Liposuzione

La lipoaspirazione consiste nell’asportazione del tessuto adiposo in eccesso, il cui volume determina una disarmonia delle forme e del profilo.
La lipoaspirazione può essere impiegata per il trattamento delle adiposità localizzate in qualsiasi regione del corpo.Si effettua con delle cannule molto sottili che vengono inserite nel sottocute attraverso incisioni di pochi millimetri.
E’ molto importante che la paziente venga selezionata da un chirurgo esperto il quale deve saper valutare le caratteristiche della cute, lo spessore e la consistenza del grasso, la disfunzioni vascolari, gli edemi, la storia clinica, le diete eventualmente praticate, i trattamenti precedentemente effettuati, l’età, l’attività sportiva, il quadro ormonale e metabolico.
La lipoaspirazione può essere anche un complemento ad altri interventi quali addominoplastica, il lifting, la riduzione mammaria, etc.
L’intervento può essere effettuato in anestesia locale, epidurale o generale a seconda del caso, ma comunque sempre e rigorosamente in sala operatoria attrezzata e da specialisti.
L’intervento di liposuzione serve a dare quella giusta proporzione e quell’equilibrio che non è possibile ottenere con metodi alternativi e non va mai inteso come un metodo per dimagrire.

La liposuzione è una metodica che viene impiegata per modellare il profilo corporeo rimuovendo il grasso in eccesso da specifiche aree quali: i fianchi, l’addome, la regione trocanterica, le ginocchia, il mento, etc.. La Liposuzione, conosciuta anche con il nome di liposcultura o di lipoaspirazione, dopo oltre 25 anni di pratica regolare e quindi di sempre maggior affinamento della tecnica, prende oggi più correttamente il nome di Lipoplastica. Numerose sono le tecniche con cui si può effettuare la metodica: dalla Lipoplastica meccanica con tecnica tumescente o ancora con tecnica super-bagnata o ancora quella con tecnica mediante ausilio di ultrasuoni (UAL). Io personalmente utilizzo la tecnica meccanica e non quella ad ultrasuoni. In nessun caso comunque la lipoplastica può sostituirsi ad una dieta ed all’esercizio fisico, ma dovrebbe essere riservata quindi solo a quei casi in cui le aree interessate non rispondono ai metodi tradizionali e non invasivi per la perdita del peso.
Un buon candidato per la liposuzione deve innanzitutto avere delle aspettative realistiche circa il risultato, godere di buona salute, essere psicologicamente stabile ed avere dei tessuti elastici. L’età quindi non riveste un’importanza particolare, infatti pazienti in età avanzata possono avere trofismo tissutale migliore di pazienti più giovani.

Rischi
La lipoplastica è una procedura chirurgica sicura se praticata da un chirurgo plastico esperto. Mi preme sottolineare ancora che la liposuzione è innanzitutto una procedura chirurgica e non può essere trattata invece come spesso accade in Italia come una procedura cosmetica di un parrucchiere o di una estetista. La metodica va eseguita in ambiente protetto (sala operatoria) e non in retrobottega di negozi e la paziente deve essere monitorizzata (per controllare in ogni istante i parametri vitali). I rischi di eventuali complicanze, quali l’infezione ad esempio, possono aumentare se le aree da trattare sono numerose e se la quantità di liquido aspirato eccede i 5 litri.
Sarebbe opportuno che il/la paziente si accertassero che l’intervento venga eseguito da uno specialista. Ricordo che in Italia non occorre il titolo di Specializzazione per esercitare la Chirurgia Plastica e quindi un semplice laureato può fare una Lipoplastica. Diffidare quindi di tutti coloro che prospettano l’intervento come una banalità che può essere eseguita anche in un ambulatorio.

Preparazione all’intervento
E’ buona norma, a cominciare dalla settimana precedente all’intervento, non assumere Ac. Acetilsalicico (aspirina) per evitare problemi di coagulazione, e per i fumatori astenersi per almeno 4 settimane (due prima e due dopo l’operazione).
Se si è reduci da un’infezione cutanea è necessario posporre l’intervento chirurgico.
Se si viene operati in regime di Day-Surgery (dimissione nello stesso giorno) è indispensabile che il/la paziente venga accompagnato da una persona che possa prendersene cura nel riaccompagnarla a casa e nelle necessità delle prime 24-48 ore.

L’intervento chirurgico
Il tempo richiesto per eseguire una liposuzione varia evidentemente a seconda della quantità di grasso da asportare, del numero di aree da trattare, dalla tecnica scelta dal chirurgo. La procedura prevede in ogni caso un’infiltrazione dell’area da aspirare , l’inserimento attraverso una minuscola incisione di una piccola cannula collegata ad un apparecchio che produce vuoto. Questa cannula, con un’azione meccanica, rompe il tessuto adiposo e lo aspira attraverso dei fori presenti sulla sua punta. L’infiltrazione che viene effettuata in precedenza, invece è un cocktail di soluzione fisiologica, anestetico locale e vasocostrittore che aiuta il chirurgo ad effettuare manovre più efficaci. La quantità varia a seconda della tecnica preferita dal chirurgo. Una medicazione modicamente compressiva viene realizzata e subito dopo una guaina contentiva viene fatta indossare al/la paziente.

L’Anestesia
L’intervento può essere condotto sia in Anestesia Generale che in Anestesia Locale con associata o meno una sedazione. La scelta dipende da vari fattori: la quantità di grasso da asportare, la durata dell’operazione, la preferenza del/la paziente.
Se la quantità di grasso da asportare è ridotta ed i siti da trattare sono pochi, è ipotizzabile praticare soltanto una anestesia locale che consente una dimissione immediata. Man mano che aumenta la quantità di grasso e le aree da trattare si passerà ad un’anestesia locale con sedazione, che può ancora prevedere la dimissione in giornata (day-surgery), sino ad una anestesia generale che obbliga al ricovero del/la paziente.

Il post-operatorio
Il fastidio nel post-operatorio è presente per alcuni giorni, mentre il dolore è in realtà di lieve entità ed è ben controllato dalla terapia farmacologica. L’edema è notevole e nel primissimo periodo, in associazione al bendaggio, rende impossibile la visualizzazione del risultato. La guaina viene indossata per 4 settimane (le prime due notte e giorno, le seconde due solo durante il giorno, mentre la notte può essere rimossa) alla fine delle quali il gonfiore è notevolmente ridotto, le ecchimosi sono quasi totalmente scomparse e il nuovo profilo corporeo può essere finalmente visualizzato. L’attività normale può essere ripresa in un paio di giorni, mentre quella sportiva è sospesa per 1 mese.
Alcune volte ed in alcuni casi il gonfiore può persistere anche per 6 mesi.

Ripresa dell’attività
La guarigione è un processo graduale che richiede tempo. Il ritorno alle normali attività è evidentemente in relazione all’entità dell’intervento subito, alle condizioni fisiche in cui si è affrontato l’intervento chirurgico ed alle singole capacità reattive.
Ci sono numerosi/e pazienti che riprendono le loro normali attività dopo 48 ore, ma generalmente una ripresa graduale non comincerà prima di 7 giorni.
I punti di sutura delle piccolissime incisioni, vengono rimossi dopo una settimana.
Qualsiasi attività sportiva va interrotta per almeno 1 mese, così come non vanno eseguiti massaggi, linfodrenaggi e sedute di idromassaggi durante tutto il periodo in cui viene tenuta la guaina.
E’ invece consigliabile sempre eseguire dei massaggi linfodrenanti dopo la quarta settimana, per ridurre il periodo di ripresa post-operatorio.
In taluni casi il gonfiore può persistere anche per oltre 6 mesi dall’intervento.

Il nuovo aspetto
Il/La paziente noterà subito il differente profilo corporeo, anche se occorreranno almeno 3 mesi per vedere un risultato vicino a quello definitivo, perchè l’edema (gonfiore) dei tessuti tende a persistere per lungo tempo dopo l’insulto subito.
Se le aspettative sono realistiche, il risultato sarà sempre soddisfacente e con un buon regime dietetico ed un esercizio fisico regolare, si potrà mantenere stabile nel tempo il nuovo profilo corporeo.
La lipoplastica può cambiare l’aspetto e restituire quella self-confidence perduta, ma non necessariamente cambia il proprio look secondo i propri desideri o modifica il modo di fare delle persone che ci circondano.

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