Liposuction is the removal of fat from certain areas of the body. This procedure can be done anywhere from the abdomen to the knees. For those who have attempted to diet and exercise, liposuction can help get rid of stubborn fat deposits that cannot otherwise be eliminated. It can be done alone or in combination with other procedures, such as breast reductions or tummy tucks. It can also be done in more than one area at once. Liposuction goes by many names. It is known as lipoplasty, laser assisted liposuction, or ultrasound assisted lipoplasty.
According to statistics compiled by the American Society for Aesthetic Plastic Surgery (ASAPS), liposuction was the number one cosmetic procedure performed on both genders in 2007. 456, 828 of these were performed during that year. This is an increase of 158.3% since 1997.
What Happens during a Liposuction
The surgeon’s first step is to mark the areas where fat will be removed. This is done using a magic marker or Sharpie. These markings will help the surgeon plan the procedure for best results.
Liposuction is often performed under general anesthesia though a local anesthesia can be used in some instances. Epidural blocks and intravenous sedation are also options. The anesthesiologist will work with the plastic surgeon in order to determine the best type of anesthesia for you. They will also consider the length of the surgery, and where on the body the surgery is being performed.
The area in which liposuction is being performed is filled with a fluid solution. The solution contains saline, a saltwater blend, and epinephrine, which helps prevent blood loss. The solution also contains a local anesthetic. There are a number of different types of solutions available. The biggest difference is the amount of fluid in each. The first solution, also known as the wet technique, uses 100-300 mL of fluid in each site. This lessens the amount of blood that is sectioned out to 20–25%. The second solution, also called the super wet technique, uses an amount of fluid that is equal to the amount of fat removed. Less than 1% of blood is lost using this solution. The last solution uses 3 to 6 times more fluid than the second solution. This is called the tumescent technique. This technique is not always popular, because some say that it interferes with the surgeon’s ability to sculpt the remaining skin. Critics also say that this technique can cause potential overload of fluids and may result in an overdose of anesthetic. Surgeons did not always use solutions during liposuction. When they did not, the surgery resulted in a great deal of blood loss and bruising.
Getting the Fat Out
At last, the fat is removed. There are many different ways to remove this. The first is traditional liposuction, via suction. A cannula is inserted through an incision in the skin to vacuum up the fat cells. The surgeon moves the cannula back-and-forth to break up the fat layer and remove it. In ultrasound liposuction, the surgeon inserts a cannula through specially placed incisions. Sound waves are played through the cannula, which helped break up the fat layer. A more updated version of this technique is called vaser assisted liposuction. This procedure uses gentler sound waves to break up the fat. The bonus to this procedure is that it does not damage blood vessels and nerves, or connective tissue. This means that the patient suffers less from bruising, swelling and pain. Power assisted liposuction uses a cannula with a motor in it to break up the fatty tissue. Laser assisted lipo uses lasers to liquefy the fat; proponents say that it leads to tighter skin, while critics say it does nothing new except add to the cost. They also feel that it can make the entire procedure harder to deal with for both the patient and the doctor. Body jet liposuction uses water to loosen the fat from the connective tissue and vacuum it out at the same time. Since it loosens the fat cells rather than destroys or breaks them apart, it is less traumatic to the body and may even have a shorter recovery time. Also, the fat and water are removed immediately, which means the doctor can tell if more lipo is needed in the area. The procedure can be used to harvest fat for transfer to other areas that may need it. Body jet liposuction falls under the same anesthesia requirements as the other methods, but more research is needed to determine all of the risks and benefits.
Cannulas—Size Does Matter
The cannula, the long, hollow tube used to remove fat, is usually about 3 millmeters in diameter. In the past, they have been as large as 12 millimeters. The smaller the cannula, the less damage is dome to surrounding tissues. This means a faster healing time, and less brusing and bleeding. Ask the doctor about his choice in cannulas during your initial visit.
To Sum It All Up…
Most surgeons prefer general anesthesia for liposuction, except for the smallest removals. The super wet technique is also used, unless the traditional technique is chosen. In the case of the latter, aspiration is preferred. The surgeon picks the cannula according to the area that is being treated. Vaser is the preferred method for ultrasound treatment. The amount of time for the surgery is dependent upon the size of the area being treated; a large area can take as long as five hours, but a small one can take as little as 30 minutes. Multiple areas can take more time as well.
Who Gets Lipo?
The first step is choosing a licensed plastic surgeon for your consultation. The surgeon should ask about your medical history (this includes all medicines), your weight, whether you have ever had any sudden weight gains or losses, and your plans for weight loss before the surgery. The surgeon will also discuss realistic expectations for your results.
The ideal candidates are of normal weight but have fat deposits that cannot be removed with regular diet and exercise. Firm and elastic skin tone are a must, since lipo will not remedy sagging skin. Older patients tend to lack this skin tone, so the results are less than ideal.
Getting Ready For Surgery
Your surgeon will give you instructions to prepare you for your surgery. There may be rules on eating and drinking, and you must not smoke 30 days beforehand. Doing so would increase the possibility of risks during surgery. Certain medications, such as aspirin and NSAIDs (non-steroidal anti-inflammatory drugs), may increase the chance of bleeding and should not be used before surgery. Go over a list of all your medications and determine which ones must be discontinued. Never stop taking any medicine without discussing it with your surgeon and the prescribing doctor.
After the Lipo
Your suctioned areas will be swollen and uncomfortable for several days afterward. To help drainage, small incisions may be left open for a short period of time and tubes may be inserted. Your surgeon may give you an antibiotic as well to help avoid infection. The treatment area will be covered with a bandage. To help compress tissue and lessen bruises and swelling, you may wear support hose or a girdle. This may continue for several days or weeks.
Movement after surgery is encouraged to lessen the chance of blood clots. This can happen after being sedentary for long periods of time. In a few days, you may return to your normal activities. Some can return sooner, if their lipo was not done across an extended area. Strenuous activity may not be done for at least three weeks. You may not be able to see complete results for up to six months, but providing your weight remains stable, they are permanent. Some patients have been known to see results as soon as one week afterward; it depends on how little swelling and bruising took place.
Risks for lipo include
- Fluid imbalance. Fat tissue can hold a lot of liquid. When the fat is removed, the liquid is removed as well. Some of this is put back during tumescent liposuction, but there is often a great deal of excess. This fluid imbalance can create heart problems, lung problems, or kidney issues. In particular, the kidneys are responsible for excreting fluid, so they may become overtaxed by the effort.
- Puncture wounds in tissue or organs
- Shock or infection
- Blood clots in the lung
- Hematoma (pooling blood in the suctioned areas)
- Temporary loss of feeling or discoloration in the treated area
- Uneveness, dimpling, wrinkling and other irregularities over the area
- Reaction to anesthesia
- Burns (most common in ultrasound and laser assisted lipo)
Patients with medical conditions such as diabetes or poor circulation are most likely to suffer from these risks. Those who have had surgery in the same area as the liposuction may also experience these side effects. You and your surgeon should address these during the initial consultation.
THE PURPOSE OF THIS ARTICLE IS TO ENHANCE, NOT REPLACE THE DISCUSSION AND CONSULTATION WITH YOUR PHYSICIAN SO THAT YOU CAN MAKE AN INFORMED DECISION BASED UPON THE RISKS, BENEFITS, AND ALTERNATIVES FOR YOUR SPECIFIC NEEDS AND DESIRES. AFTER REVIEWING THIS ARTICLE YOU WILL BE ABLE TO HAVE A MORE MEANINGFUL DISCUSSION WITH YOUR DOCTOR. PATIENTS NEED TO READ ALL CONSENT FORMS FULLY, AS THEY CONTAIN IMPORTANT INFORMATION REGARDING THEIR TREATMENT.