Fat Removal from The Body: Liposuction: Compilation 2019

What is fat? Is it tissue or organ? Are there any hormones that lose weight or appetite suppressant? Was the gene of obesity found?

The tissue of obesity is considered as an organ with hormones according to many metabolism experts (Zhang, 1994). In this study, obesity (Human Obese: OB) gene has been shown to be on chromosome 7 (7q31.3). Scientists demonstrate the tissue of fat and our skin as the largest tissue of our body. Unappetizing (appetite suppressant) Leptin and Ghrelin (appetizing) are the proven mediators and very important hormones of this organ. They manage the energy balance coordinated with insulin hormone by controlling fat metabolism in deep sleep. Leptin is responsible for burning fat and diminishing appetite while Ghrelin is excreted from the stomach and plays the role of quickly appetizing and energy accumulative. Insulin is responsible for the conversion of excess sugars from foods into fat and storage. Anorexigenic (appetite suppressant) Leptin levels in the blood circulation enhance in patients with high body mass index and therefore in patients who come for massive or moderate liposuction (1000-5000 cc.), while orexigenic (appetizing) Ghrelin levels are low. Therefore, patients who apply for liposuction are leptin-resistant. Weight gain is maintained under energy control and balance. The balance disorder means excess weight or regional obesity or contour deterioration. While the levels of Leptin (appetite level) diminish after exercise and more than 40 years, the leptin levels increase after eating and especially sugar consumption.

Fat removal from the body is done to correct the contour with the loss of excess fat tissue, and in fact, this hormonal mechanism in the central hypothalamus gives a task / adjustment again. The reason for gaining weight / fat again after surgery or heavy diet / exercises is that this mechanism is left to itself without any precautions. Each patient should be given a personalized and sustainable balanced diet / exercise program to avoid gaining weight (fat) after each liposuction (removal fat) procedure or transient (diet) or permanent (tube stomach surgery) for fat metabolism. Please take not these: they decrease the level of leptin and Ghrelin in the blood at the same time after consuming high-fat foods, (1, 2), high carbohydrate consumption reduces Ghrelin level (2), there is no clear study on the effects of protein consumption on the Leptin / Ghrelin level, and most studies are controversial (3). Ghrelin decreases as body weight (BMI) increases, and Leptin level increases in blood (4). Not only the aesthetic aspect of the body contour, but also the postoperative nutrition / exercise balance should be shaped according to these scientific data when removal fat from the body. All energy / metabolism balance and endocrine symphony will be updated with new software after the removal of fat.

What is the removal of fat from the body?

In the medical Literature, Lipo means “fat” and suction means “removal”.
Liposuction is a surgical procedure of fat removal applied for body / face shaping and contour revision. That’s why we call liposuction.

How the removal of fat from the body is done?

The procedure of fat removal is made with the help of perforated cannulas of different lengths and diameters. Developing technology and surgical techniques are full of innovations in this field that make fat ready to take out without removal. Vaser liposuction technique that represents the third generation ultrasound technologies is one of the applications that works in 3 stages by selectively affecting the fat and commits comfortable healing. The fat can be taken under local anesthesia with the help of an injector or by a motorized closed-circuit system that supplies energy. fat taken less than 1000 cc. is called as light, applications extracted fat between 1000-5000 cc are called as intermediate and fat taken more than 5000 cc. is named as massive liposuction. The recovery time extends according to directly proportional to the volume taken and the side effect rate increases.

Can the taken fat be given another place or discarded?

Many studies have been carried out on the viability of fat tissues collected with liposuction. In the case that fat cells are collected without dissolving (melting) into the triglyceride structure, fat tissues can be used as a packing material. The survival rate of the transplanted fat cells in fat transfers varies according to the fat collection / delivery technique used (cannula length, hole diameter, delivery rate, etc.), amount and place of delivery (30-70%). The person transfused cannot wear compressive corset and lie down on the transfused area. Prepared fat tissues (this fat is now called grafts) are submitted to the required areas of the face or body area in order to provide filling and contour restoration. Tissue cocktails obtained from the person’s own blood called PRF are used in order to increase the viability of fat grafts. Undesirable excessive fat tissues are not necessarily submitted to pathology in contrast to the tissues removal from the breasts.

Who is at risk group for body fat removal?

The following items can be considered as risk factors for the patient:

Duration of surgery, the age and general health status of the patient, smoking, previous heart attack, history of stroke, remaining immobile for a long time after surgery, previous deep vein occlusion or inflammation (phlebitis / thrombosis), pneumatic compression stockings in surgery, heating, catheter etc. lack of supportive attempts, hormone therapy and abort history, blood coagulation disorders and / or factor deficiencies, exceeding the limit of massive liposuction (excessive fat removal applications for the purpose of losing weight), patients without realistic expectations, adhesions, scars and withdrawals from previous operations, exercise scheme and systemic drugs of the patient can be included. In the presence of these substances, the patient should be informed completely, clearly and correctly, the duration of the operation should not be extended, and if necessary, the operation should be divided into several sessions.

What are the encountered problems after liposuction?

Contour disorders, skin fluctuations, dimpled styled holes, sensory disorders, edema, hematoma and ecchymosis due to bleeding, color changes, asymmetries can be seen. The most dangerous complications are skin necrosis and fat embolism with increased incidence following high fat intake in risky patients. Sensory disorders get over within 3-6 months. Filling or surgical corrections can be made with fat grafts to the remaining areas after 6 months of massage treatments for asymmetry and skin irregularities.

Rohrich and Muzaffar make the following suggestions 2000 (5) for the purpose of less serious complications after liposuction

• Appropriate patient selection
• Appropriate surgical technique
• To avoid fluid and drug toxicity given to the patient
• Careful observation and control of the patient during surgery
• To wear the patients with active (pneumatic) compression stockings
• Strict clinical follow-up on the first night after surgery

In addition to these, I also add the following articles in order to encounter less unwanted situations in fat removal operations.

• Selection of atraumatic surgical cannula and instrument,
• Topographic marking for skin quality and cellulite in liposuction areas,
• Total surgery time should not exceed 4-6 hours,
• Adequate heating of the patient in the operating room environment,
• The amount of fat to be taken should be under 5000 cc.,
• Early (within 3-4 hours) movement and walking after surgery
• The B vitamin support for postoperative sensory disorders,
• Alignment with a waiting period of at least 1 year for patients undergone tube gastric surgery (bariatric surgery) in case of weight gain again,

Help patients to be given a diet / exercise program in post-operative metabolism regulation that is to say in the body shaping of fat to be structured.

What is the healing process after liposuction and how long does it take shape?

The healing according to the patient’s general health level, age, and the degree of fat collected from the operation allows the patient to return to work for 3-7 days. Wearing compressive corset within 7-21 after the surgery. The corsets are garments that accelerate healing and prevent the formation of extra edema. If there are not combined suture (breast reduction, abdominoplasty, etc.) procedures, the person can take a shower in 3rd day, drive a car, travel and start to walk. Shaping is completed at the end of the 3rd week, largely after the period of 2-3 terms. The procedures of fat removal from the body that are applied for the purpose of contour correction commit lasting results provided that the dietary / exercise and daily life recommendations should be given to the patients. Approach with the intention of healing to not only fat tissue under the skin but also sagging, relaxation, cellulite, fluctuation, dimpling, maculation or chap on the skin will make the results of fat removal process more satisfactory. Skin quality-enhancing, firming and regenerating energy-based and with session treatment protocols can be applied postoperatively.

Tags: Leptin, obesity, Ghrelin, adiposity, liposuction, fat removal from the body, vaser, fat transfer, vaserlipo, vaserliposuction, body shaping, contourplasty, Ankaraliposuction, lipoankara, complication, aesthetic surgery, plastic surgery, obesity, BMI, Ankara aesthetic surgery

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2. Monteleone P, Bencivenga R, Longobardi N, Serritella C, Maj M. Differential responses of circulating ghrelin to high-fat or high-carbohydrate meal in healthy women. J Clin Endocrinol Metab 2003; 88: 5510–5514.

3. Greenman Y, Golani N, Gilad S, Yaron M, Limor R, Stern N. Ghrelin secretion is modulated in a nutrient- and gender-spe- cific manner. Clin Endocrinol 2004; 60: 382–388.

4. Klok MD, Jakobsdottir S, Drent ML. The role of leptin and ghrelin in the regulation of food intake and body weight in humans: a review. Rev. 2007 Jan;8(1):21-34.

5. Rohrich RJ, Muzaffar AR. Fatal outcomes from liposuction: census survey of cosmetic surgeons. Plast Reconstr Surg. 2000;105:447–448.