Liposuction Saarland

Liposuction of the abdomen is not covered by health insurance. Only in rare cases where there is a “pathological disfigurement” does an application for reimbursement of costs make sense.

Since January 2020, liposuction of the legs for stage III lipedema has been included in the benefits catalog of statutory health insurance. The admission is limited until December 31, 2024. Lipoedema is a pathological increase in fatty tissue, particularly on the legs and arms. The surgeons at CenterPlast have many years of experience in the treatment of lipedema. The specialists at CenterPlast are permitted to perform liposuction for stage III lipedema at the expense of statutory health insurance.

• Liposuction should be performed when you have reached your desired weight.
• All questions about possible complications & alternative treatments should have been answered in advance.
• Keep the consumption of nicotine and alcohol to a minimum!
• If necessary, adjust the temporarily stop taking hormone-containing medication (the pill).
• Blood-thinning medication (e.g. ASA, Thomapyrin®) must be discontinued at least 10 days before the operation (after consultation with your doctor).
• Vitamin preparations (A & E) and dietary supplements (omega-3 fatty acids / St. John’s wort preparations, etc.) must be taken at least once a week. 4 weeks before the plastic-aesthetic procedure.
• Follow-up cost insurance should be taken out before cosmetic surgery is carried out.
• Surgical procedures restrict your ability to travel by air. For this reason, do not plan any business or private air travel in the 6 weeks following the operation.

It is a misconception that a shower before wound healing is complete is dangerous. Wounds are normally covered with a dressing until the skin sutures are removed to protect them from moisture. A large number of studies have also shown that showering does not increase the risk of inflammation. Showering with tap water helps to clean a wound after an operation. Daily showers are very important for personal hygiene. Based on our many years of experience and scientific findings, we recommend showering with tap water on the 3rd day after the procedure, without soaking or rubbing the wounds. After showering, dry the wound(s) with a clean towel or with cool air from a hair dryer.

The surgeons at CenterPlast take numerous measures to prevent possible pain. All steps of the procedure are considered in order to make the procedure as comfortable as possible. The surgeons, the operating staff and the anesthetist will take care of your well-being. Even small details such as listening to music help you to relax. They are given pain-relieving medication. These also take away your fear.

The tissue is then gently injected with a long-acting local anesthetic. This ensures that you are not in pain even after the operation. As a preventive measure, you will be given well-tolerated pain medication such as paracetamol or ibuprofen. During the entire operation, you can put on virtual reality goggles and watch movies or your favorite series. In addition to entertainment, distraction has also been shown to help reduce sensitivity to pain. We will also provide you with the necessary pain medication to take home and after a week at the latest you will no longer need any pain medication.

The very fine cannulas for liposuction are inserted under the skin via 2 to 3 mm incisions. These incisions are made in the fold lines of the skin so that they are barely visible. The gentle, careful and atraumatic treatment of the tissue ensures particularly inconspicuous scar healing. The fine suture material creates a fine, line-shaped scar that is barely visible. An additional measure is to make the incisions on the right and left side of the body in different places so that even the tiniest scar does not give the impression of a planned operation.

The amount of fluid removed during liposuction consists of the removed body fat and the previously injected tumescent solution. The tumescent solution consists mainly of water and adrenaline and helps to minimize blood loss. Liposuction can remove up to eight percent of the body weight in fat volume per procedure (four to eight liters). The American Society of Plastic Surgeons defines five thousand milliliters as a large volume liposuction. There is no fact-based information on the maximum amount of fat that can be aspirated. In 2015, plastic surgeons from Chicago investigated the correlation between the amount of suction and the body mass index. They have found that minor complications (seromas) occur more frequently from a suction volume of one hundred milliliters per unit of body mass index. The risks of liposuction are lower in healthy patients. Obesity, diseases of the heart, lungs or metabolism, cigarette smoking and hormonal contraception are a health risk. These factors therefore also influence the risk of liposuction. How much fat can be suctioned out varies from patient to patient. The exact suction volume is determined during a personal consultation.

Liposuction of the abdomen, buttocks and legs is indeed possible in a single procedure. However, the total amount of fat tissue removed should always be moderate so as not to increase the risk of surgery. This upper limit naturally varies from patient to patient. The maximum amount depends on your state of health, your body weight and your lifestyle habits. In some individual cases, liposuction in several separate procedures is the safer way to achieve an optimal result. Whether this is the case will of course be clarified in a personal consultation.

CenterPlast uses several methods to prevent the occurrence of dents.

1. The skin is marked before the operation for precise planning.
2. The deep layers of fatty tissue are treated as a priority.
3. The tissue is loosened with a so-called tumescent solution (super wet technique).
4. The amount of tumescent solution used per area and side is precisely controlled.
5. The tissue is loosened using the SAFELipo technique.
6. Vibration liposuction helps to avoid unevenness.
7. Fine cannulas are used to create even contours.
8. Cannulas with openings that allow targeted treatment are mainly used.
9. Liposuction is performed in a set standardized sequence.
10. The amount of liposuctioned fat tissue is constantly monitored per area and side.
11. The contours are constantly and subtly scanned during the procedure.
12. Immediately after the operation, you will be put on a special compression garment.

The healing process can be accompanied by a hardening of the tissue. Two to three weeks after liposuction, tissue cells migrate into the treated regions. These cells form new collagen. The collagen is then gradually remodeled, realigned and cross-linked. During this remodeling phase, the tissue feels harder. If there is pronounced swelling and bruising after the procedure, the subsequent remodeling phase is correspondingly more intensive. To prevent hardening, it is therefore very important to wear compression underwear consistently, especially in the first three weeks. Manual lymphatic drainage and ultrasound treatments can also support healing. The operation itself can be ideally successful – the final result is only perfect after the follow-up treatment.

Swelling is unavoidable in the first few days after the operation. The special injected liquid (tumescent solution) is used to prevent bruising. Most of it is suctioned out during the procedure. A small proportion is taken up by the associations. The rest is excreted via the kidneys in the hours following liposuction. At the same time, various messenger substances increase the permeability of the blood vessels in the treated regions. This phase of wound healing lasts 1 to 2 weeks. The swelling then reduces considerably. The special compression underwear also serves to greatly reduce the swelling. If swelling is pronounced despite compression garments, early lymph drainage is necessary.

The compression underwear:

1. reduces the unavoidable swelling after an operation.
2. shortens the duration of the swelling.
3. prevents the accumulation of wound water in the suctioned regions.
4. promotes the shrinkage of the skin and helps to create a more beautiful contour.
5. ensures that scars remain as fine and inconspicuous as possible.

High-quality studies show that compression stockings (anti-thrombosis stockings) reduce the risk of thrombosis after certain operations. The CenterPlast doctors recommend wearing compression underwear and compression stockings for three weeks after liposuction.

The results of liposuction become clearer with each passing day. The swelling can fluctuate throughout the day. The new body contours become more visible from week to week. The result is largely visible after approx. 4 weeks. The treated areas of the body may still feel a little hard at this stage and the surface of the skin may still be a little numb. The hardening of the skin and the feeling of furredness usually disappear completely in the 3rd month after treatment. Four months after the operation, the actual final result can be seen in around ninety-five percent of patients.

During a general anesthetic, your consciousness is temporarily switched off. The respiratory drive and protective reflexes are also completely suspended. Twilight sleep (also known as analgosedation) takes away your fear, reduces your sensitivity to pain and makes you sleepy. Twilight sleep offers many advantages:

1. By combining different painkillers, the amount of stressful medication can be significantly reduced. They recover more quickly.
2. Side effects such as nausea are much rarer.
3. Serious side effects such as thromboses or embolisms are also rarer after twilight sleep than after general anesthesia.
4. After a twilight sleep, you can return home more quickly and also eat and drink again more quickly.
5. Patient satisfaction after twilight sleep is very high.

Tumescent anesthesia is a form of local anesthesia using a highly diluted anesthetic that is administered under the skin in large quantities. The technique was described by Matas as early as 1915 and later used by Klein for liposuction. In 1920 it was recognized that the addition of adrenaline is helpful. Adrenaline is a stress hormone that constricts the blood vessels when applied locally. This reduces the risk of bleeding. The anesthetic remains in the tissue for longer and the anesthesia lasts longer. The tumescent solution takes about twenty minutes to take effect. The use of a long-acting anesthetic ensures that you feel no pain even after the procedure. The amount of tumescent solution helps to keep blood loss to a minimum. The good tolerability and low risks as well as the excellent pain-relieving effect explain why the tumescent technique is also used for other procedures. The tumescent technique is also used at CenterPlast for tummy tucks, breast lifts, breast reductions, breast augmentations and face lifts. The advantages of the tumescent technique are

• You do not need general anesthesia.
• A sleeping pill is not absolutely necessary.
• Less medication enters the body’s circulation.
• Side effects such as nausea are unlikely.
• You recover more quickly and are back home more quickly after the operation.

Drains are not necessary for liposuction. If liposuction of the abdomen is combined with a tummy tuck, the short-term use of drains may be necessary in selected cases. In liposuction to correct a man’s breast in conjunction with the removal of a mammary gland, a drain is sometimes also used. Thanks to the use of a tumescent solution (injection of water with adrenaline) before liposuction, the use of blunt cannulas, careful preparation for the operation, good aftercare and a certain amount of sensitivity, there is no need to worry about post-operative bleeding. Patchy bleeding of the skin is unavoidable. The bruises will disappear on their own after five to ten days.

As early as 1964, the plastic surgeon Schrudde from Cologne removed fat deposits using a minimally invasive procedure. Schrudde drew marking lines on the skin to plan the operation and recommended wearing compression garments after the procedure. In 1976, Kesselring and Meyer developed the forerunners of today’s instruments: long hollow needles connected to a vacuum pump. In 1977, Parisian surgeon Illouz injected the tissue with an enzyme and a saline solution to reduce the risk of secondary bleeding.

In 1987, the Californian doctor Klein used the tumescent anesthesia technique described by Matas in 1915 for liposuction. The term is derived from the Latin and means “to swell”. The dilution of the anesthetic and the addition of adrenaline mean that only a small amount of anesthetic enters the body’s circulation. This means that a stressful general anesthetic can be dispensed with. Patients also recover more quickly after the procedure.

In 1990, Gasperoni also performed liposuction on the superficial layers of fat in order to correct contours more precisely. Matarasso first combined liposuction techniques with tummy tuck techniques in 1997 to perfect the results.

Vibratory liposuction was first approved by the US Food and Drug Administration (FDA) in 1998. With this method, a motor causes the hollow liposuction probe to vibrate. The hollow probe moves three millimeters back and forth up to four thousand times a minute. The fat tissue is loosened by the vibration. The fine vibration allows precise suction of fatty tissue. By aligning the openings in the hollow probe, the fatty tissue can be thinned out in a targeted manner. The amount of fat tissue suctioned off can be controlled by the vibration frequency. Unlike laser or ultrasound-assisted liposuction, there is no risk of burning. The risk of wound fluid accumulation is also lower than with ultrasound or laser-assisted liposuction. When treating the superficial fat layer, skin shrinkage is observed, similar to ultrasound or laser-assisted liposuction.

The SAFELipo technique is a special vibratory liposuction procedure that was described by the American plastic surgeon Wall in 2010. The technique is performed in three steps and reduces the risk of bruising and irregular contours. The acronym SAFE is made up of the English terms: “Separation”, “Aspiration” and “Fat Equalization”. After the injection, the fatty tissue is loosened using the vibration-assisted liposuction device and a special cannula. The fatty tissue is then suctioned out with three to four millimeter thin cannulas using vibratory liposuction. Finally, the contours are leveled with a special cannula. The SAFELipo technique is also used for autologous fat treatment. The technique offers many advantages and is therefore frequently used in the USA:

• Special cannulas stretch the tissue and enable even suction of the patient’s own fat.
• The vibration loosens the fatty tissue. This prevents dents and irregularities.
• The shape of the cannulas protects the blood vessels and reduces the risk of bruising.
• The cannulas are easy to guide, allowing precise and targeted correction of contours.
• Specially preformed cannulas increase the safety of the treatment.

The use of ultrasound for liposuction was first described by Scuderi in 1987. Ultrasounds are mechanical vibrations with a wave frequency above 16 kilohertz. During liposuction with ultrasound, the tip of the hollow probe is vibrated 19 to 27 thousand times per second. The vibrations cause pressure changes and a rise in temperature. Both lead to a liquefaction of the fatty tissue. Ultrasound-assisted liposuction is particularly effective for fibrous tissue. The superficial application of ultrasound waves and the increase in temperature leads to a slight shrinkage of the skin. There is evidence that ultrasound-assisted liposuction is gentler on the skin vessels than conventional liposuction (“suction-assisted liposuction”, SAL). However, the method has a significant disadvantage compared to the usual procedure. The ultrasound waves can cause burns and scarring. Newer third-generation ultrasound-assisted devices such as VASER® (Solta Medical, Hayward, CA, USA) therefore use pulsed ultrasound waves.

The use of water-jet assisted liposuction was first described in 2009. In this method, the liquid is injected over a wide area at an estimated pressure of 20 bar. The fatty tissue is then suctioned out as in the conventional suction-assisted liposuction (SAL) method. The Body-Jet® device required for this (Human Med, Schwerin) is mainly used in Germany. The fan-shaped injection at high pressure means that less tumescent solution is required.

Apfelberg first used laser-assisted liposuction in a study in 1991. The laser beam is emitted either before or during liposuction in the fatty tissue. Laser-assisted liposuction leads to a targeted increase in temperature in the fatty tissue. This destroys the fat cells, obliterates the smallest vessels and changes the structure of the collagen fiber bundles. Similar to ultrasound-assisted liposuction, the increase in temperature leads to a slight shrinkage of the skin. Laser-assisted liposuction therefore also carries a risk of burns. The combination of different wavelengths between 900 and 2800 nanometers is intended to improve skin shrinkage and reduce the risk of burns.

Several companies offer such devices as a supplement to liposuction:

• SlimLipo® (Palomar Medical Technologies GmbH, Hamburg) 924 and 975 nanometers.
• SmartLipo® (Cynosure Inc., Westford, MA, USA) 1064 and 1320 nanometers.
• ProLipo Plus® (Sciton, Palo Alto, CA, USA) 1064 and 1319 nanometers.

Radiofrequency surgery is a widely used surgical procedure. The terms high-frequency surgery, electrosurgery and diathermy are used synonymously. The process generates high-frequency electrical energy between two electrodes. The technology operates at frequencies of one megahertz and outputs of twenty-five to seventy-five watts. The electrical energy generates an increase in temperature. In radiofrequency-assisted liposuction, an electrode is inserted into the tissue. The other electrode is placed on the skin. The inner electrode is a hollow probe with a diameter of three millimeters. This hollow probe is insulated right down to the tip. The electrode on the skin surface is wider and absorbs the high-frequency current. Both electrodes are connected to a handpiece. The highest temperature is reached one centimeter around the tip of the hollow probe and the fat is liquefied. The liquefied fat is sucked out by the negative pressure in the hollow probe, as with conventional liposuction. The outer probe measures the temperature on the surface of the skin to prevent burns. On the skin surface, a temperature of 40°C to 42°C leads to the desired skin shrinkage and the formation of new collagen. The tissue is then further thinned using the conventional negative pressure method or vibratory liposuction. A device that is approved for performing radiofrequency-assisted liposuction is called BodyTite® (Invasix Ltd, Yokneam Ilit, Israel). BodyTite® received approval from the US Food and Drug Administration (FDA) in 2016.