Liposuction

Answer 1

Definition

Liposuction is the removal of excess body fat by suction using special surgical equipment. A plastic surgeon typically does the surgery.

Alternative Names

Fat removal - suctioning

Description

Liposuction is a popular type of cosmetic surgery. It removes unwanted deposits of excess fat, to improve body appearance and to smooth irregular or distorted body shapes. The procedure is sometimes called body contouring.

Liposuction may be useful for contouring under the chin, neck, cheeks, upper arms, breasts, abdomen, buttocks, hips, thighs, knees, calves, and ankle areas.

However, liposuction is a serious surgical procedure and may involve a painful recovery. Because liposuction can have serious or occasionally fatal complications, you should carefully think about your decision to have this surgery.

Several different liposuction procedures exist:

• Tumescent liposuction (fluid injection) is the most common type of liposuction. It involves injecting a large amount of medicated solution into the areas before the fat is removed (sometimes, the solution may be up to three times the volume of fat to be removed). The fluid is a mixture of local anesthetic (lidocaine), a drug that contracts the blood vessels (epinephrine), and an intravenous (IV) salt solution. The lidocaine in the mixture helps to numb the area during and after surgery, and may be the only anesthesia needed for the procedure. The epinephrine in the solution helps reduce the loss of blood, the amount of bruising, and the amount of swelling from the surgery. The IV solution helps remove the fat more easily and it is suctioned out along with the fat. This type of liposuction generally takes longer than other types.

• The super-wet technique is similar to tumescent liposuction. The difference is that not as much fluid is used during the surgery--the amount of fluid injected is equal to the amount of fat to be removed. This technique takes less time; however, it often requires sedation with an IV or general anesthesia.

• Ultrasound-assisted liposuction (UAL) is a fairly new technique, used in the U.S. since 1996. During this technique, ultrasonic vibrations are used to liquefy fat cells. After the cells are liquefied, they can be vacuumed out. UAL can be done in two ways, external (above the surface of the skin with a special emitter) or internal (below the surface of the skin with a small, heated cannula). This technique may help remove fat from dense, fiber-filled (fibrous) areas of the body such as the upper back or enlarged male breast tissue. UAL is often used together with the tumescent technique, in follow-up (secondary) procedures, or for greater precision. In general, this procedure takes longer than the super-wet technique.

A liposuction machine and special instruments are used for this surgery. The surgical team first preps the operative site and administers either local or general anesthesia. Through a small skin incision, a suction tube with a sharp end is inserted into the fat pockets and swept through the area where fat is to be removed. The dislodged fat is "vacuumed" away through the suction tube. A vacuum pump or a large syringe provides the suction action. Several skin punctures may be needed to treat large areas.

After the fat is removed, small drainage tubes may be inserted into the defatted areas to remove blood and fluid that gather during the first few days after surgery. If you lose a lot of fluid or blood during the surgery, you may meed fluid replacement (intravenously) or a blood transfusion.

Why the Procedure Is Performed

The following are some of the uses for liposuction:

• Cosmetic reasons, including "love handles," fat bulges, or an abnormal chin line.
• To improve sexual function by reducing abnormal fat deposits on the inner thighs, thus allowing easier access to the vagina.
• Body shaping for people who are bothered by fatty bulges or irregularities that cannot be removed by diet and/or exercise.

Liposuction is generally NOT appropriate for these uses:

• As a substitute for exercise and diet, or as a cure for general obesity. However, it may be used to remove fat from isolated areas at different points in time.
• As a treatment for cellulite (the uneven, dimpled appearance of skin over hips, thighs, and buttocks).
• In certain areas of the body, such as the fat on the sides of the breasts, because the breast is a common site for cancer.

Many alternatives to liposuction exist, including a tummy tuck (abdominoplasty), removal of fatty tumors (lipomas), breast reduction (reduction mammaplasty), or a combination of plastic surgery approaches.

Risks

Certain pre-existing conditions should be checked and brought under control before liposuction, including:

• History of heart problems (heart attack)
• High blood pressure
• Diabetes
• Allergic reactions to medications
• Pulmonary problems (shortness of breath, air pockets in bloodstream)
• Allergies (antibiotics, asthma, surgical prep)
• Smoking, alcohol, or drug use

There are also risks associated with liposuction, including:

• Shock (usually when not enough fluid is replaced during the surgery)
• Fluid overload (usually from the procedure)
• Infections (strep, staph)
• Bleeding, blood clot
• Tiny globules of fat in the bloodstream that block blood flow to tissue (fat embolism)
• Nerve, skin, tissue, or organ damage or burns from the heat or instruments used in liposuction
• Uneven fat removal (asymmetry)
• Drug reactions or overdose from the lidocaine used in the procedure
• Scarring (skin surface may be irregular, asymmetric, or even "baggy," especially in older people)

Finally, make sure to review and sign any informed consent (legal) and permission forms for photographs.

Before the Procedure

Before your surgery, you will have an initial patient consultation, which will include a history, physical exam, and a psychological evaluation. You may need to bring someone (such as your spouse) with you during the visit. You may need a second consultation to give you time to think over the surgery.

You should feel free to ask questions, and to feel satisfied with the answers to those questions. A properly informed person makes a better patient. You must understand fully the pre-operative preparations, the liposuction procedure, and the post-operative care. Understand that liposuction may enhance your appearance and self-confidence, but it will probably not give you your ideal body.

Before the day of surgery, you may have blood drawn and be asked to provide a urine saple. This allows the health care provider to rule out potential complications. If you are not hospitalized, you will need a ride home after the surgery.

After the Procedure

After the surgery, bandages are applied to keep pressure on the area and stop any bleeding, as well as to help maintain shape. Bandages are usually kept in place for at least 2 weeks. Your doctor may call you from time to time to check on your health and to monitor your healing. A visit back to the surgeon after 5-7 days is often recommended. Sometimes people gain weight after liposuction. This is due to the increased fluid from surgery.

Liposuction may or may not require a hospital stay, depending on the location and extent of surgery. Liposuction can be done in an office-based facility, in a surgery center on an outpatient basis, or in a hospital. For reasons of cost and convenience, liposuction of smaller volumes is usually done as an outpatient. You may need to stay in a hospital if a larger volume of fat is being removed, or if you are having other procedures done at the same time.

Most informed patients are satisfied with the cosmetic result of their surgery. Informed patients understand that there are limits to what liposuction can accomplish.

Outlook (Prognosis)

The liposuctioned area may appear larger than before surgery because of swelling. You must wear a tight stocking, girdle, or snug elastic dressing over the treated area to reduce swelling and bleeding, and to help shrink the skin to fit the new contour. You should wear this garment continuously for 2 to 3 weeks.

You will likely have swelling, bruising, numbness, and pain, but it can be managed with medications. The stitches will be removed in 5 to 10 days. Antibiotics may be prescribed to prevent infection.

You may feel sensations such as numbness or tingling, as well as pain, for weeks after the surgery. Walk as soon after surgery as possible to help prevent blood clots from forming in your legs. Avoid more strenuous exercise for about a month after the surgery.

You will start to feel better after about 1 or 2 weeks following liposuction surgery. You may return to work within a few days of the surgery. Bruising and swelling usually go away within three weeks; however, you may still have some swelling several months later.

Your doctor will check your progress through follow-up visits. If you have any questions or problems between office visits, call your doctor. Your new body shape will begin to emerge in the first couple of weeks; however, the improvement won't become more visible until about 4 to 6 weeks after surgery. By exercising regularly and eating a healthy diet, you can help maintain your new shape.

References

Burns JL, Blackwell SJ. Plastic sursgery. In: Townsend CM, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 18th ed. Philadelphia, Pa: Saunders Elsevier; 2008: chap 73.

Kucera IJ, Lambert TJ, Klein JA, et al. Liposuction: contemporary issues for the anesthesiologist. J Clin Anesth. 2006;18(5).

Answer 2

A vibrating suction cannula, or flexible tube, is used in a liposuction procedure. The cannula is inserted through a small hole into the abdominal fat tissue to remove excess fat deposits.

Reviewed By

Review Date: 06/16/2011

David A. Lickstein, MD, FACS, specializing in cosmetic and reconstructive plastic surgery, Palm Beach Gardens, FL. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.