Meera - In this day and age, with cosmetic surgery becoming quite a common occurrence some people resort to liposuction to remove this weight. This week Iím at the Cadogan Clinic, a day surgery centre in London. With me is Dr Brian Mayhew, the man who first introduced liposuction to the UK. Brian, what exactly is liposuction?
Brian - Liposuction is simply removing fat by the most convenient way. You can just remove fat by cutting it out but then youíre left with scars and a rather uneven shape. With liposuction you can take the fat out quite smoothly. Itís basically loosened by rasping it with the end of this tube or canula that we use and sucking it out into a bottle. Once itís sucked out it doesnít come back.
Meera - Why does sucking out the fat make a bigger difference than say if someone lost weight and reduced their fat cells?
Brian - Normally when people put on weight their fat cells just get bigger. When they lose weight they get smaller but thereís no reduction in number of cells. Here weíre reducing the number of cells and therefore the shape.
Meera - Weíre actually down in one of your operating theatres at the moment. I can see the liposuction machine in front of me. Itís kind of a tall, rectangular unit which has bags of solution hanging from the top of it. How does this machine work to actually suck fat out of people?
Brian - The basic principle is weíve got a suction machine and we suck out the fat as fast as we can. The maximum we can achieve is one vacuum so we try and get as close to that. We have some fluid in some bags to which we add adrenaline to reduce bleeding. It restricts the blood vessels. Thereís bicarbonate as well. This is just used for the pH to the body pH. If itís not the same pH itís uncomfortable and local anaesthetic short-acting and long-acting. Very often the patients are asleep during this, itís under general anaesthesia. Itís perfectly possible to do it under local. In this particular machine which is use, the body jet machine, the water-assisted machine thereís a small tube coming up the cannula that squirts out, like a pressure washer, the local anaesthetic. If we just do it slowly people donít feel any pain. Fat doesnít have a lot of nerve endings in it and then we suck out the fat in an even manner.
Meera - Does the solution break up the fat cells and just make it easier to suck up the fat afterwards?
Brian - Generally the removal of the fat is done by the rasping action of the blunt end of the cannula. Itís the mechanical action of the fat against the blunt edges of the cannula. Fat is sort of sucked through these holes and as you move the cannula back and forth it sort of pulls, drags it away from its bearings. Dragging it away is better than cutting. If you cut the vessels bleed. If you drag them they tend to contract. However, in this water-assisted technique this slight pressure of fluid does dislodge the fat. Thatís really quite useful where the fatís difficult to remove.
Meera - Is it purely fat cells you are sucking out or is there any risk of sucking out any other things in the process?
Brian - Most of the layers weíre treating there is only fat there beneath the skin and the next layer down is the muscle which is pretty resistant to trauma.
Meera - Iíd like to know a bit about what happens to the person afterwards. What are the risks of infection and things through this procedure?
Brian - Infection really doesnít occur with liposuction unless someoneís doing something else as well: excision, some skin operation as well. Bleeding with the adrenaline itís reduced but it is only bruising. It does disappear so after about 3 weeks the visible bruising is gone and, depending on the area of the body, the healing process continues and deeper damage heals too; usually after about 3 months.
Meera - What about the functioning of the patientís metabolism? Youíve just removed all these fat cells from the person. What would happen if they were to put on weight?
Brian - Theyíd put on weight elsewhere in exactly the same way as they did before the operation. It doesnít affect that at all. They donít put it on at a greater or lesser rate but they donít have the fat being put on in the area thatís treated. Itís a permanent change of shape.
Meera - Even is someone does have liposuction they should really be having a healthy diet and reasonably moderate exercise afterwards in order to keep themselves that way?
Brian - Yes, thatís absolutely right.
Meera - By the sounds of it this procedure is quite purely aesthetic. Itís not an actual treatment for obesity as such.
Brian - no, it isnít really and if you were going to remove that amount of fat it would be many very big procedures and it would probably be very difficult to get the result even. The other limitation is just the general effect on the body. If weíre removing more than about 3 or 4 litres of fat thereís going to be a lot of bleeding. Therefore the haemoglobin will drop and people will feel very weak afterwards.
Meera - Could liposuction help to reduce the effects or chances of getting obesity-related diseases such as diabetes?
Brian - I have had a request of physicians who treated fat people who are diabetic to try and gain control of the diabetes. We havenít done enough to know if this is very effective or not but we certainly Ė that was the principle that we were working to and I think for some of those patients it did help them.