upper portion of the stomach together come undone. Some other complications may be stricture, an unusual narrowing of the body canal, weight regain, vomiting and heartburn, and psychological difficulties. Before the patient personally understands how much his or her stomach can hold, diet control is a difficult concept. Because their stomach can only hold so much, the food it does hold needs to be high in nutrients otherwise the body will not obtain what it needs. Especially if the patient's diet consists of fatty substances the body will only retain the fat and thus regain or add on more weight. 20% of people who have this procedure also suffer from digestive problems. Because of the biochemical changes within the body from both the weight loss and new diet, the patient may suffer emotional changes and possibly depression. [13]

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References

  1. 1.0 1.1 1.2 Liposuction Perfect Yourself
  2. Liposuction (Lipoplasty) The American Society for Aesthetic Plastic Surgery. ASAPS
  3. liposuction risks Docshop.com. Einstein Industries, Inc.
  4. Liposuction Benefits Docshop.com. Einstein Industries, Inc.
  5. 5.0 5.1 Laser Liposuction Risks by Brooke Seckel. Ezine
  6. 6.0 6.1 6.2 How SmartLipo Works SMARTLIPO
  7. SmartLip Technology SMARTLIPO
  8. Post Operative Care SMARTLIPO
  9. 9.0 9.1 9.2 9.3 Gastric Bypass Surgery Baylor College of Medicine
  10. 10.0 10.1 10.2 10.3 health dangers of gastric bypass surgery By Anne Collins
  11. 11.0 11.1 11.2 11.3 11.4 11.5 11.6 11.7 11.8 11.9 Abdominoplasty surgery Docshop.com. Einstein Industries, Inc.
  12. Tummy Tuck Abdominoplasty Risks and Possible Complications Bermant Plastic Surgery. By Dr. Michael Bermant, MD.
  13. 13.0 13.1 13.2 13.3 13.4 Vertical banded gastroplasty Encyclopedia of Surgery. Advameg, Inc.

Additional Information