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Liposuction (Lipoplasty)

Getting rid of excess fat can be a daunting task, and sometimes diet and exercise won't cut it. In order to gain a more perfect form, many people utilize liposuction - one of the most popular plastic surgery techniques for the last 30 years. Often used with other plastic surgery techniques, liposuction removes pockets of fat from troublesome areas such as the thighs, abdomen, and upper arms.

There are several different aspects to the liposuction procedure, including results, costs, and alternative treatments, and information about each can help inform someone who is considering this effective and popular treatment.

Here we cover some of the most basic parts of liposuction, but you are invited to explore and learn more about liposuction in greater detail within each section that follows.

Procedure

Liposuction is a procedure in which fatty tissue is removed from a specific area of the body. Generally, people with a stable body weight choose to have liposuction surgery to target pockets of fat that persist in spite of changes in diet and exercise. Liposuction can be performed under local or general anesthesia, depending on how many areas are being treated, and takes place either in a doctor’s office or surgical facility.

Anesthesia

The liposuction procedure can be performed using local or general anesthesia. The term anesthesia simply means “without pain,” and the difference between local and general anesthesia is how much of the process you will be aware of. In most liposuction techniques, the process itself involves the injection of a numbing solution. With local anesthesia, your doctor will only numb the area of your body being targeted, and you will be conscious during the entire liposuction surgery. General anesthesia can be administered either as a gas or through a needle injection, and will put you to sleep for the duration of the operation. Once you awaken, you will still be numb in the area of the body that has been treated, and will feel little or no pain.

The Liposuction Procedure

The concept of liposuction surgery may seem simple - the fat is vacuumed out, and you’re good to go – but it is actually a complex process just like any other surgery. A skilled physician will be well trained in all aspects of the liposuction procedure, and will be able to explain the process to you in as much detail as you wish. Following is a basic outline of liposuction surgery:

Creating the Incisions

After administering anesthesia and, in some cases, injecting fluids, the next step in liposuction surgery is to create tiny incisions in the area of the body where fat deposits will be removed. These incisions are usually quite small, ranging from a quarter to a third of an inch.

Fat Removal

Next, your surgeon will insert a thin vacuum tube, called a cannula, through the incision and into the deep fat layer. Your surgeon will move the cannula back and forth to break up the fat cells, and, with the help of an attached syringe or vacuum pump, suction them out. Because a significant amount of blood and other bodily fluids are removed along with the fat, patients receive replacement fluids intravenously during and after the liposuction procedure.

Closing the Incisions

Depending on the preference of your physician, your incisions can either be closed with a few stitches or left open. Some doctors prefer to keep the incisions open to reduce the amount of bruising and swelling that can take place after liposuction surgery.

Visit the DocShop gallery to view liposuction before and after photos.

Photo credit: Dr. Dina Eliopoulos

Variations in Liposuction Surgery Techniques

Because there are a number of different types of liposuction surgery that are currently in use, the procedure will vary based on technique:

  • In tumescent liposuction, a large amount of fluid (a mixture of salt solution, lidocaine, and epinephrine) is injected into the area to be treated. The amount of fluid is usually measured at three times that of the fat being removed. This provides local anesthetic, prevents fluid and blood loss, and makes fat removal easier.
  • Super-wet liposuction is a variation of the tumescent technique that uses less fluid injection. The amount of fluid is usually equal to the amount of fat being removed. General anesthetic is required for this type of liposuction.
  • In ultrasound-assisted liposuction (UAL), a special, ultrasonic cannula is used to liquefy the fat cells and remove them without the traditional suctioning. This technique is usually used as a secondary procedure when more precision is required.
  • Power assisted liposuction (PAL) uses a high-powered cannula that moves back and forth about 5,000 times per minute. This variation allows for the gentler removal of fat cells, resulting in less pain during surgery and less bruising afterward.
  • LipoSelection® is similar to UAL, using ultrasound waves to break up and emulsify fatty tissue. This technique allows for minimal disturbance of surrounding tissues.
  • Laser liposuction techniques such as Smartlipo™, SlimLipo™, and CoolLipo™ use laser energy to liquify fat before it is removed from the body.

Immediately Following Surgery

After liposuction surgery, there is always some amount of fluid left beneath the skin. If the incisions are stitched shut, the fluid drains less easily and can lead to bruising or swelling. However, if this method is used, you will need to wear an elastic compression garment (which resembles a girdle) to force the blood vessels into absorbing excess fluid. The current “open drainage” technique allows the incisions to stay open after liposuction surgery, and the fluid continues to drain from the area for several days. You will also wear a compression garment during this time to encourage proper draining and to protect your clothing from residual blood and fluid.

Treatable Areas of the Face and Body

Liposuction is not intended to be used strictly for weight loss. Rather, liposuction is most effective and beneficial when used to contour a patient’s overall figure by removing pockets of fat in specific areas that are resistant to diet and exercise. Liposuction can be very useful when performed on localized areas of the abdomen, flanks, hips, thigh area, buttocks, arms, and breasts.

Liposuction of the Abdomen

Liposuction is very effective for shaping the abdominal area in men and women. The lower abdomen in particular tends to be resistant to diet and exercise, making even the most fit and active individuals insecure about their appearance. Pregnancy and cesarean births can have a disfiguring effect on the lower abdomen, which diet and exercise cannot correct. Most abdominal fat is located directly beneath the skin (subcutaneous), and can easily be removed through liposuction procedures. However, fat that is located deep in the abdomen (between the intestines) cannot be removed with liposuction because of the increased risk of severe complications. Abdominal liposuction may be performed with a tummy tuck.

Liposuction of the Flanks

Male flanks are located just above the belt line on the sides and back. Liposuction can greatly improve the appearance of flanks and reduce the amount of fat that bulges over the belt. Liposuction in females addresses the flanks that are located just under the bra line on the sides and back.

Liposuction of the flanks should be done under local anesthetic, so that the patient can roll over and allow the surgeon access to the back of the flanks. It is dangerous to roll a patient who is under general anesthesia because the movement can interfere with the placement of the breathing tube. Liposuction of the flanks may be performed with a body lift.

Liposuction of the Hips

Liposuction of the hips is generally successful in creating a more contoured figure. This type of liposuction is usually performed on female hips as men are not as susceptible to retaining fat deposits in this area. Patients who undergo liposuction to improve the appearance of the hips may require additional procedures to attain the desired contour. The procedure is usually performed under general anesthesia. Liposuction of the hips may be performed with an extended tummy tuck.

Liposuction of the Thighs

Liposuction of the entire thigh (circumferential liposuction) is not recommended due to an increase in swelling and lengthened recovery time. Liposuction of the thighs should be performed in a series of surgeries spaced about one month apart. Focusing the liposuction on one targeted area of the hips allows the lymphatic tissue to drain excess fluids quickly and evenly throughout the thigh, yielding more desirable results in a shorter amount of time. Liposuction of the thighs may be performed with thigh lift surgery.

Liposuction of the Buttocks

It is important to remember when considering liposuction that shaping the buttocks is more important than reducing the size. Excess removal of fatty tissue in the buttocks can result in an asymmetrical, lumpy, or sagging appearance. The buttocks serve the functional purpose of acting as a soft cushion on which to sit, and are also important in the overall aesthetic appearance of the body. Surgeons should approach liposuction of the buttocks with the subtle touch of an artist, and should always use a micro-cannula, not more than three millimeters (1/8 inch) in diameter.

Liposuction of the Arms

Liposuction of the arms has a high rate of patient satisfaction. Liposuction of the arms yields a slimmer appearance that can give the rest of the body a more contoured look. Liposuction of the arms may be performed with arm lift surgery.

Visit the DocShop gallery to view liposuction before and after photos.

Photo credit: Aesthetic Day Surgery

Liposuction of the Breasts

Enlarged breasts in women can cause back pain, neck pain, headaches, and poor self esteem. Liposuction is a more effective and less invasive method of breast reduction than other forms of breast reduction surgery. Using liposuction to remove excess fat has a natural lifting effect on the breast because it results in less volume weighing it down.

Liposuction of Male Breasts

Liposuction can also be used as a form of breast reduction in men, but several important factors must be considered first. The surgeon must determine whether the excess tissue in the breast is fatty or glandular. If the breast is primarily fatty tissue, then liposuction is an excellent method for reducing the size and improving the appearance of the chest.

If a man’s breasts are enlarged with glandular tissue, liposuction is not an option and other hormonal or medication therapies should be pursued. If the breasts are asymmetrical or oddly shaped, the patient should be examined for possible tumors prior to any surgical intervention. A mammogram is the most effective method for detecting tumors and the possible presence of male breast cancer. After proper testing has been conducted, a physician can help you determine the best course of action.

Face, Neck, and Chin Liposuction

Facial liposuction removes fatty deposits from specific areas of the face such as the chin, neck, and jowls. Facial liposuction rids patients of these excess fat deposits that make them look and feel older. A safe procedure with dramatic results, facial liposuction has helped thousands of people look and feel younger and more attractive.

Facial liposuction is most often performed with a micro-cannula using a tumescent technique that involves injecting fluid into the targeted area while suctioning the fat out. In some cases, liposuction of the chin, neck, and jowls, as well as other facial liposuction procedures, can have better results in these problem areas than other surgical techniques. Facial liposuction can also be more desirable because it minimizes scarring when compared to other surgical techniques. Facial liposuction is usually performed on or below the chin and jaw line to reduce the appearance of sagging skin in the neck, a double-chin, or hanging jowls.

Manual Liposuction Types

Within the different regions listed above, there are several different manual techniques that a surgeon can use to eliminate fat:

Traditional Liposuction

Liposuction traditionally involves taking a thin steel tube (called a cannula) connected to a powerful suction pump and removing extra fat by inserting it through an incision. Once inserted, the plastic surgeon helps break up the fat by manipulating the cannula and injecting fluid into the area (although amounts vary by surgeon's preference).

This is the most common type of liposuction and is very effective in taking out fat, although it does carry some risks. Still, an American Society for Aesthetic Plastic Surgery survey published in the February 2011 issue of Aesthetic Surgery Journal shows that with all the different liposuction types available, over half of America's plastic surgeons prefer traditional liposuction.  

Ultrasonic Liposuction

This popular liposuction type uses a specialized cannula that emits ultrasonic sound waves into the fat deposits to liquify fat and make it easier to remove. By using ultrasound, larger and denser fat deposits can be removed and skin will be tighter, but there is a greater risk of burns and scarring due to the heat the ultrasounds create.

LipoSelection®

This is a particular type of ultrasonic liposuction, developed by VASER®, where the fat tissue is emulsified with ultrasound prior to removal and is then broken up even further with the LipoSelection® probe. The fat is then easily taken out with liposuction tubes, leaving the surrounding blood vessels, nerves and other tissue virtually unharmed. This technique has less pain and bruising than most other types of liposuction, but is somewhat more expensive.

Tumescent Liposuction

Tumescent liposuction involves injections of solution in large amounts into the targeted area. The solution is a special cocktail of pain killer, fat enlarger, and blood-vessel shrinker; helping ease pain without general anesthesia, suction out fat, and reduce bleeding. Any risks lie within how much of the solution is injected, and how much lidocaine is utilized within it.

Power Assisted Liposuction

By employing a cannula that has a vibrating tip in power assisted liposuction, surgeons are able to break up fat cells for easier removal. It also allows for more fat to be removed, smaller incisions, reduced recovery time, and a safer procedure since the cannula can be moved with smaller, more exact movements. In short, a technique that pulls out more fat with less bruising and smaller scars. Still, like all liposuction techniques, skin can be left more loose and wrinkled than desired.

Laser Liposuction Types

These types of liposuction incorporate lasers to loosen the fat cells and make them easier for removal, although they are typically more expensive than manual liposuction techniques:

CoolLipoTM

This is a minimally invasive technique that is designed for sensitive areas like the neck, jowls, arms and underneath the chin. CoolLipoTM also tightens skin with minimal bruising and utilizes only local anesthetic.

SlimLipo™

By applying a laser through small incisions, SlimLipo™ melts the fat before it is removed, reducing the trauma associated with normal liposuction - patients have even been known to go to work the day after the procedure.

SmartLipoTM

This technique creates minimal scarring and is considered a technique used for fine tuning, removing only up to eight pounds of fat at a time.

Visit the DocShop gallery to view liposuction before and after photos.

Photo credit: Dr. Dina Eliopoulos

Body vs. Facial Liposuction

Although it can be used to eliminate fat, liposuction is usually most beneficial when it is used to contour the body. By strategically removing deposits of excess fat that exercise and diet have a hard time affecting, a surgeon can model a person's frame into a more attractive figure. This liposuction type can remove fat and enhance the look of the abdomen, hips, thighs, and buttocks, arms, tummy and breasts.

Facial liposuction is a type of liposuction that specifically sculpts the neck, chin and jowls, and is a good cosmetic accompaniment to face lifts and neck lifts. By using a micro-cannula and the tumescent technique, a surgeon can reduce the appearance of double-chins and drooping skin with minimal scarring.

Candidacy

When looking to see if liposuction may be the right choice, people must consider whether or not they can even be considered a candidate for liposuction.

The best candidate is someone who is in excellent health, is within 25 pounds of his or her ideal body weight, and has deposits of fat that have not responded to diet or exercise. This goes for both men and women, and any adults older than 18 that can meet the necessary health requirements.

Any candidates should make sure they have realistic expectations of the results that can be achieved through the procedure and should be in good physical and mental health.

General Requirements for Liposuction Surgery

  • Patients should be at least 18 years old.
  • Pregnant or lactating women cannot have liposuction.
  • Men can utilize liposuction as well.
  • Individuals with certain health problems may not be good candidates for liposuction.
  • Anyone who is taking blood-thinning medication such as aspirin, ibuprofen, or any non-steroidal anti-inflammatory must discontinue use of the medication before and after surgery.
  • Lidocaine anesthesia is used in liposuction, and those with lidocaine allergies will be unable to undergo the procedure.

Teens and Liposuction

There have been cases of children as young as 12 undergoing liposuction. While this is uncommon, the American Society of Plastic Surgeons (ASPS) reports that 3,179 teens between the ages of 13 and 19 underwent liposuction in the United States in 2009. The majority of these patients choose to have one problem area contoured to help with self-esteem issues. Some teens are affected by excess fat under the chin, in the calves, hips, or other areas, and it can be a source of embarrassment and ridicule among peers. In these cases, liposuction can eliminate the extra fat and produce a more sculpted, toned appearance.

Adults

While there are no age limits for patients that can undergo liposuction, there are risks associated with any type of surgery and patients should be in good health and have good skin tone in order to safely undergo the procedure. Patients that suffer from certain medical conditions or take certain medications are not good candidates for surgery. Consult with your primary care physician and plastic surgeon to find out if you are an appropriate candidate for surgery.

According to ASPS 2009 Plastic Surgery Statistics, the majority of patients that undergo liposuction are age 30 to 54.

  • 20-29: 30,023
  • 30-39: 64,578
  • 40-54: 79,231
  • 55+: 21,240

Realistic Expectations

Liposuction should not be expected to help you lose a substantial amount of weight, nor can it eliminate stretch marks and cellulite from the skin. Liposuction can only remove small, localized concentrations of fat. In most cases, 10 pounds of fat or less will be removed from the treated area. If you expect liposuction to dramatically change your appearance, you will probably be disappointed. The ideal liposuction candidate is already at a healthy weight, but is interested in subtle body recontouring.
Because liposuction removes fat but does not tighten skin, patients with good skin elasticity will experience the most aesthetically pleasing results. Older patients typically have less elastic skin than younger patients.

Visit the DocShop gallery to view liposuction before and after photos.

Photo credit: Aesthetic Day Surgery

Medical Problems

Prevailing health conditions may prevent you from being a good liposuction candidate. Chronic ailments like heart and lung diseases, diabetes, and high blood pressure could cause a less-than-desired aesthetic result. Therefore, those that suffer from these diseases are advised against undergoing liposuction.
It is also important to remember that patients who are immuno-compromised or suffer from diabetes, poor blood circulation, or heart or lung disease should not undergo liposuction. If you have recently undergone other surgery in the area you would like to treat, you should wait until the area has healed before considering liposuction.

Preparing for Liposuction Surgery

Though liposuction has become a common procedure for anyone wishing to eliminate stubborn deposits of fat that seem oblivious to diet or exercise, it is important to remember that liposuction is still surgery. Prospective patients can eliminate much of the anxiety associated with surgery by learning the basics of the process beforehand. This page serves as a primer for the procedure, providing information on what to expect and how to prepare for liposuction.

Schedule a Consultation with a Liposuction Surgeon

To prepare for liposuction surgery, your doctor will require you to meet for an in-depth planning session. During the meeting, you will discuss the entire procedure, its risks and side effects, and all steps you need to take prior to the operation. Your doctor will give you details about the kind of anesthesia he or she will use, the type of facility where the liposuction procedure will take place, the costs involved, and any medications or supplies you will need to pick up beforehand.

You and your doctor will also discuss your medical history and lifestyle to determine your risk during liposuction surgery. You will be asked about the drugs you are currently taking (prescription, over the counter, recreational, or herbal supplements), whether or not you smoke or take oral contraceptives, and any medical conditions you may have. It is crucial that you are honest with your doctor about any drugs you are taking, as this can greatly affect the outcome of your surgery.

Remember: this is your opportunity to ask any lingering questions you may have, or to express your anxieties or concerns about liposuction.

Two Weeks Prior to Liposuction Surgery

Two weeks prior to your liposuction surgery you should stop taking all forms of aspirin, as well as any medication and vitamins that could interfere with your blood’s clotting ability. If you smoke, you should attempt to stop for at least two weeks before liposuction.

The Day before the Liposuction Procedure

Be sure to properly prepare for liposuction surgery by packing loose and comfortable clothing, getting adequate sleep the night before, and arranging a ride home.

The Day of Liposuction Surgery

When you arrive for liposuction surgery, you will be asked to sign a consent form that ensures your understanding of the risks, benefits, possible outcomes, and all liposuction alternatives prior to the procedure.

Although the methods required to prepare for liposuction can vary doctor to doctor, your physician will likely draw on your skin to mark the areas to be treated, take a “before” picture to compare with your results after liposuction, and provide you with a dressing gown to change into before surgery.

If you are undergoing general anesthesia, you will be required not to eat or drink anything for at least six hours before surgery (this prevents you from developing an upset stomach while under anesthesia).

Visit the DocShop gallery to view liposuction before and after photos.

Photo credit: Atlantic Plastic Surgery Center

Benefits

Liposuction is one of the most popular plastic surgery procedures because it offers safe, effective fat and cellulite removal and can easily be combined with other cosmetic surgery techniques. Some of the main liposuction benefits include improved health associated with fat loss, improved overall appearance, and the reduction in the appearance of cellulite.

Improved Health

Fat removal, whether through dieting or plastic surgery such as liposuction, can have beneficial effects on your overall health and well-being. Most doctors agree that weight loss is the best way to reduce your risk of heart disease, diabetes, and even certain types of cancer. Although liposuction cannot be used to remove large quantities of fat, it can be used for removal of stubborn pockets of fat of 10 pounds or less that resist dieting and exercise.

Liposuction also benefits those in need of breast reduction. This type of breast surgery is often used when disproportionately large breasts cause health problems such as back pain, neck pain, and headaches, including migraines.

Improved Appearance

Problem areas that are resistant to diet and exercise can often be dramatically improved through liposuction. The body smoothing and contouring available with liposuction can make an individual look and feel better by simple virtue of the fact that their clothes fit better. Plastic surgery patients who undergo liposuction may even find unexpected benefits of the procedure as they begin to partake in activities that they had previously shied away from because they were unhappy with their appearance.

Fat Removal

Every cell in the body has a specific function that is vital to the body’s overall health and well-being. Fat cells are designed to store any unused energy from the food we eat. The body uses fat for insulation, shock absorption, and an emergency source of fuel.

The specific body areas where fat is stored depend on your body type, which is largely determined by genetics. Liposuction is an effective fat removal treatment and can help eliminate unwanted pockets of fat that accumulate disproportionately in various areas of the body, contributing to a more desirable overall appearance.

Visit the DocShop gallery to view liposuction before and after photos.

Photo credit: Dr. Dina Eliopoulos

Cellulite Removal

Cellulite is caused by fat cells pushing through the collagen connective tissue directly beneath the skin’s surface, causing a dimpled appearance. The appearance of cellulite is not related to the amount of body fat an individual has and is prevalent even in healthy and underweight people. Cellulite is more common in women because men have a tighter collagen mesh pattern beneath their skin. Liposuction can help aid cellulite removal in both men and women, but it is important to remember that there is no permanent "cure" for cellulite. The success of cellulite removal is dependent on many factors, including genetics. Because of this, liposuction should not be expected to eliminate cellulite from the body.

Results

Full liposuction results will be visible several months after surgery. Liposuction is designed to improve the shape of your body and is not an effective cosmetic surgery option for significant weight loss. Small pockets of fat unresponsive to exercise, however, can be effectively treated.

Initial Liposuction Results

Immediately after liposuction, the patient will see the results of surgery. Usually, up to 10 pounds of fat can be removed, resulting in a noticeably more pleasing body contour. Liposuction can remove stubborn fat deposits from small areas for an aesthetic improvement, but should not be expected to dramatically alter your overall weight or appearance.

Initial liposuction results may seem minimal. This is standard, as swelling and bruising add to the recovery time that is necessary after liposuction to see the desired results. Most physicians will ask the patient to wear a compression garment to aid in recovery. This will help reduce the long-term effects of post-liposuction swelling, bruising, and scarring.

How Long Does It Take to See Optimal Results?

Side effects such as swelling can last for weeks and often months after liposuction, obscuring the results of surgery. Skin in the treated area may also appear loose, as it takes time for your body to adjust to its new, slender shape. It may take one to three months for swelling and bruising to subside and up to six months for skin to tighten over the area from which fat has been removed. The finished liposuction results should be visible after six months. It is important to remember that liposuction benefits are not exclusively aesthetic; indeed, liposuction can be the first step toward a healthier, more active lifestyle for the patient. Many patients begin strict diet and exercise regimes to maintain results after liposuction.

Visit the DocShop gallery to view liposuction before and after photos.

Photo credit: Aesthetic Day Surgery

Liposuction Scars

Many patients are concerned with liposuction and the amount of scarring that will be apparent after healing. With the new, less invasive techniques in liposuction, scars can be minimized and hidden in parts of the body where they will not be noticeable. Scars from liposuction are typically much smaller than with other cosmetic surgeries. Usually, liposuction scars are no longer than a quarter of an inch in length. This is because an incision will be only made large enough for the cannula to be inserted. The scars will begin to fade in the weeks following surgery. It is a good idea to discuss your concerns regarding liposuction scars and bruising during your initial consultation with your physician. Although these are minor concerns in the scheme of the surgery, they are still aesthetically important and should be addressed. Patients should fully understand post-liposuction side effects, including bruises and swelling, before undergoing the procedure.

Cost

The cost of the procedure can vary greatly depending on the type you chose, the area(s) of the body you want to target, and your surgeon. Generally, liposuction procedures run anywhere from $1,500 to $7,500, your total cost depending on the number of treatments you undergo.

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