Liposuction

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Persons with localized fat may decide to have liposuction to remove fat from that area. Liposuction is a procedure for shaping the body and is not recommended for weight loss. Liposuction may be performed on the abdomen, hips, thighs, calves, arms, buttocks, back, neck, or face. A liposuction procedure may include more than one site, for instance, the abdomen, back, and thighs all on the same day. Liposuction is also used to reduce breast size in men with large breasts (gynecomastia) or to remove fat tumors (lipomas) but it is most commonly used for cosmetic body shaping.

Many liposuction surgeries are performed by plastic surgeons or by dermatologists. Any licensed physician may perform liposuction. While some physicians' professional societies may recommend training before performing liposuction surgery, no standardized training is required. As a result, there will be differences in experience and training in physicians performing liposuction. You can ask your physician to tell you whether he or she has had specialized training to do liposuction and whether they have successfully done liposuction before. But remember, even the best screened patients under the care of the best trained and experienced physicians may experience complications as a result of liposuction. Liposuction may be performed in a doctor's office, surgical center, or hospital.

Because liposuction is a surgical procedure, it is important that it be performed in a clean environment. Emergencies may arise during any surgery and access to emergency medical equipment and/or a nearby hospital emergency room is important. These are things that you should ask your physician before the liposuction. Liposuction requires one or more small incisions made near the fatty area that is going to be removed. A hollow tube called a cannula is inserted which suctions the fat. Most liposuction is performed using the tumescent technique, which provides sustained local anesthesia and minimizes bruising. Another technique called ultrasound-assisted lipoplasty (UAL), which uses ultrasonic waves to break up the fatty tissue, is indicated for certain patients undergoing liposuction.

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 2 hours, but extensive procedures can take longer. The length of time required also varies with the manner in which the anesthetic is injected.

After the surgery, the patient will need to wear a support garment continuously for 2-3 weeks. If ankles or calves were treated, support hose will need to be worn for up to 6 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 discomfort 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 3-6 months for the final contour to be reached.