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Liposuction

By

Megan Freedman

What is liposuction?

Liposuction is the surgical removal of body fat. Also called lipoplasty, body shaping, and body contouring, liposuction can remove excess fat tissue on many body areas. These include the abdomen, buttocks, back, face, neck, arms, breasts, hips and legs. Most often people seek liposuction for aesthetic reasons. However, in some cases, doctors use liposuction to treat medical conditions involving excess fat deposits, such as gynecomastia and lipoma.

Liposuction is one of the most common cosmetic surgical procedures in the world. It is also major surgery with significant risks and potential complications. You may have less invasive treatment options. Consider getting a second opinion about all of your treatment choices before having a liposuction. 

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Why is liposuction performed? 

Your doctor may recommend liposuction as a medical treatment for certain conditions that cause a buildup of excess body fat. However, liposuction is most commonly a cosmetic surgical procedure to change the size and shape of the body, such as in the thighs, abdomen and breasts. Your doctor may only consider liposuction if other treatment options that involve less risk of complications have not worked. Ask your doctor about all of your treatment options and consider getting a second opinion.

Liposuction is a surgery your doctor may use to remove excess body fat caused by: 

  • Gynecomastia, which is excess breast tissue growth in men

  • Heredity, which causes body fat deposits that healthy diet and regular exercise cannot eliminate

  • Lipoma, which is a benign (noncancerous) type of slow-growing tumor made up of fat cells (adipocytes). Lipomas are usually small but can grow quite large. Liposuction is not the standard treatment for removal of these benign tumors but can be performed in selected cases.

Who performs liposuction?

Plastic surgeons often perform liposuction. A plastic surgeon is a specialist in aesthetic and reconstructive surgery. Dermatologists, doctors who specialize in treating conditions of the skin, hair and nails, may also perform liposuction. 

How is liposuction performed?

Liposuction is performed in a hospital, a surgeon's office, or an outpatient surgery clinic. 

Surgical approaches to liposuction

Your surgeon will perform liposuction using one of the following approaches:

  • Traditional liposuction, also called tumescent or fluid injection liposuction, is the most common type of liposuction. Your surgeon makes a few small incisions in the fat removal area and injects a fluid mixture containing a salt solution, a local anesthetic, and epinephrine through the incisions. This fluid prevents excessive blood loss, swelling, and bruising. Your surgeon then inserts a thin, hollow tube called a cannula into the incisions and pumps it back and forth to loosen and dislodge the fat cells. A small surgical vacuum or syringe is used to remove the fat through the cannula.

  • Ultrasound-assisted liposuction (UAL) is a type of liposuction that the Food and Drug Administration (FDA) approved for use in the United States in 1996. Your surgeon makes a few small incisions in the fat removal area and uses ultrasonic vibrations to heat and break up the fat. Your surgeon will apply these ultrasound vibrations above your skin with an emitter device, or below the skin with an ultrasonic cannula (a thin tube). A small surgical vacuum or syringe is used to remove the fat through the cannula. 

  • Laser-assisted liposuction is also called by its brand name: SmartLipo. The FDA approved laser-assisted liposuction in 2007. Your surgeon makes a few small incisions in the fat removal area and injects a fluid mixture containing a salt solution, a local anesthetic, and epinephrine through the incisions. This fluid prevents excessive blood loss, swelling, and bruising. Your surgeon inserts a thin laser fiber into the incisions to heat and loosen the fat. A small surgical vacuum or syringe is used to remove the fat through a cannula. 

Your surgeon will determine which type of surgery is best for you. Learn about the different liposuction procedures and ask why your surgeon will use a particular type for you.
Types of anesthesia that may be used

Your surgeon will perform liposuction using either regional anesthesia or general anesthesia: 

  • General anesthesia is a combination of intravenous (IV) medications and gases that put you in a deep sleep. You are unaware of the procedure and will not feel any pain.

  • Regional anesthesia is also known as a nerve block. It involves injecting an anesthetic around certain nerves to numb a large area of the body. To numb a smaller area, your doctor injects the anesthetic in the skin and tissues around the procedure area (local anesthesia). You will likely have sedation with regional anesthesia to keep you relaxed and comfortable.

What to expect the day of your liposuction

The day of your surgery, you can expect to:

  • Talk with a preoperative nurse. The nurse will perform an exam and ensure that all needed tests are in order. The nurse can also answer questions and will make sure you understand and sign the surgical consent.

  • Remove all clothing and jewelry and dress in a hospital gown. It is a good idea to leave all jewelry and valuables at home or with a family member. The surgical team will give you blankets for modesty and warmth.

  • Meet with your surgeon. Your surgeon will use a special pen to mark the area(s) of your body where fat will be removed.

  • Talk with the anesthesiologist or nurse anesthetist about your medical history and the type of anesthesia you will receive.

  • A surgical team member will start an IV.

  • The anesthesiologist or nurse anesthetist will start your anesthesia.

  • A tube will be placed in your windpipe to protect and control breathing during general anesthesia. You will not feel or remember this or the surgery as they happen.

  • The surgical team will monitor your vital signs and other critical body functions. This occurs throughout the procedure and your recovery until you are alert, breathing effectively, and your vital signs are stable.

What are the risks and potential complications of liposuction? 

As with all surgeries, liposuction involves risks and potential complications. Complications may become serious and life threatening in some cases. Complications can develop during the procedure or throughout your recovery.

General risks of surgery 

The general risks of surgical procedures include: 

  • Anesthesia reaction, such as an allergic reaction, toxicity, and problems with breathing

  • Bleeding, which can lead to shock

  • Blood clot, particularly one that develops in the leg or pelvis. This type of blood clot—a deep vein thrombosis—can travel to your lungs causing a pulmonary embolism.

  • Infection

Potential complications of liposuction

Potential complications of liposuction include:

  • Body asymmetry caused by removing different amounts of fat tissue from different body areas

  • Damage to skin, muscle, nerves, and internal organs

  • Fat embolism, which are loosened fat cells that enter the bloodstream and block blood flow

  • Fluid imbalance

  • Irregularities in skin texture or contour, such as dimpling or bagginess

  • Numbness 

  • Pooling of liquid where fat is removed

  • Scarring

  • Skin burns from ultrasound-assisted liposuction

  • Swelling, which can take months to go away

  • Skin discoloration

  • Skin necrosis, which is death of skin cells above the fat removal area. This can lead to a serious infection. 

Reducing your risk of complications

You can reduce the risk of certain complications by following your treatment plan and:

  • Following activity, dietary and lifestyle restrictions and recommendations before surgery and during recovery. This includes physical therapy, occupational therapy and other rehabilitation treatments.

  • Informing your doctor if you are nursing or there is any possibility that you may be pregnant

  • Notifying your doctor immediately of any concerns, such as bleeding, fever, increase in pain, or wound redness, swelling or drainage 

  • Taking your medications exactly as directed. Your doctor may prescribe an antibiotic before surgery to prevent infection. Take this as directed. 

  • Not smoking. Many plastic surgeons will not perform elective surgery on smokers because of the increased risk of complications. 

  • Telling all members of your care team if you have any allergies 

How do I prepare for my liposuction? 

You are an important member of your own healthcare team. The steps you take befo