Liposuction

Liposuction

Liposuction

Treatment Overview

Liposuction is the removal of fat from the body using suction. In traditional liposuction, small, thin blunt-tipped tubes (cannulas) are inserted through tiny incisions in the skin. Fat is suctioned out through the cannulas as the doctor moves the cannula around under the skin to target specific fat deposits.

In recent years, doctors who perform liposuction have improved on the traditional technique to make it safer, easier, and less painful. These newer techniques include:

Tumescent liposuction. This is considered the safest and most effective liposuction technique, with the quickest recovery time. In tumescent liposuction, a large amount of an anesthetic solution containing lidocaine and epinephrine is injected into the fatty tissue before traditional liposuction is performed. The solution makes the fat expand and become firmer, which allows the cannula to move more smoothly under the skin. It also causes the blood vessels to shrink temporarily (vasoconstriction), which greatly reduces blood loss during the procedure. With the large volume of anesthetic solution injected, tumescent liposuction rarely requires general anesthesia (which makes you sleep through the procedure) and thus does not carry some of the risks of traditional liposuction. It also reduces bruising, swelling, and pain after the procedure.
Ultrasound-assisted (ultrasonic) liposuction. This newer technique uses energy generated by ultrasound to liquefy the fat before it is removed. The cannula moves more smoothly under the skin once the fat has been liquefied, so this technique may be particularly helpful in areas where the fat is very firm or fibrous (such as the sides, the back, male breasts, and the area around the navel). It may also be used when removing large amounts of fat. Ultrasound-assisted liposuction may take 2 to 4 hours longer than traditional or tumescent liposuction.

Liposuction is usually done as an outpatient procedure in a properly equipped doctor's office, ambulatory surgery center, or hospital. In general, it does not require an overnight hospital stay unless a large volume of fat is being removed. Local anesthesia is used in most cases, and you may or may not be given a sedative to help relax. If traditional (non-tumescent) liposuction is being done, or if a large area or volume of fat is being treated, general anesthesia or deep sedation with a local anesthetic may be used.

What to Expect After Liposuction Treatment

After the procedure, the area of the body that was treated is tightly wrapped to help reduce swelling, bruising, and pain. Elastic bandages and tape, support hose (such as those used to treat varicose veins), a special girdle, or another type of tight-fitting garment may be used, depending on which part of the body was treated. You may have to wear the compression garment or wrap for a week or more.

If you have had tumescent liposuction, fluid may drain from the incision sites for several days. In some cases, you may be given antibiotics to reduce the risk of infection.

Most people are able to get up and move around as soon as the treatment is finished and the effects of the anesthesia and any sedation have worn off. You can return to normal activities as soon as it feels comfortable to do so. This may take several days to a few weeks. Most people can return to work within a few days. Recovery may take longer if you have large areas treated.

Liposuction: Why It Is Done

The main purpose of liposuction is to reshape an area (or areas) of the body, not to reduce body weight. Liposuction is typically used on "problem" areas that do not respond well to diet and exercise, such as the outer thighs and hips on women ("saddlebags") and the waist and back on men ("love handles"). The face, neck, abdomen, back, buttocks, legs, and upper arms are all commonly treated areas.

It is sometimes used in combination with other cosmetic surgery procedures, such as a tummy tuck (abdominoplasty), breast reduction, or face-lift.

Liposuction may also be used to treat certain medical conditions, including:

Benign fatty tumors (lipomas).
Abnormal enlargement of the male breasts (gynecomastia or pseudogynecomastia).
Problems with metabolism of fat in the body (lipodystrophy).
Excessive sweating in the armpit area (axillary hyperhidrosis).
Liposuction is not used to treat obesity. It will not get rid of cellulite or stretch marks.

How Well Liposuction Works

Liposuction is usually very effective at removing fat deposits in small areas.

Some improvement in body contour is usually noticeable right after surgery, but improvement may continue for several weeks (or even months) as the swelling goes away. The full effects of having liposuction may not be visible for several months to a year.

Liposuction generally does not tighten the skin over the treated area. After fat has been removed, the skin around the area may be somewhat loose. It may take up to 6 months for the skin to tighten (retract) around the treated area. Some people's skin is very elastic and retracts more quickly; other people's skin may not tighten up as quickly or as completely. Younger skin tends to have greater elasticity than older skin.

People who expect liposuction to help them lose weight are usually disappointed.

Liposuction Risks

Liposuction done by an experienced doctor in a properly equipped facility is usually safe. Having more than one area treated, or having a very large area treated, may increase the risk of complications during or after the procedure. Tumescent liposuction is considered the safest technique.

Common side effects of liposuction include:

Temporary swelling, bruising, soreness, and numbness in and around the treated areas. Tumescent liposuction minimizes these effects in comparison to traditional liposuction.
Irritation and minor scarring around the incision sites where the cannulas were inserted.
Baggy or rippling skin. The skin will usually tighten and retract after a few months. In some people, however, the skin may remain somewhat loose.

Other complications are not common, but they may include:

Permanent color changes in the skin.
Uneven skin surface over the treated area.
Infection. In some cases, antibiotics may be given before or after liposuction to help prevent infection.
Damage to the nerves and skin. The heat generated during ultrasonic liposuction may burn the skin or damage the tissue under the skin.
Excessive blood and fluid loss, leading to shock. This is extremely unlikely with the tumescent and ultrasonic techniques, because they usually result in very little blood loss.
Fat clots or blood clots, which may travel to the lungs (pulmonary embolism) and become life-threatening.
Buildup of fluid in the lungs (pulmonary edema). This is most likely to occur with tumescent liposuction, during which a large volume of fluid may be injected into the body.
Toxic reaction to the injected solution (lidocaine toxicity).
Although life-threatening complications (fluid loss leading to shock, pulmonary embolism, pulmonary edema, and lidocaine toxicity) are very rare during liposuction, some deaths have been reported.

Liposuction: What to Think About

Liposuction is not a substitute for exercise and a balanced diet if you are trying to lose weight. In fact, most cosmetic surgeons agree that the best candidates for liposuction are healthy people who are at or close to a healthy weight but who have stubborn fat deposits that do not respond to exercise. The results of liposuction can be long-lasting if you exercise regularly, eat a balanced diet, and maintain a healthy weight after the procedure. When people gain weight after having liposuction, the fatty bulges that were removed often return.

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Source: Klein AW, et al. (1999). Tumescent liposuction. In IM Freedberg et al., eds., Fitzpatrick's Dermatology in General Medicine, 5th ed., pp. 2967–2999. New York: McGraw-Hill.