Liposuction

What Is Liposuction?

Liposuction is surgery to improve the contour of your body by removing pockets of excess fat from specific areas of the body. “Lipo” comes from the Greek word “lipos,” meaning fat. Other names for liposuction are lipoplasty and suction lipectomy.

Liposuction uses suction to remove fat deposits. The suction is provided by a vacuum-like device or sometimes by a large syringe. The suction device is inserted through a small incision in the body, and the surgeon suctions out the fat tissue.

Liposuction is not an alternative to weight loss if you are overweight. But it offers a way to a smoother, trimmer body for those with extra pockets of fat that won’t go away with weight loss or exercise.

The best candidates for liposuction are people who:

• Are close to normal weight
• Have pockets of excess fat, but with firm skin
• Are physically and psychologically healthy
• Have realistic expectations about what they hope the procedure will do for them

Liposuction can remove fat from many different areas of the body, including the thighs, hips, abdomen, buttocks, breasts, waist, upper arms, and neck.

The techniques to perform liposuction have improved significantly in the past decade.

When Is Liposuction Most Effective?

Liposuction works best in healthy adults who have:

• Relatively normal and stable weight
• Firm, elastic skin
• Isolated areas of fat that don’t go away with exercise or diet

The areas of the body that are most commonly treated by liposuction are:

• Thighs
• Hips
• Abdomen
• Legs (inner knees, calves, and ankles)
• Neck, chin, and cheeks
• Buttocks
• Under upper arms
• Breasts
• Waist
• Flanks (“love handles”)
• Back

Liposuction may not be appropriate for some older people, because sagging or loose skin, which often occurs with aging, may not be sufficiently elastic to conform to the body’s new contour after liposuction. Age is not a major consideration, however.

Are There Other Treatment Options To Remove Excess Fat?

There are a number of options for surgically removing excess fat. A surgeon will choose the best technique for you depending on the amount and location of the fat and whether you also have excess skin.

Common fat-removal methods include:

• Liposuction
• Ultrasound-assisted liposuction
• Tummy tuck (abdominoplasty)

Liposuction

As the name implies, liposuction uses suction to remove fat deposits. The suction is provided by a high-pressure vacuum pump or sometimes by a large syringe (needle). The suction pump is attached to a tube that the surgeon inserts into a small incision in the body. Fat cells are then suctioned out through the tube.

Ultrasound-Assisted Liposuction

A new liposuction technique uses ultrasound, or sound waves, to “dissolve” fat before it is suctioned out. Typically, doctors reserve ultrasound-assisted liposuction either to remove large volumes of fat or to remove fat from difficult areas, such as the back, flanks or from oversized breasts of men.

Tummy Tuck (Abdominoplasty)

Abdominoplasty, commonly called a “tummy tuck,” is a method of removing fat from the abdomen (stomach region). If your abdomen has an excessive amount of skin and fat, a tummy tuck may be a better option for you than liposuction. Sometimes abdominoplasty is done in addition to liposuction.

This operation involves surgically removing excess skin and fat from the belly, and it may involve tightening the abdominal wall muscles as well. The end result is a flatter stomach.

For details about this procedure, go to Tummy Tuck (Abdominoplasty).

Liposuction: What Are The Risks?

Liposuction is generally safe. As with any surgery, however, the procedure does have the potential for complications.

Occasional risks of liposuction include:

• Heavy bleeding (less of a problem with ultrasound-assisted liposuction)
• A bad reaction to the anesthetic
• Emergency hospital admission
• Noticeable irregularities in body contour
• Prolonged swelling
• Brown spots on the skin (hyperpigmentation)

The following factors increase the risks of liposuction:

• Removal of too much fat
• Inadequate monitoring after removal of a large volume of fat (greater than 10 pounds)
• Injection of overly large amounts of fluid and anesthetic
• Performance of multiple surgical procedures in the same surgical session
• Poor health, such as having diabetes, poor circulation, or severe lung or heart disease

Rare complications of liposuction are:

• Infection
• Lasting nerve damage
• A hole (perforation) in the bowel during abdominal procedures
• Blood clots, particularly in women taking birth control pills
• Skin tissue death (necrosis), especially in smokers and people with diabetes
• Skin burn (during ultrasound-assisted liposuction from the heat of the ultrasound device)
• Fluid in the lungs (during tumescent liposuction)
• Shock

How Do I Prepare For Liposuction?

• Consult with your surgeon
• Follow your doctor’s suggestions
• Make special arrangements

Consult With Your Surgeon

During the first appointment with your surgeon, discuss your expectations and concerns. Remember that liposuction will improve your body shape, but you will not achieve physical perfection.

After examining you, your surgeon will discuss treatment choices and recommend his or her best option to achieve your goals.

During the consultation, the surgeon will explain:

• The procedure
• Benefits, risks and costs
• Recovery time

Follow Your Doctor’s Suggestions

Your surgeon is the best one to tell you how to prepare for surgery. He or she may advise the following precautions:

• If you are on the birth control pill, stop taking it and use another birth control method until after surgery. This is necessary to reduce the risk of blood clots in your legs after surgery.
• Avoid aspirin, ibuprofen and other nonsteroidal anti-inflammatory drugs for seven to ten days before surgery. These drugs may contribute to bleeding during and after surgery. Some vitamins and herbs also affect bleeding, so ask your doctor which nutritional supplements to avoid.
• If you smoke, stop smoking before surgery and don’t resume after surgery. Smokers risk chest infections after anesthesia. Smoking also reduces blood flow to the skin, which can increase the risk of circulation problems after surgery.

  For further information about how to stop smoking, go to Smoking: How To Stop.

• You will probably be told not to eat or drink after midnight (or some other timeframe) the day before the operation.

Make Special Arrangements

Liposuction usually takes place on an outpatient basis, allowing you to go home the same day of surgery. However, you may need to plan for a hospital stay if a large amount of fat is to be removed or other procedures are to be done at the same time.

How Is Liposuction Performed?

There are several different types of anesthesia and techniques that surgeons use to perform a liposuction.

Anesthesia

Procedure

Ultrasound-assisted liposuction

Anesthesia

The anesthesia your surgeon will choose depends on several factors, including:

• The amount of fat removed
• The liposuction technique selected
• Your pain tolerance

There are three primary types of anesthesia:

1. Local: This form of anesthesia numbs only the area to be treated. Usually, you will also receive a sedative, which will make you drowsy or may cause you to fall asleep. The local anesthetic is injected into the surgical area. The sedative is generally administered through an intravenous tube. You should feel no pain during the procedure but may experience a sensation of pulling or tugging.
2. Regional: An epidural block, the kind of regional anesthesia often used in childbirth, may be given in a liposuction surgery. It’s administered in the form of an injection and is given in the back. This injection numbs the lower half of your body. These numbing effects wear off within a couple of hours after surgery. You will be awake during surgery but will feel no pain during the procedure.
3. General: You are unconscious with this type of anesthesia. This anesthesia is administered intravenously, often through a tube inserted into the back of your hand or elsewhere. As with the other types of anesthesia, you will not experience pain during the operation.

The Procedure

In most cases, the first thing the surgeon does is to inject a solution into the treatment area. The solution is comprised mostly of salt water, which works to make fat removal easier. This wetting solution also contains epinephrine, a medication that shrinks blood vessels, which acts to decrease bleeding and bruising. The solution also usually includes a local anesthetic to temporarily minimize pain.

The amount of wetting solution injected before the procedure varies depending on the technique employed.

• Wet liposuction: The amount of wetting solution is less than the volume of fat removed. This technique often requires intravenous (IV) sedation or general anesthesia.
• Super-wet liposuction: The wetting solution is equal to the volume of fat removed. This technique often requires intravenous (IV) sedation or general anesthesia.
• Tumescent liposuction: The wetting solution is two to three times the volume of fat removed. This solution causes fat deposits to swell (tumesce). Tumescent liposuction is the most commonly used liposuction technique and it usually requires only local anesthesia. This technique has the advantage of resulting in less bleeding, and therefore less bruising, than the wet techniques.

Doctors rarely perform dry liposuction anymore because fluid injection is safer.

After the fluid has been injected, the surgeon makes a small incision (cut) in your skin near the area that contains the fat that is targeted for removal. A narrow metal tube called a cannula is inserted through the cut into the area of excess fat.

The cannula is attached to a strong vacuum pump via a flexible pipe. By manipulating the cannula back and forth through the fat, the surgeon can suction out the fat cells. Usually, the incisions are closed with a few stitches.

Ultrasound-Assisted Liposuction

Ultrasound-assisted liposuction follows the same technique as with standard liposuction with the following steps:

• Fluid injection
• Small incision in the skin
• Insertion of a cannula (tube) into the incision

However, with ultrasound-assisted liposuction, the cannula is connected to an ultrasound machine, which uses energy from sound waves to break apart the cells in the unwanted fat. Then the surgeon suctions out the “melted” fat as well as the previously injected fluid. Usually, a few stitches are used to close the wounds.

The time for this type of surgery varies, but it generally is longer than for liposuction without ultrasound.

What To Expect After Liposuction

After-effects

Special care

Results

When to contact the doctor

After-Effects

Common side effects after liposuction may include:

• Temporary minor contour imperfections, such as lumps or dents in your skin
• Mild to moderate discomfort/pain; you may need pain medication during the first few days
• Bruises and swelling
• Bleeding
• Temporary numbness of the treated area
• Nausea or vomiting if you had general anesthesia

Special Care

You will need to wear an elastic bandage or pressure garment over the treated area to control swelling and help with healing.

Your surgeon will tell you how long to wear this garment. During this timeframe, you should take it off only to bathe.

Results

Results of your liposuction will become more apparent as the swelling goes down. Most people see their final results after about three or four months.

The surgeon’s incisions leave small scars, but generally these scars are in areas where they are not noticeable, such as around the pubic hairline.

How Long Does Healing Take?

Everyone heals at different rates, so the following points are general guidelines only for healing from liposuction:

• If you had stitches, they will usually be removed within the first week after surgery.
• Bruises take three weeks or longer to fade after liposuction and about six weeks after ultrasound-assisted liposuction.
• Swelling can take six months to disappear but begins to recede after the first week.
• Numbness in the treated area nearly always goes away in three months, often sooner.
• Wait until your wounds heal before you have sexual intercourse.
• In most cases, you may resume your normal activities within a few weeks. However, avoid strenuous exercise for a month.

How Soon Can I Return To Work After Liposuction?

How much time you will need to take off work depends on your general fitness and the extent of your surgery. Most people who have a small area treated may return to non-strenuous work within several days or a week. If you have a larger area treated, you may need up to three weeks of rest before you may return to work. Ultrasound-assisted liposuction may require two weeks of recovery without work.

Will Results Last?

Liposuction removes the fat cells from your body, and they can’t regenerate. Therefore, results will be permanent as long as you do not gain a great deal of weight. Gaining a few pounds should not affect your results, but gaining more than 30 to 50 percent of your body weight can affect your appearance.

Remember that liposuction is not a substitute for a healthy diet and regular exercise.

Liposuction: Frequently Asked Questions

Here are some frequently asked questions related to liposuction.

Q: Is liposuction for me if I am very overweight?

A: No, liposuction is not recommended for very heavy people. The procedure can safely remove only moderate volumes of fat. Therefore, it is most suitable for people who are only slightly overweight or of normal weight but whose fat cells have distributed unusually thickly in certain parts of the body and are not affected by exercise.

Q: Where on the body do people most often have liposuction done?

A: The most commonly treated areas are:

• Thighs
• Hips
• Belly
• Legs (including knees and ankles)
• Buttocks
• Face and neck
• Upper arms
• Breasts

Q: Will liposuction reduce cellulite?

A: No, liposuction will not improve cellulite, which is a collection of fat that causes the skin to look lumpy or dimpled. It could even make cellulite worse.

Q: Is liposuction done on an outpatient basis?

A: Yes, liposuction often is done in a physician’s office surgical suite or in an outpatient surgery center. Even if you get liposuction in a hospital, you probably will be able to go home the same day unless you are having a large amount of fat removed.

Q: How soon can I return to work after liposuction?

A: How much time you will need to take off work depends on your general fitness and the extent of your surgery. Most people who have a small area treated may return to non-strenuous work within several days or a week. If you have a larger area treated, you may need up to three weeks of rest before you may return to work. Ultrasound-assisted liposuction may require two weeks of recovery without work.

Q: Is liposuction safe?

A: As with any surgery, liposuction has risks. However, improved techniques have increased the safety of this procedure. Some estimates put the risk of major complications from liposuction at less than 0.5 percent. If you are considering having liposuction, talk to your surgeon about any safety concerns that you may have.

Q: Will my insurance pay for liposuction?

A: Liposuction is considered a cosmetic procedure and therefore is not covered by most insurance plans. The cost varies greatly, depending on the location of the fat to be removed and the extent of the procedure. Ask your surgeon about cost and possible payment options at your initial visit.

Liposuction: Putting It All Together

Here is a summary of the important facts and information related to liposuction.

• Liposuction is surgery to improve body contour and not a weight-loss technique.
• Liposuction can remove pockets of excess fat from specific areas of the body, including the thighs, hips, tummy, and legs.
• The best candidates for liposuction are healthy adults who have a normal weight; isolated areas of fat that will not go away with exercise or diet; and firm, supple skin.
• As with any surgery, liposuction has risks. Fortunately, serious complications, such as infection, nerve damage, blood clots, shock and death, are rare.
• You can help decrease the risks of liposuction by following your surgeon’s instructions before and after surgery, having only a moderate amount of fat removed, and limiting the number of other surgical procedures done at the same time.
• Immediately after liposuction, expect to have some minor contour imperfections, discomfort, bruises, swelling, and temporary numbness of the treated area.
• You likely will not see the full effects of liposuction until healing is complete, after three months or longer.
• Remember that liposuction will improve your body shape, but you will not achieve physical perfection.

Liposuction: Glossary

Here are definitions of medical terms related to liposuction.

Abdominoplasty: An operation that involves surgically removing excess skin and fat from the abdomen; commonly called “tummy tuck”

Anesthetic: A drug used to temporarily reduce or stop pain sensation

Body contour: Shape of the body

Cannula: A tube, which (for liposuction) connects to a handpiece that in turn connects to a suction pump

Cellulite: Collection of fat that causes the skin to look lumpy or dimpled; it does not go away with liposuction

Incision: Surgical cut

Large-volume liposuction: A type of liposuction that removes a large amount of fat and fluid from the body (more than 5 liters, or over 10 pounds)

Liposuction: A cosmetic surgery to improve body contour by removing pockets of excess fat from specific areas of the body

Lipoplasty: Another name for liposuction

Localized fat: Fat that is restricted to one or more spots

Super-wet liposuction: A liposuction method in which the wetting solution injected before the procedure is equal to the amount to fat removed

Tumescent liposuction: A liposuction method in which fat deposits swell (tumesce) after injection of a salt water-anesthetic solution that is two to three times the amount of fat removed

Ultrasound: A medical technique using sound waves for diagnosis or treatment; it is used in liposuction to produce heat that breaks up fat cells

Wet liposuction: A liposuction method in which the amount of wetting solution injected before the procedure is less than the volume of fat removed

Liposuction: Additional Sources Of Information

Here are some reliable sources that can provide more information on liposuction.

Organizations

You can obtain more information about liposuction or find a physician who performs liposuction from these organizations:

American Academy of Dermatology 
Phone: 1-888-462-3376
http://www.aad.org

American Society for Aesthetic Plastic Surgery 
Phone: 1-888-272-7711
http://www.surgery.org

American Society of Plastic Surgeons 
Phone: 1-888-475-2784
http://www.plasticsurgery.org

Web articles

You may find these articles useful:

“Liposuction”

http://www.plasticsurgery.org/surgery/body/liposuction/liposuction.cfm

Summary: This online brochure from the American Society of Plastic Surgeons contains a lot of good information about liposuction as well as before and after pictures.