Plastic surgery liposuction removes hard to lose small pockets of fat from the abdomen, thighs, buttocks, neck and backs of the arms. The fat is usually removed via a cannula (a hollow tube) and aspirator (a suction device).

Liposuction is not a low-effort alternative to exercise and diet. It is a form of body contouring with serious risks and is not a weight loss method.

The amount of fat removed is typically less than 5 kg. (Removal of more than 5 kg is a complex and potentially life-threatening procedure.) There are several factors that limit the amount of fat that can be safely removed in a session. Ultimately, the plastic surgeon and the patient make the decision. There are negative aspects to removing too much fat. Unusual "lumpiness" and/or "dents" in the skin can be seen in those patients "over-suctioned". The more fat removed the higher the surgical risk.

The contouring possible with liposuction may cause the appearance of weight loss to be greater than the actual amount of fat removed. The procedure may be performed under general or local (tumescent) anesthesia.

According to the American Society for Aesthetic Plastic Surgery, liposuction was the most common plastic surgery procedure performed in 2006 with 403 684 cases.

Candidates

Candidates must be fit and in good general health. Candidates must not have diabetes, any infection, heart or circulation problems.

No anticoagulants should be taken for 2 weeks before the surgery. If receiving general anesthesia or sedation, the surgery will be in the morning; so, fasting from midnight the night before is required. If only local anesthesia will be used, fasting is not required. Smoking must be avoided for 2 months prior to surgery beacause nicotine interferes with circulation and can result in loss of tissue.

Techniques

Considerations

Amount of fluid injection

Dry liposuction does not use any fluid injection at all. It is seldomly used today.

Wet liposuction injects a small amount of fluid into the area. It contains Lidocaine (local anesthetic), Epinephrine (to contract the blood vessels and thus minimize bleeding) and a salt solution (to make it saline, like our body fluids). This fluid helps to loosen the fat cells and reduce bruising. The fat cells are then suctioned out as in the basic procedure.

Super-wet liposuction is the preferred technique for high-volume liposuction as it better balances hemostasis and potential fluid overload. It takes 1 to 3 hours. It may require either an IV sedation as well as the local lidocaine or a complete anesthesia.

Tumescent liposuction is the precursor of wet liposuction. A large volume of dilute solution containing a local anesthetic and vasoconstrictor is injected directly into the subcutaneous fat to be removed. The technique eliminates the need for general anaesthetic, blood products and intravenous fluids. The high volume of fluid creates a space between the muscle and the fatty tissue allowing more room for the cannula. The procedure requires more time than comparable techniques but can provide smoother results. Despite a large total volume of anaesthetic injected into the tissue, absorption by the body is spread over 24-36 hours because of the vasoconstrictors used.

Laser assisted liposuction uses thermal energy to affect lipolysis.

Mechanism in which the cannula works

Suction-assisted liposuction is the standard method. A small cannula (like a straw) is inserted through a small incision. It is attached to a vacuum device. The cosmetic surgeon pushes and pulls it carefully through the fat layer, breaking up the fat cells and drawing them out of the body by suction.

Ultrasonic liposuction uses cannula that transmits ultrasound vibrations within the body. This vibration bursts the walls of the fat cells, emulsifying (liquefying) the fat and making it easier to suct out. It is a good choice for working on more fibrous areas, like the upper back. It takes longer to do than traditional liposuction, but not longer than tumescent liposuction. There is slightly less blood loss. There appears to be slightly more risk of seromas forming (pockets of fluid) which may have to be drained with a needle. After ultrasonic liposuction, it is necessary to perform suction-assisted liposuction to remove the liquified fat.

Power-assisted liposuction uses cannula with a mechanized movement, so that the surgeon does not need to make as many manual movements. Otherwise it is similar to traditional ultrasonic liposuction.

Twin-cannula (assisted) liposuction uses a tube-within-a-tube cannula pair, so that the cannula that aspirates fat, does not impact the patients tissue or the surgeonís joints with each and every forward stroke. It allows decreased bleeding and bruising, faster recovery and reduced blood loss.

External ultrasound-assisted liposuction applies the ultrasonic energy from outside the body, through the skin, making the specialized cannula of liposuction unnecessary. It was developed because the ultrasonic method sometimes caused skin necrosis (death) and seromas (pockets of fluid from the body) It also causes less discomfort for the patient, both during the procedure and afterwards, decrease blood loss, allows better access through scar tissue and can treat larger areas.

Water-assisted liposuction uses a thin fan-shaped water beam, which loosens the structure of the fat tissue, so that it can be removed by a cannula. During the liposuction the water is continually added and almost immediately aspirated via the same cannula. It requires less infiltration solution and produces less edema from the tumescent fluid.

Sutures

Since the incisions are small and the amount of fluid that must drain out is large, some surgeons opt to leave the incisions open, the better to clear the patients body of excess fluid. They find that the unimpeded departure of that fluid allows the incisions to heal more quickly.

Others suture them only partially, leaving space for the fluid to drain out.

Others delay suturing until most of the fluid has drained out, about 1 or 2 days.

In either case, while the fluid is draining, dressings need to be changed often. After 1 to 3 days, small self-adhesive bandages are sufficient.

Liposuction and tightening / lifting skin

Liposuction is not a good tool for tightening the skin. The removal of quantities of fat from under the skin can leave the skin even more loose. When drooping skin and fat are the issue, then lifts like a facelift, breast lift, tummy tuck, thigh lift or buttock lift are better tools and may include liposuction during surgery to refine the sculpture but may have higher complication rates.

The procedure

An antibiotic will be given either about an hour beforehand or afterwards.

The targeted areas are marked on the body while the candidate is in a standing position. Sometimes photos will be taken of the area to be treated, so the patient will have before and after photos.

In the operating room, a sterilizing solution such as Betadine, is applied to the relevant areas.

Local anesthetic is injected and the patient may be given a sedative, either orally or through an IV injection.

Incisions are small, about a quarter to a third of an inch.

The patient will probably have an IV fluid line, since they will be losing fluid with the fat and the fluid balance must be kept intact.

There will be some monitoring devices attached to the body to keep track of the blood pressure, heart rate and blood oxygen level. The patient will feel only a scraping or rasping sensation from the cannula movement.

Usually the patient can get up, walk around and go home the same day if they did not receive general anesthesia, although they will need someone else to drive.

Recovery

A compression garment or bandage is worn for 2 to 4 weeks. If non-absorbable sutures are placed, they will be removed after 5 to 10 days. Any pain is controlled by a prescription or over-the-counter medication and may last as long as 2 weeks.

Swelling will subside in anywhere from 2 weeks to 2 months. Bruising will fade after a few days or maybe as long as 2 weeks. Numbness may last for several weeks.

Patients are generally able to return to work or school 2 days to 2 weeks. Normal activity can be resumed anywhere from several days to several weeks afterwards.

The final result will be evident from 1 to 6 months after surgery.

To exped recovery the patient should:
Drink enough water to prevent dehydration. Avoid using heating pads on the treated areas. Postpone soaking the wounds until they are sealed (usually 48 hours for sutured wounds and a little longer for unsutured ones). If any dizziness is experienced, the patient should take it easy: stand up slowly, get some help for the shower, remove the compression garment slowly, etc.

The suctioned fat cells are permanently gone. However, if the patient does not diet and exercise properly, the remaining fat cell neighbors could still enlarge, creating irregularities.

Side effects

Bruising can be painful in the short term, but should fade after a few weeks.

Swelling should subside gradually over a month or 2.

Scars will vary in size depending on the particular procedure and should fade over the weeks. Scarring is an individual thing, partly dependent on heredity. For some, scar healing may take as long as a year.

Pain should be temporary and controlled by either over-the-counter medication or by a prescription.

Numbness sometimes persists for a few weeks.

Limited mobility may be due to wearing a compression garment, keeping the head elevated, temporary swelling or pain.

Complications

Allergic reaction to medications or material used during surgery.

Infection in the small puncture wounds that are made for inserting the cannula.

Damage to the skin may happen as the cannula is moved in the tissue beneath the skin and may show up as a spotted appearance on the skin surface. Skin necrosis (dead skin) is a rare complication, in which the skin falls off in the necrotic area. The problem can vary in degree.

Puncture of an internal organ e.g. the intestines during abdominal liposuction, may happen because the plastic surgeon cant see the cannula. Such damage can be corrected surgically, although in rare cases it can be fatal. An experienced plastic surgeon is unlikely to puncture any internal organ.

Contour irregularities may happen because of uneven fat removal or poor skin elasticity. It makes the skin may look bumpy and/or withered. Not all patients heal in the same way. Sometimes a small touch-up procedure is necessary.

Thromboembolism and fat embolisation risk is a low, but the risk cant be ignored.

Burns happens when the cannula movement cause friction burns to skin or nerves. The heat from the ultrasound device can cause injury to the skin or deeper tissue.

Lidocaine toxicity happens when too much saline fluid is injected or the fluid may contain too high a concentration of lidocaine. Then the lidocaine may become too much for that particular persons system. Lidocaine poisoning at first causes tingling and numbness and eventually seizures, followed by unconsciousness and respiratory or cardiac arrest.

Fluid imbalance. Since fat contains a lot of fluid and is removed in liposuction and since the plastic surgeon injects fluid for the procedure, even a very large amount of it for tumescent liposuction, there is a danger of the bodys fluid balance being disturbed. This could happen afterwards, after the patient is at home. If too much fluid remains in the body, the heart, lungs and kidneys could be badly affected.

The cosmetic surgeon should give the participant a written list of symptoms to watch for, along with instructions for post-op self-care.

Cost

Liposuction surgery costs from US$ 2300 - US$ 7000.
The surgical procedure for liposuction takes 1 to 3 hours.

This page has been updated on the 2017-12-18.