Liposuction
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Liposuction

(Lipoplasty; Suction Lipectomy; Body Fat Removal; Lipocontouring)

Pronounced: Lie-poe-suck-shun

Definition

Liposuction is an elective cosmetic surgery. It reshapes the body through the removal of excess body fat.

Liposuction of the Abdomen

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© 2008 Nucleus Medical Art, Inc.

Parts of the Body Involved

Areas for which liposuction is commonly used include:

  • Cheeks, chin, and neck
  • Upper arms
  • Breasts or chest region
  • Abdomen and waist
  • Back
  • Hips, thighs, and buttocks
  • Inner knees
  • Calves and ankles

Reasons for Procedure

Some common reasons for choosing to have liposuction include:

  • To reshape the body so that it is more in tune with an individual’s ideal body image
  • To remove unwanted fat pockets that could not be lost with diet and exercise
  • To boost self-confidence and feelings about appearance
  • To reduce the chest size of males suffering from gynecomastia

Risk Factors for Complications During the Procedure

  • Allergies to fluids and other materials used during surgery, or to anesthesia
  • Diabetes
  • Being a smoker
  • Severe heart or lung disease
  • Taking birth control pills (increased risk of blood clots)
  • Poor blood circulation
  • Recent surgery near the area to be suctioned
  • Having a large area suctioned, or large amounts of fat removed

What to Expect

Prior to Procedure

Select a plastic surgeon:

  • Find a plastic surgeon that is board certified (eg, by the American Board of Plastic Surgeons or Royal College of Physicians and Surgeons of Canada).
  • Ask patients or others in the doctor’s office about their experience with the doctor.
  • Ask if the doctor has been granted the ability to practice at an accredited hospital.
  • Choose someone you are comfortable with, and can talk openly to.

Your plastic surgeon will likely:

  • Evaluate you as a candidate for liposuction
    • Ask about your medical history, illnesses, medications, and previous surgeries
    • Discuss previous weight losses/gains, and how they affected your body
    • Stop/start medications as directed (eg, taking aspirin or other anti-inflammatory drugs may encourage postoperative bleeding)
    • Have you identify the areas you would like to have suctioned
    • Test your skin elasticity (ability of the skin to stretch and return to normal)
    • Estimate the amount of fat needed to be removed for best results
    • Discuss your ideal surgical outcome and body image versus realistic expectations
    • Determine your emotional stability (after surgery, some patients tend to become depressed temporarily)
  • Prepare you for the procedure
    • Discuss surgical techniques and anesthesia options.
    • Determine if the procedure should be conducted in a surgical suite, at an ambulatory clinic, or in a hospital. The location of the procedure will depend on the amount of fat to be removed. When large amounts of fat are removed, it is safest to perform the surgery in a hospital.
    • Give you instructions for the days proceeding, and day of the procedure.
    • Address your questions and concerns.

In the days leading up to your procedure:

  • Stop/start medications as directed (eg, taking aspirin, or other anti-inflammatory drugs may encourage postoperative bleeding).
  • Refrain from smoking and drinking alcoholic beverages.
  • Follow your doctor’s instructions regarding diet.
  • Arrange to have someone drive you home, stay overnight on the first night, and help out around the house for a few days.
  • Wear comfortable, loose-fitting clothing.
  • Find out if you should have blood drawn before the procedure. When large amounts of fat are removed, blood is lost, and a transfusion may be necessary, in which case having your own blood on hand is ideal.

Anesthesia

There are three anesthesia options for liposuction. Your doctor will help you to decide which is best for you.

  • Local anesthesia
    • Used for removal of small quantities of fat
    • Anesthetic can be applied like a lotion or injected
    • Only the area where the anesthetic is applied loses feeling
    • Consciousness is not lost
  • Regional anesthesia
    • Used when larger amounts of fat are being removed
    • Anesthetic is injected
    • Regional loss of feeling (similar to the injection given to numb the pelvic region during childbirth)
    • Consciousness is not lost
  • General anesthesia
    • Usually used when large amounts of fat, or multiple areas will be suctioned
    • Medication is given intravenously (IV)
    • Entire body is numbed
    • Consciousness is lost

Description of the Procedure

After anesthesia has taken effect, a special fluid containing saline and additional anesthetic is injected into the fatty areas. One of the following three extraction techniques is used depending on the procedure:

  • Wet technique—The amount of fluid injected is less than the amount of fat to be removed. This technique is generally used in combination with IV sedation or with general anesthesia.
  • Super wet technique—The amount of fluid injected is equal to the amount of fat removed. A procedure using this technique takes about two hours. IV sedation or general anesthesia is typically used.
  • Tumescent technique—Three times as much fluid is injected to the body as fat removed. Surgery using this technique runs approximately 4 to 5 hours. Local anesthesia is typically used.

After the fluid is added, a half-inch incision is made near the area to be suctioned. The surgeon uses a cannula as if it were a vacuum to suck up the fat. A cannula is a hollow tube, like a drinking straw. A vacuum pressure unit, which is attached by a hose to the cannula, provides the suction for the procedure. Once fat has been removed, incisions are stitched shut. In some cases, a drain may be inserted to help fluids to drain.

When certain areas with harder to remove fat are to be suctioned (eg, upper abdomen, thighs, hips, and back), a relatively new technique may be used that employs an ultrasonic generator.

  • Ultrasound-assisted Lipoplasty (UAL)—Ultrasonic energy supplied by an ultrasonic generator is used to explode the walls of fat cells prior to the injecting fluid. This causes fat to become an oily substance and easier to vacuum. The tumescent technique is then used to remove the liquefied fat. Although this technique carries higher risk of complications, it helps the surgeon to remove difficult fat deposits with less bruising and swelling.

After Procedure

  • You will be taken to a recovery room for monitoring.
  • IV fluids may be given to aid in rehydration.
  • You may be asked to take short walks to improve blood circulation.
  • Pain medication may be prescribed to help manage discomfort.
  • An elastic garment to help speed recovery will be given with instructions for usage.

How Long Will It Take?

The length of a procedure depends on the amount of fat to be removed, number of areas being suctioned, and the liposuction technique being used. The tumescent technique may take 4 to 5 hours, while the super wet technique may only require 30 minutes. UAL takes the longest amount of time.

Will It Hurt?

Liposuction itself should not hurt. Anesthesia numbs and relaxes the body. Let your doctor know if you experience pain during the procedure. Recovery from liposuction can be painful. Ask your doctor about pain relievers to help manage the pain.

Possible Complications

  • Infection—Bacterial infection may result from unsanitary surgical practices, having a low immune system, or from soaking in a hot tub, lake, or ocean too soon after surgery.
  • Allergic reaction—Allergies to materials used during surgery, or the anesthetic can cause a reaction. To reduce your risk, tell your doctor about your allergies prior to the procedure.
  • Permanent numbness—Numbness may result from damaging nerves during the liposuction process.
  • UAL complications—Burns under or on skin, injury to deep tissue, increased scarring, and seroma (fluid build up under the skin) are due to the use of ultrasonic heat-producing waves.
  • Bleeding from incisions—Bleeding can be triggered by physical exertion, and by taking certain medications. Risk can be reduced by limiting strenuous activities, and by only taking medications approved by your surgeon.
  • Blood clots in veins—Clots form when a person is immobile for long periods of time. Flex feet, and take short walks every hour to keep blood flowing, and reduce risk of clotting.
  • Pulmonary edema—The build-up of fluid in the lungs is most likely to occur during the tumescent technique since so much fluid is injected into the body.
  • Shock—Fluid and blood loss that occurs with fat removal can induce shock.
  • Organ injury—Internal organs may be punctured with the cannula, or burned by the ultrasonic waves.
  • Death—Usually caused by infection, poisoning, injury to internal organs, or by blood clots that lodge in the lung and is extremely rare.

Average Hospital Stay

Hospital stay varies in relation to the amount of fat removed. Lesser procedures, where a small amount of fat is removed, may only require a few hours to be spent at the hospital. When five liters of fat or more is removed, an overnight stay will be required.

Postoperative Care

  • Walk around as directed to help blood circulation and to prevent blot clots from forming
  • Rehydrate by drinking water, and replace lost electrolytes with sports drinks
  • Refrain from resuming activities until directed to do so
  • Keep incisions clean by washing with luke-warm water and soap
  • Do not soak in hot tubs, or the ocean for several weeks (can cause infection)
  • Take pain medication as prescribed to manage pain
  • Wear the elastic garment as directed
  • Refrain from smoking and drinking alcoholic beverages
  • Arrange for follow up doctor visits to monitor healing

Note: If you feel depressed, speak with your doctor. This feeling is natural, and is common in liposuction patients. Depression may last for several days or weeks. It may occur because results are not immediate, and because recovery may be long and uncomfortable.

Outcome

Results of the liposuction will not be seen immediately. Depending on the amount of fat removed, and the body’s ability to heal, visible results may take weeks or months to appear. Typically, swelling begins to decrease within a week of surgery. However, it may take months to fully subside. Bruising may last three or more weeks. Numbness may persist for several weeks before it begins to fade. After the swelling and bruising disappears, the true result of the procedure is seen. If postoperative weight is maintained, the results of the liposuction can be permanent.

Liposuction results are not the same for everyone. Some factors that may affect results include:

  • Age—Older patients may not see the same results as younger patients because their skin is less elastic. For example, older individuals are more likely to experience skin wrinkling and discoloration.
  • Experience of the surgeon—Doctors with more experience tend to have better results and fewer complications. If a doctor has less experience, dimpling and depressions are more likely to occur. These imperfections are caused by removing fat in an irregular manner, and by removing too much fat
  • Degree to which the surgeon’s orders are followed—Restraining from certain activities, and wearing the elastic garment can reduce the risk for excess bleeding, swelling, and discoloration. Individuals who do not wear the garment properly, or refuse to suspend smoking and drinking, may have poor results.

In the end, if desired results are not achieved, or if the skin remains loose, additional surgery may be needed.

Call Your Doctor If Any of the Following Occurs

It is important that you monitor your recovery once you leave the hospital. That way, you can alert your doctor to any problems immediately. Call your doctor if any of the following occurs:

  • Fever and/or chills
  • Coughing, chest pain, severe nausea or vomiting
  • Increased pain or tenderness
  • Oozing or discharge from incisions
  • Bleeding
  • Redness or increased swelling
  • Signs of shock (pale clammy skin, confusion or weakness, rapid pulse)

RESOURCES:

The American Society for Aesthetic Plastic Surgery
http://www.surgery.org/public

Liposuction Information
US Food and Drug Administration
http://www.fda.gov/cdrh/liposuction

CANADIAN RESOURCES:

Cosmetic Plastic Surgery
http://www.nationalsurgery.com/FCSC/procedures-cosmetic.php

Plasticsurgeryinfo.ca
http://www.plasticsurgeryinfo.ca

References:

Body fat removal. Mayo Clinic website. Available at: http://www.mayoclinic.org/cosmeticsurgery-sct/bodyfat.html . Accessed September 13, 2005.

Hughes C. Reduction of lipoplasty risks and mortality: an ASAPS survey. Aesth Plast Surg . 2001;21:120-127.

Lipoplasty or liposuction. American Society of Plastic Surgeons website. Available at: http://www.plasticsurgery.org/public_education/procedures/Lipoplasty.cfm . Accessed September 15, 2005.

Liposuction: considerations about body sculpting. MayoClinic.com website. Available at: http://www.mayoclinic.com/invoke.cfm?objectid=42111054-10B3-486D-9B01D212AEC550B8 . Accessed September 15, 2005.

Liposuction (lipoplasty). The American Society for Aesthetic Plastic Surgery website. Available at: http://www.surgery.org/public/procedures-lipoplasty.php . Accessed September 15, 2005.

Ultrasonic liposuction. Mayo Clinic website. Available at: http://www.mayoclinic.org/cosmeticsurgery-sct/ultralipo.html . Accessed September 15, 2005.



Last reviewed May 2008 by Rosalyn Carson-DeWitt, MD

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.

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