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Surgical Fat Removal-Reduction (liposuction)

Surgical Fat Removal-Reduction (liposuction)2019-02-28T18:50:36+00:00

Surgical Fat Removal-Reduction (liposuction)

What is Liposuction? What are Liposuction Types?

Liposuction, the number one cosmetic surgery performed in world, is a procedure removing unwanted lumps, bulges and areas of resistant fat deposits from specific areas of the body. Liposuction is performed by using a hand-held instrument (cannula) attached to a vacuum-like machine or a syringe. By pushing and pulling the cannula, fat cells are broken up and then sucked out with a vacuum. This is named traditional liposuction

As the public’s demand for greater efficacy and safety has grown steadily over the past decades, so has the search for and development of new liposuction technologies and techniques. Recent decades have seen the introduction of internal ultrasound assisted liposuction, external ultrasound-assisted liposuction, power-assisted lipoplasty, laser-assisted lipolysis, and most recent radiofrequency assisted lipolysis.

There are several options and techniques available at MSI our professional staff will help you in deciding which is the right treatment approach for you, considering effectiveness, safety, cost, and appropriateness for your needs.

Today, several liposuction techniques can be used to improve the ease of the procedure and to enhance the outcome. Based on the experience of Prof Moawad for the last 20 years, he prefers the tumescent technique assisted with powered cannula and the most recent external ultrasound energy when indicated.  Prof. Moawad was the first to introduce these techniques in the Middle East over last 20 years with supreme results and safety.

What is Tumescent Technique?

All liposuction techniques are done at MSI using tumescent anesthesia without need to general anesthesia. Tumescent anesthesia (Fluid Injection) is a technique in which a medicated solution is injected into fatty areas before the fat is removed. The fluid, a mixture of intravenous salt solution, lidocaine (a local anesthetic), and epinephrine (drug that contracts blood vessels), helps to remove fat more easily, reduces blood loss, and provides anesthesia during and after procedure for up to sixteen hours. Fluid Injection also helps to reduce the amount of bruising after a procedure. The amount of fluid that is injected varies depending on the judgment of Prof Moawad. The fluid is absorbed and eliminated through urine.

Tumescent Technique requires a large volume of anesthetic fluid, sometimes as much as three times the amount of fat to be removed and is injected into the area of fat just prior to the procedure being performed. The liquid causes compartments of fat to become swollen and firm (tumescent). The expanded fat compartments allow the liposuction canella to travel smoothly under the skin as the fat is removed. Since injected fluid contains an adequate amount of anesthetic, additional anesthesia may not be necessary. In fact, many patients receive only minor sedation to help them relax, remaining completely conscious and comfortable during the suctioning portion of tumescent liposuction surgery.

What is Syringe Liposculpture?

I started using syringe liposculpture to treat the whole body in 1999. With the advent of superficial liposculpture in 1989, some areas of the abdomen, which needed skin retraction, could now be treated with liposuction instead of resection. The use of this superficial technique increased the indications for liposuction and reduced the number of patients for traditional lift procedures. Applying new technique, liposuction we can be combined with skin resection in the same procedure.

What is Ultrasound assisted Liposuction (UAL)?

Ultrasonic assisted liposuction (UAL) is a modified liposuction technique that delivers ultrasonic energy to subcutaneous fat to facilitate traditional negative-pressure liposuction. There are two types of UAL: Internal UAL and external UAL. Internal UAL delivers ultrasonic energy directly to subcutaneous fat by a metal rod or cannula inserted through an incision in the skin. Recently, external UAL delivers ultrasonic energy to subcutaneous fat by means of applying a paddle-shaped instrument directly to the overlying skin.

What is Internal Ultrasound Assisted Liposuction(IUAL)?

The concept of IUAL is intuitively appealing. A piezoelectric crystal converts electric energy to rapid (ultrasonic) vibrations and heat that are transmitted to a small metal rod or paddle and thus injure living tissue. Ultrasonic energy delivers a combination of vibratory mechanical energy and thermal energy to subcutaneous fat.

Europeans were the first to embrace internal UAL. After an initial period of enthusiasm for internal UAL, it was eventually rejected by most European liposuction surgeons because of an unacceptable incidence of complications. Despite the misgivings of many European surgeons, internal UAL was subsequently introduced into North America.

Many surgeons tried internal UAL because it was promoted as the “cutting-edge” of cosmetic surgical technology. Because of insufficient proof of safety, the FDA (U.S. Food and Drug Administration) never approved the sale of internal UAL devices for liposuction. Nevertheless, equipment manufacturers and some prominent surgeons promoted internal UAL, and many surgeons purchased these devices with the intention of using them on liposuction patients. Eventually the risks of UAL became apparent, and sales of UAL devices plummeted. The company that sold most of the Internal UAL devices in America has declared bankruptcy.

IUAL has become less popular because of an increased awareness among liposuction surgeons that IUAL is associated with increased risks of complications such as; skin, muscle, and neurovascular perforations. Furthermore, thermal burns at the entry sites and overlying skin, skin necrosis, sensory alterations, perforation of the abdominal cavity, seromas, poor results and a variety of other complications.

What is Vibration Amplification of Sound Energy at Resonance (VASER)?

The Vibration Amplification of Sound Energy at Resonance (VASER) System is another method of internal ultrasound liposuction. VASER is a third-generation ultrasound-assisted liposuction tool that delivers energy in pulses through a specially designed probe. Pulsating energy and the specially developed probe help to prevent overexposure to ultrasonic waves and the subsequent side effect.

What is Internal Ultrasound (IUAL), High Definition and 4D High Definition?

High-definition liposuction, also known as hi-definition liposuction, hi-definition liposculpture, or simply hi-def lipo; is a surgical procedure that involves suctioning excess fat out of target areas of the body to create a slim, muscular and athletic appearance in different areas of the body such as the abdominals, hips and flanks, upper back, breasts, bra roll, arms, male pec,  glutes and leg.

In the abdominal region of the body, for example, plastic surgeons remove excess fat and provide sculpting to create the appearance of a six-pack in men or a “turtle tummy” in women. During high-definition liposculpture, small incisions are made in the target area and either ultrasonic energy or laser energy is transmitted through a small probe into the targeted area. This energy breaks cellular membranes surrounding fat cells releasing the lipid contents. A small cannula or hollow tube is then inserted under the skin and moved back and forth while suctioning the melted fat out of the body. These areas are then accentuated using superficial liposuction to make deeper grooves in the underlying tissues, thereby highlighting the musculature.

The most appropriate candidate for high-definition liposculpture is a patient who is close to their ideal body weight and who has good muscle tone already. VASER still inherent the risk of internal ultrasound assisted liposculpture with increased incidence of skin burns, skin necrosis and seromas.

What is External Ultrasound assisted Liposuction (EUAL)?

After the introduction of internal ultrasonic-assisted liposuction (UAL), reports of a higher incidence of complications such as skin necrosis and seromas tempered patient and physician enthusiasm for internal UAL. The consequence has been new interest in testing the application of external ultrasound prior to liposuction.

Although external ultrasound has been used in the clinical setting to enhance post-traumatic and postoperative healing, the use of external ultrasound preoperatively for liposuction is a relatively new concept The application of external ultrasound prior to liposuction is a technique that requires transcutaneous application of high-frequency ultrasonic fields delivered into wetted tissue, followed by traditional aspirates liposuction, with the goal of improving the mechanical removal of adipose cell.

External UAL, during which the ultrasonic energy is applied through the skin, must be differentiated from internal UAL, during which the ultrasonic energy is applied through a specialized cannula. Recently, external UAL at frequencies of 2-3 MHz and a potency of 3 W has been associated with complete fat tissue disruption, including both adipose cells and collagen networks

This new technique reported to soften or disrupt adipose tissue and (1) facilitate the task of suctioning adipose tissue, and increase the amount of fat extracted (2) make the patient more comfortable during and after the procedure, and (3) improve the quality of the aspirate by decreasing the amount of blood(4) it allows superior access through scar tissue(fibrous); and (5) it is not constrained by internal structures and can, therefore, be used to treat larger areas.

Ultrasound causes tissue destruction via 3 mechanisms: (1) cavitation, (2) micromechanical disruption, and (3) thermal damage. Reports on ultrasound suggest that the disruptive biologic effects of external ultrasound are due to micromechanical disruption or tissue heating. Other reports postulate that external UAL loosens adipose cell attachments, facilitating aspiration. It disrupts membranes and affects calcium influx, which can stimulate mast cell degranulation.

Ultrasound can induce fibroblast activity and enhance collagen production. It can stimulate endothelial cell activity and new capillary formation in chronically ischemic tissue. These effects make ultrasound useful for the care of chronic wounds, as well. In addition, the manifestations of effects of external ultrasound appear to be directly proportional to the intensity delivered, with simple cellular detachment at 1 MHz to complete adipose cellular destruction at 2-3 MHz.

What is High-intensity focus ultrasound or HIFU?

Recently, high-intensity focused ultrasound (HIFU) was used to treat and ablate subcutaneous adipose tissue prior to abdominoplasty cases with histologically proven success. This represents a new potential use for external ultrasound technology as a pretreatment regimen for ablating and remodeling subcutaneous deposits.

EUAL is useful for body contouring, of localized fat in patients with moderate obesity especially in patients with fibrous and inveterate cellulite. Furthermore, EUAL is a safe and effective method for the treatment of dense fibrous breast of male breast (gynecomastia and pseudo-gynecomastia) because of its effect not only on fatty tissue but also on fibrous connective tissue.

It appears most useful for treating larger or more fibrous areas that would be otherwise difficult with liposuction alone such as the back.  When compared to conventional tumescent liposuction (CTL), patients report less pain and discomfort on the ultrasound-treated sides and we found less swelling and bruising, with superior skin shrinkage. Clinical recovery was also enhanced with less effort by the surgeon. Combination of this innovation with tumescent liposuction seems to improve the results with no complications.

What is Power-Assisted Liposuction?

Almost all types of energy have been combined with liposuction to improve patient experience and results. The “power” in power-assisted/power-tumescent liposuction refers to the use of a small mechanical tube (cannula) that efficiently removes fatty tissue. The mechanical vibrations produced by the power unit are soothing and may decrease procedure time. Powered liposuction can increase fat extraction by 30% or more over non-powered liposuction. Patients love the vibration sensation of powered liposuction or traditional non-powered liposuction.

Prof. Moawad was the first to use this technique in Middle East 15 years ago. In power-assisted liposuction, a cannula with a back-and-forth motion of the tip passes through tissue to suction out fat and fibrous or scarred tissue with reduced effort. Studies that compared power-assisted to traditional liposuction found that power-assisted liposuction was superior in the ease and speed of fat extraction, faster healing and recovery time for patients, shorter procedure times with less surgeon fatigue, and lower incidence of touch-up secondary procedure. Appropriate tissue accommodation or retraction occurred after liposuction in most treated sites, except in areas that exhibited preoperatively a significant degree of tissue laxity.  The short-powered strokes can be used more precisely than the longer “to and fro” motion of manual liposuction. The devices can also be used while holding the hand still to remove fat in difficult areas such as the peri-umbilical region.

What is Laser-Assisted liposuction (LAL)

Different wavelengths have been selected for laser lipolysis to specifically target fat, collagen (water), and blood vessels. According to the theory of selective photothermolysis, these chromophores will preferentially absorb laser energy based on their absorption coefficients at specific wavelengths. Various wavelengths, including 924, 968, 980, 1064, 1319, 1320, 1344, and 1440nm, have been evaluated for interactions within the subcutaneous compartment.

Aggressive marketing by these companies have peaked interest in laser lipolysis procedures. Similar to internal ultrasound assisted liposuction, LAL is a two-stage procedure. In the first stage, laser energy is delivered to the tumescent adipose tissue through an optical fiber, resulting in the coagulation of adipose tissue which heats the subcutaneous tissue. Photoacoustic, photomechanical, and photothermal effects are additional theorized mechanisms of action in laser lipolysis.

Liquefied fat is then aspirated gently, with less bleeding. Definition of laser-assisted liposculpture was the application of laser energy until tactile warmth and ease of cannula advancement were achieved. Then “traditional” tumescent liposculpture with aspiration was performed.

The added value of the LAL over these liposuction modalities is the heating of the reticular dermis and thermal induced skin contraction. Despite these findings, some clinicians have been reluctant to accept laser lipolysis citing longer procedural times, increased risk of adverse reactions, and lack of evidence supporting superiority over traditional liposuction.

The inherent weakness of LAL is the delivery of power through the tiny fiber having a diameter of less than one square millimeter. The strong concentration of laser energy near the fiber tip creates a risk of hot spots and under-treated areas. While LAL provides effective and quick results for small areas such as the neck or arm, it is not a convenient method for treating large areas such as the abdomen, thighs or hips because of the relatively slow speed of treatment.

Although many studies have produced promising results, the disadvantages of laser-assisted lipolysis cannot be overlooked. These include risk of thermal injury, equipment cost, steep learning curve, and long procedure time. The only randomized controlled trial comparing laser-assisted lipolysis with traditional liposuction failed to demonstrate enhanced cosmesis. It cannot be emphasized enough that the studies available in the literature do not show at this point any advantage of laser-assisted liposuction over tumescent. Furthermore, no studies exist that directly compare the purported advantages of skin tightening, neocollagenesis, and greater hemostasis with tumescent liposuction.

What is Radiofrequency-assisted liposuction (RFAL)?

RFAL is the newest addition to the liposuction family and can be found only in the BodyTite device. RFAL uses RF energy to deliver a thermal effect to the adipose tissue, skin and sub-dermal matrix. RFAL technology uses two electrodes— one external and one internal, connected by a handpiece—which contribute to creating a thermal profile. The hand-piece controls treatment depth from 5–50mm, allowing uniform treatment over not only the treatment area but also through the depth of the subcutaneous tissue. This uniform heating is a basis for safe and effective tissue tightening. Initial contraction studies show immediate linear contraction of 15% and long-term linear contraction of 30-40% over 12 weeks, enhancing the contour results in patients with marginal or compromised laxity.

What Does MSI Offer Patients for Liposuction?

Am I a good Candidate for Liposuction?

Fat distribution is determined by two factors: heredity and diet. Heredity determines location and number of individual fat cells that are fixed and unchanging after puberty. Diet can increase or decrease the amount of fat in each cell but will not affect the total number of cells or their distribution.

For example, if you have inherited large numbers of fat cells on your thighs and small numbers of fat cells on your chest, you will always have more fat on the thighs than on the chest, and strenuous attempts at weight loss can leave you with a thin upper body and persistently bulky thighs.

The ideal candidate for liposuction is a person of normal weight with relatively firm, elastic skin, but except for pockets of excess fat in certain areas of their body that is resistant to diet and exercise and disproportionate to the rest of their body.

Patients should be in good health, emotionally stable, and realistic in their expectations. Age is not a consideration, but older patients usually have diminished skin elasticity, thus will probably not achieve the same results as a younger person with tighter skin.

The localized fat deposits are termed lipodystrophy, and, even if the patient is at or below his or her ideal weight. Overweight patients may also have lipodystrophy, but diet and exercise, rather than large-volume liposuction, are the mainstays of treatment for generalized obesity.

Some patients must have multiple procedures if they have more fat than can safely be removed in one operative setting. While no method of liposuction is a substitute for good nutrition and physical exercise, nor is it an alternative for general weight reduction, it is however, ideal for permanently removing localized areas of fat that are diet and exercise resistant.

What areas of the body can be performed?

The most common areas for treatment include upper thighs (saddle bags), abdomen, flanks (Love handles), and upper arms. Other areas include facial accumulations of fat, including a double chin, neck and jowls, breast, hips, buttocks, and knees. Cheeks, calves, and ankles can be done, but results are generally less impressive in these areas. In men, liposuction can be used to correct gynecomastia (enlarged breasts) and more recently as scar less breast reduction in females. In addition, liposuction is used in the removal of sweat glands in the underarm to reduce excessive sweating, without affecting the body’s ability to cool itself.

Your consultation with Prof Moawad

During consultation, Prof. Moawad will review your medical history, evaluate your present health, and assess the current condition of your skin, considering elasticity as well as localized fat deposition. Your present weight, and whether you plan to lose or gain, will factor into this evaluation, along with what effects, if any, prior weight-loss had on the areas of your body you want contoured.

Your expectations will be addressed as to whether they can be realistically achieved, in addition to which body contouring method and procedure technique will be most suitable in your case. Prof. Moawad will discuss how factors like the general state of your health, overall condition of your skin, your weight, age, hormonal influences, and certain other factors, can all influence the outcome of your procedure.

Instructions for patients

Pre-operative instructions

  • DO NOT SMOKE for 2 weeks prior to and 2 weeks after surgery. Smoking reduces blood circulation, slows down healing and increases complications.

  • DO NOT TAKE ASPIRIN or products containing aspirin, or anti-inflammatories such as Brufen, Cataflam, and Ponstan for 2 weeks prior to or following your scheduled surgery. These medications affect your blood’s ability to clot and could increase your tendency to bleed during surgery or during the post-operative period. If you need to take a mild painkiller, you can take paracetamol.

  • DO NOT TAKE DIETARY SUPPLEMENTS for 2 weeks before and after surgery. These include vitamins, ginger, ginko biloba, garlic, ginseng and fish oils. They may increase your risk of bleeding and bruising during and following surgery.

  • DO NOT DRINK ALCOHOL for 5 days prior to surgery. Alcohol may increase your risk of complications as well as bruising.

  • IF YOU DEVELOP A COLD, COLD SORE, FEVER, OR ANY OTHER ILLNESS PRIOR TO SURGERY PLEASE NOTIFY US.

Day Prior to and the day of surgery

  • Please shower using only anti-bacterial soap. Males receiving abdominal or flank treatment may prefer to shave the treatment area; females receiving abdominal or thigh treatment may prefer to shave pubic areas below the hairline.

  • Wear comfortable, dark, loos-fitting clothing on the day of surgery, including a shirt that buttons all the way up the front. Wear nothing that you must put on over your head. Slip-on shoes are recommended for maximum post-operative comfort. We suggest you safeguard your car seat and bedding with a protective cover as there will be some leakage of fluid following surgery.

  • Leave jeweler and valuable at home. Do not wear wigs, hairpins or hairpieces.

  • Avoid wearing makeup , facial and body moisturizers.

  • SURGERY TIMES ARE ESTIMATES ONLY. You could be at the clinic longer than indicated.

  • ARRANGE FOR A DRIVER TO AND FROM SURGERY. We cannot discharge you to a taxi. Put a pillow and blanket in the car for the trip home.

  • HAVE A LIGHT BREAKFAST on the morning of surgery.

Post-operative instructions

  • IF YOU EXPERIENCE EXCESSIVE PAIN OR BLEEDING, FULLNESS OR SPREADING REDNESS IN TREATMENT AREAS, OR FEVER, PLEASE CALL US IMMEDIATELY

  • DRIVING: A family member or friend must drive you home from your surgery (it is best to have them stay and assist you for the first 24–48 h). Please do not drive if you are taking the prescription pain medication Tramodol like.

  • COMPRESSION GARMENTS: If you had liposculpture performed on your knees, thighs, hips, arms or abdomen, a special elastic-type garment was put on at the end of surgery to provide comfort and support while helping your skin conform to your new body contour. The day following surgery, you may remove the garment once a day for laundering, sponge bathing and bandage changing (if present). Continue wearing the garment 24 h a day for the first 2 weeks, followed by 12 h a day (remove at night) for the subsequent 2 weeks.

  • BATHING OR SHOWERING: Sponge bathe only for the first 72 h when removing the compression garment. After 72 h, you may take a shower or bath when the garment has been temporarily removed. Avoid Whirl Pools and hot tubs for at least 1 week (until the incision sites have healed).

  • TREATMENT SITES: Please keep your dressings as clean and dry as possible, changing daily if wet to help prevent infection. Do not apply heat or ice to the surgical areas. You should expect significant drainage (oozing) of blood-tinged anesthetic solution at the incision sites due to fluids injected during your procedure. Although the fluid may appear red, it is mostly anesthetic solution and saline and only 1% blood. In general, the more drainage there is, the less bruising and swelling there will be. Many patients have found it helpful to use a shower curtain or other protective covering on their mattress for the first few days after their liposculpture procedure. When your incisions stop draining, please clean with tap water and apply petroleum jelly to the incisions. Itching, pulling, pinching, hardness, tightness and/or numbness sensations are normal. All should subside within 24 h to 1 week, but sometimes can last for months. This is part of the healing process and your patience is appreciated.

  • ACTIVITY: Rest for the first 12 h. It is normal to experience light-headedness when rising or removing/changing your compression garments. Please have someone help you with this for the first few days after surgery. Take it easy for the first week, resuming normal activity as tolerated. Experiencing more than mild swelling and discomfort may indicate that you are overdoing it. Avoid strenuous activities, lifting over 10 Ibis, or aerobic exercise for 2–3 weeks. Protect incisions and any bruised areas from the sun until completely healed; use SPF30 or greater for 6 months. Avoid tanning until bruising has faded, which normally takes 10–14 days. If you like, feel free to treat yourself to a gentle massage during your post-operative course. Therapeutic massage is very helpful to speed the healing process and may be done beginning 2 weeks after surgery, as often as every second day and as hard as you can tolerate.

  • DIET: If you experience any post-operative nausea, try carbonated drinks and dry crackers to settle your stomach. Take your post-operative medications with food to minimize irritation. If your stomach feels normal, start slowly with liquids and bland foods, progressing to soups, and finally a normal diet as tolerated. Drink plenty of clear fluids.

  • ALCOHOL: As well as/In addition to refraining from drinking alcohol for at least 5 days before surgery, it is especially important that you do not consume alcohol if you are taking over-the-counter or prescription pain medication following surgery as they may interact.

  • SMOKING: We continue to stress the importance of not smoking. Smoking reduces blood circulation to skin and tissues and delays healing. Do not smoke at all during the first 14 days following the procedure.

  • EXPECTATIONS: Remember, the goal of fat removal is not weight loss but improved contour. In fact, since the body retains fluids in response to surgery, you may notice a temporary weight gain, resolving over the first week. In addition, remember that for most people the goal is significant improvement, not perfection. Lower abdominal patients may experience significant swelling in the pubic area. Post-operative discomfort usually takes the form of deep muscle soreness and normally improves over the following 2–7 days. Slight temperature elevation and flushing of the face, neck, and upper chest could last 48 h. You may initially experience a mild depression that should begin lifting after the first week, once you see the bruising and swelling fade. Menstrual irregularities (premature or delayed monthly onset) are a common side effect to surgery. If areas on the thighs were treated, you may have swelling in your calves and ankles for up to 3 weeks.

POST-OPERATIVE MEDICATIONS.

Please take the antibiotics and pain medications as advised or prescribed by your doctor. If you have no allergies, you may start with regular paracetamol (1,000 mg every 6 h). If this does not relieve discomfort or pain, you can take the prescription pain medication in addition to the paracetamol. Do not take aspirin, Brufen or Neurofen. If antibiotics are prescribed, it is very important you complete the full course.

POST-OPERATIVE APPOINTMENTS.

For maximum healing and optimal long-term results, you must follow the schedule of appointments that are made following your surgery.

What are the risks involved?

Liposuction performed under general anesthesia with hospital admission carries a higher risk of serious adverse events. This form of liposuction, referred to by some authors as “traditional” or “conventional,” Tumescent liposuction is a safe procedure on condition that patients are carefully selected, the operating facility is properly equipped, and the physician is adequately trained in the procedure. Tumescent liposuction has few significant side effects when performed by a qualified cosmetic  surgeon says Porf Moawad.

How do I prepare prior to my procedure?

You are provided with specific preoperative instructions, and preoperative photographs will be taken, which are important aids in planning out and performing the procedure, due in part to the patient being in a horizontal position during the procedure. Postoperative photographs are taken at 3- and 6-months post-surgery (body photographs are faceless).

If you smoke, you are advised to stop two weeks prior to your procedure. Smoking can affect the operation and impede healthy healing. Additionally, you must alert your our medical staff to any medication you are taking; certain drugs like aspirin, non-steroidal anti-inflammatory  and Vitamin E may increase bleeding during and after the operation.

In addition, some medications, e.g. certain antibiotics may interact with the local anesthesia. It is generally advised to stop eating and drinking at least 6 hours prior to the procedure. Pending your circumstances, you may want to arrange for someone to drive you home following your surgery, as well as to help you at home for a day or two.  It is recommended you reschedule your procedure should you develop a cold or an infection of any kind, especially a skin infection, as well as during your menstruation.

Is the incision large?  Will I have scars?

A tiny incision (2mm) is all that is required for the insertion of the tube. Incisions are generally very small, about ¼ inch. At MSI our method of re-contouring leaves minimal scars, and Prof. Moawad strategically place incisions within the natural folds of the body.

How long is the procedure? How many areas can be done at one time?

The duration of the operation lasts anywhere from thirty minutes to two hours, sometimes more depending on how many areas are treated. And, although multiple areas can be done at the same time, Prof Moawad prefers to do one site at a time to ensure the patient’s safety and a rapid recovery. Large deformities affecting several areas of the body, can be planned and done in several stages (sessions), allowing for a shorter healing period, and a safer, rapid recovery.

Where will the procedure be performed?

Liposuction is performed at MSI as an outpatient/ in-office procedure for reasons of cost, convenience and comfort. It’s now a well-known fact that in-office lipo-sculpture is safer than traditional liposuction done within a hospital setting.

Is the procedure painful? Will I be awake?

The principle factors in determining the type of liposuction and type of anesthesia patients should have, for example, straight tumescent method, sedation standby or sedation, are pain tolerance, the amount of fat to be removed, and the patient’s past and current medical health conditions; all factors considered when selecting the anesthesia that will provide the safest, most effective level of comfort during you procedure.

If only a small amount of fat, and a limited number of body sites are involved, liposuction can be performed under local anesthesia, which numbs only affected areas. The local is usually used along with intravenous sedation to keep you more relaxed during the procedure.

Some patients enjoy being awake during the procedure, and Prof Moawad also prefers his patients to be awake in order that he obtain optimum positioning with patient cooperation.

What can I expect immediately following the procedure?

Though tumescent liposuction is more refined, you may still experience some pain, burning, swelling, ecchymosis and temporary numbness. With the tumescent technique, postoperative discomfort is significantly reduced since the local anesthesia remains in the treated tissue, usually causing numbness for sixteen hours or more after surgery. If required, Extra Strength Tylenol or Tylenol with Codeine is enough to control relatively minor discomfort that may occur following your surgery.

Immediately after surgery, you are transferred to our luxurious recovery room where you are fitted with a support garment that you are required to wear continuously for two to four weeks (if calves and/or ankles were treated, you will need to wear support hose for up to six weeks).

Generally, after the procedure you will probably have some fluid drainage from the incisions and can expect some bruising and swelling (bruising generally goes away in 3 weeks; swelling can last for 3 months depending on the amount of work done).

Most patients can walk out of the office without assistance. Recovery time will vary greatly depending on the individual, how extensive the procedure and the technique used.

How Will I look During My Recovery?

You may remove the garment to shower the day after surgery. For the first few days after your procedure, you may feel stiff and sore, but you are encouraged to move about, even a little since this will aid in blood circulation.  Dressings will be removed in several days, so Prof. Moawad and his staff can examine treated areas.

You will be scheduled for follow-up visits to monitor your progress and receive an ultrasound massage, lymphatic drainage the day following your surgery, then every other day for the first week.

Subsequent follow-up visits are scheduled at 1 month, then again at 3- and 6-months following surgery. If you have any unusual symptoms between visits, for example heavy bleeding or a sudden increase in pain or any questions about what you can and cannot do, you are advised to call MSI immediately.

For the most part, results of liposuction can be dramatic. Saddlebags may disappear. Legs and hips become thinner and shapelier. Stomachs become flatter and firmer, and double chins can be sucked away.

Occasionally the skin may have an uneven or slightly rippled effect. The surface can sometimes be irregular or asymmetric, or pigmentation changes may occur, especially in older patients with dark skin. If you have skin dimpling (cellulite), it will still be there following your surgery.

Scars from liposuction are usually very small and strategically placed within body folds. Overweight patients who have localized areas of fat removed must be willing to accept a greater chance of contour irregularities, and less than ideal skin re-draping in exchange for improving the way they look in clothing.

At MSI we are proud to be the first center in Egypt who offer post liposuction special skin tightening program that involve vacuum, soft laser and photodynamic therapy using LED technology speed recovery time and ensure tight skin.  Additional tightening effect can be achieved only at MSI using the FDA approved monopolar radiofrequency device for non-surgical skin lifts.

Strenuous activity should be avoided for about three weeks. Patients may return to work in one week, although many returns earlier. You are advised not to take aspirin or certain anti-inflammatory drugs, and not to smoke.

Are results permanent?  Will my fat return?

On condition you stay at your postoperative weight, and a proper diet and exercise become part of your routine, the results of liposuction will be permanent, since there are now fewer fat cells in those areas that were contoured.  Weight gain is the actual enlargement of existing fat cells, not the creation of new ones.

The greater number of fat cells there in a specific location, the more difficult it is to reduce in that area simply by dieting. Dieting usually reduces the size of all fat cells proportionately, but to a large degree leaves the basic silhouette unchanged. Should you gain a few pounds however, the weight will be more evenly distributed rather than accumulating in the same problem areas before the procedure. Doctors believe that once fat cells have been removed by liposuction, these same cells do not return.

Will my skin hang after liposuction?

Prof. Moawad ‘s initial assessment determines the amount of fat to be removed in order that your skin re-drapes appropriately. The degree of skin change after liposuction surgery is the same as one would expect if it were possible to lose an equal amount of fat in these localized areas imply by dieting.

Because the small cannulas simply make small tunnels through the fat, there remain multiple connections between the skin and the underlying tissue. These fibrous connections contract with the healing process and maintain the skin in its natural position.

After liposuction by tumescent liposuction, one does not have to worry about excessive folds of the skin in the areas treated by liposuction surgery. This effect is so dramatic that many patients who previously would have required a surgical excision of skin, called a tummy tuck, can now have excellent results simply by having power assisted liposuction.

At MSI we are proud to be the first center in Egypt who offer post liposuction non surgical skin tightening program that involve vacuum, soft laser and photodynamic therapy using LED technology and radiofrequency.  Additional tightening effect can be achieved only at MSI using the FDA approved monopolar radiofrequency device for non-surgical skin lifts. Only those individuals with lax musculature and loose skin with or without excess fat, might require additional procedures like abdominoplasty (tummy tuck) or thigh lift.

Will I need a second procedure?  If so, when?

Most patients require just one procedure. Less than ten percent of patients need a fine-tuning procedure, after of period of after least six months.

Will liposuction Treats My Cellulite?

Why we treat cellulite from above the skin when the real problem lies beneath it? Ask Prof Moawad. After tumescent anesthesia is injected in the target areas of awake patient Prof Moawad use a special power cannula that help him to subcise the fibrous septa that dimple the surface of the skin in a very precise manner without suction of fat. By holding the cannula in place making the powered stroke precisely cut these fibrous septa (subcise) underneath the skin.  This ensure greater fat survival and successful fat transfer afterwards.

At MSI the results are excellent in treating cellulite and smoothing out the skin in combining these two procedures.  It worth mentioning that this approach is offered to our patients as a standalone treatment or in combination with liposuction or with monopolar radiofrequency skin tightening sessions afterward to achieve more skin tightening and greater smooth skin. Read more on treatment of cellulite at MSI

Can I benefit from Removed Fat For Fat Transfer or Fat Injection?

Fat transfer is a very effective means to fill in wrinkles and loss of tissue throughout the body and face. Fat transfers are done by “harvesting” fat from the abdomen or another part of the body, processing it in order to get viable fat cells, and then injecting it back in the desired location. Fat which is removed from one area of your body, can be safely stored for several months. The advantage of fat transfers is that there is usually an unlimited source of fat, it’s one’s own tissue, and it’s a reasonably reliable material. Some disadvantages are that the fat does reabsorb to some degree, and it may take a few procedures to get the results wanted

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