Tumescent Liposuction

Tumescent liposuction, also known as tumescent liposculpture, is internationally recognized as the safest liposuction technique with the fastest recovery time, the best aesthetic results and the least pain.

Tumescent means “swollen.” In tumescent liposuction, the areas targeted for fat reduction are injected with a mixture of a local anesthetic and a substance that causes the capillaries to contract. This results in fat becoming “swollen” or “firm.” The doctor is then able to remove the fat without general anesthetic while avoiding significant blood loss.

This method of liposuction is done completely by local anesthesia and avoids the dangers of general anesthesia, narcotic analgesics and IV sedation.

Tumescent liposuction does require the surgeon have a high level of skill but gets fantastic results. Plastic surgeons who avoid this technique and opt for general anesthesia may feel more comfortable having a patient who is unconscious, may want to complete the procedure faster or simply may not be confident enough in the skill required for tumescent liposuction.

The use of general anesthesia should not, however, be based upon what is convenient for the surgeon, but instead should be based on what is best for the patient and the patient’s preference.


Liposuction & Body Sculpture

Body sculpture by liposuction is an ideal solution for those who have stubborn fat that is not responding to diet and exercise. These fat pockets can be permanently removed by liposuction.

For most people, body fat tends to increase as they age. After age 30, we tend to gain fat according to genetic predisposition. As an example, many women have difficulty with fat on the abdomen and hips after giving birth. This fat distribution is often very resistant to exercise and dieting. For this reason, liposuction is the most effective method of actually changing the body’s shape. You can think of this as equivalent to being able to focus the effects of dieting to a specific area of the body.

What is liposuction?

Liposuction is a surgical procedure that removes excess fat. The surgery involves the use of small stainless steel tube called a cannula. The cannula is attached to a suction pump which effectively removes the fat from targeted areas predetermined by you and your surgeon.

Which areas can be treated by liposuction?

The most commonly treated areas in women are beneath the chin, ankles, calves, knees, thighs, hips and the abdomen. Arms can also be treated with liposuction. For men, the most commonly treated areas are the neck and chin area, male breast area, love handles and abdomen.

Does the fat come back after liposuction?

The fat cells that are removed during liposuction do not come back. As long as the patient maintains proper diet and exercise, they can maintain their new shape. For example, a woman who tends to put on weight in her thighs and knees will find that these areas are less likely to gain weight after she undergoes liposuction. However, it is possible to gain weight, it just usually manifests itself in areas other than those that were the target of liposuction.

Am I a good candidate for liposuction?

The best candidates for liposuction have realistic expectations as to what can be achieved with liposuction and are in good health. There is no specific weight limit or age limit for patients who choose to undergo liposuction. Most patients simply have localized accumulations of fat. Some of our happiest patients have been those who were moderately obese, but it is important to note that liposuction is not a treatment for those who are severely obese. Liposuction is not effective as a last resort for those unable to maintain a moderate weight through diet and exercise. For those who are overweight and have maintained a stable weight over time, liposuction may be a good solution to address stubborn problem areas of fat.

How would you describe a successful liposuction surgery?

The most successful liposuction surgeries are safely executed and result in patients who are happy with their results. Dr. Goravanchi’s goal is to achieve an aesthetically appealing result–not to remove the most fat possible. Excellent cosmetic results depend on sculpting inches, not removing pounds. For example, removing half a pound from each thigh will not result in a significant weight loss but it can significantly shape the thigh and produce an excellent cosmetic result.

Liposuction with Local Anesthesia Only

The local anesthetic used in tumescent technique for liposuction is so effective that patients no longer require intravenous sedatives, general anesthesia or narcotic analgesics. Numerous patients who previously received liposuction with general anesthesia and opted for a second treatment with the tumescent technique said they found the tumescent technique less painful with better results and said they experienced more rapid recovery and healing.

Virtually No Blood Loss

There is minimal bleeding during and after tumescent liposuction with local anesthesia. This is a major improvement over the traditional liposuction technique that uses general anesthesia.

The tumescent technique is so effective that patients were found to lose more blood during routine preoperative laboratory tests than during the actual liposuction procedure.

When are blood transfusions necessary during liposuction?

There is no need for blood transfusions during tumescent liposuction because there is minimal blood loss. In fact, doctors who still prefer to use general anesthesia during liposuction are opting for the tumescent technique in order to to minimize blood loss. While their patients still undergo the side effects of general anesthesia, they do experience the benefits of reduced blood loss.

General Anesthesia Risks

General anesthesia is associated with more risks than local anesthesia. General anesthesia is associated with fatal complications in 1 of every 2,500 patients. Local anesthesia is associated with fatal complications in 1 of every 10,000 patients. The serious risk factors associated with general anesthesia can be eliminated simply by not using this method of anesthesia. It is well recognized that local anesthesia is safer than general anesthesia.

For further information about tumescent liposuction and to schedule a consultation with Dr. Goravanchi, call our offices at (+98) 912 038 6704.


Abdomen (Tummy) Liposuction

The abdomen is the most common area of the body to be treated by liposuction among both men and women. Important factors that affect the success of abdominal liposuction include: the amount and location of abdomen fat, history of weight gain and weight loss, history of pregnancy, and the age and the sex of the patient.

Previous Pregnancy
A previous pregnancy tends to stretch the abdominal muscles, and cause the lower abdomen to bulge out. This bulge of the abdominal wall muscles determines the flatness or the shape of the abdominal after liposuction. Nevertheless, the vast majority of women who have been pregnant are usually very satisfied with liposuction alone, and do not require an abdominoplasty (tummy tuck).

C-Section Bulge
After Cesarean sections, or a hysterectomy, a persistent bulge of subcutaneous fat just above the incision may occur. Liposuction can easily repair this annoying deformity.

Prior weight gain
Prior weight and weight loss produce fat that is more fibrous. This makes liposuction more difficult.

Location of Belly Fat
Position of abdominal fat is an important factor in predicting the success of liposuction. Abdominal fat occurs in two different places: superficial and deep. Superficial fat is located just below the skin and above the muscles. The deep abdominal fat is located inside the abdominal cavity on the intestines. Some people have more deep (intestinal) fat than superficial fat. Only superficial fat can be removed by liposuction. Deep fat cannot be removed by liposuction because it would be too dangerous. Deep Fat can only be reduced by weight loss through diet and exercise. Thus liposuction cannot remove all of the abdominal fat. Most patients have more subcutaneous fat than intestinal fat. Thus most patients will see a good cosmetic improvement with abdominal liposuction.

Age of the patient is not an important factor in the success of liposuction. Some of the happiest patients are women who are more than 60 of age. In a healthy older woman, liposuction can improve an obese abdomen with little risk or discomfort.

Female Patients
Women have softer fat than men, and therefore liposuction on a woman is easier.

Upper Abdomen
Upper abdomen skin may appear slightly wrinkled after liposuction. In older patients with decreased skin tone, there is a tendency for the skin to appear somewhat crêpé or slightly wrinkled. Interestingly, the lower abdominal skin does not seem to be susceptible to this type of post-liposuction crêpiness.

Fat on the Upper Abdomen
This usually less of a concern than the fat on the lower abdomen. However if the upper abdominal fat is either not suctioned or inadequately suctioned, subsequent weight gain will enlarge the upper abdomen and give the appearance of bulky midriff.

The Old-Fashioned Tummy-Tuck
Tumescent liposuction of the abdomen is so effective that few patients require the more invasive tummy-tuck. The traditional tummy-tuck involves several surgical steps. First the fat is removed by liposuction or excision with a scalpel; next the surgeon removes a large piece of skin; then the muscles are tightened using sutures; and finally the large wound where the skin was excised is closed with staples or sutures.

The two most important reasons to have a tummy tuck are 1) extensive looseness of skin or muscles as a result of pregnancy, 2) excessive stretch marks.  Compared to liposuction, tummy tucks are associated with a much higher risk of serious complications.

If a patient not sure if she wants a tummy-tuck, it is usually advisable to separate the traditional tummy-tuck into two separate surgical procedures. Liposuction should be the done initially. Then one should wait a couple months and evaluate the cosmetic results of liposuction before deciding to proceed to the skin-excision part of the tummy-tuck. The surprising aspect of using this two-stage approach to abdominoplasty is the high degree of satisfaction that patients find from liposuction alone. In fact, the vast majority of patients are so please with the results of liposuction alone that they decide not to pursue the second stage skin resection.


After Liposuction Healing
Discomfort after tumescent liposuction of the abdomen typically does not require any pain medications stronger than acetaminophen (Tylenol). The quality of the pain is similar to the muscle soreness and burning experienced after having worked-out too much. The intensity of the pain is similar to that of a sunburn; it is most noticable when the skin of the area is flexed or touched, such as getting in and out of a car, or rolling-over in bed. When sitting still in a chair. There is minimal discomfort when walking or sitting.

With liposuction totally by local anesthesia patients do not typically need any pain medication immediately after abdominal liposuction because the tumescent local anesthesia last for up to 18 hours. From 2 to3 days after surgery patients experience the greatest degree of soreness and discomfort, but rarely need anything more than acetaminophen (Tylenol).

When general anesthesia has been used for liposuction, there is often somewhat more pain after liposuction. This is because surgeons who use general anesthesia usually uses less tumescent local anesthesia, do liposuction of more body areas during on the same day, use larger cannulas, and usually close the incisions with sutures.

The use of smaller liposuction cannulas (microcannulas) requires a little more time to complete the surgery, but they are associated with less pain, and allow smoother results. Because the incisions are smaller, they do not need to be closed by sutures; the open incisions allow more drainage of the blood-tinged tumescent fluid. When incisions are closed with sutures this fluid is trapped under the skin and causes prolonged swelling, and increased pain and soreness.

Post Surgery Swelling and Soreness
The day after liposuction, as a result of open-drainage (incisions are not closed with sutures) of the blood-tinged anesthetic fluid and wearing a compression garment, the degree of cosmetic improvement is easily visible and quite dramatic. The over the next several days, after the drainage has ceased, and as the inflammatory healing process progresses, there is a gradual onset of swelling which decreases over the following four to 12 weeks. This subcutaneous abdominal swelling can reduce the ease with which the patient bends forward. For example, tying ones shoes becomes a minor challenge. The edema that occurs after liposuction of the abdomen typically takes longer to resolve than edema in other treated areas. A certain degree of swelling, firmness and lumpiness is normal for the first four to 12 weeks. This firmness of the abdominal skin and subcutaneous tissue gradually decrease over 3 to 4 months after surgery.

The open-drainage technique, which reduces swelling and soreness, requires the use of special super-absorbent pads to absorb the drainage and special garments to hold the pads in place. See Absorbent Pads and Compression Garments.

Activity and Bathing
There is no restriction on postoperative physical activity. Patients are advised not to remain in bed, but rather to walk about inside their home or leave their home for a short walk on the evening of the surgery. The patient is expected to shower at least once or twice daily beginning the morning after the day of surgery.


Risks of Abdominal Liposuction

Abdominal Hernia – An abdominal hernia (muscle separation) near the bellybutton increases the risk of accidental injury into the abdominal cavity by the liposuction cannula. To eliminate this increased risk, an abdominal hernia can be repaired by a general surgeon several weeks before abdominal liposuction. Typically an abdominal hernia repair is a simple procedure which can often be accomplished under local anesthesia.

Prior Abdominal Liposuction Prior abdominal liposuction often causes a certain degree of scaring or fibrosis within the remaining subcutaneous fat. Doing liposuction a second time will be more difficult because of this excessive fibrosis.

Multiple procedures – Doing abdominal liposuction together with other surgical procedures increases the risk of surgical complications. Multiple surgical procedures require a longer exposure to general anesthesia, and more pain medications. Multiple procedures require more postoperative bed rest which increases the risk of fatal blood clots in the lung. Such complications are extremely rare when liposuction is performed alone and totally by local anesthesia.

Peritoneoscopy Abdominal liposuction and another surgery inside the abdomen is unnecessarily dangerous. Peritoneoscopy, using a scope to see inside the abdomen, creates a pathway directly into the abdominal cavity and increases the risk of a liposuction cannula entering the abdomen and injuring the intestines or the liver.

General Anesthesia – The risk of a liposuction cannula accidentally penetrating the abdomen cavity and causing an intestinal injury is very small. If a liposuction cannula causes a bowel perforation under general anesthesia, it might not be diagnosed immediately. When the patient awakes it is likely that any complaint of abdominal pain may be dismissed as the normal and expected discomfort of abdominal liposuction. If the delay goes beyond 18 to 24 hours, there is a grave risk of a life-threatening infection. In contrast, with liposuction totally by local anesthesia, any traumatic bowel perforation will be diagnosed immediately and a general surgeon can repair the wound before there is a serious infection.

Excessive Compression – Excessive Compression after an abdominal liposuction can impair breathing by limiting the expansion of the lungs. Non-adjustable, high compression postoperative garments are especially dangerous after general anesthesia, when respiratory depressant drugs have been given. In contrast adjustable compression garments are safer.

Excessive Fat Removal – Excessive fat removal from the abdomen can be a big mistake. The goal is not to remove as much fat as possible, but rather to produce a result that is a cosmetic improvement and appears natural. For example, following an aggressive liposuction by a surgeon who had removed virtually all of her patient’s subcutaneous abdominal fat, the patient’s husband found the firm hard feel of his wife’s abdomen to be sexually repulsive. Needless to say, the patient did not regard her result as optimal. Excessive liposuction of pubic area fat (mons pubis) may result in the area being so deficient in fat that normal sexual intercourse becomes exceedingly painful.

Other risk factors that may affect the relative safety and ultimate cosmetic results of abdominal liposuction include: prior abdominal surgery, laparoscopic procedures, and radiation therapy in the abdominal area.

For further information about tumescent liposuction  and abdominoplasty and to schedule a consultation with Dr. Goravanchi, call our offices at (+98) 912 038 6704.


Inner Thighs Liposuction

Inner thighs is a major area of concern among many women who seek liposuction. Inner thigh liposuction can significantly improve the shape of the thigh and reduce the rubbing together of the inner thighs. Occasionally a male patient may request liposuction of the upper inner thigh.

Inner Thighs and Inner Knees
Inner thighs and knees are usually treated at the same time.  Liposuctioning the inner thigh and inner knee as separate areas may result in unevenness. When liposuction of the both the inner thigh and knee areas is needed, then complete liposuction will have smoother results.

Incomplete Liposuction with general anesthesia

Liposuction of the inner thighs with the patient lying on her back does not allow adequate access to the fat on the back of the inner thighs. This situation arises most often when general anesthesia is used. Under general anesthesia rolling a liposuction patient onto her side to get access to the back is risky. Attempting to treat the entire inner thigh with the patient on her back often results in inadequate fat removal from the back of the inner thigh.

Skin Elasticity
Women who have inner thigh fat and good skin tone can expect excellent results following liposuction. When the skin is excessively wrinkled and crepey, liposuction may not provide the best improvement. In older women, and especially in women who have lost a considerable amount of weight, the skin  of the thigh tends to be wrinkled. Liposuction will not improve this wrinkled appearance. In fact liposuction may worsen the wrinkling.

Thigh Liposuction Vs. Thigh Lift
A women who has extensive wrinkling of the inner thigh, there is the option of a surgical thigh lift. In my experience most women are often disappointed by the aesthetic results of an inner thigh lift. They find the scaring associated with a medial thigh lift to be worse than the wrinkling. For patients with marked wrinkling, and only a minimal amount of medial thigh fat, the most reasonable option might simply be no surgical treatment.

After Liposuction
Postoperative care for the inner thighs or knees is simple and designed so that most patients can change dressings easily, and without assistance. The recovery quite rapid. One need only apply adequate absorptive padding and moderately firm compression. The drainage usually ceases within 36 to 48 hours. Many women choose to wear the garments beyond the minimum time because of the comfort and security provided by the garments.


Arms Liposuction

Liposuction of the arms provides excellent cosmetic results. The arms are one of the areas that consistently yield the highest level of patient satisfaction and happiness.

Am I a good candidate for arms liposuction?
Not everyone is a good candidate. But for appropriate patients, the results are most satisfying. Liposuction of the arms is almost exclusively a procedure for women. Exercise of the arms does not reduce the volume of fat located on the arms. A heavy bulky arm gives the appearance obesity, a thinner arm helps to give the appearance of a thinner body.

Skin Excision
Older liposuction techniques would also often include an additional excision of skin from inner side of the arm with resulting unsightly scars. With tumescent liposuction of the arms using microcannulas excision of skin might not be necessary.

Cosmetic Goals
The aesthetic goal of arm liposuction is for a woman to feel more attractive in social situations while wearing short sleeve clothing. The typical social activities involve standing or walking, sedately sitting at a table while eating or drinking, or seated at a desk writing, typing or conversing on a telephone. The goal of arm liposuction is

1) to improve a disproportionate appearance of the arm, while maintaining the quality of female beauty,

2) to allow the patient to feel more comfortable and less self-conscious when wearing a sleeveless blouse,

3) to achieve a thinner appearance of the arms when the arms are in a relaxed, dependent position alongside of the torso.

The goal is not to remove the maximum possible amount of fat. Arms that are disproportionately skinny with an otherwise obese body, might appear deformed rather than attractive.

Front Arm Fat Pads
These are located on the chest just in front of the arm-pit. These fat pads become more prominent with age and with gaining weight. However, in some relatively thin women, the anterior arm fat pad can be disproportionately large. A tightly fitting bra causes the fat pads to bulge unattractively above the bra. These fat pads can be treated by liposuction using microcannulas.

Posterior Arm Fat Pads
These are located just behind the arm-pit on the side of the back. In some women these fat pads can be a cosmetic problem. It is often convenient to do liposuction of the posterior arm fat pads at the same time as liposuction of the arms.

After Arm Liposuction
After surgery care for liposuction of the arms is relatively simple with only a moderate degree of compression necessary for only a few days. Drainage from the arms usually lasts less than a couple of days after surgery. Dressings consist of absorbent pads, initially held in place by tubular elastic netting, over which are wrapped elastic non-adhesive ace-type bandages. The patient can usually remove and re-apply these dressings without assistance. Postoperative improvement is rapid. Virtually every patient attains significant degree improvement within a few days after surgery.


Hip Liposuction

Hips in women is called waist and inn men is referred to as flanks. In men the fat bulges over the belt-line in a most unflattering fashion and is accentuated by a pair of pants with a tight belt. in women In women the same area is referred to as muffin top.

Insufficient Liposuction with General Anesthesia

Liposuction of the hips the patient lying on his back does not allow sufficient access to the fat on the back, and the area is often insufficiently treated. This situation arises most often when general anesthesia is used the patient positioned lying on the back. Rolling a liposuction patient onto his side can be done but it is risky. When doing liposuction totally by local anesthesia the problem of changing the patient’s position does not exist. One merely asks the patient to roll over on his/her side.

After Liposuction
After liposuction there is some drainage of blood-tinged solution of local anesthetic fluid. Which in turn reduces post-operative swelling, and bruising. After liposuction patients wear absorptive pads to accommodate the drainage. With open drainage there is no need to wear an elastic compression garment for a prolonged time.

Post-liposuction Compression
Post-liposuction compression of the male flanks is usually accomplished with the use of elastic garment.


Back and Bra roll Liposuction

The Back Fat

Liposuction of  back in women can produce noticeable improvements. The back fat can be divided into:

  • Bra roll: the fat pad that bulges just below the bra strap
  • Back of arm fat pad
  • Back of the  waists and hips fat pad
  • Tailbone fat pad.
  • Buffalo hump: fat pad which is located on the upper back near the neck

Back Fat is Fibrous

Back fat is fibrous and very stubborn to liposuction.  The fat on the back seems to contain a higher proportion fibrous tissue than the fat in other areas of the body. The highly fibrous nature of fat in the back area makes liposuction a challenge. This dense fat is nearly impossible to penetrate with large instuments. However with the use of microcannulas and tumescent infiltration this area can be successfully treated.

Best result is achieved with liposuction followed by weight loss by dieting. Liposuction after a large weight loss is less satisfactory. So patients with rolls of fat on the back, liposuction is relatively easy if the patient is near her maximum all-time weight. For mildly overweight patients who do not have excessively fat back, liposuction can also provide great improvement. However, if a patient gains a significant amount of weight after liposuction, then some of the benefit of liposuction may be reversed.

Incision Sites Scarring
The skin on the back is especially prone to scarring surrounding incision sites. The number of incisions placed on the back should be kept at the minimum. Trauma to the skin near an incision site can result in a dark mark.

Hyperpigmentation at incision sites for liposuction seems more likely to occur on the back than do incisions located more laterally toward the sides. Thus when doing liposuction on the back, dr. Goravanchi will often place incisions sites as far laterally as is practical.

Risks of Back liposuction
Because there is no deep layer fat on the back  so too much liposuction could injure the skin. The consequence of excessive liposuction that injures the skin is a permanent discoloration of the skin.

After back liposuction
After liposuction, you require adequate coverage with super-absorbent pads, held in place with an appropriate compression garment for a couple of days.

For further information about liposuction and to schedule a consultation with Dr. Goravanchi, call our offices at (+98) 912 038 6704.


Outer Thighs Liposuction

Excess fat of the thighs and hips is mainly genetics in women, and it is often resistant to exercise and dieting. For some women, the lack of any significant improvement in the size despite vigorous exercise can a nightmare. Heavy thighs tend to convey an image of aging or an inactive life style. In contrast, long slender thighs suggest youth, athleticism, and vitality. For many women, liposuction of the thighs help them look better in their cloths, and they no longer need to feel self-conscious when wearing a bathing suit.

The Two-Body Syndrome
Thighs can be so large that when a woman is buying clothing, she is forced to buy different sized tops and bottoms in order to properly fit the upper and lower body. For women with this “two-body syndrome” liposuction is a dream come true.

Don’t Forget the Hips
For the purposes of liposuction, the outer thigh should be grouped together with the inferior lateral buttock, and the upper posterior thigh. If the liposuction surgeon only treats the outer thigh, and ignores the excessive fat in the inferior buttock and the upper posterior thigh, then the result may be disproportionate and cosmetically displeasing. Although a woman might regard her thighs as her biggest problem, optimal cosmetic results may also require liposuction of the hips.

Effects of Age
The shape of the outer thigh and buttock can change with age. It is probably attributable to an age related increased buttocks weight, and loss of tissue tone. Thus older woman may require a small amount of liposuction of the inferior outer buttocks.

The Banana-Shaped Bulge
The prominent banana-shaped bulge of fat on the upper posterior thigh immediately below the buttock is often regarded as a cosmetic “defect.” When attempting to treat this banana-shaped bulge by liposuction, it is very easy of the surgeon to do too much liposuction and create an extra horizontal infra-gluteal crease. Such a double crease beneath the buttock can be avoided by treating a banana-shaped bulge in two stages. During the first liposuction only fifty percent of the estimated amount of required-liposuction should be done. Several months later, when the results of the first liposuction are apparent, one can decide if an additional “touch-up” in the area is required. It is always better to do too little liposuction the first time, rather than too much.

Inferior Buttock Crease
Some women do not have a prominent crease between the buttock and the posterior thigh may. When this crease is present, it is the result of fibrous tissue that connects skin to muscles. The crease cannot be artificially created by liposuction. When a liposuction surgeon attempts to create such a crease, there is a significant risk of removing too much fat and creating a permanent deformity that look unnatural.

Open Drainage

Open Drainage means that skin incisions are not closed with sutures after liposuction, but instead are left open to encourage drainage of residual blood-tinged fluid.  Specially designed super absorbent pads are used to absorb the drainage, and to uniformly distribute the compression from postoperative garments.

360 degree Thigh Liposuction

Circumferential Thigh Liposuction around the entire circumference of the thighs on a single day can produce excessively prolonged healing and swelling. Circumferential liposuction produces circumferential trauma and inflammation with impaired absorption of localized fluids leading to swelling of the leg and foot. This swelling can impair venous drainage from the leg and increase the risk of deep vein thrombosis.

In order to minimize postoperative swelling and pain, circumferential thigh liposuction should be done as a two-stage procedure done on two different days at least a month apart. For example, one might initially do liposuction the hips and outer thigh, then a month later complete the circumferential liposuction by doing the anterior and inner thigh. By separating circumferential thigh liposuction into two surgeries, patients can return to normal activity almost immediately after each procedure, with minimal swelling.