Liposuction is the most common surgical procedure performed by American Board of Plastic Surgery members. Liposuction removes deposits of subcutaneous fat over diverse areas of the body—including the face and neck, upper arms, trunk, abdomen, hips, buttocks, inner and outer thighs, knees, and occasionally the calves and ankles. Some of these areas are resistant to diet and exercise, and many scientists believe they were designed by nature to function as fat storage regions meant to withstand famine. Some studies claim these subcutaneous cells appear different from the fat cells in other areas of the body under microscopic analysis.
The best candidates for liposuction are people of normal weight who have excellent overlying skin tone and localized areas of fullness. Those considering liposuction should also realize liposuction is not a weight loss procedure. Age is of less importance when it comes to liposuction, but older patients may not have the same skin elasticity as younger people. The popular literature in the mid-1980s stated that anyone over 40 years old couldn’t have liposuction, but the age has been raised. I’ve done liposuction on a 63-year-old woman with a surprisingly good result.
Liposuction is as much art as science, and it is important to choose a board-certified plastic surgeon who you feel comfortable with and have conﬁdence in. When you come in for an initial consultation with me, you should expect to spend a couple of hours in my office. I show prospective patients a video describing the procedure and give them a book of before and after photos, as well as patient testimonials, so they can get an idea of my work and the results that are possible. Then I examine the patient in the presence of a nurse. Together, we discuss the results the patient would like to see and the best way to achieve them.
It is vital that you are as clear as possible about your expectations. If you are hoping for a perfectly ﬂat stomach, for example, it might take a tummy tuck as well as liposuction to achieve the results you want. Sometimes it is better to do a little more than the areas you are concerned with to achieve a smooth long-term result. If you store a lot of fat in your hips and stomach, for example, suctioning only the hips can leave you looking perpetually pregnant if you later gain weight. Your doctor can advise you about the best way to achieve the look you want.
If your expectations are realistic, you should be pleased with your result, no matter how subtle or dramatic.
Liposuction is often performed with complementary surgeries, such as a facelift following suction of the neck area; a tummy tuck following suction of the abdominal wall; or a thigh lift following suction of the area to be tightened.
Several different liposuction techniques, including tumescent, super-wet, power-assisted, and ultrasound-assisted lipoplasty, may be used. Your doctor will go over each option and determine which is best for your particular case.
Liposuction is generally done on a same-day basis, often in a surgical center specializing in cosmetic surgery. High volume procedures, in which more than eleven pounds of ﬂuid is planned for removal, should be done at a hospital. High volume procedures carry much higher risks and I generally don’t recommend them.
You will meet with your doctor before the surgery and the areas to be suctioned will be marked with a felt-tip marker to ensure accuracy during surgery. This also helps ensure the patient and doctor are on the same wavelength. This is where you need to be very clear about your expectations. If you are having your buttocks suctioned, do you want them to be full and rounded or ﬂat and boyish? Unless you tell your surgeon what your own idea of beauty is, you’ll end up with his or hers.
Once you are marked, the surgery will begin. A narrow tube called a cannula is attached to a vacuum machine and passed through small skin incisions, which are strategically placed in skin folds whenever possible. By a repetitive gliding and suction motion, fat is removed and sculpted until good contour and symmetry is established. It’s a fairly common practice to inject a wetting solution into the surgical area prior to beginning the suction. This enhances results and greatly diminishes blood loss. Using a wetting solution is fairly standard practice and allows a dilute local anesthetic and adrenaline to be deposited. This can diminish discomfort during the procedure and decrease post-operative bruising.
During liposuction, fat isn’t the only thing being removed. Vital body ﬂuids are being removed as well, so it’s important to replace these ﬂuids to prevent shock. You’ll be carefully monitored during the procedure and will receive intravenous ﬂuids during and immediately after surgery.
ULTRASOUND-ASSISTED LIPOSUCTION (UAL)
Although the development of suction-assisted lipectomy has advanced the ﬁeld of plastic surgery, speciﬁc areas were not, until recently, as amenable to treatment. These areas include ﬁbrous areas of the back, the breast area in men, and regions in which liposuction was previously performed (in certain patients). It was discovered that ultrasound energy delivered through a hollow titanium probe into the subcutaneous tissue could selectively destroy fat cells. Usually, this procedure is followed by traditional liposuction to remove remaining liqueﬁed material not harvested by the ultrasound probe. Some patients also see a dramatic tightening of the skin.
There are some additional risks to using UAL compared to traditional liposuction, including skin burns and micro-fragmentation of the cannula. Since this is a newer procedure, there may be additional risks that are not yet evident. I have seen some skin irregularities develop during the procedure, which generally resolve on their own. UAL is touted as having fewer post-operative problems, such as bruising, but this has not really been a factor in my experience because the classic suction-assisted technique is always used following the UAL, and bruising is normal with this procedure.
Some plastic surgeons melt the underlying fat through the skin with an external ultrasound machine. This requires injecting ﬂuid into the underlying tissue, so there will still be an incision or a puncture site. Only moderate amounts of fat can be removed with this technique and a large volume would have to be treated in multiple surgical sessions. As of now, the best bet for removing larger volumes still involves surgery.
Your procedure will be done under local, regional, or general anesthesia. Discuss the various options with your surgeon to choose the one that is best for you.
Local (with or without sedation): If small amounts of fat or a limited number of body sites are involved, a local anesthetic can be used to numb the area. You may have a mild sedative to help you relax. This method is referred to as IV (intravenous) sedation or monitored anesthesia care (MAC).
For more extensive procedures, a regional anesthetic can be used. This comes in the form of an epidural block. A catheter is inserted into the spine in a relatively painless procedure and a continuous ﬂow of anesthetic is delivered that results in no feeling from the waist down. You’re fully awake when this method is used. The same anesthesia is used in childbirth.
General: You may opt for general anesthesia if you are having a large amount of fat removed. In this case you will be unconscious throughout the procedure and may have a breathing tube and catheter inserted for the duration of the procedure.
Most patients report that pain is a three on a scale of one to 10, but some report seven or eight. Some ﬂuid will drain from the incisions. You may experience pain, burning, swelling, bleeding, and numbness. You will be prescribed pain medication and anti-nausea medication, and can expect to feel stiff and sore for a few days. If you have any unusual symptoms not outlined on your discharge sheet, call your surgeon immediately.
To control swelling and help your skin ﬁt its new contours, you will have to wear a snug elastic surgical garment, like a girdle, for six weeks following your surgery. This is usually worn 24 hours a day for the ﬁrst three weeks, and 12 hours a day during the daytime for the last three weeks.
Following this surgery, patients are sore but most feel better during the ﬁrst week. Many patients compare the feeling to the muscle soreness you experience following a too-strenuous workout. You may experience some mild discomfort for several weeks. Swelling following the procedure may last up to six months, although many patients see a dramatic improvement within the ﬁrst week.
Even though you may not want to do it, walking is the best way to speed up your recovery. It helps reduce swelling and prevents blood clots. If your ankles swell from walking, your body is telling you to cut down your activities and get off your feet more. Sit down, put your feet up, and ﬂex your ankles frequently to help your circulation. Avoid strenuous activities for about two weeks.
Most people are able to return to work in about a week, but it may be as little as a few days, depending on your procedure and the kind of work you do. Stitches will dissolve in about ten days.
Road to Recovery
You may feel nervous or anxious in the days and weeks following your procedure. You may be stiffer and more sore than you had expected, or you may have thought you would look a lot different sooner. Many patients feel somewhat depressed following surgery. This is a normal reaction to the stress your body has experienced and should go away in a few days. Be patient. The more time passes, the better you will look and feel.
Bruising will improve within about three weeks, but you may experience some residual swelling for as long as six months or even more. Don’t expose your skin to the sun or a tanning booth while bruising is still present. This may ﬁxate the blood cell pigment in the skin and the bruising may become more prolonged or even permanent.
The areas of suction may feel numb and strange for a couple of months, but this should improve over time. Some areas may be tender to the touch for several months. The small scars from your incisions will fade gradually and should eventually either disappear altogether or become almost unnoticeable.
Your risks with this procedure are minimal if you are physically healthy, a good candidate for the surgery, and if your doctor is adequately trained. If you have heart or lung disease, diabetes, or poor blood circulation, liposuction carries some increased risks that should be discussed with your doctor.
Although complications are very rare, they do occur. Possible complications during the surgery can include excessive ﬂuid loss, which can lead to shock. You will be given intravenous ﬂuids during the procedure to prevent this. Rare but serious complications include friction burns, damage to the skin or nerves, perforation injuries to vital organs, and adverse reactions to injected ﬂuids or anesthesia.
Post-surgical complications are similar to those of other surgeries and can include infection, healing delays, blood clots, and ﬂuid accumulation requiring drainage. Complications are rare when an experienced medical team performs the procedure in a licensed surgical facility.
Though serious medical complications from liposuction are rare, the risks increase if a greater number and size of areas are treated at one time. Removal of large volumes of fat and ﬂuid may require sizeable volumes of pre-injection ﬂuid and longer operating times. The combination of these factors can create hazards for infections, delays in healing, improper ﬂuid balance, shock, and unfavorable drug reactions.
The most common problems with liposuction are cosmetic. Your skin surface may be irregular, asymmetric, or even baggy, depending on your skin tone. Sometimes additional surgeries can improve these imperfections. Touch-up surgery is widespread following liposuction. Residual areas of fullness are quite common, and your surgeon may allow for a follow-up procedure in his fee. As always, you will still have to pay for any new surgical center charges.