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Liposuction

Liposuction can help sculpt the body by removing unwanted fat from specific body areas, including the abdomen, hips, buttocks, thighs, upper arms, chin, cheeks or neck.

Who’s a Candidate?

The best candidates for liposuction are normal-weight people with firm, elastic skin who have pockets of excess fat in certain areas. Age is not a major consideration; however, older patients may have diminished skin elasticity and may not achieve the same results as a younger person with tighter skin. Liposuction carries greater risk for individuals with medical problems such as diabetes, significant heart or lung disease, poor blood circulation, or those who have recently had surgery near the area to be contoured.

What are the Risks of Liposuction?

Risks increase if a greater number of areas are treated at the same time or the operative sites are larger in size. Risks include infection; delays in healing; the formation of fat or blood clots which may migrate to the lungs and cause death; excessive fluid loss, which can lead to shock; friction burns or other damage to the skin or nerves; and unfavorable drug reactions. Certain liposuction techniques also carry risks.

Scars from liposuction are small and strategically hidden from view. Imperfections in final appearance, however, are not uncommon. The skin’s surface may be irregular, asymmetric or even "baggy," especially in older patients. Numbness and pigmentation changes may also occur.

Preparing for Surgery

Your surgeon will evaluate your health, determine where your fat deposits lie and assess the condition of your skin. He or she will explain the body-contouring methods that are the most appropriate for you. Liposuction may be performed in an office-based facility or in a hospital. Smaller volume liposuction is usually done on an outpatient basis. If a large volume of fat is being removed, a stay in the hospital may be required.

A Typical Liposuction Procedure

If only a small amount of fat is being removed, liposuction can be performed under local anesthesia. For more extensive procedures, a regional anesthesia or general anesthesia is used. The time that is required for the procedure may vary considerably, depending on the size of the area, amount of fat being removed, type of anesthesia and technique used.

A narrow tube, or cannula, is inserted through a tiny incision and used to vacuum the fat layer deep beneath the skin. The cannula is pushed, then pulled, through the fat layer, breaking up the fat cells and suctioning them out. A vacuum pump or large syringe provides the suction action. Fluid is lost along with the fat, making it crucial that fluid be replaced intravenously during the procedure to prevent shock.

There are several variations of this procedure, including fluid injection and ultrasound-assisted lipoplasty:

• In fluid injection, a medicated solution is injected into fatty areas before removal. The fluid is a mixture of intravenous salt solution, a local anesthetic (lidocaine) and epinephrine. This method allows the fat to be removed more easily, reduces blood loss and bruising, and provides anesthesia before and after surgery. In the tumescent liposuction, large volumes of fluid (up to three times the amount of fat) are injected. Super-wet liposuction is similar, with lesser amounts of fluid. Tumescent can take as long as five hours to perform while super-wet liposuction is performed in about two hours.
• Ultrasound-assisted lipoplasty and vaser uses a special cannula that produces ultrasonic energy. As it passes through the fat, the energy explodes the walls of fat cells, liquefying the fat. The fat is then removed using traditional liposuction techniques. It has been shown to improve the ease and effectiveness of liposuction in fibrous areas of the body.

Both of these techniques carry associated risks. Fluid injection techniques may cause lidocaine toxicity from injection of the anesthetic fluid. Another drawback is the collection of fluid in the lungs if too much is injected. With ultrasound-assisted lipoplasty, the heat from the ultrasound device may cause injury to the skin or deeper tissues.

After the Surgery

After surgery, you will likely experience some fluid drainage from the incisions. A small drainage tube may be inserted for a few days to prevent fluid buildup. To control swelling and help your skin better fit its new contours, you may be fitted with a snug elastic garment that is worn over the treated area for up to 6 weeks. Stitches are removed or dissolve within the first seven to 10 days.

Strenuous activity should be avoided for about a month. Although most of the bruising usually disappears within three weeks, some swelling may remain for six months or more. Your surgeon will schedule follow-up visits to monitor your progress and see if any additional procedures are needed.