Plastic surgery for the body

Plastic surgery is not limited to the face. Two of the most popular procedures carried out on the body are liposuction, a procedure which removes fat from certain locations on the body, and augmentation mammoplasty, the surgical insertion of either saline or silicone implants to increase the size of the breasts.

Liposuction is a procedure in which deposits of fat are removed to recontour an area of the body. Through a tiny incision, a cannula (internal suction probe) is inserted and used to suck out the fatty layer that lies under the skin. The cannula is pushed and pulled through the layer to make tunnels like those in Swiss cheese; fat cells are broken up and then suctioned out. While not a substitute for dieting and exercise, liposuction can remove areas of fat that won’t respond to traditional weight-loss methods. According to plastic surgeon Dr Amorn Poomee, women request liposuction most commonly on their hips, thighs and abdomen, while men ask for the procedure to be done on their abdomen, love handles, and breasts. ("Men hate having breasts!" says Dr Amorn.)

During the past few years, liposuction has benefited from the development of several new techniques, the most popular of which is the tumescent technique. This technique uses saline containing a local anesthetic, which is injected into the fatty tissue. The injected area is therefore anesthetised, so no general anaesthetic is required. The liquid causes the compartments of fat to become swollen or "tumesced", and these larger compartments allow the cannula to move more smoothly under the skin. This technique allows for the use of much smaller cannulae – an important benefit, because when the tunnels mentioned above eventually collapse, ridges remain; and the bigger the cannula, the bigger and more noticeable the ridges. "It take a longer time to do the operation, but the results are much better than five years ago," says Dr Amorn.

Although they are rare, complications can occur. Risks increase when several areas are treated in one session and a large volume of fat is being removed, as the operation time is lengthened. Fat or blood clots can develop and block the lungs, leading to death; excesss fluid loss can lead to shock; and infection can occur. Surgeons will usually reduce the risk of complications by dividing surgery on multiple sites into several sessions.

Augmentation mammoplasty, a surgical procedure to enhance the size and shape of a woman’s breasts, is another popular procedure. The surgery is performed on women who believe their breasts are too small; to increase the size of the smaller breasts that follow pregnancy; to balance a difference in breast size; or to reconstruct a breast following surgical removal.

The two-hour procedure beings with an incision being made under the breast, around the areola, or in the armpit. The surgeon then lifts the breast tissue and skin to create space behind the breast tissue or under the pectoral muscle – placing them under the latter is believed by some to reduce the likelihood of the breasts hardening later on. The implants are then inserted. The surgery can be done using a general anaesthetic, or a local in conjunction with sedatives. Patients can head home immediately, or stay in hospital for one to two days if they prefer. Swelling can take up to five weeks to disappear.

Complications can occur. The most common problem is called capsular contracture. This occurs if the area around the implant tightens, and leads to the breast hardening. It can usually be rectified by further surgery. Excessive bleeding may occur; if it is severe, another operation may be required. Infection can also develop around an implant – most frequently within a week of surgery – requiring its removal (it can be reinserted later on). There may also be a change in nipple sensitivity, and occasionally implants break or leak. With saline implants, the salt water will be absorbed by the body with no side effects. With silicone, however, there may be further complications, with reports of silicone leading to "connective-tissue" disorders. However, no definitive link has been found. In the US, silicone implants are banned except on a case-by-case basis, but in Thailand, both types are available.

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