Today's Liposuction

By Ron M. Shelton, MD

Published on August 01, 2006

Liposuction has evolved considerably from its origins in the early 1980s. Back then the procedure was performed in hospital operating rooms, requiring blood transfusions and a significant period of recovery. Now liposuction is a safe outpatient operation with minimal blood loss and a quick convalescence.

Current Forms of Liposuction

Tumescent Liposuction

This procedure involves the use of a large amount of a diluted local anesthetic. Patients do not require any sedation or general anesthesia. Their recovery is quick and often they can return to work and resume exercise within a few days.

Superficial Liposuction

Superficial liposuction evolved through the use of smaller cannulas – hollow, cylindrical, blunt-tipped instruments that are hooked up to an aspirator machine; they penetrate the fatty tissue and remove the fat under suction. The smaller cannulas allow the surgeon to remove the fat in a finer and more superficial (less invasive) manner, potentially providing smoother results.

Ultrasonic and Power Liposuction

These are more recent advancements. Whereas the former has fallen into disfavor, the latter has been promoted by some physicians to provide better results. Power liposuction uses a cannula that moves in a forward and back motion; it moves only a few millimeters, several times per second. This allows more fat to enter the cannula than with a conventional cannula, but with the same stroke. The rhythmic vibration felt by the patient is perceived as a distraction and helps minimize any discomfort felt during the procedure.

Who Is a Candidate for Liposuction?

Many individuals have noted that despite a healthy diet and regular exercise regimen, their weight loss stabilizes at a certain level. The last inch doesn't seem to want to come off certain portions of their thighs (the ‘saddlebags'), lower tummy, or lovehandles. And there are other areas as well. Because the fat cells present in these sites have different biochemical properties, they are greatly resistant to the calorie-burning effects of exercise. Patients who notice this are usually not more than ten pounds overweight. The majority of patients undergoing liposuction range in age from the late thirties to fifties, although younger and older patients are not excluded, provided that their medical health is good. The patient's medical history must be reviewed carefully by the surgeon, as there are several conditions that preclude the potential patient from undergoing liposuction, such as liver failure, hypertension, and diabetes. Concurrent medication and herbal supplements could affect the metabolism of the local anesthetic; therefore, the patient must disclose all medication to the doctor.

The Surgery

Once the potential patient has undergone a thorough consultation with a nurse and surgeon and preoperative lab work and medical clearance is obtained, the patient can schedule surgery.

Surgery should be performed in an accredited ambulatory surgical practice. The patient's comfort during the procedure is extremely important. A nurse's soothing personality, a warm blanket, background music – even the opportunity to watch a video or DVD during the procedure – helps ameliorate the patient's anxiety. The local anesthetic is delivered slowly to minimize discomfort. The procedure then begins with fat being removed through a few insertion areas strategically placed to lessen the number of scars.

Power liposuction is performed on occasion, in areas where fat is firmer or where there has been prior surgery. The powered liposuction cannula moves back and forth, creating a vibration that makes it glide more easily through the tougher tissue. This produces a pleasant, distracting sensation, taking the patient's mind off of the actual movement of the cannula.

Once the procedure is complete, the patient is asked to stand and the treated areas are examined. By being awake and able to stand up, the patient can show the physician (and vice-versa) any areas he or she considers questionable. Further surgery can ensue immediately, reducing the probability of secondary procedures.

As the cannula insertions sites are small, no stitches are needed. The small openings also facilitate drainage, which decreases bruising and swelling and increases the safety of the procedure.

The patient wears a compressive garment that provides comfort during the initial postoperative period. This garment may also improve the retraction and final contour of the skin. Patients are allowed to go home the same day and are encouraged to walk around in their home – not to be sedentary or to place themselves on bed rest. Activity will increase drainage, improve blood flow, and help one to heal more quickly. Patients are able to resume their exercise regimen as early as two days after surgery.

Ron M. Shelton, M.D., is Co-Director at The New York Aesthetic Center, LLP.