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Liposuction

Definition

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

Alternative Names

Fat removal - suctioning; Body contouring

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.

Liposuction is a surgical procedure with risks, and may it involve a painful recovery. Because liposuction can have serious or occasionally fatal complications, 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 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-assistedliposuction (UAL) uses ultrasonic vibrations 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.

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 cannula used during LAL is smaller than the ones used in traditional liposuction, surgeons prefer applying 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, which helps 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, 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. The surgeon may approach the areas to be treated from different directions to get the best contour.
  • 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.

Why the Procedure Is Performed

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. 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.

Risks

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 medications
  • Pulmonary problems (shortness of breath, air pockets in bloodstream)
  • Allergies (antibiotics, asthma, surgical prep)
  • Smoking, 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 in your skin or contouring problems
  • Drug reactions or overdose from the lidocaine used in the procedure
  • Scarring or irregular, asymmetric, or even "baggy," skin, especially in older people

Before the Procedure

Before your surgery, you will have a patient consultation. 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.

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.

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.

After the Procedure

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 need the compression garment for several 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 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 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 surgeon may call you from time to time to check on your health and to monitor your healing. A follow-up visit with the surgeon will be required.

Outlook (Prognosis)

Most patients are satisfied with the result 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 a healthy diet, you can help maintain your new shape.

References

Coleman WP III, Flynn TC, Coleman KM. Liposuction. In: Bolognia JL, Jorizzo JL, Schaffer JV, eds. Dermatology. 3rd ed. Philadelphia, Pa: Elsevier Saunders; 2012:chap 156.

Farrior EH, Park SS. Liposuction. In: Flint PW, Haughey BH, Lund VJ, et al., eds. Cummings Otolaryngology Head and Neck Surgery. 5th ed. Philadelphia, Pa: Elsevier Mosby; 2010:chap 31.

Jacob CI, Kaminer MS. Rejuvenation of the neck using liposuction and other techniques. In: Robinson JK, Hanke CW, Siegel DM, Fratila A, eds. Surgery of the Skin: Procedural Dermatology. 2nd ed. Philadelphia, Pa: Elsevier Mosby; 2010:chap 40.

Pelosi MA, Pelosi MA. Liposuction. Obstetrics and gynecology clinics of North America. December 1, 2010; vol. 37: pp 507-519.


Review Date: 5/15/2013
Reviewed By: David A. Lickstein, MD, FACS, specializing in cosmetic and reconstructive plastic surgery, Palm Beach Gardens, FL. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Bethanne Black, and the A.D.A.M. Editorial team.
The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997- A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
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