Liposuction, also known as lipoplasty or suction-assisted lipectomy, is cosmetic surgery performed to remove unwanted deposits of fat from under the skin. The doctor sculpts and recontours the patient's body by removing excess fat deposits that have been resistant to reduction by diet or exercise. The fat is permanently removed from under the skin with a suction device.
Purpose
Liposuction is intended to reduce and smooth the contours of the body and improve the patient's appearance. Its goal is cosmetic improvement. It is the most commonly performed cosmetic procedure in the United States.
Liposuction does not remove large quantities of fat and is not intended as a weight reduction technique. The average amount of fat removed is about a liter, or a quart. Although liposuction is not intended to remove cellulite (lumpy fat), some doctors believe that it improves the appearance of cellulite areas (thighs, hips, buttocks, abdomen, and chin).
A new technique called liposhaving shows more promise at reducing cellulite.
Precautions
Liposuction is most successful on patients who have firm, elastic skin and concentrated pockets of fat in cellultite areas. To get good results after fat removal, the skin must contract to conform to the new contours without sagging. Older patients have less elastic skin and therefore may not be good candidates for this procedure. Patients with generalized fat distribution, rather than localized pockets, are not good candidates.
Patients should be in good general health and free of heart or lung disease. Patients with poor circulation or who have had recent surgery at the intended site of fat reduction are not good candidates.
Description
Most liposuction procedures are performed under local anesthesia (loss of sensation without loss of consciousness) by the tumescent or wet technique. In this technique, large volumes of very dilute local anesthetic (a substance that produces anesthesia) are injected under the patient's skin, making the tissue swollen and firm. Epinephrine is added to the solution to reduce bleeding, and make possible the removal of larger amounts of fat.
The doctor first numbs the skin with an injection of local anesthetic. After the skin is desensitized, the doctor makes a series of tiny incisions, usually 0.12-0.25 in (3-6 mm) in length. The area is then flooded with a larger amount of local anesthetic. Fat is then extracted with suction through a long, blunt hollow tube called a cannula. The doctor repeatedly pushes the cannula through the fat layers in a radiating pattern creating tunnels,
removing fat, and recontouring the area. Large quantities of intravenous fluid (IV) is given during the procedure to replace lost body fluid. Blood transfusions are possible.
Some newer modifications to the procedure involve the use of a cutting cannula called a liposhaver, or the use of ultrasound to help break up the fat deposits. The patient is awake and comfortable during these procedures.
The length of time required to perform the procedure varies with the amount of fat that is to be removed and the number of areas to be treated. Most operations take from 30 minutes to two hours, but extensive procedures can take longer. The length of time required also varies with the manner in which the anesthetic is injected.
The cost of liposuction can vary depending upon the standardized fees in the region of the country where it is performed, the extent of the area being treated, and the person performing the procedure. Generally, small areas, such as the chin or knees, can be done for as little as $500, while more extensive treatment, such as when hips, thighs, and abdomen are done simultaneously, can cost as much as $10,000. These procedures are cosmetic and are not covered by most insurance policies.
Preparation
The doctor will do a physical exam and may order blood work to determine clotting time and hemoglobin level for transfusions should the need arise. The patient may be placed on antibiotics immediately prior to surgery to ward off infection.
Aftercare
After the surgery, the patient will need to wear a support garment continuously for two to three weeks. If ankles or calves were treated, support hose will need to be worn for up to six weeks. The support garments can be removed during bathing 24 hours after surgery. A drainage tube, under the skin in the area of the procedure, may be inserted to prevent fluid build-up.
Mild side effects can include a burning sensation at the site of the surgery for up to one month. The patient should be prepared for swelling of the tissues below the operated site for 6-8 weeks after surgery. Wearing the special elastic garments will help reduce this swelling and help to achieve the desired final results.
The incisions involved in this procedure are tiny, but the surgeon may close them with stitches or staples. These will be removed the day after surgery. However, three out of eight doctors use no sutures. Minor bleeding or seepage through the incision site is common after this procedure. Wearing the elastic bandage or support garment helps reduce fluid loss.
This operation is virtually painless. However, for the first postoperative day, there may be some discom-fort which will require light pain medication. Soreness or aching may persist for several days. The patient can usually return to normal activity within a week. Postoperative bruising will go away by itself within 10-14 days. Postoperative swelling begins to go down after a week. It may take three to six months for the final contour to be reached.
Risks
Liposuction under local anesthesia using the tumescent technique is exceptionally safe. A 1995 study of 15,336 patients showed no serious complications or deaths. Another study showed a 1% risk factor. However,
as with any surgery, there are some risks and serious complications. Death is possible.
The main hazards associated with this surgery involve migration of a blood clot or fat globule to the heart, brain, or lungs. Such an event can cause a heart attack, stroke, or serious lung damage. However, this complication is rare and did not occur even once in the study of 15,336 patients. The risk of blood clot formation is reduced with the wearing of special girdle-like compression garments after the surgery, and with the resumption of normal mild activity soon after surgery.
Staying in bed increases the risk of clot formation, but not getting enough rest can result in increased swelling of the surgical area. Such swelling is a result of excess fluid and blood accumulation, and generally comes from not wearing the compression garments. If necessary, this excess fluid can be drained off with a needle in the doctor's office.
Infection is another complication, but this rarely occurs. If the physician is skilled and works in a sterile environment, infection should not be a concern.
If too much fat is removed, the skin may peel in that area. Smokers are at increased risk for shedding skin because their circulation is impaired. Another and more serious hazard of removing too much fat is that the patient may go into shock. Fat tissue has an abundant blood supply and removing too much of it at once can cause shock if the fluid is not replaced.
A rare complication is perforation or puncture of an organ. The procedure involves pushing a cannula vigorously through the fat layer. If the doctor pushes too hard or if the tissue gives way too easily under the force, the blunt hollow tube can go too far and injure internal organs.
Liposuction can damage superficial nerves. Some patients lose sensation in the area that has been suctioned, but feeling usually returns with time.
Normal results
The loss of fat cells is permanent, and the patient should have smoother, more pleasing body contours without excessive bulges. However, if the patient overeats, the remaining fat cells will grow in size. Although the patient may gain weight back, the body should retain the new proportions and the suctioned area should remain proportionally smaller.
Tiny scars about 0.25-0.5 in (6-12 mm) long at the site of incision are normal. The doctor usually makes the incisions in places where the scars are not likely to show.
In some instances, the skin may appear rippled, wavy, or baggy after surgery. Pigmentation spots may develop. The recontoured area may be uneven. This unevenness is common, occurring in 5-20% of the cases, and can be corrected with a second procedure that is less extensive than the first.
BOOKS
Hetter, Gregory P. Lipoplasty: The Theory and Practice of Blunt Suction Lipectomy. Little, Brown and Co., 1990.
Pitman, Gerald H. Liposuction & Aesthetic Surgery. Quality Medical Publishing, Inc., 1993.
Stegman, Samuel J., Theodore A. Tromovitch, and Richard G. Glogau. Cosmetic Dermatologic Surgery. Year Book Medical Publishers, Inc., 1990.
Wilson, Joleen. The American Society of Plastic and Reconstructive Surgeon's Guide to Cosmetic Surgery. Simon & Schuster, 1992.
PERIODICALS
"Downsize Your Thighs." Good Housekeeping, May 1997, 69-75.
Hanke, C. W., G. Bernstein, and S. Bullock. "Safety of Tumescent Liposuction in 15,336 Patients." Dermatologic Surgery 21 (May 1995): 459-462.
Murray, Louann. "Tumescent Liposuction Technique is Great Improvement." Dermatology Times (Sept. 1995): 4. Murray, Louann. "What is the Best Approach to Liposuction?" Dermatology Times (Sept. 1995): 24-25.
"Sound Waves Help Break Up Fat." USA Today, Oct. 1997, 15-16.
Taylor, Mia, Lloyd A. Hoffman, and Michael Lieberman. "Intestinal Perforation after Suction Lipoplasty: A Case Report and Review of the Literature." Annals of Plastic Surgery 38. No. 2: 169-172.
Van Ness, David. "The Skinny on Liposuction." Muscle and Fitness, Nov. 1997, 128-132, 201.
ORGANIZATIONS
American Society of Aesthetic Plastic Surgery. (888) 272-7711.
Lipoplasty Society of North America. (800) 848-1991.
Louann W. Murray, PhD
KEY TERMS
Cellulite—Cellulite is dimply skin caused by uneven fat deposits beneath the surface.
Epinephrine—Epinephrine is a drug that causes blood vessels to constrict or narrow. It is used in local anesthetics to reduce bleeding.
Hemoglobin—Hemoglobin is the component of blood that carries oxygen to the tissues.
Liposhaving—Liposhaving involves removing fat that lies closer to the skins surface by using a needle-like instrument that contains a sharp-edged shaving device.
Tumescent technique—The tumescent technique of liposuction involves swelling, or tumescing, the tissue with large volumes of dilute anesthetic.
