Liposuction

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Liposuction

Alternative names

Fat removal - suctioning
Definition

Liposuction is the removal of excess body fat by suction using special surgical equipment. A plastic surgeon typically does the surgery.

Description

Liposuction is a popular type of cosmetic surgery. It removes unwanted deposits of excess fat, to improve body appearance and to smooth irregular or distorted body shapes. The procedure is sometimes called body contouring.

Liposuction may be useful for contouring under the chin, neck, cheeks, upper arms, breasts, abdomen, buttocks, hips, thighs, knees, calves, and ankle areas.

However, liposuction is a serious surgical procedure and may involve a painful recovery. Because liposuction can have serious or occasionally fatal complications, you should carefully think about your decision to have this surgery.

Before your surgery, you will have an initial patient consultation, which will include a history, physical exam, and a psychological evaluation. You may need to bring someone (such as your spouse) with you during the visit. You may need a second consultation to give you time to think over the surgery.

You should feel free to ask questions, and to feel satisfied with the answers to those questions. A properly informed person makes a better patient. You must understand fully the pre-operative preparations, the liposuction procedure, and the post-operative care. Understand that liposuction may enhance your appearance and self-confidence, but it will probably not give you your ideal body.

Several different liposuction procedures exist:

Tumescent liposuction (fluid injection) is the most common type of liposuction. It involves injecting a large amount of medicated solution into the areas before the fat is removed (sometimes, the solution may be up to three times the volume of fat to be removed). The fluid is a mixture of local anesthetic (lidocaine), a drug that contracts the blood vessels (epinephrine), and an intravenous (IV) salt solution. The lidocaine in the mixture helps to numb the area during and after surgery, and may be the only anesthesia needed for the procedure. The epinephrine in the solution helps reduce the loss of blood, the amount of bruising, and the amount of swelling from the surgery. The IV solution helps remove the fat more easily and it is suctioned out along with the fat. This type of liposuction generally takes longer than other types.
The super-wet technique is similar to tumescent liposuction. The difference is that not as much fluid is used during the surgery--the amount of fluid injected is equal to the amount of fat to be removed. This technique takes less time; however, it often requires sedation with an IV or general anesthesia.
Ultrasound-assisted liposuction (UAL) is a fairly new technique, used in the U.S. since 1996. During this technique, ultrasonic vibrations are used to liquefy fat cells. After the cells are liquefied, they can be vacuumed out. UAL can be done in two ways, external (above the surface of the skin with a special emitter) or internal (below the surface of the skin with a small, heated cannula). This technique may help remove fat from dense, fiber-filled (fibrous) areas of the body such as the upper back or enlarged male breast tissue. UAL is often used together with the tumescent technique, in follow-up (secondary) procedures, or for greater precision. In general, this procedure takes longer than the super-wet technique.
Before the day of surgery you may have blood drawn and be asked to provide a urine sample. This allows the health care provider to rule out potential complications. If you are not hospitalized, you will need a ride home after the surgery.

A liposuction machine and special instruments are used for this surgery. The surgical team first preps the operative site and administers either local or general anesthesia. Through a small skin incision, a suction tube with a sharp end is inserted into the fat pockets and swept through the area where fat is to be removed. The dislodged fat is "vacuumed" away through the suction tube. A vacuum pump or a large syringe provides the suction action. Several skin punctures may be needed to treat large areas.

After the fat is removed, small drainage tubes may be inserted into the defatted areas to remove blood and fluid that gather during the first few days after surgery. If you lose a lot of fluid or blood during the surgery, you may meed fluid replacement (intravenously) or a blood transfusion.

After the surgery, bandages are applied to keep pressure on the area and stop any bleeding, as well as to help maintain shape. Bandages are usually kept in place for at least 2 weeks. Your doctor may call you from time to time to check on your health and to monitor your healing. A visit back to the surgeon after 5-7 days is often recommended. Sometimes people gain weight after liposuction. This is due to the increased fluid from surgery.

Liposuction may or may not require a hospital stay, depending on the location and extent of surgery. Liposuction can be done in an office-based facility, in a surgery center on an outpatient basis, or in a hospital. For reasons of cost and convenience, liposuction of smaller volumes is usually done as an outpatient. You may need to stay in a hospital if a larger volume of fat is being removed, or if you are having other procedures done at the same time.

Indications

The following are some of the uses for liposuction:

Cosmetic reasons, including "love handles," fat bulges, or an abnormal chin line.
To improve sexual function by reducing abnormal fat deposits on the inner thighs, thus allowing easier access to the vagina.
Body shaping for people who are bothered by fatty bulges or irregularities that cannot be removed by diet and/or exercise.
Liposuction is generally NOT appropriate for these uses:

As a substitute for exercise and diet, or as a cure for general obesity. However, it may be used to remove fat from isolated areas at different points in time.
As a treatment for cellulite (the uneven, dimpled appearance of skin over hips, thighs, and buttocks).
In certain areas of the body, such as the fat on the sides of the breasts, because the breast is a common site for cancer.
Many alternatives to liposuction exist, including a tummy tuck (abdominoplasty), removal of fatty tumors (lipomas), breast reduction (reduction mammaplasty), or a combination of plastic surgery approaches.

Risks

Certain pre-existing conditions should be checked and brought under control before liposuction, including:

History of heart problems (heart attack)
High blood pressure
Diabetes
Allergic reactions to medications
Pulmonary problems (shortness of breath, air pockets in bloodstream)
Allergies (antibiotics, asthma, surgical prep)
Smoking, alcohol, or drug use
There are also risks associated with liposuction, including:

Shock (usually when not enough fluid is replaced during the surgery)
Fluid overload (usually from the procedure)
Infections (strep, staph)
Bleeding, blood clot
Tiny globules of fat in the bloodstream that block blood flow to tissue (fat embolism)
Nerve, skin, tissue, or organ damage or burns from the heat or instruments used in liposuction
Uneven fat removal (asymmetry)
Drug reactions or overdose from the lidocaine used in the procedure
Scarring (skin surface may be irregular, asymmetric, or even "baggy," especially in older people)
Finally, make sure to review and sign any informed consent (legal) and permission forms for photographs.

Expectations after surgery

Most informed patients are satisfied with the cosmetic result of their surgery. Informed patients understand that there are limits to what liposuction can accomplish.

If you are having a large amount of fat removed, or you are being put to sleep (general anesthesia) for the procedure, you should expect to be admitted to the hospital. If you are having a smaller amount of fat removed with just the area numbed (local anesthesia), you may be able to have it done on an outpatient, same-day basis, as long as the office has the proper equipment and oxygen on hand.

Convalescence

The liposuctioned area may appear larger than before surgery because of swelling. You must wear a tight stocking, girdle, or snug elastic dressing over the treated area to reduce swelling and bleeding, and to help shrink the skin to fit the new contour. You should wear this garment continuously for 2 to 3 weeks.

You will likely have swelling, bruising, numbness, and pain, but it can be managed with medications. The stitches will be removed in 5 to 10 days. Antibiotics may be prescribed to prevent infection.

You may feel sensations such as numbness or tingling, as well as pain, for weeks after the surgery. Walk as soon after surgery as possible to help prevent blood clots from forming in your legs. Avoid more strenuous exercise for about a month after the surgery.

You will start to feel better after about 1 or 2 weeks following liposuction surgery. You may return to work within a few days of the surgery. Bruising and swelling usually go away within three weeks; however, you may still have some swelling several months later.

Your doctor will check your progress through follow-up visits. If you have any questions or problems between office visits, call your doctor. Your new body shape will begin to emerge in the first couple of weeks; however, the improvement won't become more visible until about 4 to 6 weeks after surgery. By exercising regularly and eating a healthy diet, you can help maintain your new shape.





What is Liposuction?
Liposuction is a surgical procedure intended to remove fat deposits and shape the body. Fat is removed from under the skin with the use of a vacuum-suction canula (a hollow pen-like instrument) or using an ultrasonic probe that emulfsies (breaks up into small pieces) the fat and then removes it with suction.

Persons with localized fat may decide to have liposuction to remove fat from that area. Liposuction is a procedure for shaping the body and is not recommended for weight loss.

Liposuction may be performed on the abdomen, hips, thighs, calves, arms, buttocks, back, neck, or face. A liposuction procedure may include more than one site, for instance, the abdomen, back, and thighs all on the same day.

Liposuction is also used to reduce breast size in men with large breasts (gynecomastia) or to remove fat tumors (lipomas) but it is most commonly used for cosmetic body shaping.

Who Performs Liposuction & Where is Liposuction Performed?
Many liposuction surgeries are performed by plastic surgeons or by dermatologists. Any licensed physician may perform liposuction. While some physicians' professional societies may recommend training before performing liposuction surgery, no standardized training is required. As a result, there will be differences in experience and training in physicians performing liposuction. You can ask your physician to tell you whether he or she has had specialized training to do liposuction and whether they have successfully done liposuction before. But remember, even the best screened patients under the care of the best trained and experienced physicians may experience complications as a result of liposuction.

Liposuction may be performed in a

doctor's office.
surgical center.
hospital.
Because liposuction is a surgical procedure, it is important that it be performed in a clean environment. Emergencies may arise during any surgery and access to emergency medical equipment and/or a nearby hospital emergency room is important. These are things that you should ask your physician before the liposuction.

How can I find the right doctor for me?
The FDA cannot recommend physicians to you. However, there are some things that you may consider:

Ask questions. If you decide to take the step to talk to a doctor about liposuction, be sure that you ask questions and understand what happens during the liposuction procedure and what you can expect. Your physician should also answer any and all questions you have about potential problems with liposuction. Remember that you are purchasing a service when you pay a physician to do a liposuction procedure and you shouldn't feel embarrassed to ask hard questions about the procedure or about the physician's experience in performing liposuction.

Advertising. Be wary of advertisements that say or imply that you will have a perfect appearance after liposuction. Remember that advertisements are meant to sell you a product or service, not to inform you of all the potential problems with that service.
Don't base your decision simply on cost and remember that you don't have to settle for the first doctor or procedure you investigate. The decision you make about liposuction surgery is an important one but not one that you must make right away.
Read. You should learn as much as you can about liposuction. It is important for you to read the patient information that your doctor provides.
Don't be pressured. Do not feel that because you speak to a physician about this procedure that you must go through with it. Take your time to decide whether liposuction is right for you and whether you are willing to take the risks of undergoing liposuction for its benefits.
What Does the FDA Regulate?
In the United States, the Food and Drug Administration (FDA) regulates the sale of medical devices, such as the equipment (canulas, pumps, collecting containers, ultrasound probes, etc) and drugs (anesthesia) used for liposuction.

Before a medical device can be legally sold in the U.S., the person or company that wants to sell the device must seek approval from the FDA. To gain approval, they must present evidence that the device is reasonably safe and effective for a particular use, the "indication." Once a device is approved, other similar devices may be cleared by the FDA for use. This requires less information since an equivalent device has already been shown to be safe and effective. In some cases, devices that were on the market before FDA started regulating medical devices may be cleared. Once the FDA has approved or cleared a medical device, a doctor may decide to use that device for other indications if the doctor feels it is in the best interest of a patient. The use of an approved or cleared device for other than its FDA-approved indication is called "off-label use."

The FDA does not have the authority to:

Regulate a doctor's practice. In other words, FDA does not tell doctors what to do when running their business or what they can or cannot tell their patients.
Set the amount a doctor can charge for liposuction surgery.
"Insist" that patient information be provided to the potential patient.
Make recommendations for individual doctors, clinics, or liposuction centers. FDA does not maintain nor have access to lists of doctors performing liposuction.
Recommend a physician to you.
Conduct or provide a rating system on medical devices it regulates.

Liposuction or lipoplasty is performed to sculpt the body and remove unwanted localized deposits of fat from specific areas, including the abdomen, hips, buttocks, thighs, knees, upper arms, chin, cheeks and neck.

Over the years, several techniques of liposuction have evolved. Therefore, it is advisable to consult your physician to review what type of procedure would be most appropriate. Liposuction can be done under general anesthesia or under local anesthesia and mild sedation depending on the type of surgery and specific patient.

Tumescent liposuction technique:

A solution of very dilute lidocaine, a local anesthetic, and epinephrine, a capillary constrictor, is first injected into the subcutaneous fat.

The targeted tissue then becomes swollen

A tiny incision is made in an inconspicuous location on the skin.

Then a suction tube is inserted through the incision. With high-pressure vacuum, fat cells are extracted through this tube.

Super-Wet technique:

The super-wet technique is similar to the tumescent technique, except that lesser amounts of fluid are used. Usually the amount of fluid injected is equal to the amount of fat to be removed.

Ultrasound-Assisted Lipoplasty (UAL):

This technique requires the use of a special cannula that produces ultrasonic energy. As it passes through the areas of fat, the energy explodes the walls of the fat cells, liquefying the fat. The fat is then removed with the traditional liposuction technique.