Liposuction 101

Liposuction is most often used for cosmetic purposes, to give a smoother shape to areas such as the thighs, abdomen, buttocks, hips, thighs, calves, arms or back -- areas that haven't responded to diet and exercise. It can also be used to reduce the size of male "breasts" or to remove fat tumors (lipomas, or abnormal fatty deposits). Fat can be removed from more than one part of the body during a single surgical procedure.

­ It's important to note that liposuction is not a weight-loss technique; it is merely a reshaping technique. Only diet and exercise can result in real weight loss.

Having a lot of excess fat doesn't necessarily make you a good candidate for liposuction. In fact, the opposite is true. People of normal weight and in generally good shape who have a few trouble spots make the best candidates, because their skin is firm and elastic. If the skin is not elastic enough, it will remain baggy after the procedure. For this reason, older patients may not see the same type of results as younger patients. You also need to be in good shape physically to do well during the surgery.

­Anyone who has diabetes mellitus, a heart condition, poor circulation, an infection, past history of bleeding or a coagulation disorder (such as thrombophilia) should check with their primary care physician before undergoing liposuction. Liposuction is also not recommended for people who are on medication that interferes with blood clotting (blood thinners such as aspirin, warfarin and heparin).

It is also important to know that liposuction is not its own medical specialty, and no specialized training is required, which means that any licensed physician, including plastic surgeons and dermatologists, can perform it. The Food & Drug Administration recommends that you ask your doctor whether he or she is specially trained to perform liposuction. It's also a good idea to ask how many procedures the doctor has performed. And don't be swayed by ads promising amazing results -- if they sound too good to be true, they probably are.

See the next page to see how the liposuction surgery is performed.

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Because not everyone benefits from the same type of surgery, and some people aren't good candidates at all, every liposuction procedure starts off with a consultation. The doctor will evaluate your health (both physical and psychological) and determine whether your skin elasticity and fat placement makes you a good candidate. Then he or she will help you decide which liposuction procedure is most appropriate for you.

Liposuction can be performed in a surgeon's office, an outpatient surgery center or in a hospital. Smaller liposuction procedures are usually performed on an outpatient basis, which tends to be less expensive.

Before the procedure, the doctor marks the skin to indicate from which area(s) the fat will be removed.  Then, as ­­with most types of surgery, liposuction requires anesthesia. But the type of anesthesia depends upon how much of the body is being worked on. For small areas, doctors can use local anesthesia (which numbs only the area involved). Usually, the doctor administers a sedative (either orally or via injection) along with the local anesthesia to relax the patient.

Alternately, the doctor may give the patient an epidural, which is given intravenously and blocks sensation to an entire part of the body (for example, from the waist down). General anesthesia may be used in a hospital setting when a large amount of fat is to be removed, but it is not recommended by the American Academy of Dermatology. With most liposuction procedures performed today, the doctor injects a local anesthesia as part of a fluid mixture.

During the surgery, the doctor makes a small incision (or several small incisions) and inserts the cannula into the fat layers of the targeted areas. The cannula moves rapidly back and forth to loosen fat cells, which are suctioned out -- typically using a vacuum device attached to the cannula -- and placed into a flask. The cannula creates tunnels in the fat layer that need to collapse in order to heal and create the new body shape. For this reason, the patient must wear a compression garment after surgery. Because fluid is also lost during the procedure, patients sometimes require intravenous fluids following the surgery.

Doctors use several different types of liposuction procedures. These include:

Tumescent technique

Developed by plastic surgeons in the 1980s, this has become the most popular liposuction method. It is also considered safer than other methods because it limits blood loss and does not usually require intravenous fluid replacement afterwards.

In this procedure, the doctor injects a large volume of anesthetic-containing fluid (as much as five times the fluid and tissue that is removed) into the areas containing fatty deposits. The fluid contains a local anesthetic (lidocaine), a drug that constricts blood vessels to reduce blood loss (epinephrine) and a salt solution to allow for easier fat removal. The fluid causes the fatty tissue to swell up and harden (become tumescent), making it easier to remove with the cannula. Because the fluid contains quite a bit of lidocaine, this procedure is usually performed under a local anesthetic. Although it tends to take longer than other techniques -- as many as four to five hours -- the tumescent technique has the advantages of reducing postoperative swelling, bruising and pain.Courtesy University of Nebraska Medical Center

Super-wet technique

This technique is similar to the tumescent technique, with the exception that it uses less fluid (about the same amount as the amount of fluid and fat tissue removed). Although a small amount of lidocaine is sometimes added to the fluid, this technique often requires general or IV-epidural anesthesia. The procedure takes between one to two hours to perform.

­Ultrasound-assisted liposuction (UAL)

T­his re­latively new technique uses a special cannula that vibrates very rapidly and gives off ultrasound energy. As the cannula passes through the fat cells, that energy liquefies the fat cells, which are then su­ctioned out. The ultrasound can be administered either above the skin (with a special emitter) or below the surface of the skin (with an ultrasound cannula).

There are two types of ultrasound cannulas:

The solid probe creates a collection of emulsified fat and tumescent solution beneath the skin, which is then removed with a standard, suction-type cannula. The hollow-core probe both emulsifies fat and removes it, but the doctor must usually go back in with a standard cannula to remove the emulsified fat that the probe leaves behind (Sattler, 2005).

The UAL takes longer to perform than other types of liposuction, but it is more precise and tends to be more effective, especially at removing fat from fibrous areas of the body, such as the back and male breasts. The drawback is that it generates a lot of heat. If the cannula is not removed quickly enough, it can cause a burn. What's more, doctors still don't know the long-term effects of internal ultrasound exposure.

Power liposuctionDoctors now have at their disposal a motorized cannula, which moves back and forth at very rapid speeds over a distance of 3 to 5 millimeters. It can remove about 40 percent more fat per minute than manual liposuction, meaning the procedure takes less time to perform, and it provides smoother results, say doctors (Wagner, 2001). ­

­If the pat­ient was under local anesthesia for the procedure, he or she can typically go home within the same day after surgery. General anesthesia often requires an overnight stay at the hospital or surgical center.

After the procedure, many patients have fluid drainage from the liposuction site. Sometimes, doctors need to insert tubes to facilitate that drainage. Often, patients wear a tight-fitting elastic garment over their surgical site to compress the affected area, reduce swelling and promote healing. Patients may also take antibiotics to prevent infection (see How do antibiotics work?).

The stitches in the incision are removed or dissolve after about 10 days. Many patients experience pain, soreness or burning during the healing process, but these symptoms usually go away within three weeks. After about four to six weeks, the swelling should go down enough to see results. Patients need to avoid heavy exercise and other strenuous activity for about a month after the procedure.

Liposuction is permanent, but it cannot erase obesity. If a person undergoes liposuction and then eats too much and doesn't exercise, he or she will notice a rippling in the treated areas, and the fat will pop up in other parts of the body. This occurs, in part, because of a hormone called leptin, which is made in fat cells. Levels of this hormone drop when fat is removed. That drop triggers an increase in appetite (and therefore food intake) until levels are back up. The problem is especially pronounced in people who were overweight prior to the procedure. To compensate for the lost fat cells, their bodies produce more fat cells in other areas, and fat begins to congregate there. The liposuction procedure can be repeated if necessary, but there is no guarantee that the same effect won't happen again.

The Risks

As with any surgery, liposuction carries some risks. These include:

In rare cases, liposuction can lead to death. Research on the subject is mixed, but estimates range from 3 to 100 deaths per 100,000 liposuction procedures [ref].

For more information on liposuction and related topics, check out the links on the next page.

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