Liposuction may be performed in a plastic surgeon’s office, an outpatient surgery center or a hospital. It is typically an outpatient procedure. However, patients having a large quantity of fat removed or receiving general anesthesia may require hospitalization.

Patients are advised to bathe the morning of the procedure and arrive at the facility in loose-fitting clothing. Upon arrival, they will have a final opportunity to ask any questions about the procedure. After all questions are addressed, patients will be instructed to sign a final consent form if they have not done so already. They may also be asked to change into a hospital gown, and their vital signs (e.g., heart rate, blood pressure) will be taken. Preoperative photographs may also be taken at this time in some instances.

The plastic surgeon will then mark the areas of the body to be suctioned, and the surgical team will administer either local or general anesthesia, depending of the type of liposuction being performed. Tumescent liposuction, the most common method, typically requires only local anesthesia. Other methods often require intravenous (I.V.) sedation or general anesthesia. The anesthesia will be accompanied by other fluids (epinephrine and a salt solution), which cause swelling and stiffening of the area to be suctioned, making fat removal easier. The amount of fluid used may vary depending on the size of the patient and the area being treated.

After the patient is anesthetized, one or more small incisions will be made in the skin near the area to be treated. The surgeon will insert a tube (cannula), which is connected to a machine that resembles a vacuum, through the incisions and into the fat pockets. The surgeon will then use back-and-forth movements to dislodge the excess fat, which is suctioned through the tube into a sanitary collection system. In powered liposuction, a motorized cannula, which moves back and forth in short strokes at 800 to 10,000 repetitions per minute, will be employed.

The fat that is aspirated (suctioned) should be yellow, or slightly tinged with blood. Red liposuction aspirate indicates excessive bleeding, and the surgeon will reposition the cannula in such instances. Guidelines published by the American Academy of Dermatology recommend that no more than 4,500 milliliters (ml) of fat should be removed during a single operative session. However, most liposuction patients have significantly less than 4,500 ml of fat removed during the procedure.

After the surgeon removes the appropriate amount of fat, small tubes may be inserted into the suctioned areas to drain any blood and/or excess fluid from the body. Sites where the cannula was inserted are often left open because suturing may result in a greater likelihood of edema (swelling) and bruising. Cannula insertion sites may be treated with antibiotic ointment and dressings will be applied to the treated area(s). If the procedure results in significant blood loss, I.V. fluid replacement or a blood transfusion may be necessary.

In some instances, ultrasound-assisted lipoplasty (UAL) may be used. This procedure can be performed externally or internally. With external UAL, an ultrasonic probe (a device that uses high-frequency sound waves) is passed over the region to be treated to loosen or liquefy the fat. With internal UAL, the tip of the cannula or probe employs ultrasonic vibration to liquefy fat before suctioning occurs. Although this simplifies the liposuction, studies indicate an increased potential for burns and seromas (swelling or mass that occurs when serum accumulates within an organ or tissue), and many surgeons contend that the cannula used in UAL is more difficult to use than a manual cannula.