Liposuction is a method of body sculpting, body contouring or "spot-reduction" involving removal of excess, unsightly fat from specific areas of the body. Liposuction can be done in abdomen, hips, buttocks, back, thighs, knees, calves, ankles, upper arms, jowls, cheeks and neck.
These localized fat deposits may sometimes be inherited and typically do not respond to dieting or exercise. Liposuction is often the only way to improve them.
Liposuction can be done alone or with other plastic surgery procedures such as breast reduction or tummy tuck (abdominoplasty). In addition, liposuction can be performed on several areas of the body at once. Sometimes, liposuction is performed as the first step in a fat transfer procedure such as the Brazilian butt lift, fat grafting to the breast or a stem cell facelift. In these cases, fat is removed via liposuction, processed and then re-injected into another area of the body.
Other names for liposuction are lipoplasty, suction-assisted lipectomy, ultrasound-assisted liposuction or lipoplasty, laser-assisted liposuction or lipoplasty, power-assisted liposuction or lipoplasty, and water-assisted liposuction or lipoplasty.
Best Candidates for Liposuction
In general, the ideal candidates for liposuction are men and women who are of relatively normal weight, but have isolated pockets of fat that do not respond to an adequate diet and exercise program. Think love handles or muffin tops.
You should have firm and elastic skin tone and have excessive fatty deposits in certain body areas. Keep in mind that liposuction removes fat, not loose skin.
Age is not a deciding factor, but many older patients have less elastic skin, so they may not get optimal results.
Fat deposits accumulate under everyone's skin. The best candidates for liposuction may have bulging and flabby areas of the body from these fat deposits, especially the abdomen, arms, thighs, and neck. Even in people who eat a healthy diet and stay physically fit, these fat deposits can persist. They can result from genetic factors, body chemistry, and other causes.
The ideal candidates for liposuction are physically fit, exercise regularly, and are not more than 20 pounds overweight. People with very localized, exercise-resistant fatty deposits may obtain the best results. Be aware that the flabby appearance of the area being treated may not disappear completely. Crash diets before or immediately after this plastic surgery procedure are not recommended.
You are also an ideal candidate if you have made a good effort to eliminate the fatty deposits through extensive exercise and diet. You may have spent an inordinate amount of time on exercise programs or with excessive diets just to reduce or eliminate one final, persistent bulge. Some bulges are simply exercise-resistant, and liposuction may provide a solution.
What Liposuction Can Do
Remember that liposuction should be used in conjunction with a good diet and exercise, not as a substitute for them. Liposuction, like other cosmetic surgery techniques, is a means to enhance body shape. But it cannot completely change your shape. You should have realistic expectations — liposuction may improve the appearance of the treated area, but may have no impact on other areas of your life. Also, remember that there are different types of liposuction, such as laser-assisted liposuction and tumescent liposuction. Your expectations can be affected by the type of procedure you and your surgeon select. During a consultation, your surgeon can also advise you about the cost of liposuction surgery. He or she may also be able to advise you about procedures that are often performed in conjunction with liposuction, such as tummy tuck surgery or breast enlargement surgery.
Liposuction's advantages include:
- It's permanent.
- In competent hands, it has an extremely high safety record.
- Scars are small and inconspicuous.
What Liposuction Cannot Do
Liposuction is not designed for weight loss. People who are very overweight or who have large areas of fat deposits are not good candidates. It is best to lose weight first and reduce the fatty area through diet or exercise before considering liposuction. If you are obese and cannot lose weight on your own, then you and your doctor may want to consider a gastric bypass.
If you lose considerable weight and have excess skin after the weight loss, then an abdominoplasty (tummy tuck) may be performed to remove excess tissue and tighten muscles; liposuction can be performed at the same time to remove excess fatty deposits. In some cases, people who have undergone bariatric surgery such as gastric bypass or gastric banding (Lap-Band or Realize Band) are left with a remaining apron of fat that may be better handled with a panniculectomy procedure than with liposuction.
Preparing for Liposuction
Your surgeon will give you a list of instructions on what to do and what not to do in the days before you undergo liposuction. This may include guidelines on eating and drinking. He or she will also discuss the importance of quitting smoking at least 30 days before liposuction. Smoking greatly increases the risks of any surgery, and liposuction is no exception.
Certain medications, such as aspirin and nonsteroidal anti-inflammatory drugs, may promote bleeding and should be discontinued before surgery. Your surgeon will advise you on which medications you should stop taking before liposuction. Never stop taking prescribed medications without first talking with your surgeon and with the doctor who prescribed them.
Using a magic marker, your surgeon will literally mark the areas of your body where he or she will remove unwanted fat. Such markings before surgery help your plastic surgeon plan the liposuction procedure.
Liposuction is typically performed under general anesthesia, but in some cases local anesthesia can be used. Other options include intravenous sedation or epidural block. The decision involves both you and your doctor. It takes into account how much time the surgery will take, as well as where on the body the liposuction will be performed and how much fat will be removed.
Wetting solutions are infused into the area before fat is removed. The fluid contains saline (salt water) and epinephrine (which constricts blood vessels to minimize any blood loss in the aspirate) and a local anesthetic. The reason that surgeons use a wetting solution is simple: they want to minimize blood loss, to increase the safety of liposuction. Various types of wetting solutions are used in liposuction. The main difference among them is the amount of fluid used.
Before wetting solutions came along, surgeons went in dry. This resulted in blood loss and bruising. In fact, about 45 percent of what was suctioned out was blood (not fat!), so it has fallen out of favor.
The surgeon will infuse 100-300 milliliters of fluid (with or without epinephrine) into each treatment site. With the wet technique, about 20-25 percent of what is suctioned out is blood.
Super Wet Technique
As its name implies, the super-wet technique involves the infusion of greater amounts of fluid than with the wet technique. It is about a 1:1 or 1:1.5 ratio, meaning that the amount of fluid is approximately equal to the amount of fat to be removed. With the super-wet technique, less than 1 percent of what is suctioned out is blood.
This involves even much more fluid than is used in the super-wet technique. Basically the surgeon will infuse three to six times as much fluid as the volume of the aspirate to be removed. Proponents say the tumescent technique swells the tissues, which aids in fat removal; but detractors say it interferes with the surgeon's ability to sculpt, and it is unsafe because of potential fluid overload and an overdose of anesthetic (which is used in the solution).
Types of Liposuction
There are many different ways to vacuum out the fat during liposuction.
Traditional Suction-Assisted Liposuction
This involves inserting a cannula (a long, thin tube) through a tiny incision to vacuum the fat cells. The surgeon moves the cannula back and forth through the fat layer to break it up, and then suction out, the excess fat.
Here the surgeon inserts a special cannula through small "access" incisions. The cannula emits sound waves to help break up the fat, presumably making it easier to vacuum. Vaser-assisted liposuction is the cutting-edge, third-generation version of ultrasound liposuction technology. In a nutshell, the cannula used for Vaser-assisted liposuction emits gentler sound waves to break up and then remove fat. These do not disturb blood vessels, nerves and connective tissue, resulting in less bruising, swelling and pain than traditional suction-assisted liposuction.
This uses a motorized cannula to break up fatty tissue that will then be vacuumed out. It is inserted through the same tiny incisions.
This involves a small incision and the insertion of a laser fiber probe that produces a burst of energy to liquefy the fat before it is removed. (Two of the brand names you may see are SmartLipo and CoolLipo.) Proponents say that laser liposuction is the latest and greatest and may also tighten skin. But detractors say it adds nothing to the results of liposuction except for expense and for making the procedure more cumbersome for both the patient and surgeon. And, they say, it can add many hundreds of dollars to the cost of liposuction without proven extra benefit.
Using a thin, fan-shaped jet that pulsates water, your surgeon loosens fat cells from connective tissue, while simultaneously vacuuming them out. It is sometimes called water-jet assisted liposuction or water-assisted liposuction. While other liposuction techniques destroy or break apart the fat cells before suctioning them out of the body, the new water-assisted technique may loosen the fat cells first. As a result, water-assisted liposuction may be less traumatic than traditional liposuction methods. There may also be a shorter recovery time if the technique is proven to be gentler. Body-Jet liposuction does not use as much fluid as tumescent liposuction.
The fluid is infused while the procedure is being performed, not beforehand as it is with other types of liposuction. The water is then immediately sucked back out with the fat; which may make it easier for your surgeon to determine if any areas need additional suctioning. Water-assisted liposuction flushes the fat instead of destroying it, so there may be an opportunity to harvest fat for fat transfer to other parts of the body where it is needed to restore plumpness.
Water-assisted liposuction may be performed under local anesthesia, but general anesthesia will likely be needed for larger areas of fat removal. The bottom line is that more research is needed to determine the exact benefits and risks of water-assisted liposuction.
Regardless of the type of liposuction you and your doctor choose, the size of the cannula is also important. The cannula is a long, hollow instrument that is connected to the fat suctioning device. The cannula enables the plastic surgeon to suction out the fat.
Today, cannulas are about 3 millimeters or finer in diameter, while in the past they were as large as 10 to 12 millimeters in diameter. The smaller diameter causes less trauma to surrounding tissues and blood vessels. Smaller cannulas equates to less bruising. Consider asking your doctor what his or her cannula choice is.
It may take several months for the swelling to fully dissipate after liposuction surgery. As it does, your new contours and enhanced self-image should continue to develop.
The fulfillment you feel from the initial results of liposuction should continue as long as you control your weight and maintain a healthy lifestyle.
A significant weight gain can reverse your results. Following liposuction, your slimmer and better-proportioned body should more accurately reflect the healthy and active life you lead.
Recovery After Liposuction
Once your procedure is completed, a compression garment or elastic bandages may cover treatment areas. These help to control swelling and compress the skin to your new body contours.
In addition, small temporary drains may be placed in existing incisions beneath the skin to remove any excess blood or fluid.
When You Return Home
Although liposuction does remove a number of existing fat cells, it does not guarantee that you won’t regain some fat. The importance of healthy lifestyle choices post- liposuction cannot be stressed enough; you should stick to a moderate diet and be sure to exercise for at least 30 minutes three to five times per week. Not only will this help you maintain your figure after liposuction, it will also improve your overall health and help prevent the onset of certain diseases. If you are going to treat yourself to liposuction, be sure to treat your body well afterward! For more post- liposuction tips, see our full section on diet and exercise after liposuction.
Liposuction Post Operative Care
If you have had liposuction totally by local anesthesia, you may resume your usual diet immediately. Drink adequate amounts of water, fruit juices or soft drinks to prevent dehydration. Avoid drinking alcoholic beverages for 48 hours before surgery and 48 hours after surgery.
Quiet rest is recommended for the first few hours immediately after surgery. Do not drive or operate hazardous machinery for 18 hours after surgery. Do not make any important personal decisions for 24 hours after surgery. Later in the day or evening of surgery you may take a short walk if desired. The day after liposuction surgery you should feel well enough to drive your car and engage in light to moderate physical activities. You may carefully resume exercise and vigorous physical activity 2 to 4 days after surgery. It is suggested that you begin with 25% of your normal workout and then increase your daily activity as tolerated. Most people can return to a desk job within one to two days after surgery, although one must expect to be sore and easily fatigued for several days.
One should expect a large volume of blood-tinged anesthetic solution to drain from the small incisions during the first 24 to 48 hours following tumescent liposuction. In general, the more drainage there is, the less bruising and swelling there will be. For the first 24 to 48 hours, bulky super-absorbent pads are worn overlying the treated areas, and under the compression garments. After most of the drainage has stopped, patients need only place absorbent pads over the incision sites that continue to drain.
When the super-absorbent pads are properly applied they should absorb all of the drainage. However, leaks beyond the pads can occur. During the first 36 hours, when sitting or lying down, you should place absorbent terrycloth towels beneath you in order to protect your furniture from any unexpected leak of blood-tinged drainage. When there is a large amount of drainage, it is advisable to place a plastic sheet beneath the towel.
Keep incisions clean. Shower once or twice daily. First wash your hands, then wash incisions gently with soap and water; afterwards gently pat incisions dry with a clean towel. Apply new absorbent pads. When an incision has ceased draining for more than 24 hours, it no longer needs to covered by pads.
Take Antibiotics as directed until the prescription is finished. Take antibiotics with food. Call our office if you notice signs of infection such as fever, foul smelling drainage, or focal redness, swelling, or pain in a treated area.
Elastic Compression Garments
Post-Op Garments are designed specifically for tumescent liposuction. Two Over-All garments are worn after tumescent liposuction of the thighs or hips. One Torso garment plus an adjustable elastic binder is used after tumescent liposuction of the abdomen, hips, waist, flanks, back, or breasts. These garments are specifically designed to be used with super-absorbent pads and to provide firm compression to encourage maximum drainage of residual blood-tinged anesthetic solution.
Beginning the day after surgery, the post-op garments are to be removed daily to permit you to shower and to wash the garments. Two Over-All garments or one Torso garment plus binders should be worn day and night until 24 hours beyond the time when all the drainage has completely stopped. Do not be concerned if you have drainage for several days. Discontinuing the use of the garments and binders too early may result in more prolonged drainage. Typically, patients will need to wear the garments for 3 to 6 days. Some patients, especially after a large amount of liposuction, will have drainage for more than a week. Many patients choose to wear the garments for a greater duration simply because of the comfort the garments provide. Wearing the post-op garment for more than the minimal number of days provides no significant advantage in terms of the ultimate cosmetic results.
Possible Liposuction Risks
All surgeries have risks, and liposuction is no exception. They include:
- Fluid imbalance. A lot of liquid exists in fat tissue, which is removed during liposuction. What's more, especially during tumescent liposuction, your surgeon may inject large amounts of fluids during liposuction. This can result in a fluid imbalance, which can lead to heart problems, excess fluid collecting in the lungs or kidney problems as your kidneys try to maintain fluid balance.
- Blood clots in the lung (pulmonary emboli)
- Hematoma (a collection of blood in the areas suctioned)
- Temporary numbness or discoloration in the treated area
- Asymmetry, dimpling, wrinkling, unevenness and surface irregularities over the treated area
- Perforation wounds in surrounding tissue or organs
- Anesthesia reactions
- Burns (from ultrasound-assisted and laser-assisted liposuction)
These risks are higher in people with underlying medical conditions such as heart or lung disease, poor circulation or diabetes. In addition, individuals who have recently had another surgery in the same area where they want liposuction are at higher risk for complications. These factors should all be addressed during your initial consultation with a plastic surgeon.
To ensure maximum safety, consult a board-certified plastic surgeon who has extensive experience with liposuction, including in the area you wish to have treated.