Body shaping: A touchy issue

Reshaping the body through liposculpting is gaining popularity among the urban wealthy unhappy with their physical appearance. The Jakarta Post's Maria Endah Hulupi discusses this hot new trend.

JAKARTA (JP): Long slim legs, a sexy back and full breasts are the ideal physical characteristics for women according to the traditional concept of beauty.

Many women going to cosmetic surgeons say they envy Marilyn Monroe for her naturally sensuous body.

Today, thanks to technology, those women, and men as well, whose bodies do not conform with the idealized image of beauty, have a choice of cosmetic surgeries to correct their perceived faults.

Among the most popular cosmetic procedures is liposculpting, which includes liposuction and lipoinjection. Liposuction became available in Indonesia in the 1980s, but the popularity of the procedure sank in the late 1990s following the death of a patient.

Many celebrities are rumored to have undergone liposculpting, though none admit to it publicly. Surgeons report more and more people are coming in for the treatment.

A teenager, Rina (not her real name), went to a beauty center in Jakarta to have her cheeks injected with fat taken from her own buttocks. And a housewife, Martha, had the backs of her hands injected with fat to her veins and bones would not be so prominent.

A middle-aged man went to a clinic to have the fat from his neck removed. And many other people go in to have liposuction performed on their inner thighs and stomachs, traditional problem areas for many people.

Over the past few years, liposuction and lipoinjection have become the cosmetic surgery of choice in the capital, as the procedures are considered safe, relatively painless and do not leave noticeable marks.

However, despite the assumption by many people that liposculpting is the quick way to a more beautiful body, the Jakarta Skin Center's medical director, Edwin Djuanda, cautioned that the procedure should only be performed by credible beauty centers that meet all safety standards and are well-versed in the procedure.

Edwin also pointed out that liposuction was not complicated but liposculpting was difficult. "The person performing the procedure must have the 'artistic skill' to define the best body shape for different people," Edwin said during a seminar organized by the Study Group of the Indonesian Skin Surgery and Jakarta Skin Center.

Edwin also stressed the importance for hygiene during the procedure, particularly in regard to the cannula (blunt syringe), because a failure to maintain hygiene can expose patients to various health risks.

"It's dangerous because it's like injecting bacteria into a person's body," he stressed, saying the mark made on the outer skin during the procedure may look insignificant but there is the danger of infection under the subcutaneous layer, which can be serious.

Such an incident occurred in the United States, where a patient had to have a large section of skin on her stomach removed to allow treatment for a serious infection in the subcutaneous gap from which excess fat was removed. The infection was the result of an unhygienic cannula.

"That's why making sure the tools and the surrounding are hygienic is very important," Edwin said.

Unlike surgery which requires making a large incision to remove body fat, liposuction is performed by pushing a blunt syringe through a small cut in the target area to administer anesthesia and tumescent liquid, both of which are used in the wet liposuction procedure.

After 15 minutes to 30 minutes, the doctors push a blunt cannula (a tube-like syringe with holes) attached to a vacuum machine through the incision and move it in a back-and-forth pattern to withdraw excess body fat.

Following the procedure, patients are required to wear tight clothes to close the gap in the subcutaneous layer.

The patients' skin retracts naturally after liposuction, but the downside of the procedure is that the skin may look uneven after the removal of fat.

The body parts on which liposuction is most commonly performed are the abdomen, legs, inner thighs, breasts, upper arms and back for women, and the waist and neck for men.

Data from the skin center shows that patients as young as 14 and as old as 86 have undergone the procedure. Most patients receive the treatment twice but there have been some who have undergone 11 procedures on different body parts.

There is a limit

However, there is a limit to liposuction and doctors will maintain a normal-ideal body shape with an adequate fat level. So if a patient demands an unrealistic result, doctors will usually turn the patient away.

"It's for the good of the patients," Edwin said.

Doctors will generally refuse to treat patients who have a mental illnesses or depression, or those whose expectations for the cosmetic procedure are too high.

Currently, there is no available data on the liposuction- related fatality rate in Indonesia, with just one fatality in the 1980s on record. In the U.S., data from the American Society of Plastic and Reconstructive Surgeons shows that the fatality rate is one out of 5,000 patients, while the American Academy of Cosmetic Surgery revealed that the use of tumescent liquid in the wet liposuction procedure was able to cut the fatality rate to one out of 40,000 patients.

Another liposuction procedure called the dry technique, which does not use tumescent liquid but uses a general anesthetic, has begun to fade in popularity among doctors and patients because it often leads to bleeding and severe pain during and after the procedure.

Liposuction is also performed for noncosmetic purposes, such as for lymphoma, angiolymphoma, hyperhidrosis axillaris, hematoma and lymphedema. The tumescent liquid is also used to diffuse anticancer drugs.

Mega-liposuction is performed to treat obesity. Ten liters to 15 liters of fat are removed per procedure.

People with fatal systemic health problems such as heart and lung disease and those taking aspirin or acetosalicilate acid are advised against undergoing liposuction. In the case of those taking aspirin, liposuction is a risk because aspirin can thin the blood and increase the risk of bleeding.

Common complications that may follow fat removal surgery are bleeding, infection and thromboembolism due to prolonged immobilization following the surgery.

Liposuction has its own risks, including hematoma (a swelling that contains blood), intravenous fluid overload (pulmonary edema), lidocain toximatose which lead to dizziness and fat embolism, which is rare but can occur when the procedure is combined with lipectomy.

According to the adage, losing weight is easy but keeping it off is difficult.

The only way to maintain your body shape following liposuction is with a proper and balanced diet and regular exercise. If patients fail to engage in regular exercise and eat a low-fat diet, the body fat will return.

But the procedure often has a positive psychological effect on patients, encouraging them to begin living healthy lives.

"Most patients develop the motivation to make the results of the procedure last," Edwin said.

As for lipoinjection, this procedure is performed by injecting fat taken from another part of body (usually the buttock) to enhance the shape of other body parts.

Most often the fat is injected into a person's cheeks, smile- lines, chin, breasts, back of the hands or penis. The procedure is also performed to fill large acne scars in order to smoothen the facial skin.

More information can be obtained at Study Group of the Indonesian Skin Surgery: www.geocities.com/bedahkulit, Jakarta Skin Center: www.skinjsc.com.