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Liposuction

Liposuction is a procedure that can help sculpt the body by removing unwanted fat from specific areas, including the abdomen, hips, buttocks, thighs, knees, upper arms, chin, cheeks, and neck. A number of new techniques exist today for liposuction, also know as lipoplasty or suction lipectomy, which offers patients more precise results and quicker recovery times.

Individuals considering liposuction often feel a bit overwhelmed by the number of options and techniques being promoted today, so ask your plastic surgeon to help you decide which is the right treatment for you.

Following surgery, patients will see a noticeable difference in the shape of their bodies, however, improvement will become even more apparent after about four to six weeks.

The perception of beauty in the human body has undergone a dramatic change in the past three centuries, culminating with an emphasis placed by modern society on a lean, youthful appearance.  This has led to an increased demand for surgical procedures designed to produce an ideal aesthetic shape.  Liposuction is now the fourth most common cosmetic surgical procedure in the United States with 202,000 procedures performed by Plastic Surgeons in 2012.

Surgical procedures to contour specific areas of the body were first described in the 1930s.   In 1974 liposuction was invented by an Italian surgeon, Dr. Fischer and then further refined in 1978 by two French physicians, Drs. Illouz and Fournier. Liposuction is defined as the removal of fat from deposits beneath the skin using a hollow stainless steel tube (called a cannula) with the assistance of a powerful vacuum.  These earlier forms of liposuction focused on the removal of fat with sharp tip curettes and cannula. Although these procedures were quite sophisticated for their time, they were fraught with many complications.  The addition of a blunt tip cannula and wetting solution in the 1980’s have decreased the complication rate dramatically.  Subsequent research on the optimal wetting solution and anatomical understanding of fat planes has made liposuction a safe and effective procedure when performed by an appropriately trained Plastic Surgeon.

The best results with liposuction are obtained when treating minimal to moderate localized fat deposits unresponsive to diet and exercise in patients whose skin is moderately elastic.  When the fat is removed from below the skin via liposuction, healthy skin with elasticity will tighten and lead to an improved contour.  When there are stretch marks present or other signs of poor elasticity the skin will usually not tighten enough which leads to a suboptimal result.   Patients in this category will usually benefit from skin removal such as is done in a tummy tuck.  Patients seeking liposuction should be in good general health and have realistic expectations. Liposuction is also not a way to lose weight, the optimal patient is within 30-50 lbs of their ideal body weight.

Small volume liposuction directed to a specific area can be done in the office, but most liposuction procedures should be performed with anesthesia in a surgical setting. Wetting solution is infiltrated to the surgical area, which significantly decreases blood loss and helps with pain control. The addition of wetting solution and the removal of fat can cause large fluid shifts, thus, it is extremely important that patients receive an adequate amount of IV fluid during surgery and are monitored appropriately.   After the wetting solution is allowed to work for 10minutes, the liposuction procedure then begins.  Very small incisions (1cm) are made to allow entry of the cannula. Various cannula may be used with the majority being blunt tipped, which causes less tissue trauma.  Suction is applied to the cannula and fat is removed.  It is extremely important that the cannula is put in the appropriate position and that liposuction is done evenly.  The most common complication after liposuction is contour irregularity due to uneven placement of the cannula.  Once the procedure is complete, sutures are placed to close the small skin incision and the patient is placed in a compression garment.  It is important that this garment is worn for six weeks as is facilitates the skin tightening down and helps decrease swelling.  As with many plastic surgery procedures, patients should not submerge their incisions under water for six weeks and should avoid strenuous exercise for 4-6 weeks as that can increase swelling and bleeding complications.  Patients will notice a dramatic improvement immediately after liposuction but it often takes up to 6 months to see the final result after the skin has tightened and all the swelling has resolved.

The vast majority of patients are extremely happy with their result but liposuction is not complication free.  The most common complications are contour irregularities, fluid collections, and skin injury.  The rate of the above complications is less than 10%.  More serious complications also happen such as blood clots, excessive blood loss, fluid overload, lidocaine (numbing medicine) toxicity and shock.   Liposuction is a surgical procedure and it is extremely important to have these procedures performed by the most trained individuals, which are board certified plastic surgeons.

It seems that every year there is new miracle liposuction technique being marketed.  Most of these involve addition of energy to the tip of the liposuction cannula, which liquefies the fat before it is suctioned out.  Cannula that transmit ultrasound energy, laser energy, and freezing capability have all been tried.   The reported benefit is decreased pain and surgery time and less work for the one performing the procedure, as it is easier to suction out liquefied fat.  Long-term studies, however, have shown higher complication rates with all of these techniques.  Rates of fluid collections, contour irregularities, and skin injury have been reported to be significantly higher.  There are also “liposculpting” techniques that are highly marketed.  Providers using this technique report that an external wand will transmit energy through the skin and break up fat cells, which are then absorbed by the body.  This is appealing to patients as it is a noninvasive office based procedure.  There is, however, no scientific data to support any long-term result in any peer-reviewed plastic surgery literature.

Suction-assisted liposuction remains the gold standard liposuction technique and the one most widely used by board certified plastic surgeons.   If you are thinking of having liposuction please visit with a board certified plastic surgeon to discuss which procedure will be best for you and if you are a good candidate for liposuction.  Liposuction is a surgical procedure and it is important to obtain the safest and most optimal outcome.

For more information visit www.plasticsurgery.org.