Liposuction

Liposuction is a type of cosmetic surgery. It removes unwanted excess fat to improve body appearance and to smooth irregular 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.

Liposuction is a surgical procedure with risks, and it may involve a painful recovery. Liposuction can have serious or rare fatal complications. So, you should carefully think about your decision to have this surgery.

TYPES OF LIPOSUCTION PROCEDURES

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 amount of fat to be removed). The fluid is a mixture of local anesthetic (lidocaine), a medicine that contracts the blood vessels (epinephrine), and an intravenous (IV) salt solution. Lidocaine helps numb the area during and after surgery. It may be the only anesthesia needed for the procedure. Epinephrine in the solution helps reduce loss of blood, bruising, and swelling. The IV solution helps remove the fat more easily. It is suctioned out along with the fat. This type of liposuction generally takes longer than other types.

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. But it often requires sedation (medicine that makes you drowsy) or general anesthesia (medicine that allows you to be asleep and pain-free).

Ultrasound-assisted liposuction (UAL) uses ultrasonic vibrations to turn fat cells into liquid. Afterward, the cells 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.

Laser-assisted liposuction (LAL) uses laser energy to liquefy fat cells. After the cells are liquefied, they can be vacuumed out or allowed to drain out through small tubes. Because the tube (cannula) used during LAL is smaller than the ones used in traditional liposuction, surgeons prefer using LAL for confined areas. These areas include the chin, jowls, and face. A possible advantage of LAL over other liposuction methods is that energy from the laser stimulates collagen production. This may help prevent skin sag after liposuction. Collagen is the fiber-like protein that helps maintain skin structure.

HOW THE PROCEDURE IS DONE

• A liposuction machine and special instruments called cannulas are used for this surgery.
• The surgical team prepares the areas of your body that will be treated.
• You will receive either local or general anesthesia.
• Through a small skin incision, the tumescent fluid is injected under your skin in the areas that will be worked on.
• After the medicine in the solution takes effect, 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. The surgeon may approach the areas to be treated from different directions to get the best contour. Sometimes the removed fat is processed and injected back into other body areas.
• After the fat is removed, small drainage tubes may be inserted into the defatted areas to remove blood and fluid that collects during the first few days after surgery.
• If you lose a lot of fluid or blood during the surgery, you may need fluid replacement (intravenously). In very rare, cases, a blood transfusion is needed.
• A compression garment will be placed on you. Wear it as instructed by your surgeon.

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 not used:

• As a substitute for exercise and diet, or as a cure for general obesity. But 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) or excess skin.
• 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. Your surgeon can discuss these with you.

Certain medical conditions should be checked and be under control before liposuction, including:

• History of heart problems (heart attack)
• High blood pressure
• Diabetes
• Allergic reactions to medicines
• Lung problems (shortness of breath, air pockets in bloodstream)
• Allergies (antibiotics, asthma, surgical prep)
• Smoking, tobacco, alcohol, or drug use

Risks associated with liposuction include:

• 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)
• Dents or dimples in your skin or contouring problems
• Medicine reactions or overdose from the lidocaine used in the procedure
• Scarring or irregular, asymmetric, or even "baggy," skin, especially in older people

Before your surgery, you will have a consultation with your surgeon. This 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 to help you remember what your surgeon discusses with you.

Feel free to ask questions. Be sure you understand the answers to your questions. 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 shape.

Before the day of surgery, you may have blood drawn and be asked to provide a urine sample. This allows your surgeon to look for conditions that may cause complications. If you are not hospitalized, you will need a ride home after the 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.

After the surgery, bandages and a compression garment are applied to keep pressure on the area and stop any bleeding, as well as to help maintain shape. Bandages are kept in place for at least 2 weeks. You will likely need the compression garment for several weeks. Follow your surgeon's instructions on how long it needs to be worn.

You will likely have swelling, bruising, numbness, and pain, but it can be managed with medicines. 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 as possible after surgery 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. You may return to work within a few days of the surgery. Bruising and swelling usually go away within 3 weeks, but you may still have some swelling several months later.

Your surgeon may call you from time to time to monitor your healing. A follow-up visit with your surgeon will be needed.

Most people are satisfied with the results of the surgery.

Your new body shape will begin to emerge in the first couple of weeks. Improvement will be more visible 4 to 6 weeks after surgery. By exercising regularly and eating healthy foods, you can help maintain your new shape.

Fat removal - suctioning; Body contouring

Padilla PL, Khoo KH, Ho T, Cole EL, Sirvent RZ, Philips LG. Plastic surgery. In: Townsend CM Jr, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery: The Biological Basis of Modern Surgical Practice. 21st ed. St Louis, MO: Elsevier; 2022:chap 69.

Stephan PJ, Dauwe P, Kenkel J. Liposuction: a comprehensive review of techniques and safety. In: Peter RJ, Neligan PC, eds. Plastic Surgery, Volume 2: Aesthetic Surgery. 4th ed. Philadelphia, PA: Elsevier; 2018:chap 22.1.

Updated by: Tang Ho, MD, Associate Professor, Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology - Head and Neck Surgery, The University of Texas Medical School at Houston, Houston, TX. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.