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How Does Liposuction Work and What Are the Risks?

Liposuction, also known as lipoplasty or body contouring, is a popular surgical cosmetic procedure that uses suctioning to remove excess fat from various regions of the body. Both men and women can have liposuction performed to improve their physical appearance.

However, the areas to be suctioned typically vary according to gender. In women, common liposuction sites include the area below the chin and the breasts. Women also commonly have liposuction performed on the thighs, hips, underarms and abdomen. Men usually opt to have the waist and flank area suctioned. Excess fat in the cheeks, neck, knees, calves, ankles, upper arms, back and buttocks may also be removed with liposuction. Liposuction can be performed on multiple areas of the body at the same time and it may also be used in conjunction with other plastic surgery procedures, though this is often not recommended.

When Is Liposuction Used

Liposuction is not a weight loss substitute. It is intended to remove localized fat deposits that have been unresponsive to diet and exercise. It is not suitable for some individuals, including those with blood clotting or bleeding disorders, poor wound healing, excessive surgeries in or around the region to be treated or an anesthetic drug allergy. Good candidates for this procedure must be generally healthy and have normal body weight or be no more than thirty pounds overweight, they must have firm, elastic skin and pockets of surplus fat concentrated in certain regions.

Patients also need to have realistic expectations about the procedure. Although liposuction can greatly enhance their physical appearance, it probably will not give them their ideal body. Liposuction also cannot remove unwanted cellulite.

Although older patients with reduced skin elasticity may be considered appropriate candidates for this procedure, they may not experience the same results as younger patients with tighter skin. Often a procedure to tighten lax skin is more appropriate or even required in combination with liposuction.

Liposuction may also be used for certain non-cosmetic conditions associated with the accumulation of excess fat in the body such as excessive sweating (hyperhidrosis) and fatty, benign tumors called lipomas. It may also be used to treat breasts enlargement in men (gynecomastia).

It usually takes one to two months after the procedure to register improvement in physical appearance. However, it may take up to six months after the procedure before results are complete in some sensitive treatment areas, like the chin. The decision to undergo liposuction should be carefully considered. Like any other surgical procedure, liposuction poses a risk of rare but serious complications and recovery may be painful.

Types of Liposuction

The tumescent technique happens to be the most common method of liposuction. This procedure involves the injection of a large amount of solution into a fatty region. The solution consists of a local anesthetic to numb the region during and after liposuction and epinephrine to reduce blood loss, bruising and swelling that accompanies liposuction as well as salt solution to make fat removal easier.

Following the injection, the surgeon will make one or more small incisions in the skin and insert a tube called cannula attached to a vacuum into the fat mass. The vacuum device suctions out the excess fat. Tumescent liposuction normally takes longer than other liposuction methods but results in lesser bleeding and bruising and fewer skin irregularities. It also has a quicker healing time.

A newer method of tumescent liposuction, known as power-assisted or powered tumescent liposuction, involves a motorized cannula, which moves back and forth in short strokes at 800 to 10,000 repetitions per minute for increased precision, reduced bruising and an faster recovery time.

The super-wet technique is a variation of the tumescent procedure. The difference is that a smaller amount of the solution must be injected into a fatty region. The amount of solution injected equals the amount of fat to be removed. The super-wet technique is less time consuming than the tumescent technique but it often requires intravenous sedation or general anesthesia, which increases the risk of possible complications.

Another liposuction procedure is ultrasound-assisted lipoplasty. Ultrasound-assisted lipoplasty uses a special tube that generates ultrasound energy to break down fat cell walls. This turns the fat cells into liquid, which is then suctioned from the body. Ultrasound-assisted lipoplasty can be performed above the skin’s surface using a special emitter (externally) or beneath the skin’s surface using a small, flexible, heated tube (internally). Ultrasound-assisted lipoplasty is not practiced by all plastic surgeons but may be useful for removing fat from areas of the body that are dense and fibrous. It may be combined with the tumescent technique for enhanced precision or follow-up procedures. Ultrasound-assisted lipoplasty is generally more time consuming than the super-wet technique.

Getting Ready for Liposuction

Patients considering liposuction will first meet with a plastic surgeon for an initial consultation. A dermatologist certified and trained in liposuction may also be consulted. During this meeting, the surgeon should evaluate the areas of the body to be suctioned. Initial photographs of the patient may be obtained at this time and the patient will usually have an opportunity to view results from previous surgeries performed on other patients. In addition, the patient may be shown a computer-generated image that illustrates how the procedure will likely change their appearance.

During the initial consultation, the surgeon should explain the procedure and any associated risks. Alternative treatment options, such as changes in diet, abdominoplasty and reduction mammoplasty, will also be discussed. Patients who decide to have liposuction will be later (approximately two weeks before the procedure) asked to detail their complete medical history, including medications they currently use. The collection of a thorough medical history is essential because there are a number of conditions and medications that can affect wound healing and blood clotting. Patients will also undergo a psychological and physical examination, including blood tests and urine tests. Depending on the patient’s medical history and the results of the physical exam, additional tests may be ordered. Prior to the liposuction procedure, patients may be instructed to take or refrain from using certain medications.

Liposuction Procedure

Liposuction can be performed in a plastic surgeon’s room, an outpatient surgery center or a hospital. It is typically an outpatient procedure. However, patients having a large quantity of fat removed or receiving general anesthesia may require short hospitalization.

The plastic surgeon will mark the areas of the body to be suctioned and the surgical team will give you either local or general anesthesia, depending of the type of liposuction being performed. The anesthesia will be accompanied by other fluids, which reduce bleeding as well as swelling and stiffening, making fat removal easier. After the patient is anesthetized, one or more small incisions will be made in the skin near the area to be treated. The surgeon will then insert a cannula, which is connected to a vacuum-like machine, through the incisions and into the fat pockets. He/she will use back-and-forth movements to dislodge the excess fat, which is suctioned through the cannula into a sanitary collection system. In powered liposuction a motorized cannula will be employed.

After the surgeon removes the appropriate amount of fat, small tubes will be inserted into the suctioned areas to drain any blood and excess fluid from the body. Places where the cannula was inserted are often left open because suturing may result in a greater likelihood of swelling and bruising. Cannula insertion sites may need to be treated with antibiotic ointment and dressings.

In some instances, ultrasound-assisted lipoplasty may be used. This procedure can be performed externally or internally. With external ultrasound-assisted lipoplasty, an ultrasonic probe is passed over the region to be treated to loosen or liquefy the fat. With internal ultrasound-assisted lipoplasty, the tip of the cannula or probe employs ultrasonic vibration in order to liquefy fat before suctioning occurs. Although this simplifies the liposuction, studies indicate an increased potential for burns and seromas and many surgeons say that the cannula used in ultrasound-assisted lipoplasty is more difficult to use than a manual cannula.

After the Liposuction Procedure

After the liposuction procedure cannula insertion sites may be treated with antibiotic ointment and by applying dressings to the treated areas. The patient will also be given an elastic compression bandage or garment to wear for about one month after the procedure to help drainage and minimize bruising.

Swelling, numbness, bruising and tingling are normal after the procedure. Tumescent liposuction patients may experience mild pain after the anesthetic wears off, which can often be relieved with an over-the-counter painkiller. Non-tumescent liposuction patients will, however, often require stronger prescription medications. Antibiotics may also be prescribed in some cases to reduce a risk of infection.

Liposuction patients typically experience postoperative drainage for up to 48 hours after the procedure. Dizziness may also occur, especially when the patient removes the garment or uses the restroom for the first time after the surgery. Patients can normally return to work within approximately 48 hours of the procedure but this varies according to the extent of liposuction performed and type of their work. More strenuous activity should be avoided for about one month.

If cannula sites were sutured, the stitches will typically be removed five to ten days after the procedure. Swelling and bruising usually subsides within three weeks of liposuction. However, residual swelling can continue for several months. Individuals who gain weight after the procedure may see fat return to the area that was treated.

Potential Risks of Liposuction

Side effects and complications of liposuction are rare, especially when tumescent liposuction is performed under local anesthesia. However, the use of general anesthesia poses greater risks, including thrombophlebitis, pulmonary embolism and respiratory failure. Procedures that remove a large amount of fat and a procedure called ultrasound-assisted lipoplasty are associated with greater risk of side effects.

Other risks associated with liposuction may include asymmetry and other irregularities of the skin, excess fluid, infections, bleeding, blood clots, fat embolism, skin, tissue and nerve damage, skin necrosis, scarring and adverse reactions to the local anaesthetic drug. It should be noted here that the risk of complications naturally increases when liposuction is performed on a larger surface.

Where to Find More Information:
American Board of Cosmetic Surgery