Liposuction after weight loss not only deals with “stubborn” fats, which do not respond to further dieting and exercise; most patients also have contour deformities due to the redundant skin and soft tissue laxity.
Massive weight loss, which is clinically defined as 50 percent or greater loss of the excess weight, can also lead to a deflated-looking appearance, which is more pronounced in the buttocks, facial region, and breasts.
As a stand-alone procedure, liposuction may not provide optimal outcome in MWL patients who generally require excision-based body contouring surgeries that may include tummy tuck, buttock lift, thigh lift, and arm lift.
Some surgeons prefer liposuction performed simultaneously with some type of excision-based plastic surgery after weight loss. They argue that a combo procedure is reasonably safe with proper patient selection, management of risk factors, close monitoring, and keeping the surgery under six hours.
Others prefer staging each surgery, performing liposuction at least six months prior to an excision-based body contouring. Dr. Tarick Smiley, a leading Beverly Hills plastic surgeon, says this approach favors patients who “need a great deal of work.”
Proponents of the staged-procedure suggest that it could minimize risk of healing problems since the amount of surgical trauma and bleeding is “controlled.”
Despite varying views on simultaneous liposuction and staged surgery, the latter approach is generally favorable if MWL patients will also require tummy tuck in which a horizontal incision within the lower abdomen is used.
By removing the excess fat in the abdominal area, and waiting for several months to see how much skin retraction or slackening will occur, doctors are able to assess the most ideal tummy tuck scar in terms of its length and placement.
Dr. Smiley says that most MWL patients require debulking or large volume liposuction in which 4 liters or more of fat is removed in one day. Because of the increased risk of fluid imbalance, this approach entails a hospital stay, as opposed to a same-day operation in “standard” liposuction.
The renowned Beverly Hills plastic surgeon further adds that previously obese individuals have fat that is more fibrous, making liposuction more difficult. Nevertheless, certain procedures can address this “challenge” such as the use of microcannulas and tumescent fluids.
Microcannulas are suction probes with an outside diameter that is 2 mm or less, thereby they provide more control and accuracy than large cannulas. Also, surgeons use less force when extricating the fatty tissue with these flexible tubes.