Liposuction

Alternate Names
suction lipectomy
lipoplasty



Definition of Liposuction

Liposuction is a procedure used to shape the body by removing unwanted fat from certain areas. Liposuction may be done in any of these areas:

• abdomen
• buttocks
• cheeks
• chin
• hips
• knees
• neck
• thighs
• upper arms

Who is a candidate for the procedure?

The best candidates for liposuction are people of average weight. They should have firm, elastic skin with pockets of fat they want removed. Candidates need to be in good physical health.

This procedure is not a substitute for exercise and healthy eating as a means of weight reduction. Rather, it is used to remove stubborn pockets of fat that do not go away with regular exercise and dieting.

Older people may not respond to liposuction as well as younger people because their skin may not be as tight. Those who have diabetes, heart disease, or lung disease may be at risk for complications during liposuction.

Liposuction is sometimes used for noncosmetic reasons to treat fat tumors such as lipomas. Enlarged breasts either in women or men may also be a basis for liposuction. In some cases, it may be used to reduce excessive underarm sweating.

How is the procedure performed?

The basic technique of liposuction begins with fluid injection. This injection consists of a mixture of:

• salt solution, called saline. This helps firm up the skin.
• an anesthetic, such as lidocaine. This helps numb the area.
• epinephrine. This medicine constricts the blood vessels, so less blood is lost.

This mixture makes it easier for the fat to be removed from the body.

A tiny incision is made through the skin. A narrow, hollow tube called a cannula, is then inserted into the fat layer beneath the skin. The cannula is used to vacuum out the fat layer. The tube is pushed and pulled back and forth through the fat layer, breaking up the fat. The fat is then pulled up through the tube using a vacuum pump or large syringe.

How long liposuction takes depends on the following:

• how many areas must be worked on
• the size of the areas
• how much fat is in each area
• the type of anesthesia used

A few new techniques for liposuction have been developed in recent years. These new techniques may help provide better results. Patients who have them often recover more quickly too. These techniques include:

• Tumescent technique. In this procedure, larger amounts of fluid combined with anesthesia are injected into the fat. The fluid injected may be equal to as much as three times the amount of fat to be removed. This procedure takes 4 to 5 hours, considerably longer than traditional liposuction.
• Super-wet technique. In this type of fat removal, an amount of fluid roughly equal to the amount of fat to be removed is injected into the fat. This procedure requires intravenous or general anesthesia.
• Ultrasound-assisted lipoplasty. Also called UAL, this technique uses ultrasound waves to break up the walls of the fat cells. Then the fat is removed using the same technique as for traditional liposuction. This procedure can improve the success rate for liposuction when used in fibrous areas of the body, such as the upper back or the male breast.

The type of anesthesia needed during liposuction can vary quite a bit. A person may just need a local anesthetic at the site of the procedure. This may be combined with an intravenous medicine to make him or her sleepy.

In more extensive liposuction, regional anesthesia may be used. The lower part of the body can be numbed by an injection of anesthetic into the spinal canal if the liposuction is being done below the waist.

Some people may need a general anesthesia for extensive liposuction. General anesthesia means the person is put to sleep with medicine given through an intravenous line.

What happens right after the procedure?

During and right after surgery, the person will be monitored closely for fluid loss. When the fat is broken up and vacuumed out of the body, fluid is also removed. This fluid may need to be replaced during and after the procedure to avoid shock. After the procedure, there may be some leaking from the surgery site. Sometimes a small tube is inserted to drain the excess fluid. A tight- fitting garment may need to be worn for a few weeks to control swelling and help shape the body.

The surgeon may prescribe antibiotics to reduce the risk of infection. Pain, swelling, tingling, or numbness may last for a few days to a few weeks after surgery. The body needs several days to several weeks to take shape where the fat pockets were removed.

What happens later at home?

The person is asked to walk shortly after surgery to decrease the risk of blood clots in the legs, known as deep venous thrombosis, and to speed healing. Most people are able to go back to work a few days after liposuction, depending on how extensive it was. Any stitches are removed in 7 to 10 days.

In most cases, moderate exercise can resume within a few days after surgery, but strenuous activity may need to be avoided for up to a month after the procedure. The surgeon can advise on any limits needed. It may take 3 to 6 weeks for bruising and swelling to subside.

What are the potential complications after the procedure?

Liposuction is usually a very safe procedure when done by a skilled, experienced, and specially licensed surgeon, although no surgery is risk-free.

Risks increase as more fat is removed, the area of fat is larger, or if the procedure takes a long time. Risks include:

• infection
• blood clots or fat clots, which can travel to the lungs. Known as a pulmonary embolus, a clot in the lungs can cause death
• puncture wounds of organs from the movement of the tube
• seroma, which is a pooling of serum in the area where the fat was removed
• damage to the skin and nerves from the movement of the tube under the skin
• swelling of the surgical area, which can sometimes last for several weeks or months
• burns from the ultrasound probe, if UAL is used
• shock from loss of fluid that was not replaced
• allergic reaction to the medicines used for anesthesia or to break up the fat
• death, although this is not common

Any increase in pain, bleeding, fever, weakness, or other symptoms should be reported to the surgeon as soon as they are noticed. It is important that the patient have a caretaker for the first day or so after liposuction, especially after an extensive procedure.