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Secondary liposuction succeeds with understanding of wounding process

Key iconKey Points

  • Revision liposuction requires correction of contour irregularities
  • Excess deposits of fat may result if liposuction is performed unevenly under the skin
  • Inner thighs, triceps, buttocks among more challenging revision liposuction areas

High-tech tools and surgical techniques cannot replace the years of experience required to achieve good aesthetic outcomes in liposuction procedures. Knowing how to optimally wound the tissue when performing liposuction and understanding how tissues heal when performing either primary or secondary liposuction are instrumental in achieving the best aesthetic results possible.


Dr. Sadick
Liposuction procedures have become one of the cornerstones of cosmetic surgery, but often, the cosmetic results achieved may fall short of the patient's and the surgeon's expectations.

"Revision liposuction procedures are more challenging than primary liposuction procedures because they require a more aesthetic eye in terms of perfecting contour irregularities not achieved in the primary surgery," says Neil S. Sadick, M.D., F.A.C.P., department of dermatology, Cornell University Medical College, New York. "Often, patients already have some degree of indurations from previous procedures, requiring more of an aesthetic finesse during the revision liposuction procedure."


Dr. McMenamin
REASONS FOR REVISION According to Dr. Sadick, the most common reason why patients ask for a revision liposuction is because the previous surgeon removed either too much or too little fat. If too much fat was removed, lipotransfer techniques can be used to supplement the remaining fat and in turn shape the targeted areas more symmetrically.

Revision liposuction can also be geared toward improving uneven contours resulting from the primary procedure, says Patrick McMenamin, M.D., a Sacramento, Calif., cosmetic surgeon. These irregularities may be the result of an uneven wounding process during the primary procedure, which can result in skin-texture changes and excess deposits of fat.

Excess deposits of fat can result if the liposuction is performed unevenly under the skin. If the surgeon removes fat in an uneven manner, a less-than-smooth contouring may result.

"One of the premises of revision liposuction surgery is the creation of an extremely uniform wound," Dr. McMenamin says. "Surgeons should not only try to create the most uniform wound possible in respect to the contour they are trying to make, but also perform the wounding such that the tissue heals in a very particular way, as this will more likely result in more uniform and predictable contouring outcomes."

When performing liposuction procedures, surgeons must bring years of experience to the table in order to optimally sculpt the fat. Additionally, they must understand how to address the subcutaneous compartments when disrupting the connections between the deeper tissue and the overlying skin.

According to Dr. McMenamin, an accurate assessment of the skin, the integument, the location of the fat, the patient's age and the ability of the skin to contract all play a crucial role in achieving optimal aesthetic results.

"Different degrees of sun-damaged skin and the age of the patient can impact the ability of the skin to contract down. Therefore, the surgeon not only has to be able to aesthetically sculpt the contour of the body when removing the fat in choice areas, but also pay extreme attention to the skin and how it retracts following the procedure," Dr. McMenamin says.

The creation of an extremely uniform wound and control over the healing process both set the stage for consistent postoperative liposuction results. In any liposuction procedure, the surgeon must take care not to alter or traumatize the subdermal vascular plexus supplying the overlying skin. Sculpting too close to the skin's surface may result in uneven contours and may change skin texture, and blood flow patterns and may cause skin loss. Leaving a uniform layer of fat beneath the skin exactly the same thickness in the area that one is sculpting is instrumental in creating a uniform wound, which will more likely result in even and smooth contour outlines.


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