Body fat (body mass index: BMI) and its distribution (waist-hip ratio, hourglass silhouette) play a decisive role in assessing attractiveness. In men, subcutaneous fat tissue accounts for fifteen to twenty percent of body weight, while in women, subcutaneous fat tissue can account for between twenty and twenty-five percent of total body weight. For both men and women, a well-trained stomach is a sign of fitness and health. Exercise and diet are not always enough to achieve the desired figure. The body's fat cells differ according to age, gender, disposition and body region. In the course of life, the number and size of fat cells change. Certain fat deposits at the waist, hips, loins and abdomen react differently to changes in lifestyle. Fat deposits are therefore harder to lose in certain places, both in men and women.
Aesthetic surgery has become safer due to medical progress. Many factors have contributed to this: a better understanding of the anatomy, more specific treatments, high-resolution examination procedures, gentle (minimally invasive) surgical methods, modern anaesthesia methods, as well as a proactive preparation and follow-up of the procedure. From year to year there is an increasing demand for cosmetic surgery. Liposuction and abdominoplasty account for about a quarter of all cosmetic surgery worldwide. Abdominoplasty requires precise knowledge of the anatomy of the abdominal wall. The abdominal wall can be divided into five different layers: the skin, the superficial fat tissue, the superficial connective tissue layer (Scarpa fascia), the deep fat tissue and the deep connective tissue layer above the abdominal muscles.
The deep fat layer increases with age or weight gain. The deep fat layer is less sensitive to certain hormones (stress hormones and insulin). Excess fatty tissue on the abdomen can be accompanied by cardiovascular diseases and diabetes. A weight regulation leads to an improvement of the metabolism. Problem zones at the hips, waist, stomach or loins can remain and be stressful. Strong weight loss and successive pregnancies can lead to sagging of the skin, weakness of the abdominal wall or stretch marks. For an aesthetically pleasing treatment result, the shape of the abdomen, the proportions and the quality of the skin must all be taken into consideration. The preparation of a treatment plan therefore requires a detailed examination. Abdominal liposuction is an effective technique for improving contours, alone or in combination with other treatments.
- Both the deep and the superficial layer of fat tissue is effectively reduced by abdominal liposuction.
- Abdominal liposuction can be performed in a painless twilight sleep.
- As a rule, patients can go home four to six hours after abdominal liposuction.
- Liposuction can eliminate the abnormality from which one suffers and increase self-esteem.
- Liposuction leads to a higher satisfaction with the external appearance and a better quality of life.
- Studies suggest that liposuction positively influences the health consequences of overweight (Sailon AM, et al. Ann Plast Surg. 2017).
Dr. Santos Stahl or private lecturer Dr. Stahl will discuss your individual needs during the initial consultation. During a consultation, the surgeons take the time you need. It is very important to talk openly about the problem areas that disturb them. General information such as height, weight, weight loss, pregnancy are also important for optimal consultation. Medications and dietary supplements can affect blood thinning or the metabolism of narcotics. In order to advise you about possible risks, circumstances such as cigarette smoking or elevated blood sugar levels are asked. The surgeon will examine your contour and palpate your abdomen. Weakness of the abdominal wall (rectus diastasis), excess skin or abdominal hernias may require other surgical procedures. Fat deposits on the hips (riding breeches) or pubic bone should not be ignored for a harmonious result. Reduced skin elasticity or stretch marks can be treated additionally. Finally, the waist circumference and the hip circumference are measured. The findings are carefully documented. It is very important to discuss your expectations openly with your surgeon. Often a poorly informed patient or surgeon is the cause of an unsatisfactory result, even if there are no complications during the operation. The individual steps of the treatment and the costs will be explained to you in a transparent and comprehensible way. Before an operation, further examinations may be necessary (e.g. blood test or ultrasound examination). We look forward to a consultation appointment.
The procedure on the day of the operation will be explained to you step by step during the consultation. On the day of the operation you will be received personally by your surgeon. The body parts to be treated will be precisely marked in consultation with you. The drawing resembles the contour lines of a map. You will be put on compression stockings and taken to the operating room. Here we make sure that you lie as comfortably as possible. For your safety and comfort, the operating table has a special state-of-the-art foam core. If you wish, you can listen to music to relax. A special warm air flow ensures that you are pleasantly warm. In accordance with the highest safety standards, the entire team discusses the treatment plan on the basis of a checklist. If you wish, you will be given medication to relax. The operating field is then disinfected with an alcohol solution and protected with sterile cloths. The anaesthetic is gently injected into the tissue using small cannulas. After the anaesthetic solution has developed its maximum effect, the fatty tissue is dissolved using the SAFELipo technique. If you do not sleep peacefully anyway, you may notice the surgeon's hand movements. The fat pads are specifically thinned out with fine cannulas. During the operation, the surgeon sensitively scans the skin with great care. Each step is precisely documented. The small punctures are finally sutured and connected with fine skin threads. You will then be dressed in compression garments. The procedure takes about 1.5 to three hours, depending on the findings. You can then rest while your vital parameters are monitored for a few more hours. If you feel like it, you can also drink or eat something. Before you are picked up by your relatives, you will receive a report. The report will explain all the steps of the operation and the post-operation behaviour in a way that you can understand. Appointments will be made to check your well-being and recovery. In the report you will also find the personal mobile phone number of the surgeon, who is always available for you. By the way, before, after and even during the operation you can watch movies or your favourite series with virtual reality glasses. This is not only entertaining, the distraction also demonstrably leads to less sensitivity to pain.
CenterPlast surgeons are highly trained specialists in plastic and aesthetic surgery. Dr. Santos Stahl and Privatdozent Dr. Stahl have passed the German and European specialist examinations. Dr. Santos Stahl completed her specialist training in Brazil. The country is regarded as a pioneer in the field of aesthetic surgery. Privatdozent Dr. Stahl is a former clinic director in a maximum care hospital. The specialists are distinguished by their many years of experience, their commitment to the safety of their patients and the development of innovative techniques. They have experience as senior doctors, train other doctors and are networked with leading plastic surgeons in Europe, the USA and Brazil.
For the best possible result, every single step on the way to the goal is crucial. CenterPlast's specialists take all necessary precautions to avoid unexpected complications. When unavoidable complications occur, the surgeons know what to do. Thanks to many years of experience with a variety of techniques (firming operations, autologous fat treatment, minimally invasive treatment methods, microsurgery), surgeons can also treat complications after liposuction. CenterPlast is equipped with the latest technology. Modern methods are used to prevent pain. Each procedure is performed according to the strictest hygienic standards.
In the CenterPlast Saarbrücken, the specialists systematically check the success of the treatment. The complete documentation serves the continuous improvement of our services. Your satisfaction with the appearance is evaluated before and after the treatment. Quality assurance is an everyday practice for us. Many patients agree to share their experience to help you make the right decision. During a consultation we help you to establish contact with other patients. The satisfaction of our patients is the yardstick for the quality of our work. We therefore welcome the evaluation of our patients on publicly accessible evaluation portals.
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 pleasant as possible. The surgeons, the surgical staff and the anaesthetist take care of your well-being. Even small details such as listening to music will help you to relax. You will receive medication that will relieve your anxiety and reduce your sensitivity to pain. The tissue is then gently injected with a long-acting local anaesthetic. This ensures that you will not experience any pain after the operation. As a preventive measure, you will be given well-tolerated painkillers such as paracetamol or ibuprofen. Before, after and even during the operation, you can watch movies or your favourite series with virtual reality glasses. This is not only entertaining, the distraction also demonstrably leads to less sensitivity to pain. We also provide you with the necessary pain medication at home. At the latest after one week you will no longer need any pain medication.
The following remuneration components must be taken into account when performing abdominal liposuction:
- Value added tax of 19%.
- Remuneration for plastic surgery.
- Necessary nursing services within the scope of the treatment.
- Medical anaesthesia services.
- Consumables required during the above procedure.
- Follow-up cost insurance.
- The operation-related wound controls.
- The operation-related long-term controls.
- Compression garments with alternating supply.
- Constant availability of the surgeon in the two weeks after the operation.
- Medication to treat nausea or pain in the first two weeks after surgery.
- Heparin injections to prevent thrombosis.
- Medical stockings to prevent thrombosis.
Aesthetic surgery requires a high degree of trust in the surgeon. For this purpose, it can be helpful to obtain information from various surgeons in advance. Please keep in mind that the terms "cosmetic surgeon", "aesthetic surgeon" or "cosmetic surgeon" are not protected. The performance of aesthetic operations requires special experience and specialization on the part of the surgeons. It happens again and again that during aesthetic operations the boundaries of the specialty are crossed. Therefore, ask for the name of the specialist and the additional names of the doctors who advise you.
Unfortunately, it is not possible to give an exact price without an examination. The scope of treatment, the method of treatment, any previous illnesses and/or pre-treatments influence the complexity and duration of an operation. We can therefore only tell you the exact costs after an examination as part of the consultation. We will also be happy to advise you on financing options without obligation.
- Liposuction should be performed when you have reached your desired weight.
- All your questions about possible complications and alternative treatments should be answered in advance.
- Keep nicotine and alcohol consumption to a minimum.
- The intake of hormone-containing medication (pill) should be temporarily stopped.
- Blood-thinning medication (e.g. ASA, Thomapyrin®) must be discontinued ten days before the operation after consultation with your doctor.
- Stop taking vitamin preparations (A, E) and dietary supplements (e.g. omega-3 fatty acids, St. John's wort preparations) four weeks before the operation.
- A follow-up cost insurance should be taken out for the performance of aesthetic operations.
- Surgery limits the ability to travel by air. Therefore, do not plan any professional or private air travel in the four weeks following the operation.
- Take out follow-up insurance before an aesthetic operation.
- On the day of the operation, shower with a disinfectant soap (e.g. HiBiScrub® Plus, Octenisan® Wash Lotion, Prontoderm® Shower Gel).
- Moderate exercise immediately after the operation is beneficial for recovery.
- Immediately after the operation, we agree with you on regular checks on your well-being.
- Showering is possible immediately before the wound control from the third postoperative day.
- As a rule, you can resume your usual daily activities after five to seven days.
- The skin threads are removed after about ten days.
- Previously fitted compression corsets and stockings should be worn continuously for three weeks.
- If in rare cases there is still a noticeable swelling after the second week, lymphatic drainage is started.
- Scar care (scar massage, sun protection, silicone overlay) from the third postoperative week onwards helps to create inconspicuous scars.
- Sport, saunas, swimming, heavy work and sunbathing should be avoided for at least three weeks.
- Starting from the third postoperative week, massage the scar several times a day for a few minutes. Use an oily cream such as Bepanthen® Ointment or Linola® Fat. Pay attention to circular, longitudinal and transverse movements of the scar. These measures help to create an inconspicuous scar.
- Avoid bending over, lifting heavy loads, swimming, sauna, sexual intercourse and sporting activities for three weeks. If there is still swelling, prolonged protection may be advisable.
- Smoking increases the risk of inflammation and thrombosis. Avoid smoking tobacco and e-cigarette after surgery.
Both women and men may develop a disruptive excess of fat on the abdomen, waist or hips. Liposuction leads to higher satisfaction, improves well-being and quality of life. However, certain conditions have to be taken into account. Patients who are in good health have the best conditions. Smoking a tobacco cigarette or e-cigarette reduces the blood circulation in the tissue for half an hour. This increases the risk of wound healing disorders, inflammations, thromboses and embolisms. Your body mass index should ideally be below 30. If there is an excess of skin, a weakness of the abdominal wall (rectus diastasis) or an abdominal wall fracture, additional treatment procedures should be planned.
Liposuction can help to achieve an accentuated waist. The aim of liposuction in women is a tight abdomen. Newer techniques can achieve more. High Definition Liposculpture (HDL) refines the contours. A deepening in the vertical abdominal centre line above the navel (champagne channel) as well as laterally of the straight abdominal muscles (in Latin "Linea semilunaris") is emphasized. In order to maintain harmonious proportions, the mons veneris should also be taken into account during liposuction. In order to improve the skin tone and to treat pregnancies, a microneedling (Dermaroller ®) treatment can also be performed.
Many women wish to have their physical changes corrected after pregnancy. The abdomen and breasts change the most after pregnancy. After multiple pregnancies or after late pregnancies, these changes often do not regress on their own. Excess skin around the navel, on the hips or above a caesarean section scar can be noticeable. There can be several reasons for a change in the waist circumference. There may be an increase in fatty tissue in the abdominal wall or in fatty tissue in the abdomen. Pregnancy can weaken the connective tissue between the straight abdominal muscles. The navel may bulge outwards. The elasticity of the skin can be reduced by the formation of stretch marks. Liposuction effectively reduces the fatty tissue of the abdominal wall, the hips and the mons veneris. A weakness of the abdominal wall (rectus diastasis) is treated as part of an abdominoplasty. Excess skin is treated with a miniabdominoplasty or an abdominoplasty. Stretch marks can be effectively improved by a microneedling. Several procedures can be safely and effectively combined to achieve an optimal aesthetic result.
There are no reports of negative effects of abdominal liposuction on later pregnancies. The reduction in fat tissue caused by abdominal liposuction is not affected by pregnancy and childbirth with normal weight gain and proper nutrition.
In the last ten years there has been an increasing demand for the removal of fat deposits from men. Abdominal liposuction is the most common procedure for men. The demands have increased with the development of ever better techniques. Thanks to vibration liposuction and the SAFELipo, finer contouring is possible. The aim is to restore an athletic and attractive abdominal contour. A six-pack or washboard stomach is created by the horizontal subdivisions of the straight abdominal muscles. On the sides, the so-called V-bar rounds off the image of a well-trained abdomen. A special technique of liposuction (High Definition Liposculpture, HDL) can reveal the abdominal muscles. In this procedure, the deep fat tissue is first thinned out. The natural contours of the muscles are then accentuated by further thinning of the superficial fat tissue. The technique requires precise planning and a great deal of sensitivity.
A special liposuction technique can be used to emphasize the appearance of the abdominal muscles. High definition liposculpture" is a widely used technique in the USA and Brazil. CenterPlast Saarbrücken is one of the few specialized centers in Germany to offer this technique. Athletic contours of the abdominal muscles can thus be emphasized in men and women. The technique is suitable for patients up to the age of fifty who have a moderate excess of fat. The body mass index should be below 26 for women and below 28 for men. For a good result, the skin should have a good elasticity.
The technique of vacuum liposuction, as performed in 1976, is known as "suction-assisted liposuction" (SAL). In this technique, the fatty tissue is removed using a hollow needle. The hollow needle has a blunt tip and lateral openings through which the fatty tissue is sucked off with a negative pressure of 0.8 to 0.9 bar. The following techniques offer a complementary procedure to remove the cells from the tissue:
- Vibration liposuction (power-assisted liposuction, PAL).
- Water jet assisted liposuction (WAL).
- Ultrasonic liposuction (ultrasound-assisted liposuction, UAL).
- Laser-assisted liposuction (LAL).
- Radiofrequency-assisted liposuction (RAL).
Vibrational liposuction was first approved by the US Food and Drug Administration (FDA) in 1998. With this method, a motor causes the hollow probe for liposuction to vibrate. The hollow probe moves three millimetres back and forth up to four thousand times a minute. The fat tissue is released by the vibration. The fine vibration allows precise suction of fatty tissue. By aligning the openings in the hollow probe, the fat tissue can be specifically thinned out. The amount of fat tissue extracted can be controlled by the vibration frequency. Unlike laser or ultrasound-assisted liposuction, there is no risk of burning. The risk of an accumulation of wound water is also lower than with ultrasound or laser-assisted liposuction. Skin shrinkage is observed in the treatment of the superficial fat layer, similar to ultrasound or laser liposuction.
The SAFELipo technique is a special procedure of vibration liposuction described by the American plastic surgeon Wall 2010. The technique is performed in three steps and reduces the risk of bruising and irregular contours. The acronym SAFE is composed of the English terms "Separation", "Aspiration" and "Fat Equalization". After the injection, the fat tissue is loosened with the device for vibration-assisted liposuction and a special cannula. The fat tissue is then aspirated with three to four millimeter-thin cannulas using vibration liposuction. Finally, the contours are levelled 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 allow an even suction of the patient's own fat.
- The vibration loosens the fat tissue. Dents and irregularities are thus avoided.
- The shape of the cannulas protects the vessels and reduces the risk of bruising.
- The cannulas are easy to guide, allowing precise and targeted correction of the contours.
- Specially shaped cannulas increase the safety of the treatment.
The use of ultrasound for liposuction was first described by Scuderi in 1987. Ultrasound is a mechanical vibration with a wave frequency above 16 kilo-hertz. During liposuction with ultrasound, the tip of the hollow probe vibrates 19 to 27 thousand times per second. The vibrations cause changes in pressure and an increase in temperature. Both lead to a liquefaction of the fatty tissue. Ultrasonic-assisted liposuction is particularly effective for fibrous tissue. The superficial application of ultrasound waves and the rise in temperature leads to a slight shrinkage of the skin. There are indications that ultrasound-assisted liposuction is more gentle on the skin vessels than conventional suction-assisted liposuction (SAL). However, this method has a major disadvantage compared to the conventional method. The ultrasound waves can lead to 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 fat tissue is then aspirated as with the conventional vacuum method ("suction-assisted liposuction", SAL). The device Body-Jet® (Human Med, Schwerin) required for this is mainly used in Germany. Due to the fan-shaped injection with high pressure, less tumescence solution is required.
Apfelberg applied laser-assisted liposuction for the first time in a study in 1991. The laser beam is emitted into the fat tissue either before or during liposuction. Laser-assisted liposuction leads to a targeted temperature increase in the fat tissue. This destroys the fat cells, the smallest vessels become desolate and the structure of the collagen fibre bundles is changed. Similar to ultrasound-assisted liposuction, the rise in temperature leads to a slight shrinkage of the skin. Laser-assisted liposuction therefore also involves a risk of burns. The combination of different wavelengths between 900 and 2800 nanometers should improve the shrinkage of the skin 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. In this procedure, high-frequency electrical energy is generated between two electrodes. The technology works with frequencies of one megahertz and powers 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 millimetres. This hollow probe is isolated up to the tip. The electrode on the skin surface is wider and absorbs the high-frequency current. Both electrodes are connected with a handpiece. One centimeter around the tip of the hollow probe the highest temperature is reached and the fat liquefies. The vacuum in the hollow probe sucks off the liquefied fat, just like with the usual liposuction. The external probe measures the temperature on the skin surface to prevent burns. At 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 vibration liposuction. A device approved for radio frequency assisted liposuction is called BodyTite® (Invasix Ltd, Yokneam Ilit, Israel). BodyTite® received US Food and Drug Administration (FDA) approval in 2016.
Liposuction is one of the most frequently performed procedures in plastic surgery, with over two hundred thousand procedures performed every year. Surgery is considered to be one of the safest, provided that certain safety measures are taken into account. Unfortunately, liposuction is also offered by doctors without any surgical training. Increasingly, larger amounts of fat tissue are removed. There are more and more reports of serious complications. Plastic surgeons, are the only specialist group to learn liposuction, in their continuing education. To avoid complications, the CenterPlast:
- competent advice from experienced specialists in the selection of the appropriate treatment,
- the treatment by first-class trained specialists for plastic and aesthetic surgery,
- supervision and accompaniment by experienced anaesthesiologists,
- atraumatic surgical procedures and a sensitive surgical technique.
The most common risk after liposuction is the occurrence of dents. Dents are observed in two to three percent of cases. Differently long legs or an oblique hip are generally widespread. Pre-existing lateral differences are often perceived more consciously after liposuction. Liposuction is not suitable for compensating for incorrect posture. Irregularities can be corrected six months after liposuction with a fat injection. The CenterPlast specialists take the following preventive measures to minimize the risk of irregularities:
- The suction is performed with the SAFELipo technique.
- Fine suction cannulas with a diameter of two to three millimeters are used.
- The thickness of the soft tissue layer of the skin is constantly checked during the operation.
- The deep layers of fatty tissue are thinned out.
- The suction cannulas are carefully guided and the opening of the cannula is aligned with the tissue to be sucked off.
- The movements of the cannula tip are constantly controlled by the subtle palpation of the treated body parts during the operation.
- The tissue is sucked off in a "criss-cross" technique, i.e. crosswise, in order not to create any furrows.
- The suction is switched off when the cannula enters or exits the wound.
The aspiration of large quantities of fatty tissue, especially in the lower abdomen, can lead to the accumulation of wound water (seroma). The accumulation of wound water is treated by a puncture under ultrasound control. The risk is higher in patients with a high body mass index and with ultrasound-assisted liposuction. Wound water can accumulate on the abdomen in the first week or three to four weeks after liposuction. The CenterPlast specialists prevent the accumulation of wound water through the following measures:
- We recommend a moderate liposuction in the area of the lower abdomen.
- We use the SAFELipo technique.
- We make sure that excess wound water can escape naturally through the wounds.
- We provide you with a special compression wash.
- We encourage you to moderate physical activity immediately after the operation.
Liposuction can cause a dark discoloration of the skin. This may be caused by bleeding into the skin, sunbathing after liposuction or certain medications such as iron or hormone preparations. In rare cases a skin sinking (skin necrosis) may occur. Patients with diseases of the connective tissue and heavy smokers are at risk. Scars on the stomach or blood sugar disease can increase these risks. These complications are unlikely with a careful selection of the treatment method and a gentle surgical technique. A feeling of furryness occasionally occurs after liposuction. In the vast majority of cases, the loss of sensation spontaneously improves or disappears after two to three months.
Every injury to the skin is in principle a gateway for bacteria to enter. Certain circumstances can impair the body's defences and favour the multiplication of germs. This applies, for example, to long-term cigarette smokers, elderly people and people with chronic illnesses. Inflammation after liposuction requires antibiotic treatment and, in rare cases, surgical removal of infected tissue. The CenterPlast specialists take a number of measures to keep the risk of inflammation as low as possible:
- In the morning of the operation, we recommend that our patients take a shower with a disinfectant soap.
- Before the operation, your skin is carefully disinfected several times over a wide area with an alcohol solution.
- We use local anaesthetics, which also have an antibacterial effect.
- Operations that take more than two hours are performed under a preventive single antibiotic administration.
- We use disposable cannulas for suction.
- We plan close monitoring of wound healing in order to detect and treat a wound healing disorder in time.
When large quantities of fatty tissue are aspirated, a relevant loss of blood cannot always be ruled out. The surgeons at CenterPlast therefore recommend checking for anaemia before liposuction. A gentle surgical procedure, the SAFELipo and the use of the tumescent solution reduce the risk of significant blood loss.
The probability of death during liposuction is about 0.02 percent (source: Mendez, Aesthet Surg J. 2019). This corresponds to the risk of a fatal accident by car after 46,000 kilometres (source: Destatis 2018). The most common causes of death in liposuction are thrombosis, embolism, abdominal injuries, fat embolism and heart-lung failure.
The risk of thrombosis and embolism is greater when large amounts of fat are aspirated and in severely overweight patients. Further risk factors of thromboembolism are smoking (tobacco cigarettes, e-cigarettes), hormone replacement therapy and permanent lying. Plastic surgeons take the following measures to minimise the risk:
- They are examined for their individual risks for thromboses and embolisms (age, smoking, hormonal contraceptives).
- The surgeons will help you to create the best possible conditions for performing liposuction.
- We recommend liposuction in twilight sleep, which is associated with a lower risk of thrombosis.
- Specialists recommend the suction of a moderate amount of fatty tissue per procedure.
- You will receive compression stockings for thrombosis prophylaxis during the first three weeks after liposuction.
- We encourage you to move on the day of the operation. On the first day after the operation you should walk shorter distances several times.
- Depending on your individual risk, you will be given heparin injections to prevent thrombosis.
- Long flights can promote thrombosis. We therefore advise against air travel in the first four weeks after the operation.
The fine cannulas for liposuction are inserted through two to three millimetre incisions. The incisions lie in the wrinkle lines of the skin and are hardly visible. Two tiny scars are located in the area of the groin so that they can also be hidden under a swimsuit. A scar disappears deep inside the navel. The gentle atraumatic and careful treatment of the tissue ensures inconspicuous scar healing. The fine suture material ensures a fine scar in the form of a line. So that even the smallest scar does not give the impression of a planned operation, the skin incisions on the right and left half of the body are made in different places.
The amount of liquid sucked off during liposuction consists of the removed body fat and the tumescent solution injected beforehand. The tumescent solution consists mainly of water and adrenaline and helps to keep blood loss to a minimum. With liposuction, up to eight percent of the body weight in fat volume can be removed per procedure (four to eight liters). The American Society of Plastic Surgeons defines five thousand milliliters as 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 examined the relationship between the suction volume and the body mass index. They have found that smaller complications (seromas) occur more frequently from a suction volume of one hundred millilitres per unit of the body mass index. The risks of liposuction are lower in healthy patients. Overweight, diseases of the heart, lungs or metabolism, cigarette smoking and hormonal contraception are health risks. These factors therefore also influence the risk of liposuction. How much fat can be removed from the abdomen varies from patient to patient.
Abdominal liposuction can be repeated several times. However, this is not necessary with a healthy diet and regular exercise. A suction of moderate amounts of fat (one hundred millilitres per unit of the body mass index) helps to keep the risks of surgery low. In the case of a large abdomen, liposuction can be planned in several steps, especially if an abdominoplasty is necessary. Corrections after liposuction should not be made until the final result is visible after six months.
External characteristics that determine the attractiveness of women are manifold and complex. Numerous scientific studies have shown that a waist-to-hip ratio (WHR) is an important beauty feature in women. A waist-to-hip ratio of 0.7 for women is considered particularly attractive by both men and women. The evaluation is instinctive and takes only fractions of a second (Del Zotto, 2018). The treatment of different body regions can be useful for maintaining or restoring beautiful proportions. Liposuction of the abdomen, legs and bottom is possible in one procedure. The total amount of fat tissue removed should be moderate in order not to increase the risk of the operation. The upper limit varies from person to person and depends on your body weight, health and lifestyle. In individual cases, liposuction in several procedures is the safer way to an optimal result.
Abdominal surgery using the keyhole technique or with a large incision, as well as a cesarean section, can leave unsightly scars on the abdominal wall. Before abdominal liposuction, the scars must be critically examined to rule out scar hernia. Incorporated scars can be corrected during liposuction. Supplementary autologous fat treatment can positively influence the shape and tonicity of the scar. Larger scars, especially below the belly button, can be removed by abdominoplasty. Studies show that abdominoplasty and liposuction can be performed safely for scars on the abdomen.
External characteristics that determine the attractiveness of women are diverse and complex. Numerous scientific studies have shown that a waist-to-hip ratio (WHR) in women is an important beauty feature. A waist-to-hip ratio of 0.7 in women is perceived as particularly attractive by both men and women. The assessment is instinctive and takes only fractions of a second (Del Zotto, 2018). Treating different areas of the body can be useful for preserving or restoring beautiful proportions. Liposuction of the abdomen, legs, and buttocks is possible in one procedure. The total amount of fat tissue removed should be moderate so as not to increase the risk of surgery. The upper limit varies from individual to individual and depends on your body weight, health and lifestyle habits. In individual cases, liposuction in several procedures is the safer way to achieve an optimal result.
Fatty tissue is a highly complex tissue. It consists of fat cells, connective tissue cells, phagocytes, white blood cells and stem cells. Stem cells have the unique property of being able to develop into different body cells (for example muscle or skin cells). About five hundred times more stem cells can be obtained from fat tissue than from bone marrow (Fraser, Trends Biotechnol. 2006). The importance of stem cells for regenerative medicine and anti-aging treatment has been known since 2006. In the months following an autologous fat treatment, the skin quality improves. The skin pores become finer, the wrinkles are reduced and the skin colour becomes more even (Coleman SR. Plast Reconstr Surg 2006). Own fat is also successfully used to treat scars. The own fat is immediately available for liposuction. Allergic reactions are excluded. It therefore makes sense to make use of the many positive properties of one's own fat during liposuction. A self fat treatment of the buttocks or the breasts is easily possible during a liposuction on the abdomen. Wrinkles can be injected and lips can be enlarged as part of liposuction.
The Brazilian plastic surgeon Juarez Avelar first combined liposuction with abdominoplasty in 1985. After him, the Brazilian Oswaldo Saldanha further refined the method. The combination of the two methods is considered safe and provides excellent aesthetic results. A more beautiful waist is achieved. The tightening can be carried out more effectively. This makes it easier to hide the scar. The contours can be corrected more precisely. Details such as a champagne channel and a natural depression at the side of the straight abdominal muscles (in Latin "Linea semilunaris") can be emphasized. At the same time, the proportions of the Venus Hill can be adapted to the slimmer waist.
The CenterPlast uses several methods to prevent the appearance of dents.
- For precise planning, the skin is marked before the operation.
- The deep layers of fatty tissue are given priority.
- The tissue is loosened with a so-called tumescence solution (super wet technique).
- The amount of tumescent solution used per area and side is precisely controlled.
- The tissue is loosened with the SAFELipo technique.
- The vibration liposuction helps to avoid unevenness.
- Fine cannulas are used to create even contours.
- Cannulas are mainly used, the openings of which allow targeted treatment.
- Liposuction is performed in a standardized order.
- The amount of fat tissue removed is constantly monitored per area and side.
- The contours are continuously and subtly scanned during the procedure.
- 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 rebuilt, realigned and cross-linked. During this transformation phase, the tissue feels harder. If there is a pronounced swelling and bruising after the procedure, the subsequent remodelling phase is correspondingly more intensive. In order to prevent hardening, it is therefore very important to wear compression underwear consistently, especially in the first three weeks. Manual lymph drainage and ultrasound treatments can additionally support the healing process. The operation itself can be ideally successful - the final result is only perfect after the after-treatment.
A certain amount of swelling is unavoidable in the first few days after the operation. The injected fluid (tumescent solution) serves to prevent bruising. A large part of the fluid is sucked off during the operation. A small part is absorbed by the bandages. The rest of the fluid is excreted by the body via the kidneys in the hours following the operation. At the same time, various messenger substances increase the permeability of the blood vessels in the treated regions. This phase of wound healing lasts one to two weeks. The swelling then subsides considerably. The compression wash reduces the swelling. In the case of severe swelling despite compression garments, lymphatic drainage should be started early.
The compression wash:
- reduces the inevitable swelling after surgery.
- shortens the duration of the swelling.
- prevents the accumulation of wound water in the suctioned regions.
- promotes the shrinkage of the skin and helps to achieve a more beautiful contour.
- The result is that scars remain as fine and inconspicuous as possible.
High-quality studies prove that compression stockings (antithrombosis stockings) reduce the risk of thrombosis after certain operations. The doctors at CenterPlast recommend wearing compression underwear and compression stockings for three weeks after liposuction.
The result of liposuction becomes more visible every day. The slimmer figure is covered by the swelling for the first ten days. The new body contours become clearer from week to week. After four weeks the result is visible. The treated body regions may feel somewhat hardened. The skin surface may feel a little numb. Hardening and the feeling of furryness usually disappear completely in the third month. The swelling, which can fluctuate during the day, is then minimal. Four months after the operation, about ninety-five percent of patients see the final results.
Outpatient surgery offers many advantages:
- Scientific studies show that outpatient surgery in twilight sleep with experienced plastic and aesthetic surgeons as well as experienced anaesthesiologists are safe.
- The coordination of the date of the operation is uncomplicated.
- The excitement before an outpatient procedure is usually less.
- They are spared the cumbersome formalities and the filling out of long forms before in-patient admission.
- You do not have to do without the comfort of your home.
- You will recover more quickly in your familiar surroundings. The healing process is often better.
- There is no danger of getting infected with germs.
- The foreign and anonymous environment of a clinic can be dispensed with.
- Clinics are often designed to perform operations under general anaesthesia. The experience with less stressful anaesthesia is greater in outpatient centres.
- With outpatient surgery, you can expect all-round care from your familiar and experienced specialist in plastic and aesthetic surgery. Postoperative care is provided by your surgeon. Treatment from a single source improves quality and gives you security.
- Outpatient care strengthens the doctor-patient-confidence relationship. This gives you the feeling of security and contributes to the success of the treatment.
In general anaesthesia, your consciousness is temporarily switched off. The respiratory drive and protective reflexes are also completely eliminated. A twilight sleep (also called analgosedation) takes away your fear, reduces your sensitivity to pain and makes you sleepy. Twilight sleep offers many advantages:
- By combining different painkillers, the amount of stressful medication can be significantly reduced. You will recover faster.
- Side effects such as nausea are much rarer.
- Severe side effects such as thromboses or embolisms are also less common after twilight sleep than after general anesthesia.
- After a twilight sleep you can return home faster and eat and drink again faster.
- The satisfaction of patients after twilight sleep is very high.
Tumescent anesthesia is a form of local anesthesia using a highly diluted anesthetic that is administered in large quantities under the skin. The technique was already described by Matas in 1915 and was later used by Klein for liposuction. In 1920 it was recognized that the addition of adrenaline was helpful. Adrenaline is a stress hormone that constricts blood vessels when used locally. This reduces the risk of bleeding. The anaesthetic stays longer in the tissue and the anaesthesia lasts longer. The tumescent solution takes about twenty minutes to take effect. The use of a long-acting anaesthetic ensures that you will not experience any pain after the procedure. The amount of tumescent solution helps to keep blood loss to a minimum. The good tolerability and the low risks as well as the excellent analgesic effect explain why the tumescence technique is also used in other procedures. The tumescence technique is also used in the CenterPlast for tummy tuck, breast lift, breast reduction, breast enlargement and face lift. The advantages of the tumescent technique are:
- You do not need a general anaesthetic.
- A sleeping pill is not absolutely necessary.
- Fewer medications get into the body's circulation.
- Side effects such as nausea are unlikely.
- They recover faster and are back home faster after the operation.
Many patients and doctors believe that a shower before wound healing is complete is dangerous. Wounds are usually dressed and protected from moisture until the skin threads are removed. However, numerous studies have shown that showering does not increase the risk of inflammation. Showering with tap water helps to clean a wound after an operation. Daily showering is very important for personal hygiene and well-being. On the basis of scientific knowledge and our many years of experience, we recommend showering with tap water on the third day after the operation, without soaking or rubbing the wounds. After the shower, dry the wounds with a clean towel or cool air from a hair dryer.
According to the Heilmittelwerbegesetz § 1 Absatz 1 Nr. 2 before and after pictures may not be shown on the Internet. In the opinion of the legislator, the comparative presentation of the appearance before and after liposuction is inappropriately influential advertising. The evaluation of before/after images on the Internet does indeed require some caution. The impression of an image is influenced by the camera setting, perspective, cropping, background and lighting. Makeup or manipulated images can simulate results. The plastic and aesthetic surgeons at CenterPlast document the results under uniform conditions. In the course of an informative discussion, the doctors will be happy to show you before/after images in order to show you the possibilities and limits of cosmetic surgery.
Drainage is not necessary for liposuction. A combination of abdominal liposuction and abdominoplasty may require short-term drainage in selected cases. In the case of liposuction to correct a male breast in conjunction with the removal of a mammary gland, drainage is also occasionally used. By using the tumescent solution (injection of water with adrenalin) before liposuction, the use of blunt cannulas, careful preparation for the operation, a good follow-up treatment and a certain dexterity, there is no need to worry about bleeding after the operation. Patchy bleeding of the skin is unavoidable. The bruises disappear on their own after five to ten days.
The body fat tissue can be divided into the fat tissue under the skin and the fat tissue around the internal organs within the abdominal cavity. The fatty tissue under the skin consists of two layers - the superficial and the deep fatty tissue. A layer of connective tissue called Scarpa Faszie separates these two layers. The shape, structure and metabolic properties of fatty tissue differ in the respective regions. Women of childbearing age have less fatty tissue in the abdominal cavity. Fatty tissue accumulates mainly on the buttocks and thighs. After menopause, the fatty tissue in the abdominal cavity increases. In men, fat accumulates under the abdominal skin and in the abdominal cavity. An increase in fat tissue in the abdominal cavity increases the risk of diabetes, heart attacks and calcification of the blood vessels. Liposuction can remove excess fatty tissue under the skin. However, the fatty tissue in the abdominal cavity can only be reduced by lifestyle changes, good eating habits and physical activity.
As early as 1964, the plastic surgeon Schrudde from Cologne removed fat deposits using a minimally invasive procedure. To plan the operation, Schrudde drew marking lines on the skin and recommended wearing compression garments after the operation. In 1976 Kesselring and Meyer developed precursors of today's instruments: long hollow needles connected to a vacuum pump. In 1977, the Parisian surgeon Illouz injected the tissue with hyaluronidase and a saline solution to reduce the risk of secondary bleeding.
In 1987 the Californian physician Klein applied the tumescent anaesthesia technique described by Matas in 1915 to liposuction. The term derives from the Latin and means "swelling". The dilution of the anaesthetic and the addition of adrenalin mean that only a small amount of anaesthetic gets into the body circulation. This means that a stressful general anaesthetic can be dispensed with. In addition, the patients recover faster after the operation.
Gasperoni also performed liposuction in the superficial fat layers in 1990 in order to correct contours more precisely. In 1997 Matarasso first combined the techniques of liposuction with the technique of abdominoplasty in order to perfect the results.
The loss of fat deposits increases well-being and attractiveness. Reducing the body's fat mass is an important step towards a healthier life. New technology and increased research efforts are leading to new non-invasive procedures. Compared to surgery, non-invasive technology is characterized by shorter recovery times and less risk. However, severe complications after liposuction affect less than one percent of patients. Overweight, diseases of the heart, lungs or metabolism, cigarette smoking and hormonal contraception are health risks. These risks are associated with surgery. Local anesthetics, well-tolerated painkillers, a relaxed atmosphere and mental distraction are used to treat and prevent pain. Under proactive follow-up treatment, the swelling and bruises have clearly subsided within one to two weeks after liposuction. In the meantime, there are many alternatives to surgery:
- Cryolipolysis (CoolSculpting®)
- Ultrasound (Liposonix®)
- electromagnetic impulses (Emsculpt®)
- Radio frequency (Thermage®)
- Laser lipolysis (SculpSure®)
- the fat pathway injection (Lipostabil® N)
The effectiveness of these techniques cannot be compared to liposuction. The effect is limited to the fat tissue immediately below the skin. The superiority of one of these methods could not be proven so far.
The effect of cryolipolysis cannot be compared to liposuction. The effect of cryolipolysis unfolds mainly in the superficial fat tissue. In order to achieve a satisfactory result, several cryolipolysis treatments at two-month intervals are necessary. During liposuction, both the deep and the superficial fat tissue can be reduced. Liposuction can reduce the fat tissue considerably more than cryolipolysis.
Ultrasound can be used to reduce fat (twenty kilohertz to several gigahertz). Both the heat generated by 56 degrees Celsius and the cavitation mainly damage the fat cells. Cavitation refers to strong pressure fluctuations that cause the fat cells to burst. Ultrasound technology makes it possible to reduce the circumference of the hip by two to four centimetres. The penetration depth is one to three centimetres. The effect is therefore much less than the effect of liposuction. As a rule, at least three treatments are required every four weeks. A treatment of the abdomen takes about thirty minutes. The result can be seen after two to six months.
Electromagnetic impulses cannot be compared to liposuction in their effect. Electrical and electromagnetic impulses cause muscle tension. The electromagnetic impulses penetrate deeper into the tissue and cause no pain. In addition, electromagnetic impulses release higher muscle forces than electrical impulses. The electromagnetic impulses cause intensive muscle training and fat burning. Rapidly changing magnetic fields generate an electrical impulse in the underlying tissue. The nerves thus trigger muscle tension. A high frequency of the muscle tension leads to an increase in muscle size and muscle strength as well as to fat reduction. A reduction of a muscle gap between the straight abdominal muscles (rectus diastasis) has also been proven. One treatment lasts thirty minutes. Twenty thousand impulses are generated during one treatment. Four treatments at two-day intervals are recommended. The results are visible after four weeks. Subsequently, one treatment is repeated every three to six months to obtain the results. This technology (High-intensity focused electromagnetic, HIFEM) was approved in 2018 by the US Food and Drug Administration (FDA) for the treatment of the buttocks and abdomen. The strength of the muscle tension can be adjusted from 0 to 100% with the Emsculpt® (BTL Industries, Inc., New York, NY, USA). The stronger the muscle contraction, the clearer the result. Most patients describe the treatment as pleasant. The only known complication is a temporary, slight muscle soreness. Electromagnetic pulses should not be used during pregnancy or in patients with metal implants or pacemakers.
Radio frequency devices primarily cause a slight tightening of the skin. In addition, radiofrequency devices can degrade fatty tissue to a low degree. The radiofrequency waves are emitted to the skin by electrodes and generate heat between 43 and 45 degrees Celsius. The increase in temperature leads to a shrinkage of the tissue. The cells of the connective tissue (fibroblasts) are stimulated to form collagen and elastic fibres. The heating of the tissue leads to a degradation of the fat cells. In order to prevent burns, certain devices simultaneously cool the skin and continuously measure the temperature of the skin surface. A radiofrequency treatment lasts twenty to thirty minutes. The heat development can lead to slight pain. The redness and swelling of the treated areas improve after one day. Occasional side effects include hypersensitivity, a temporary sensation of pain, fat loss and nodulation. Several treatments are necessary to achieve an improvement. The result can be observed after two to six months.
One of the most common radio frequency devices is the radio:
- Thermage® (Solta Medical, Pleasanton, California, USA). The device received approval from the US Food and Drug Administration (FDA) in 2002. The approved applications are skin tightening and fat loss on the face, abdomen, thighs and buttocks.
- Vanquish® (BTL Industries, Boston, Massachusetts, USA). The device is suitable for low fat loss on the abdomen, back and flanks.
- truSculpt® (Cutera, Brisbane, California, USA).
- Venus Legacy® (Venus Concept, Toronto, Ontario, Canada). The device uses radio frequency and electromagnetic impulses.
Laser lipolysis is a technique for reducing fat deposits on the abdomen, back, flanks and neck (double chin). There are two different methods of laser treatment. Low level laser therapy (LLLT) with wavelengths from 532 to 635 nanometers. Low-level laser therapy makes the cell wall of fat cells permeable. The fat cells thus release their fat reserves. The treatment lasts about thirty minutes and is repeated twice a week for six weeks. The hyperthermal laser treatment (hyperthermic laser lipolysis, HTLL) applies wavelengths of at least 1060 nanometers. The laser causes the temperature of the fatty tissue to rise to 42 to 47 degrees Celsius. The effect unfolds 0.5 to 2.5 centimetres below the skin. The fat cells die off and are broken down by phagocytes. Two to twelve treatments of twenty minutes each at intervals of six weeks are required. The laser devices cool the skin surface to prevent burns. Laser lipolysis can cause slight pain. Swelling and tissue hardening will disappear after one week. The treatment areas should be free of scars and tattoos. The following devices are used for laser lipolysis.
- SmartLipo® (Manufactured by Deka, Italy, marketed by Cynosure, Westford, Massachusetts, USA). SmartLipo® uses a Neodymium:Yttrium-Aluminum-Garnet (Nd:YAG) laser (1064 nanometer, 1320 nanometer and 1440 nanometer wavelength). The device has been approved in the USA since 2006.
- SculpSure® (Cynosure, Westford, Massachusetts, USA). The device uses a wavelength of 1060 nanometers and has been approved by the US Food and Drug Administration (FDA).
- Erchonia Zerona® v2.0 (Erchonia1 LipoLaser; Erchonia Medical, Inc., McKinney, Texas, USA). The green laser has a wavelength of 532 nanometers.
- Fotona TightSculpting® (Fotona, LLC, Dallas, Texas, USA). The device is approved in the USA for the reduction of fat and tightening of the skin. Two lasers are used (1064 nanometers Nd:YAG and 2940 nanometers Er:YAG).
A liposuction cannot replace a liposuction. The repeated treatment with a fat injection reduces circumscribed fat deposits (e.g. a double chin) slightly to moderately. In the case of liposuction, it is estimated that fifty times as much fat tissue can be removed per procedure.
The health insurance companies do not participate in treatments to improve the appearance. The technique of abdominal liposuction is not covered by the health insurance companies. Only in rare cases, in which a "disfigurement worthy of illness" is present, an application for cost reimbursement is meaningful. In general, the term "disfigurement worthy of the disease" is used when the sagging skin hangs over the pubic area after massive weight loss. In these cases, the insured person can apply to his health insurance company to cover the costs of removing the fat apron. Since January 2020, liposuction of the legs for stage III lipoedema has been part of the statutory health insurance benefits catalogue. Lipoedema is a pathological proliferation of fatty tissue, especially in the legs and arms. CenterPlast surgeons have many years of experience in the treatment of lipedema. CenterPlast specialists may perform liposuction for stage III lipoedema at the expense of the statutory health insurance.