Terça-feira, 5 de Fevereiro de 2013

Lipoaspiração e gordura localizada ( liposuction and localized fat)...

Dr. Francisco,

Desde já agradeço a atenção dada a este meu pedido de informações. Desde adolescente que possuo alguma gordura localizada nas ancas e coxas, é sempre muito difícil encontrar calças que me sirvam dada a grande disparidade de medidas, pois tenho a cintura muito fina mas as ancas largas e joelhos grossos. Relativamente as ancas largas, não sinto qualquer desconforto porém no que diz respeito aos joelhos confesso que me causam incómodo e tristeza. Tenho vergonha em usar vestidos ou saias, pois é mais evidente este meu problema. O facto de ter os tornozelos finos e a perna começar a engrossar nos joelhos faz com que estes quase se unam e a perna evidencie gordura na face interna da coxa. Gostaria de saber o que fazer para melhorar esta condição e quais os custos dessa intervenção.
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publicado por Francisco Falcão de Melo às 08:58
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Sexta-feira, 2 de Novembro de 2012

Tornozelos....

Tenho 48 anos pratico exercicio físico regular e estou satisfeita com os resultados uma vez que tenho o peso adequado e praticamente não tenho gorduras localizadas, exceto nos tornozelos uma vez que é uma característica familiar.

Tenho pavor de engordar unica e exclusivamente porque a acumulação de gordura nos tornozelos é sempre muito notória uma vez que no geral sou magra.

Sou enfermeira e já poderia ter pedido opinião a um médico mas confesso que tenho algum receio da exposição. Gostaria se possível se orienta-se face a soluções.

 

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publicado por Francisco Falcão de Melo às 09:40
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Sexta-feira, 3 de Agosto de 2012

Liposuction and/or liposculpture FAQs

How is the technique performed? 


Liposuction and liposculpture and two words for the same procedure. The technique is similar, and I think that the word “liposculpture” is more a marketing driven word. There are other words like  “Liposelection”, “Vibrolipoplasty”,”SmartLipo”, etc, that are much more related to the devices that are used, then with the purpose behind them that is destroying or removing fat. Actually I think that LIPOPLASTY is the right therm.

The principles behind these techniques is to remove fat in a way that will improve the body contour. They should be small or minimal invasive, and the fat will be excised through small skin incisions (2-5mm) using a cannula connected to a vacuum pump or a syringe. These can be done with the help of different power assisted systems: mechanical ( Microair, Vibrolipoplasty, Water Jet System), ultrasound assisted (UAL), Laser (LAL) or Radiofrequency (RAL).


 

What is the duration of the operation?

 

That will depend on the extent of the   volume reduction that is required. It can be between  30 minutes to 4 or 5hours

 

 

 

Who is an “ideal candidate” for this procedure?

 

The ideal patient is of almost normal weight or slightly overweight exercises and watches their diet. They have moderate localised fat accumulations which does not  disappear through the measures just mentioned. But lipoplasty is not just suitable to these groups of patients. It can even be beneficial for other patients that are clearly overweight. It's also possible to combine it with different procedures as breast augmentation for example, or to complement an abdominoplasty.  

 

 

 

What are potential complications?

 

Complications can be distinguished between Minor (not life threatening) and Major complications. They should be differentiate from  the immediate and normal consequences of the surgery such as  swelling, bruising, transient low to moderate pain or discomfort, that are treated or prevented with common pain drugs such as paracetamol or ibuprofene.

 

 

 

Minor Complications:

 

The most frequent complain is patient dissatisfaction. These is usually due to unrealistic expectations and this should be addressed very careful during consultation. As far as I am concerned, the two formal contraindications for lipoplasty are obesity and unrealistic expectations.

 

Skin irregularities and depressions (due to fat over resection or deficient skin retraction or tightening), hematomas and seromas (organised blood or liquid accumulation in the tissues that can be drained), transient subcutaneous nodules (due to fat necrosis and inflammation), visible scars and hyperpigmentation, transient numbness on the treated areas, are other minor complications to bear in mind 

 

Major complications:

 

They are rare. 

 

Can be related to the anesthetic drugs, specially local anaesthetics, if the maximum recommended dose is exceeded. So these procedures must be performed by trained and experience surgeons and in the right surgical setting.

 

Pulmonary embolism (PE), as a result of the migration of a blood clot that can occlude the pulmonary circulation. These is usually related to prolonged procedures associated with patient risk factors as smoking, intake of birth control pills, obesity, previous history of venous thromboembolism and immobility. These patients needs additional preventive and preoperative measures in order to reduce the risk of PE.

 

Other rare complications include: Injury of abdominal organs due to penetration of the abdominal cavity, excessive blood lost, hypothermia and infection wich is extremely rare.

 

 

 

Is general anaesthesia recommended or can it done under local anaesthesia? 

 

It can be done under general or under local anaesthesia, depending essentially on the extent of the procedure and the risk factors of the patient. When selecting the anaesthesia, my main concern is safety and patient comfort.

 

 

 

What should be expected immediately post operation?

 

Swelling, bruising,  that will be diminished by the wearing of a compression garment Moderate discomfort is to be expected during the first 5 days.

 

 

 

What is the downtime and pain factor?

 

Pain is usually well tolerated and controlled with common over-the-count medication. Social and work commitments should be postponed for the first 4 to 5 days in a major lipoplasty. Otherwise they can be started on the following day, depending on the intensity of the activities. 

 

 

 

When will the stitches be removed/ cast and does this hurt?

 

If stitches were used, they should be removed between the 5th and 7 day post-op. That usually doesn’t hurt.

 

 

 

When can the patient see results?

 

The results will became better with time. I can say that the average patient would have lost 80% of the volume by  the end of the first month post-op. The remaining 20% will diminish slowly as the skin tightens around the new volume ( skin retraction). 

So we can speed this up by combining treatments such as lymphatic drainage, radiofrequency, CO2 injections. After 1 month the patient  may resume normal life with no constrains, except limited and protected sun exposure. The end result is generally stabilized  by the 6th month.

 

What is the cost in your clinic?

There is not a fixed price for lipoplasty/ liposuction at Aesthetica Clinic, as it is dependent  of the number of areas and volume of fat  to be addressed. Small procedures can be done under local in a outpatient regime and bigger ones under general anaesthesia with a over night stay. So there can be a wide range of prices according to the planed procedure.

publicado por Francisco Falcão de Melo às 09:53
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Dr Francisco Falcão Melo

Licenciado em Medicina pela Faculdade de Ciências Médicas de Lisboa, fez o Internato Complementar em Cirurgia Plástica e Reconstrutiva nos Hospitais Cívis de Lisboa. Actualmente é Assistente Graduado sendo o responsável pelo Serviço de Cirurgia Plástica e Reconstrutiva do Hospital Militar Principal. Membro da Sociedade Portuguesa de Cirurgia Plástica Reconstrutiva e Estética, da Sociedade Portuguesa de Cirurgia da Mão e da Sociedade Portuguesa de Queimaduras.Exerce a sua actividade privada em Lisboa e em Leiria.

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E-mail: franciscofmelo@sapo.pt

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