Liposuction, also known as Liposculpture, is the most commonly performed plastic surgery in the United States – where more than 400,000 men and women annually undergo this procedure. A cosmetic surgery that contours and sculpts your body into a slimmer profile, Liposuction removes unwanted and excess fat. By reducing total body fat, it can help to lower cholesterol, and reduce the risk of diabetes and heart disease.

Candidates

Three categories of men and women seek Liposuction to achieve their ideal appearance, after trying unsuccessfully to do so through diet and exercise.

The first category of patients includes those who wish to reduce their size, including women who have gained weight due to pregnancy, hormonal fluctuations or medications. This category also includes men and women who undergo Large Volume Liposuction. Normally, this procedure involves the removal of about two litres of fat, about the size of a “Coke” bottle. During Large Volume Liposuction, however, five or more litres of fat are removed – resulting in a dramatic reduction in size.

The second category includes those who have disproportionate areas of fat in their abdomen, hips, thighs, buttocks, knees, cheeks and neck. These problem areas are commonly known as “saddlebags,” “thunder thighs,” “love handles” and “double chins.” Often, these stubborn areas of fat have genetic origins, and cannot be reduced by diet and exercise.

The third category of patients includes men who suffer from Gynecomastia, excessive breast growth due to the enlargement of breast glands, and excess fatty tissue.

In all cases, men and women who undergo Liposculpture should have had a stabilized weight for at least six months. Lipoplastyis not a solution for ridding of stretch marks or of cellulite.

Techniques

There are three techniques which vary in safety and effectiveness. All involve the insertion of a cannula — a small wand-like instrument connected to a high-powered suction machine — into tiny incisions made by the plastic surgeon into the targeted area. It is through this instrument that the plastic surgeon draws fat from beneath the skin.

Tumescent Liposuction refers to the commonest, and safest, method. “Tumescence” is the swelling and firming of fatty tissues through the infusion of a saline solution that contains Lidocaine, an anesthetic with adrenaline, which reduces blood loss and bruising.

Your plastic surgeon will soak the area with a solution that is two to three times the amount of fat and fluids to be removed. In Super-Wet Tumescent Liposuction, however, tissues are infused with fluids equal to the amount of fat and fluids to be removed. Super-Wet Liposuction uses a solution that has smaller amounts of, or no, Lidocaine, reducing the risk of Lidocaine toxicity.

Once the area is sufficiently plumped up, the plastic surgeon removes the loosened fat cells, suctioning fat and fluid through transparent vacuum-like tubes.

Power Assisted Liposuction hastens the process by an electronic-powered cannula which, like a jackhammer, suctions fat more quickly. While it lessens the plastic surgeon’s exertion, it also reduces the ability to contour with precision, especially in delicate areas like the neck and the face. Likewise, Ultrasonic Assisted Liposuction, which bombards subcutaneous fatty tissues with waves of heat and energy and was developed for use in more fibrous areas, has a high rate of risks and complications such as burns, and is not a patient’s best option.

Results

For optimal results, this procedure should be performed by a plastic surgeon who has a honed aesthetic sense, as well as excellent surgical skills. The surgeon must work diligently to locate the appropriate areas of subcutaneous fat in order to successfully sculpt and contour those areas. It is therefore of the utmost importance to select a cosmetic surgeon who has the highest credentials, a fine artistic sense and who is highly experienced.

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Liposuction is a medical procedure in which surgeons physically remove fat from subcutaneous deposits. There are a number of different liposuction techniques generally employed. The process typically involves sucking out the fat deposits with a device called an aspirator through a tube called a cannula. Physicians often inject fluid or otherwise emulsify the fat deposits for easier suction.

There are many different types of liposuction available. So-called “dry liposuction” is rare, since wet and tumescent surgeries have proven easier, safer, and more aesthetically sound. Tumescent, laser-assisted, ultrasound-assisted, and water-assisted liposuction therapies may also be considered.

Liposuction can be performed under general or local anesthesia. Ideally, patients are locally anesthetized to limit the possible side effects and complications of general anesthesia. In a number of wet liposuction techniques, fluid is injected subcutaneously to emulsify the fat to make it easier for aspiration. This fluid often contains an anesthetic (such as lidocaine), a vasoconstricting agent, such as epinephrine, and a saline solution to ensure a static osmotic balance in the body.

In laser-assisted surgery, a laser beam emulsifies fat via electromagnetic radiation. In ultrasound-assisted liposuction, high energy sound waves bombard the area to be treated and literally smash fat cells open, liquifying their contents. Ultrasound liposuction was initially a very popular alternative to traditional wet liposuction. However, studies found that ultrasound liposuction created a higher risk of fluid pocket formation.

In preapring for the procedure, most patients are forbidden from taking anticoagulants for 14 days prior to surgery. Patients who must undergo general anesthesia are typically prohibited from eating in the hours prior to surgery, as well. Finally, liposuction patients must forgo smoking and nicotine gum for several weeks before surgery, since nicotine can have an adverse effect on both circulation and tissue functionality.

On the day of surgery, the patient will sign a consent form, take antibiotics, and discuss last minute preparations with the surgeon. A sedative is then given — either intravenously or orally — and the surgeon then makes an incision to drain the adipose tissue. Most patients under local anesthesia report feeling some sensation at the area of suction — typically a scraping feeling — but ordinarily go home the same day. Complications from liposuction are relatively rare — one out of every 200 patients experiences a minor complication and only one out of every 500 patients experiences a major complication, according to a published report in the trade journal, Dermatologic Surgery.

Following surgery, patients may experience a number of side effects, including reduced ability to move, slight scarring and swelling, bruising at the site of surgery, pain and numbness, and some dizziness. If you experience severe symptoms that don’t respond to over-the-counter medications, contact your doctor right away. Incision areas are often left un-sutured for a day or two to drain whatever fluids remain. Swelling, numbness, and bruising can persist for a few weeks to several months after the operation. For patients who have large adipose deposits, several liposuction surgeries may be required to ensure satisfactory results.

Controlled tumescent liposuction can be a safe and effective way to combat the long-term complications of obesity, such as diabetes, arthrosclerosis, and heart disease. However, liposuction patients should also school themselves on the physiology of obesity. Contrary to what many in the public (and medical establishment) believe, the notion that obesity is caused by a combination of overeating and underexercising is but a hypothesis. In fact, this hypothesis has not stood up very well against the data collected over the past hundred years. Epidemiologists and physicians have found again and again that obesity and malnutrition coexist both in populations and patients. In other words, contrary to all that we’ve been taught by dietary authorities, fat regulation may not, in fact, be determined by “caloric balance.”

Fat tissue does not simply act as a “bag.” Adipose tissue is complex, and it is regulated by the body’s hormonal system. The competing hypothesis to the “caloric balance” idea (which has pervaded every aspect of our medical culture) is the idea that obesity is caused by the dysregulation of fat tissue. In other words, something causes us to get fat, and then our body remembers this “set point” and returns our fat levels to that set point, regardless of how much we exercise or how many calories we intake.

The important insight here is that liposuction alters the body’s regulation of adipose tissue by literally removing some of it. The key to safe and effective weight loss, according to this alternative hypothesis of why we get fat, is to avoid doing whatever caused the fat dysregulation in the first place. And mounting evidence suggests that, for the vast majority of the obese, simple carbohydrates in the diet may be at fault. To read up on this alternative hypothesis, check out award winning science journalist Gary Taubes’ book, Good Calories, Bad Calories.

A diet low in simple carbohydrates and sugars combined with carefully performed liposuction therapy can permanently and positively transform your body. Whether you consider the health benefits of primary importance or just a nice fringe benefit along with your physical transformation, you will, in fact, reduce your risks of developing any number of debilitating conditions.

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Tumescent Liposuction

Developed about 15 years ago, this is the most common, and safest, method. The term “tumescence” refers to the swelling and firming of fatty tissues by the means of infusing fluid into the tissue. After tiny incisions are made where the patient’s skin covers fatty tissue, the area is soaked with a saline solution that contains an anesthetic (Lidocaine) and adrenaline to reduce blood loss and bruising. This reduction of blood loss through the shrinking of capillaries has been a great advance, enabling plastic surgeons to remove much fat with little blood loss.Tumescent liposuction involves swelling the areas to be suctioned with a solution that equals two to three times the amount of the fat and fluid that will be suctioned out. In the Super-Wet technique however, the tissues are infused with an amount of fluid that equals the fat and fluids that will be suctioned. Super-wet involves the use smaller amounts of, or no, Lidocaine, thereby reducing the risk of Lidocaine toxicity.

Once the area has been sufficiently plumped up, the surgeon removes these fat cells through the insertion of a cannula, a tiny wand like instrument that suctions and removes the loosened fat cells via a high-power suction machine. The fat then glides through transparent vacuum-like tubes as fat and fluid are suctioned from your body. Because of the fluid loss, you need to be monitored carefully by an experienced anesthesiologist who can balance your fluid intake and output throughout the procedure.

There is nothing arbitrary about this process. A skilled surgeon, like a sculptor, has to use his sense of sight and touch to assess the areas of fat buildup and to contour and sculpt these areas into an ideal form. It also requires a great deal of arm movement and exertion by the surgeon, as he or she both suctions and sculpts. The tumescent technique has a low complication rate in and of itself, yet is also used as preparation for other kinds of liposuction techniques.

Power Assisted Liposuction

In essence, this is liposuction hastened by a vibrating suction cannula. Developed by a German surgeon, this technique employs an electric-powered cannula, which like a jackhammer sucks out the fat faster. In my opinion, while it might help the surgeon to do his or her job faster, it takes away from the surgeon’s ability to feel the contour and the topography of tissue as this machine vibrates. Also, this machine might not be safe to be used in delicate or potentially dangerous areas such as the neck and face.

Ultrasonic Assisted Liposuction (UAL)

This method was first used in the 1990’s, and was considered an advance in treating especially fibrous areas, such as the male chests, back, and flanks. It uses cannulas that bombard subcutaneous fatty tissues with waves of ultrasound, thereby liquefying them through ultrasound energy and heat. An external method also delivers this energy by applying a paddle-shaped instrument to the skin. The higher general complication rate of this technique as compared to other conventional techniques has recently drawn surgeons away from this fad. Specifically, ultrasonic assisted lipoplasty (UAL) carries an increased risk of skin and tissue burns, permanent tissue damage and scarring, nerve damage causing lasting skin irritation or pain, and fluid buildup or formation of seroma – cavities of fluid beneath the skin. Because there is insufficient proof of the safety of UAL devices, the Food & Drug Administration (FDA) has never approved the marketing and advertising of UAL devices.

What is Large Volume Liposuction?

What person today has not heard of gastric bypass surgery, more commonly known as “stomach stapling?” The news stories about musicians, new anchors and other celebrities who have undergone this procedure are frequent. Yet, only twenty years ago, the mere mention of gastric bypass would have elicited a declaration of “that would be malpractice!” In much the same way, our assessments about the safety of Large Volume Liposuction are progressing.

Notions of what is attractive are constantly evolving. The voluptuous actresses of the 1950’s would today be considered overweight. However, while we can’t really define what an “ideal” weight is, it is widely accepted that a significant portion of Americans today are overweight. This is both a health issue, and a self-esteem issue. More than half of American women wear a size 10 or more, and are unhappy with their size.

Just as the safety of gastric bypass surgery was once questioned, so is the acceptability of Large Volume Liposuction. However, in the hands of a skilled and experienced plastic surgeon who takes all of the usual precautions that are observed during any major surgery, a patient can successfully and safely have large amounts of fat removed.

When approximately two liters of fat (about the size of a Coca-Cola bottle) are removed, this is considered Small Volume Liposuction. This is successful when smaller localized “problem” areas of the body are being contoured. However, the removal of this quantity of fat will not make a difference in a large person whose goal is significant size reduction. In the latter case, large volumes of fat, five or more liters are removed, with the dramatic outcomes- 2 to 5 size reduction in cloth size. The surgeon removes the fat with an eye towards contouring the area as well. In this procedure, it is a good practice to combine the Tumescent with the Super-Wet Technique, as the latter does not use Lidocaine (or uses less), thereby avoiding the risk of Lidocaine toxicity.

If you are considering liposuction you should seek a plastic surgeon who has very extensive experience in performing this procedure in an optimal surgical facility. A minority of qualified plastic surgeons specializes in this.

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In tumescent liposuction, areas of excess fat are injected with a large amount of anesthetic liquid before liposuction is actually performed. The anesthetic liquid causes the compartments of fat to become swollen and firm or “tumesced.” The expanded fat compartments allow the liposuction cannula to travel smoothly beneath the skin as the fat is removed. This type of liposuction can be used on any area of the body but is most often used on areas that require careful precision such as the face, neck, arms calves and ankles.

The tumescent technique is a fairly new method of performing liposuction that reduces post-operative bruising, swelling and pain. Blood loss is minimized during tumescent liposuction, and this technique also reduces the chances that a blood transfusion will be necessary during the procedure.

Although blood loss is minimized with tumescent liposuction, patients undergoing the procedure still face the same risks associated with traditional liposuction. Some of the risks with this type of liposuction include pulmonary edema (fluid in the lungs) and lidocaine toxicity (too much lidocaine).

General anesthesia is usually the best option for the tumescent liposuction procedure. Or, if it’s appropriate, the tumescent solution may serve as the only means of anesthesia for the procedure. Your cosmetic surgeon will discuss all anesthesia options with you at the time of your appointment.

The Process

In tumescent liposuction, the warmed tumescent liquid (containing lidocaine, epinephrine and intravenous fluid) is injected into the area to be treated. As this liquid enters the fat, it becomes swollen, firm and blanched. Liposuction is then performed on the tumesced areas.

The anesthesia used in the procedure can help to provide pain relief following liposuction and decrease the need for additional pain medication to be prescribed. For the first couple of days following the procedure, most patients experience swelling in the areas that were treated and some fluid drainage from the incision sites. Patients usually resume light physical activity within the first few days following surgery, and normal physical activity can be resumed within a few weeks.

Patients typically see a noticeable difference almost immediately after surgery. After three weeks, even more improvement can be seen after the majority of the swelling has subsided. After approximately three months, any persistent swelling will disappear and your final shape and contour will be visible.

Since all of the fluid that was injected during the procedure is removed, your weight after tumescent liposuction may be the same or higher as your original weight. As the extra fluid and tissue swelling are managed by your body, your weight should normalize.

Drainage from the incision sites is common with liposuction. Occasionally, a small rubber drainage tube will be inserted beneath the skin for a couple of days to prevent fluid from building up. You may need to take antibiotics while these drains are in place, and until the major drainage has stopped altogether, you may need additional gauze pads to keep your clothing from getting damp.

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