Liposuction Surgery Overview

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What is Liposuction?

Liposuction—also known as lipoplasty, liposculpture, suction-assisted body contouring and suction lipectomy—is a medical procedure designed to remove unwanted or excess fat from a specific area of the body. During liposuction, an instrument called a cannula and a machine similar to a vacuum are used to remove pockets of unwanted fat.

Although liposuction can be used to remove some body fat, it is not a substitute for diet and exercise. It can, however, be very effective in removing stubborn areas of fat that do not respond to dieting and exercise.

Liposuction can be performed on almost any part of the body where there are areas of fat you want removed. Common locations for liposuction include the abdomen, waistline, hips, buttocks, inner and outer thighs, the area above the knees, the upper arms, under the chin and the neck. You can also undergo other cosmetic procedures at the same time you have liposuction, such as a brachioplasty, or arm lift, (a related procedure designed to make the arm appear more slender) or a tummy tuck, which can create a more slender waistline.

Plastic surgeons can use one of several different types of techniques to perform liposuction surgery. These techniques include dry, wet, tumescent, super-wet, ultrasound-assisted liposuction, and power-assisted liposuction (MicroAire) techniques. Liposuction is a thriving area of cosmetic medicine, and new and safer techniques and treatment methods are continually being developed.

Choosing to undergo liposuction surgery requires serious thought. It is not a decision to be made lightly. There are inherent risks to liposuction, just as there are with any type of surgery. Although it is unlikely, you could experience complications that can have lifelong consequences. For this reason, you should make sure you are considering your options carefully, that you choose a qualified surgeon and, most importantly, that you know all the pros and cons of the procedure. When you visit with your plastic surgeon, you can ask to view his or her before and after liposuction photos and inquire about liposuction cost.

Cosmetic surgeries such as liposuction, face lift, rhinoplasty or breast augmentation can improve your physical appearance, but cannot change your mental or emotional state. If you are suffering from depression or other psychiatric or psychological problems, liposuction is not going to help you. You need to deal with mental or emotional problems before you consider any cosmetic procedure. But if you are in good mental health, a cosmetic procedure can help you feel better about your appearance, which can give you self confidence and boost your self-esteem.

Are You a Candidate for Liposuction?

According to the American Society of Plastic Surgeons, liposuction was the third most popular cosmetic surgical procedure in 2006, with approximately 303,000 procedures performed.

Before committing to liposuction surgery, you should be in good physical and mental health. You should be free of any active diseases that could make you unable to endure the surgery and liposuction recovery period. Conditions such as diabetes, high blood pressure, asthma or heart disease increase your risk of complications and you should discuss this with your surgeon. The quality of your skin can also be a factor in the success of liposuction. Your skin should be sufficiently elastic to allow it to heal properly after the procedure.

Recovering from liposuction can be difficult and slow, and requires a great deal of patience and mental stability. Some people become depressed after surgery. You must be in good mental health to ensure that this temporary depression does not worsen any pre-existing mental illness.

You should discuss your postoperative expectations with your surgeon. Liposuction is recommended for people who are already within 20% of their ideal weight. It is not a quick fix for obesity. You and your surgeon can look at liposuction before-and-after pictures to be sure you agree on how you want to look after the surgery. You can also watch a video on liposuction to make sure you completely understand the procedure.

The final results of liposuction depend on factors such as the elasticity of your skin and how well you heal. Because the procedure involves breaking up pockets of fat and suctioning them out of your body, the area treated may not be completely smooth afterward. Discuss the possibility of bumps and rippled areas with your surgeon.

Medical insurance will almost never cover the costs associated with liposuction. This means that you are responsible for the total cost of the procedure. However, there are affordable options with qualified surgeons, and you can often arrange for financing.

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Indications for Liposuction

Liposuction is intended to remove stubborn pockets of body fat that cannot be dieted or exercised away; its not intended to be a weight loss surgery. Some people have difficulty getting rid of fat in specific areas because of genetics or hormonal imbalances. For them,, liposuction can be quite effective.

Liposuction can also be used to remove excess fat that sometimes develops on the back with age or the use of certain medications. For example, people with HIV sometimes develop a pad of fat on their upper back as a result of their medications. Liposuction can remove this and return a normal appearance to the back.

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Contraindications of Liposuction

Although there are many benefit's to liposuction, the procedure is not for everyone. If you take the following medications or have any of the following health problems, you are probably not a good candidate for liposuction:

  • Accutane within 6 months before the procedure
  • Disorders involving collagen, scarring or connective tissue
  • Clotting disorders
  • Lupus erythematosus
  • Diabetes
  • Heart disease
  • Lung disease
  • Vascular problems (or problems of the circulatory system)
  • Endocrine disorders
  • Hypertension (high blood pressure)
  • Morbid obesity
  • A history of poor wound healing
  • Bleeding disorders
  • Smoking
  • Recreational drug use or excessive drinking
  • Pregnancy
  • Other active diseases that may affect outcome or increase your risks

This is not a complete list of conditions that may make you a poor candidate for liposuction. Make sure your surgeon knows your complete medical history before you have surgery.

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Body Types and Common Complaints

Liposuction can be very helpful for those who are unhappy with the shape of their body despite diet and exercise. Some individuals carry stubborn fat in particular areas of the body because of the body type they inherited. In general, there are two basic body types:

  • The apple-shaped body type is referred to as "android." These are the people who carry excess fat in the chest and stomach.
  • The pear-shaped body type is referred to as "gynoid. These are the people who carry excess fat in the hips and thighs.

People with these body types may find liposuction can help them reshape their body. As a rule, most men have an android body type, and most women have a gynoid body type, this is only a generalization and men and women can be either body type.

In the medical community, several different contour problems for the female body are classified as "deformities." Most of these are strictly cosmetic problems and do not mean that the body is not working properly or that there is a true medical problem. Some of these problems are quite common body silhouettes and calling them deformities can seem a bit harsh. You may be unhappy to have saddlebags on your thighs, but they are not truly hurting you. However, cosmetic contour deformities can benefit from liposuction.

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Typical Female Body Problems

Saddle Bags, Fatty Inner Thighs and Knees: Saddlebags is the common name for excessive fat deposit's in the area of the inner thighs and the knees. The clinical term is "trochanteric excess." For anyone with saddlebags, liposuction can reduce the fat in this area and create a more aesthetically pleasing appearance and bring balance to the body.

Excess Medial Thigh Deformity: This is excess fat in the middle point of the thigh. People with this look like their middle thigh is larger than their upper thigh and that the thighs appear to start lower than they actually do. If the rest of their body is normal sized, their thighs look particularly out of proportion.

Excess Flank, Waist and Abdominal Fat: These are areas of fat between the ribs and hips, the waist or the abdomen. Even thin people can have stubborn pockets of fat in these areas that cannot be easily removed.

Violin Deformity: A violin deformity is an indentation between the hips and the thighs. The mid-hip area may be of normal size while the upper thigh and hip may be disproportionately large.

Fatty Calves: Fatty calves are self-explanatory, but fat in the calf area can be particularly difficult to reduce through diet and exercise.

Submental (Under Chin) Fat: Excess fat around the neck and under the chin can make an otherwise thin person appear significantly heavier. Liposuction may be performed in this area either on its own or in conjunction with other facial procedures, such as a face lift, and may need to be accompanied by a neck lift, known as a platysmaplasty, if the skin is not elastic enough to rebound from the liposuction.

Upper Arm Fat: As with fatty calves, this is self explanatory. But liposuction to remove excess fat in the upper arms and contour the arms to a more appealing shape has some added risks compared to liposuction elsewhere. If the surgeon inadvertently disrupts or removes lymph nodes or lymphatic ducts, it can interfere with circulation of the fluids of the lymphatic system and lead to chronic swelling of the arms and hands.

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Typical Male Body Problems

Abdomen and Flanks: The abdomen and the area between the ribs and hips are common areas for liposuction in men.

Gynecomastia: Gynecomastia is breast development in men and it is not uncommon. Men who develop this condition, as well as men who simply have excess fatty deposit's on the chest, can benefit from liposuction.

Spare Tire: The "spare tire" refers to a roll of fat on the lower torso, abdomen, waist and back. Liposuction can remove excess fat around the abdomen, but not fat that is within the abdomen it'self. This is known as visceral fat. It surrounds the internal organs and removing it is dangerous. For some men, much of their "beer belly" may be visceral fat and not safely removable using liposuction.

Pubic Mound: A small pad of fat over the pubic bone at the bottom of the torso is normal. However, excess fat here can be unattractive and may even hide the lower penis shaft. Liposuction can remove excess fat on the pubic mound.

Submental (Under Chin) Fat: Excess fat around the neck and under the chin can make a man look significantly heavier. Liposuction may be performed in this area in conjunction with other facial procedures, such as a face lift, and may need to be accompanied by a neck lift, known as a platysmaplasty, if the skin is not elastic enough to rebound from the liposuction.

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Liposuction Techniques

There are several different liposuction techniques. All of them are variations and refinements on the same theme. Basically, liposuction consists of the insertion of a narrow tube called a cannula through a small incision in the skin. The tip of the cannula is worked back and forth through the pocket of fat to be removed, breaking it up. As the fat is broken up, a strong vacuum device sucks it out of the body through a tube connected to the cannula. If a large area is being treated, the surgeon may use two or more incision sites to keep the incisions inconspicuous and to improve the reach.

Traditional (or Dry) Liposuction: Traditional liposuction is done by inserting a cannula and suctioning excess fat out of the body under very high levels of negative pressure, without the aid of fluid. This technique is not widely used anymore. This procedure can cause excessive trauma to the tissues, extensive blood loss, nerve damage and tissue death resulting from the removal of the important vascular structure of the skin.

Wet Technique: The wet technique is similar to the traditional technique, but a small amount of fluid is injected or infused into the area being treated. The fluid is usually a solution of saline (sterile salt water) and two drugs, lidocaine and epinephrine. Lidocaine is a numbing agent and epinephrine constricts blood vessels and minimizes bleeding. The amount of fluid infused is less than the amount of fat the surgeon expects to remove.

Super-Wet Technique: In super-wet liposuction, the surgeon injects an amount of fluid equal to the amount of fat to be removed. There is less trauma than with either the dry or wet technique.

Tumescent Liposuction: This liposuction technique involves injecting large amounts of fluid during the procedure. Typically, there is twice as much fluid injected as the amount of fat to be removed, and often as much as three times that amount. The area to be treated is purposely engorged with fluid and becomes swollen and tight, or tumescent. This tumescence limit's the amount of tissue damage during the procedure.

Ultrasonic-assisted Liposuction (or lipoplasty) (UAL): In this technique, the surgeon uses high-frequency sound waves. The ultrasonic energy liquefies fat cells, which are then removed by suction. But ultrasonic liposuction has risks not associated with other types of liposuction. Although it is not heat energy, ultrasonic energy can heat tissue to the point that it can cause burns. Ultrasonic liposuction can be done with the ultrasound applied through the skin or through the tip of the cannula.

Power-Assisted Liposuction (PAL or MicroAire Technique): This liposuction technique uses tumescent technique and a cannula with a rapidly vibrating tip. The vibrations loosen fat cells with less trauma than traditional techniques and without the burn risks associated with UAL.

Laser-assisted Liposuction and Laser Lipolysis: Here, lasers are used to assist in the liposuction process. Some forms of laser lipolysis are routinely performed in other countries, but are only starting to be used in the United States.

High-volume Liposuction: Liposuction procedures where a large amount of fat is being removed are referred to as high-volume liposuction, defined as removing more than 5000 ml of fat (10 pounds). The more fat is removed, the greater the risk of complications from the procedure. Because of the much higher risks, most high-volume liposuction is performed in a hospital.

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How Liposuction Is Performed

If you are considering liposuction, you should completely understand how the procedure is performed. Liposuction can be performed in your surgeon's office, in a free-standing surgical unit or in a hospital. It can be performed under local or general anesthesia. Many patients go home the same day as their surgery.

The length of time required for liposuction depends on the technique used and the amount of fat to be removed; it can range from as little as 30 minutes to several hours. Other procedures, such as a rhinoplasty or chin augmentation, can be done at the same time as liposuction, but this will extend the total for surgery.

There are several phases involved in a liposuction. These are:

Preparation: During the preparation phase, you are being "prepped" for surgery. Your surgeon will use a marker to draw on your body to indicate where incisions will be made and the areas to be treated. These marks are usually made while you are standing. After this, you will be scrubbed with an antimicrobial agent to minimize the possibility of infection. An intravenous line will be started and you will be attached to monitors so that the surgical team can keep track of your vital signs.

Anesthesia: You and your surgeon will discuss anesthesia before the day of your surgery. For most liposuction procedures, surgeons use general anesthesia, where you are asleep through the procedure. But if only a small amount of fat is going to be removed from a few sites, you and your surgeon may opt for local anesthesia.

Liposuction Surgery: During the surgery, your legs and arms may be either wrapped or inserted into compression sleeves. These sleeves contract and expand gently to aid your circulation.

Each specific liposuction technique has its own procedure. For example, if you were undergoing external ultrasonic liposuction, your surgeon would apply a thin layer of gel on the skin in the treatment area. This gel allows the ultrasonic pad to glide smoothly over your skin during the procedure and also helps conduct the high-frequency waves to the fat below the skin. This is not done in other techniques.

After liposuction is complete, the incisions are closed.

Recovery: During the recovery phase, you will be awakened and moved to a recovery room where the staff will monitor you for a while after the surgery.

Visit the Resource Center to stay abreast of the latest news, trends and breakthroughs in cosmetic plastic surgery.

Website References:

American Society of Plastic Surgeons
American Society for Aesthetic Plastic Surgery
Humberto Palladino, MD

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