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 "Liposuction is the surgeon’s method of sculpting the body contours."
Liposuction is the most common cosmetic surgical procedure performed in the United States today and works best when treating localized fat deposits. Adipose tissue is surgically removed from specific areas through small skin incisions using a hollow metal tube attached to a vacuum apparatus. You are an ideal candidate for liposuction if you are at or close to your ideal body weight, and you want to improve the contour of your body but you have not been previously successful with traditional diet or exercise. Liposuction can slim the hips, and thighs, can flatten the abdomen and can remove excess fat from the chin and upper arms. Liposuction can also help to create a more shapely contour to the inner knees, calves and ankles. The treated areas will retain their new contour as long as you do not have large weight gains.
There are certain areas of the body, such as the upper arms, abdomen and inner thighs, that may develop loose or hanging skin following liposuction. The degree of skin retraction and tightness depends on the patient’s age, the amount of fat to be removed and the patient’s general skin tone and degree of elasticity. If you are at high risk for loose skin, we may recommend a skin tightening procedure such as a thigh lift, tummy tuck or upper arm lift. If it is equivocal whether the patient will develop skin laxity after liposuction alone, removal of excess or redundant skin can be performed at a later date.
Fat cells play numerous metabolic roles in the body. They serve as an energy source, a storage place, and interact with insulin and hormone synthesis, to name a few. Adult fat cells are thought to be incapable of multiplying. There are a fixed number distributed in a genetically predetermined fashion throughout the body. Regardless of the function, as
you gain weight these cells expand. As you lose weight, they contract but the number and distribution remain essentially unchanged. This is why thin people may still complain about localized fatty deposits that don’t go away even at their ideal weight. Dieting reduces your weight and overall size, and may show improvement in specific areas. Liposuction reduces the overall number of fat cells, and affects shape and contour.
Liposuction has come a long way since its introduction in the mid 1970’s and modern techniques have made it safer and simpler for both surgeons and patients. It is a safe and effective way to remove unsightly bulges from almost any area to produce an improved shape and contour. This is why liposuction has consistently been the most popular cosmetic surgical procedure in the world for the past several years.
Fat deposits that don’t respond to the usual litany of exercise and diet regimens are ideal targets for liposuction. If you are only overweight in certain areas of your body, you would have to lose a larger amount of weight in order to shrink the size of your thighs. The weight will come off everywhere including the breasts and face, and not just where you need it most. Most body parts can be suctioned for better contour and reduced volume, from the face down to the ankles. The most popular areas for women are the abdomen, inner thighs, outer thighs, hips, flanks and knees. Liposuction can even be used to reduce heavy breasts in some women.
Before having liposuction, we will discuss your lifestyle, aerobic shape, and body weight fluctuations. If you have a history of an eating disorder like bulimia, anorexia, binge eating, or have been on prescription weight control medications, we need to know in advance. If you are overweight you may have to undergo these procedures in stages. If you exceed your ideal weight by 50% or more, we may suggest that you lose weight prior to undergoing a liposuction procedure.
Liposuction of multiple areas should not exceed five liters of total fat removed in the outpatient setting and 10 liters in the inpatient setting. When large volume liposuction is performed, it is best to e treat “aesthetic units” of the body to maximize the result. For instance, it is possible to combine liposuction of the back, love handle area and abdomen during one session, and the hips, inner and outer thighs and knees during another session.
 Advances in liposuction techniques have greatly improved the results you can achieve. The procedure is very straightforward. Tiny incisions of approximately one quarter inch long are made at the sites where fat is to be removed and a wetting solution is infused to provide anesthesia, reduce bleeding and improve fat extraction. This requires careful monitoring to avoid toxicity and must be performed by those experienced with local anesthesia. The surgeon uses various sizes and dimensions of cannulae, hollow, tubular instruments with holes at one end to trap the fat. The cannula is attached to suction tubing through which the excess fat is evacuated.
These instruments come in various shapes, lengths and sizes depending on the thickness and location of the fat. They have highly polished surfaces to slip through the fatty tissues with minimum friction or damage, and are frequently blunt-tipped to prevent cutting through the skin. Cannulae are inserted under the skin moved in a back and forth and criss-cross fashion within the fat, essentially pushing it aside while protecting the vessels and nerves. Fat is suctioned out through one or several holes at the tip, measured, and then the patient is checked for symmetry. The procedure is completed when a safe level of fat removal and the desired contour has been achieved. The patient is then monitored closely to make sure that enough fluid hydration has been received.
The ‘wet’ techniques, and the superwet technique, referring to the amount of fluids injected, are variations of the tumescent technique. Tumescent anesthesia has had perhaps the most significant impact of all developments in liposuction. Warmed tumescent liquid, a diluted solution containing lidocaine, epinephrine and intravenous fluid, is injected into the area to be treated. As the liquid enters the fat, it becomes swollen, firm and blanched. The expanded fat compartments allow the liposuction cannula to travel smoothly beneath the skin as the fat is removed. The saline softens the fat, the adrenaline decreases the blood loss and bruising, and the anesthesia provides relief from discomfort. For small amounts of fat, the tumescent solution may be the only anesthetic given or it can be supplemented with sedatives to put you in a sleepy state. General anesthesia may also be used for longer procedures involving multiple areas.
Ultrasonic sound waves, like shock waves, are transmitted into the fatty tissues from the tip of the cannula probe. The fat cells are melted or liquefied and then removed by low-pressure vacuum through a suction tube. Ultrasonic liposuction is often reserved for more difficult areas to contour where the deep fat is thicker, and thus harder to extract; i.e. back rolls, upper abdomen, and flanks. It can be combined with traditional liposuction when both the deeper fat and more superficial fat are being removed. Some physicians use external ultrasound (EUAL) with liposuction in lower frequencies to soften fat deposits from the skin’s surface. The literature shows limited effects of this treatment except on the tissues just below the skin surface.
One of the latest advances in technology for liposuction is the addition of power. The cannulae used are motor-driven so they vibrate which makes removing fat easier and faster for the surgeon. The primary advantage is that there is less physical exertion required for the surgeon to remove the fat with this method and therefore, sculpting of the fatty bulges is more controlled.
The VASER® system utilizes probes with a grooved design and continuous bursts of ultrasonic vibrational energy to selectively target fat cells which are then removed by suction. Ultimately, the method and technology the surgeon uses is less important than his or her skill, aesthetic eye and expertise. For example, we have used ultrasonic assisted liposuction as well as power assisted liposuction. We generally prefer PAL now in combination with traditional hand held cannulae. All of these technologies work slightly differently, but they are all work effective. UAL may be useful for denser areas of tissue such as the male breast and for revisional liposuction where there has been previous scarring.
Most people have liposuction on an outpatient basis and go home the same day. For large volume procedures or multiple sites, it may be recommended that you stay overnight in the hospital. During the two days following the procedure, you can expect significant swelling, but this rapidly subsides within days and resolves quickly over the next three weeks. You will weigh more right after liposuction than before surgery. Your face, feet and hands may swell up from all the fluids given during the procedure. Swelling travels down toward the feet with gravity so it is not uncommon to be bruised and swollen in places where liposuction was not performed. There will also be numbness in some areas. Showering is usually permitted after two days. We usually request that you continue to wear a compression garment for several weeks after surgery. Many people can return to work or limited activity within two to four days, and resume an exercise program as tolerated in 10–14 days. You can see your new shape best after six to eight weeks, when most of the swelling has subsided. Residual swelling settles and skin tightens gradually over the next three to six months.
 A major benefit of liposuction surgery is that the scars are small and usually located in inconspicuous areas. The small slit-like openings for the liposuction cannulae can be placed in hidden areas like the upper skin fold of the navel, in the crease under the buttocks, and inside the knee, so they are well concealed. These scars generally heal well and they are rarely a problem. After surgery, a compression garment will be placed. Wearing the girdle for a few weeks will hold everything in and keep swelling to a minimum. Most people actually feel better with some support and compression. Specific risks from the tumescent technique include rare complications like pulmonary edema, which is a collection of fluid in the lungs that may occur if too much fluid is administered.
Another potentially fatal complication can arise from lidocaine toxicity which can occur when a large amount of solution containing lidocaine is used. Anti-embolism boots are often used during surgery to prevent a blood clot from forming in the deep veins of the pelvis or legs. If a clot forms the thigh or calf gets tender and ankles swell. The danger is that this clot may break free and travel to the lungs and impair breathing. A fat embolus can also occur where a bit of fat travels in the bloodstream to the lungs and blocks breathing. A fluid collection called a seroma, can also develop especially after ultrasound technique, and is more common in the abdomen and male chest area. In rare cases, we may need to drain the excess fluid in the office to relieve pressure.
"High volume liposuction procedures, in which a large volume of fat is removed involves greater risks."
In some cases, a touch up may be done six months after the initial procedure to refine an area that has previously been treated. If you have had liposuction and the skin is loose, additional liposuction will only make the skin look worse. A skin excision procedure may be recommended instead. The results of liposuction are permanent, as long as you keep your weight stable. If you gain weight after liposuction, you will tend to gain it back uniformly throughout the body since the normal number of fat cells are still there and will continue to expand. There are still fat cells in the areas that were suctioned as well. If you do gain fat in other areas of the body that weren’t your primary trouble spots, it is usually very responsive to diet and exercise.
The ideal patient for liposuction is at or close to a normal weight. In some cases, we will perform liposuction on patients who are thirty pounds or more overweight, or over 30% of their ideal body weight. The best pre-liposuction weight is one you can maintain without starving yourself. It is better to lose some weight before surgery and more afterwards. If you put on a few pounds after liposuction, you will lose some of the benefit of your result. If you lose some weight after, your result will look that much better. Every patient complains to his or her plastic surgeon after liposuction, “couldn’t you have taken a little more fat out?” unfortunately, too much fat removal can cause depressions, or “cobblestone” appearance, so qualified surgeons pay attention to endpoint targets to avoid over resection. A small touch-up procedure six months later is performed in about 10% of patients to fix under treated areas.
Although liposuction is an effective method for removing fat deposits, it does not cure cellulite, tighten loose skin, or affect the fat that lies underneath the muscle layer. When the degree of skin elasticity is not easy to assess, a staged procedure may be a good solution. The liposuction is done first, and if not enough skin contracts, skin excision and internal tightening can be done at a later stage. Fat from other body parts can be suctioned out and injected back to smooth and fill out dents and add curves. Liposuction can be used to delicately recontour legs from the ankles, calves, and knees up to the inner and outer thighs, taking inches off the circumference of the leg. Calves and anterior thighs are tricky because they are often largely muscle, but suctioning even small amounts can make a big difference in the overall shape. Liposuction of the legs may take longer than other areas to fully settle down, because swelling tends to travel downward and rest below the knee. This procedure is usually best left for colder months when you can easily cover up bruising and swelling under clothing.
Results from liposuction are better when patients have tighter skin. If you have loose skin due to pregnancies, aging or weight fluctuations, liposuction can potentially make the treated area look worse. Some areas of fat deposits are less forgiving than others and more often lead to sagging skin; for example, upper arms, inner thighs, abdomen, and the neck. The flanks and outer thighs are areas that respond very well after liposuction and it is less common to develop loose skin in these areas. If your ultimate goal is to be taut, a tummy tuck, thigh lift, or lower body lift, which involves tightening underlying muscles and removing and redraping excess skin, are the only viable options. The trade-off is that the scars are significant, and the recovery period is considerably longer than with liposuction alone.
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