Liposuction

Brace yourself for both the expense and the graphic description! Ranging from $2,500 to $5,000, liposuction is a general term for a procedure where localized collections of fatty tissue are removed from the thighs, calves, ankles, buttocks, abdomen, back, arms, face, neck, and chin using a thin tube that literally sucks up fat tissue.

Many different tools and techniques are used for liposuction ranging from ultrasound-assisted to tumescent procedures. When liposuction was first introduced, the method involved simply inserting a cannula (vacuum device) into an area and sucking out some of the fat. This "dry method" required general anesthesia and was associated with many risks, including bleeding and leakage after the procedure.

Now, several other methods are more widely used, including tumescent liposuction, a refined version of the dry liposuction method. It involves injecting a sterile saline solution into the area about to be worked on. The saline stretches the fat cells before suctioning begins, allowing a greater volume of fat to be removed. To minimize bruising, bleeding, and discomfort, the saline solution is mixed with xylocaine (a local anesthetic) and the vasoconstrictor epinephrine.

Ultrasound-assisted or Ultrasonic liposuction uses high-pulse sound waves to liquefy excess fat, which is then removed by the same vacuum device used in other liposuction procedures. Ultrasonic liposuction is thought to be more effective for loosening the fat cells attached to muscles or organs and is also useful in breaking down fat cells so they are easier to suck up into the cannula. Risks for Ultrasonic liposuction were once believed to be higher than for other liposuction procedures, but current research indicates that it appears to have benefits and risks similar to the tumescent method. (Sources: Aesthetic Plastic Surgery, March-April 2003, pages 146-153; British Journal of Plastic Surgery, April 2003, pages 266-271; Plastic and Reconstructive Surgery, December 2002, pages 1748-1751.)

Liposuction does remove fat, but if too much fat is removed your skin will stick unnaturally to the underlying muscle and tissues creating an abnormal appearance. Also, liposuction cannot eliminate dimpling (cellulite) or correct skin laxity, which are the result of the skin's structure and not caused by the presence of the fat itself. For some patients whose skin has lost much of its elasticity, the plastic surgeon may also recommend a skin-tightening procedure such as a thigh lift, buttock lift, or arm lift, all of which leave scarring that can be more extensive.

Liposuction is considered a low-risk procedure that offers impressive results. Depending on the area treated, tumescent or ultrasound-assisted liposuction leaves only minute scars, often as short as one-half inch in length or less. The use of refined equipment allows removal from delicate areas such as calves and ankles. It is believed that if there is any downside to this procedure it originates on the part of surgeons who do not screen their patients and help them set realistic expectations. Liposuction does not take the place of a diet. If someone is obese, gains and loses weight frequently, or has an eating disorder, he or she is not a candidate for liposuction.

An article in Plastic and Reconstructive Surgery (November 2001, pages 1753-1763), reviewed 631 liposuction cases over 12 years and found "Results showed the majority of patients to be women, aged 17 to 74 years old. Of the preoperative weights, 98.7 percent were within 50 pounds of ideal chart weight... Cosmetic results were good, with a 2- to 6-inch drop from preoperative measurements, depending on the area treated. Ten percent of patients experienced minor skin contour irregularities, with most of these patients not requiring any additional surgical procedures. One year after surgery, 80 percent of patients maintained stable postoperative weights. No serious complications were experienced in this series. The majority of the complications consisted of minor skin injuries and burns, allergic reactions to garments, and postoperative [swelling]. The more serious complications included four patients who developed mild pulmonary edema and one patient who developed pneumonia postoperatively. These patients were treated appropriately and went on to have [successful] recoveries. The results show that large-volume liposuction can be a safe and effective procedure when patients are carefully selected and when anesthetic and surgical techniques are properly performed. Cosmetic benefits are excellent, and overall complication rates are low."

A more recent study published in Dermatologic Surgery (July 2004, pages 967-978), reviewed current data and found that "The overall clinical complication rate... was 0.7% (5 of 702). There was a minor complication rate of 0.57%. The major complication rate was 0.14% with one patient requiring hospitalization. Seventy-five percent of the patients reported no discomfort during their procedures. Of the 59% of patients who responded to a 6-month postoperative survey, 91% were positive about their decision to have liposuction (rating of 4 or 5 on a scale of 1-5) and 84% had high levels (4 or 5 on a scale of 1-5) of overall satisfaction with the procedure. Conclusions. Our findings are consistent with others in that tumescent liposuction is a safe procedure with a low complication rate and high patient satisfaction."

It is important to keep in mind that sucking fat out of your body is an intense medical procedure. Liposuction is an operation that can be painful, the pain can last for several weeks, and there is risk of complications that can range from mild to serious (Source: www.fda.gov/cdrh/liposuction/risks.html). Adhering to postoperative guidelines is essential for success. "Touchup" work may be necessary because even the best techniques can remove fat unevenly resulting in unwanted bulges and contours.

Is liposuction permanent? If you gain weight, depending on how your body distributes fat, it can all show up exactly where the liposuction was performed. The good news is that adults only have a set number of fat cells and liposuction can remove a certain amount of them. You won't add more fat cells but the remaining fat cells can grow bigger, which can return the liposuctioned area to its previous appearance. Now that is some fat to chew on!