LIPOSUCTION
What is LIPOSUCTION?
This is a surgical operation designed to improve the contour and shape of prominent areas of the body by removing unwanted fat. Liposuction is designed to “spot reduce” the unwanted area of excess fat.
It is not designed to assist in overall body weight loss or control.
Liposuction does not treat or improve skin abnormalities or irregularities.
Skin deformities listed (but not limited to) below are NOT improved with liposuction:
Stretch marks (striae)
Cellulite
Excess skin and skin wrinkling
Dents , dimples ,waves or any contour irregularity within the skin
Skin discoloration or fine veins (telangiectasia) in the skin
Who can have this operation?
The typical patient who is a candidate for a liposuction procedure has little or no excess skin over an area of fat prominence which produces the unwanted contour deformity.
Often the patient has tried numerous diets and exercise regimes to reduce the unwanted fat, neither of which has successfully improved the cosmetic concerns.
Alternatively, a patient may be happy with their weight and life style, but have unwanted contour deformities caused by excess fat in areas that they would like to have removed without changing their weight.
**LIPOSUCTION IS NOT A PROCEDURE FOR AN OVERWEIGHT PATIENT TO REDUCE GENERALIZED EXCESS BODY FAT. IT IS VERY LOCATION SPECIFIC DESIGNED TO “SPOT REDUCE” A SPECIFIC ANATOMIC AREA TO IMPROVE THE CONTOUR IN THAT LOCATION.
This applies to both men and women.
Why do these deformities occur?
People in general will distribute excess fat differently and in different anatomic areas in their body, based on their anatomy and inheritance.
Excess fat may accumulate in unwanted areas, even in patients with an ideal weight:
An example of this is seen in the thin petite woman with prominent outer lateral thighs (saddle bag deformity) despite an ideal body weight.
The typical fat distribution in women and in some men is peripheral. This means the excess fat occurs in the layer between the skin and the underlying muscles.
If there is excess loose or hanging skin overlying the areas of unwanted fat prominence, removing the fat alone with liposuction without dealing with the excess skin will make the area look worse by creating an increase skin redundancy and skin wrinkling.
An example of this is seen in a person who has youthful full cheeks, then becomes ill and loses a considerable amount of weight resulting in an older looking, hollow sunken cheek, with skin wrinkling.
Another example is the arms. If there is excess fat AND skin, by removing the fat only without addressing the excess skin will create a worse deformity like a “bat wing.”
When can Liposuction be done?
The patient’s weight and life style should be stable. Typically, the patient has tried both weight loss and exercise to correct the excess fat, creating the unwanted prominence.
What anatomic areas can you Liposuction?
Any combination of the listed areas below can be liposuctioned at one or more operative sittings.
If the areas and the amount to be liposuctioned are very large, then staging the procedures is done for patient safety and to reduce risks.
The COMMON areas of the body that can be treated with liposuction include:
abdomen
lateral breast and axilla
back & bra line
hips (love handle area)
outer thigh and outer buttocks (saddle bag deformity)
inner thighs
inner knees, calf and ankles
neck and cheeks
Neck and Cheeks:
Younger patients (<35 years old) may have an excess accumulation of fat in the neck and cheek areas. This is most often inherited. It does not respond to weight loss or exercise.
A liposuction procedure can reduce the neck and cheek fat producing a slimmer face and more sculpted neck with a sharper neck jaw line angle. Because of the youthful skin, there is no concern about producing excess redundant skin.
This same fat accumulation can also occur in a heavier patient. In this instance, significant weight loss may produce a reduction in the fat accumulation in the face. Alternatively, a liposuction procedure can reduce the neck and cheek fat producing a slimmer face and more sculpted neck with a sharper neck jaw line angle. If a very large amount of fat is to be removed, there is a risk of excess skin.
Dr. Giuffre would assess the quality and character of the skin over the area to be liposuctioned to determine if the patient is a candidate for liposuction.
In the 35-49 year old patient who has excess neck fat, but has no muscle or excess skin problems, a liposuction procedure may be a reasonable alternative to a facelift procedure depending on the quality of the neck skin. The quality and character of the skin over the area to be liposuctioned will determine whether this patient type is a candidate for liposuction.
In the 50+ year old patient, a heavy neck is most often accompanied by other gravity changes in the face including loss of muscle tone in the neck (the neck muscles start to hang and form cords), loose skin (turkey gobbler deformity), and a descent of the cheek fat along the jaw line (jowls) accompanied by creases from the outer mouth to the jowl (marionette and bitterness lines).
This cannot be corrected with liposuction. A facelift, neck lift procedure addresses this skin, muscle and fat deformity.
**Please See FAQ Liposuction Section: FAQ Facelift, FAQ Liposuction:Neck & Cheeks
Do I have to lose weight before Liposuction?
If the patient feels they are overweight and wants to lose a certain amount of weight before proceeding with liposuction, this is fine, provided that the patient can maintain this new life style by permanently keeping off this lost weight.
What is critical, is not to lose weight through an aggressive diet and exercise regime that is not sustainable before the liposuction procedure:
For example, if the patient loses 20lbs using an aggressive weight loss program before liposuction surgery but is unable to maintain this life style after surgery, the lost 20 lbs will be slowly regained over the next 6 months to a year.
The surgical result will be inferior because the excess fat will redistribute to all areas of the body (this is determined by your genetics) including areas previously liposuctioned.
A common myth about liposuction is once the fat has been removed in an area, it will not return. This is not true. A general weight gain will add fat to all areas of your body, even areas previously liposuctioned.
Another myth is that the fat removed by liposuction from an anatomic area, will be the first to reappear, if the patient gains weight. Again this is not true.
Dr. Giuffre advises that the patient comes into liposuction surgery at a weight that is a “no brainer weight”: a weight that is stable, that the patient has maintained for months or years based on their current life style.
There will be no extra ordinary effort for the patient to maintain this weight after surgery. The surgical result with then be maintained without changing the patient’s life style.
What if I lose weight after surgery?
A weight loss after liposuction surgery will not affect the result of the surgery, but will reduce other areas of body fat over the hips, arms, buttocks etc.
Postoperatively, a change in life style to permanently lose weight will not negatively affect the result of liposuction surgery.
Is Liposuction surgery covered by AHS (Alberta Health Care) if I get a referral from by GP or if I am a massive weight loss patient?
A liposuction procedure is considered a cosmetic procedure by AHS and is therefore not covered, even with a referral from the Family Physician.
I am a massive weight loss patient. Can I have Liposuction ?
Patients that have lost a considerable amount of weight may have cosmetic issues with excess skin and fat involving the upper arms, upper thighs, back, hips and buttocks, and breasts. Please refer to respective sections under the FAQ for each of these areas.
Removing the fat alone using liposuction without addressing the excess skin that occurs in all patients with significant weight loss will make the deformity worse.
There are numerous surgical procedures to address each of the anatomic areas that require removal of both skin and fat to improve the contour and shape of that area of the body.
A consultation with Dr. Giuffre to outline the surgical options is recommended.
OPERATION:
**please refer to www.pclsc.ca under LIPOSUCITON in the menu
Do I have to go to sleep (General Anesthesia) to have a Liposuction Surgery?
A General Anaesthetic is required in all cases that involve a large anatomic area.
Local Anaesthesia for smaller anatomic areas like the cheeks or neck is possible.
How long does the operation last?
Approximately one to two hours. This depends on the number of areas being treated.
Where is the surgery performed?
Dr. Giuffre uses a private surgical suite adjacent to his Meadowlark Health Centre Office (#176) for his cosmetic procedures.
Where is the incision for the Liposuction?
A 1mm incision is made in the corner of the mouth just inside the lip skin, and a 1mm incision just under the skin.
When healed, the tiny scar is not visible.
Will there be a scar?
Yes, but it is very small. Any incision in the skin, regardless of where in the body will heal with a scar. The scar will mature (the scar color goes from red to pink to white and the scar softens and becomes pliable) which can take 1-2 years.
Medical paper tape placed directly over the incision and changed weekly, for 3 months, will help speed up the process of scar maturation.
Will I have stitches?
Yes. They are under the skin and absorb (disappear by themselves). No sutures are removed.
What happens surgically in a LIPOSUCTION procedure?
Before the surgery, with the patient standing, the surgical plan is made by drawing on the areas of the body that are being treated. The amount of fat removal is planned.
A photograph is taken. The patient will receive a copy of the preoperative photograph at the 6 week check with Dr. Giuffre
Once the patient is asleep (General Anaesthetic), the patient is positioned. Small incisions are made, and a local anaesthetic solution is carefully infiltrated into the fat that is to be removed.
Depending on how much solution is used, the technique is called “wet”, “super-wet” or “tumescent”.
The fat is then removed using a blunt hollow tube (called a cannula) connected to a strong suction. There are many sizes and lengths of the cannulas.
There are different ways of removing the fat:
Mechanical Liposuction: the cannula is placed through the incision and moved through the fat. To assist in the mechanical fat removal, the cannula may be connected to a Power assisted device (PAL) that vibrates the end of the cannula tip. This improves the efficiency of the fat removal. This is the most traditional and reliable technique.
Dr. Giuffre uses a PAL connected to a liposuction with varying cannula sizes after a tumescent infiltration of the fat in the area to be treated.
Laser Liposuction: The cannula uses a laser light to heat the fat as it is liposuctioned.
Ultrasonic Liposuction: The cannula sends sound waves to disrupt the fat cells as they are suctioned.
Cool sculpting: This technique uses cold pads applied directly to the skin in an attempt to kill fat cells by creating a cold injury. No mechanical removal of fat or liposuction is done.
Chemical fat removal: this technique injects a chemical solution that destroys the fat cells. No mechanical removal of fat or liposuction is done.
What happens after my surgery?
You will have a light dressing over the incisions for the first day after surgery. You will go home with this.
You will be seen the next day after surgery where all of the dressings will be removed.
You may then shower. No further dressings are required.
Some physicians are advocates of supporting garments in the liposuction areas.
Dr. Giuffre does not routinely prescribe garment use; the advantage, if any, is unclear and the pressure from the garments may produce significant post-operative discomfort. Patients may wear them if they wish, and if they find them comfortable.
You are discouraged from having a bath, hot tub, or swimming for 6 weeks following surgery.
You are encouraged to walk the day of surgery to avoid the risk of blood clots in your legs. During the surgery, you will have had special sequential stocking on your legs that maintains normal leg circulation.
Arrangements will be made to see Dr. Giuffre postoperatively.
Is the Liposuction procedure painful?
Before waking from the surgery, Dr. Giuffre will have injected long acting local anesthetic into the liposuction areas to decrease any immediate discomfort from the surgery.
When the freezing wears off, the patient will require postoperative analgesic medication (pain killers) for up to a week. The discomfort typically subsides after the first two to three days following the surgery. Liposuction discomfort has little incisional pain. It often feels like a “Charlie horse” or an ache that follows excessive exercise in an out of shape person.
**Patients taking prescription pain killers should not drive a car, operate machinery, or sign significant documents while taking this medication.
Do I go home the same day as Surgery?
Yes, you will have to arrange a ride and aftercare with a responsible adult.
**You are not permitted to leave unaccompanied, or in a taxi.
I live out of town. Should I stay overnight?
If your driving distance from Edmonton exceeds 90 minutes, you should make arrangements to stay overnight in Edmonton.
The surgical centre does not have an overnight care facility.
You will then be seen, the following day, for dressing removal and assessment by Dr. Giuffre and his staff.
Can I contact my surgeon the day or night of surgery if I have a concern?
Yes, Dr. Giuffre provides his home phone number to his cosmetic patients in case there is are patient concerns.
In the rare instance that a patient requires hospitalization, Dr. Giuffre has admitting privileges to all the major hospitals in Edmonton.
When do I see my surgeon after surgery?
You will be seen the day following surgery by Dr. Giuffre and/or his nursing staff, and again within the week following your surgery by Dr. Giuffre.
Further follow up arrangements will be made at that time.
When can I shower?
A shower is okay after the first dressing change, which is usually done the next day after surgery.
It is okay to get the incision wet from a shower, but Dr. Giuffre recommends that you avoid a hot tub or bath, swimming pools, lakes, or ocean swimming for 6 weeks following surgery.
In what position can I sleep?
Whichever position is comfortable for you.
When can I resume relations with my partner?
There are no restrictions provided the surgically treated areas are not painful or traumatized.
What should I do to minimize scarring?
Vitamin E oil and Bio oil are not proven to positively impact scar healing.
Dr. Giuffre recommends medical paper on the incision for 3 months, changed weekly by the patient.
How long should I plan to be off work?
The typical time off work is one week.
If your work is extremely strenuous and involves heavy lifting, the time off work will be longer.
How long am I off sports and my workouts?
No sports or strenuous activity is permitted for 4- 6 weeks.
Patients are to avoid strenuous activity that increases their heart rate and blood pressure for the first 3 weeks. This could produce bleeding inside the surgical site. The rule of thumb is if you are sweating from the activity, you are over doing it and you are placing yourself.
What about eating and drinking after my liposuction?
Regular food and drink consumption, as the patient did preoperatively, is recommended.
Are there before and after pictures?
Yes, every patient that Dr. Giuffre operates on for cosmetic reasons will have a preoperative photograph taken.
At the 6 week check up with Dr. Giuffre, his patients are given an 8 x 10 preoperative photograph.
Postoperative photos are also taken in some instances.
THE RISKS:
What are the risks of doing Abdominal Liposuction?
With any surgery there are surgical and anesthetic risks.
Aside from the rare risks of an anesthetic event, some of the general and specific surgical risks for this procedure would include:
Scarring- minimum due to the very small incisions
Bruising – avoid Aspirin, Advil, or herbal medication that can cause increased bleeding
Swelling – postoperative swelling can vary but the immediate swelling can last up to 6 weeks before a patient starts to see the results of the fat reduction and 9 months before the final result is achieved
Infection - rare
Decreased sensation over the areas liposuctioned for 6 weeks or more
Discomfort
Time off work and exercise
Bleeding (hematoma) -rare
DVT (deep vein thrombosis = blood clots in the legs)
*Fat embolism
Excess skin or skin deformity: dent, dimple, wave, contour abnormalities
*All skin irregularities present before the liposuction surgery, like contour irregularities, dents, dimples, waves, cellulite, and stretch marks, in the skin will remain. These are not improved with liposuction.
asymmetry
*This list is not complete.
During the consultation with the patient, Dr. Giuffre will outline and explain each of the risks in detail.
THE FOLLOWUP:
How often do I need to come back for a checkup after the surgery?
Postoperative visits include:
24 hour visit
1 week visit
6 week visit
9 month visit
If there are any patient concerns, Dr. Giuffre provides his home phone number for patient's direct access.
After the 9th month visit, if there are any future requests for an appointment, they are made directly with Dr. Giuffre office and an expedited visit is arranged.
I no longer have access to my original surgeon. What can I do?
For cosmetic or reconstructive concerns, patients are invited to contact Dr. Giuffre's office (780-428-7737) for an appointment.
Dr. Giuffre does not require a referral.
There is no charge for the consultation.
I had a Liposuction with another surgeon and I am unhappy. What can I do?
It is always wise to re-consult with your original surgeon, in order that he can assess you and your concerns.
If that fails, or you are still unhappy with your options, you can always seek a second opinion.
Dr. Giuffre would communicate your concerns with your original surgeon in order to facilitate a resolution.
I had Liposuction with another surgeon using a different technique that didn’t work and I am unhappy. What can I do?
It is always wise to re-consult with your original surgeon, in order that he can assess you and your concerns.
**Some Liposuction techniques are not as reliable or predictable as the mechanical liposuction technique. In some instances, the best treatment could involve not only fat removal, but removal of excess skin, which may not be an option in situations where the medical practioner is not trained in these additional techniques. This may lead to an inferior result.
Patients can always seek a second opinion. Dr. Giuffre would discuss further options and communicate your concerns with your original surgeon in order to facilitate a resolution.
I had Liposuction in another country. I have a problem. What can I do?
For cosmetic or reconstructive concerns, patients are invited to contact Dr. Giuffre's office (780-428-7737) for an appointment.
Dr.Giuffre does not require a referral.
There is no charge for the consultation.
I had Liposuction years ago. I have gained weight and I am unhappy with my result.
What can I do?
This can happen from weight change, pregnancy, aging, and menopause.
A consultation with Dr. Giuffre is recommended to review the cause and discuss options for improvement.
FINANCING:
Is Liposuction surgery covered by AHS (Alberta Health Care) if I get a referral from by GP?
The Liposuction procedure is considered a cosmetic procedure by AHS and is therefore not covered, even with a referral from the Family Physician.
I am a massive weight loss patient. Can I have Liposuction and is it covered by AHS (Alberta Health Care)?
The Liposuction procedure is considered a cosmetic procedure by AHS, and is therefore not covered even with a referral from the Family Physician.
There are circumstances where the fat collection around the inner thighs and knees prevents the ability of the patient to ambulate (walk).
This would be considered a functional problem, and liposuction in these areas would be covered by AHS.
Can I use the costs of a Liposuction procedure as a tax deduction?
CRA eliminated the use of cosmetic surgery as a tax deduction a number of years ago. Unless you can demonstrate the procedure is a promotional cost for your business, it is not tax deductible.
If there is a medical need confirmed by your doctor, you may be able to deduct the cost with a letter from your doctor outlining the medical need/necessity for the procedure along with the receipt for the surgery submitted to the CRA (Canadian Revenue Agency).
Can I finance the costs of the surgery? How do I do this?
Dr. Giuffre does not provide in house financing for cosmetic procedures.
There are a number of companies across Canada that will finance cosmetic surgery not much different than financing a vehicle or mortgages. Please refer to the links provided on the Home Page for this information.
**Dr. Giuffre has no financial or business relationship or affiliation with any of these companies.
If something goes wrong, do I have to repay for the operation?
You do not have to pay for the treatment of an immediate complication. In the unusual event that there is a problem with your original surgery, you do not have to pay for the correction.
**A Weight gain with recurrent fat in an area of previous liposuction surgery would not be considered a problem from the original surgery. Regular fees would apply.
How much does it cost?
The cost of cosmetic surgery is covered entirely by the patient. The one fee would include:
the cost of the anesthetist (who provides the General Anesthetic)
the rental of the operating room and equipment
the rental of the recovery room and equipment
the staff, including the nurses and administration staff
the surgical fee
The cost will vary depending on the duration of the procedure and the quality and sophistication of the surgical facility where the surgery is performed.
The fees will be discussed at the time of consultation with Dr. Giuffre.
There is no obligation to proceed with surgery following the consultation. The patient is referred to our websites and is invited back for a second consultation if need be.
Our office will endeavour to expedite a surgical procedure to accommodate both business and family obligations. All fees are receipted. GST payment is required.
What about having my Cosmetic Surgery in another country where it is cheaper?
There is a current trend to have surgery out of your country where the surgery may be cheaper.
We call this tourist surgery.
There are a number of additional risks associated with tourist surgery, which include:
The surgical skill, experience, licensing and education of an unknown surgeon.
Canada has very strict rules and requirements to be a licensed Plastic Surgeon (FRCS(C)) in our country. Your Plastic Surgeon has completed an undergraduate degree (4 years), an MD degree (4 years), a Fellowship Degree in Plastic Surgery (5 years) and often a post Fellowship (1-2 years).
A “friend” is not a good reference, nor is glitzy advertising.
The safety, sterility and equipment quality, including anaesthesia machines in the hospital or private surgical suite could be questionable; this may lead to increased risk of infection and anaesthetic risks.
Post operative care is limited to the time you spend in their country.
If you have a complication, to see your original surgeon, you will have to fly back to where your procedure took place, or see a new surgeon in your own Country.
If you have an unsatisfactory result, you will have to fly back to see your original surgeon or find a new Surgeon.
The cost of the repair may exceed what you originally paid, and the final result, fixing a mistake, is often not as good as it could have been had the surgery been done correctly the first time.
After accounting for the accumulated costs of the air travel, hotel, surgery and postoperative care, the perceived cost savings may not be significant.
If you have a severe, life threatening complication, Alberta Health Care will cover the medical costs for your care.
Correcting the reconstructive problem, as a result of the complication, would be the patient’s financial responsibility.
Caveat Emptor ("Buyer Beware")