Liposuction, also called body contouring, is a procedure that uses a suctioning process to remove excess fat from various areas of the body. More than 300,000 liposuction procedures were performed in 2006 in the United States, according to the American Society of Plastic Surgeons (ASPS). This ranks liposuction among the most popular surgical cosmetic procedures performed today.

Liposuction is intended to remove localized fat deposits that are unresponsive to diet and exercise. It is a method of altering the shape and contour of the body, and should not be viewed as a weight loss substitute. Not everyone is a good candidate for liposuction. It is best suited for healthy men and women with a normal body weight and pockets of surplus fat in certain regions. Common liposuction sites include the area below the chin, hips, thighs and abdomen, among others.

Liposuction may also be used to treat certain noncosmetic conditions associated with the accumulation of excess fat, including excessive sweating (hyperhidrosis) and fatty, benign tumors called lipomas.

The most common method of liposuction is the tumescent technique, which involves the injection of anesthetics and salt solution into a fatty region. Then a small incision will be made in the skin and a tube called a cannula is inserted. The tube is connected to a machine that resembles a vacuum. The surgeon uses back-and-forth movements to dislodge the excess fat, which is suctioned through the tube into a collection system.

Patients will meet with a plastic surgeon for an initial consultation before deciding to undergo liposuction. During the consultation, the surgeon will decide if the patient is a good liposuction candidate and describe the procedure in detail, often including pictures of previous surgeries. Prospective patients may even be shown a computer-generated image that illustrates how the procedure could alter their appearance.

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. After the procedure, the cannula site will be dressed and patients are typically instructed to wear a compression bandage or garment for an extended period. Side effects and complications of liposuction are usually rare. Recovery times from liposuction vary according to the individual and the extent of the procedure, and residual swelling may last for several months.

Liposuction is a procedure that uses suctioning to remove excess fat from various regions of the body. According to the American Society of Plastic Surgeons (ASPS), more than 300,000 liposuction procedures were performed in the United States in 2006, making liposuction one of the most popular surgical cosmetic procedures performed today.

The roots of modern liposuction date back to 1975 with the advent of the first cannula (tube used for liposuction), and education in liposuction was promoted by both the American Society for Dermatologic Surgery (ASDS) and the American Academy of Dermatology (AAD) as early as 1987. Although liposuction is not a weight loss substitute, it is a method of altering the shape and contour of the body. For this reason, liposuction is also sometimes called body contouring.

Both men and women can elect to have liposuction to improve their physical appearance. However, the areas to be suctioned typically vary according to gender. Common liposuction sites include the area below the chin and the breasts. Women also commonly have liposuction performed on the underarms, abdomen, hips and thighs. Men typically opt to have the waist and flank area (“love handles”) suctioned. Excess fat in the cheeks, neck, upper arms, back, buttocks, knees, calves and ankles may also be removed with liposuction. Liposuction can be performed on multiple areas of the body at the same time. It may also be performed in conjunction with other plastic surgery procedures.

Liposuction is intended to remove localized fat deposits that are unresponsive to diet and exercise. It is not appropriate for some individuals, including those with coagulation (blood clotting) or bleeding disorders, poor wound healing, excessive surgeries in or around the region to be treated or a lidocaine (an anesthetic) allergy. Good candidates for this procedure must meet the following criteria:

• Normal body weight or no more than 30 pounds overweight
• Firm, elastic skin
• Pockets of surplus fat in certain regions
• Good physical health
• Psychological stability

Patients should also have realistic expectations about the procedure. Although liposuction can enhance an individual’s physical appearance, it probably will not give them their ideal body. Liposuction also cannot remove unwanted cellulite from the body.

Older patients often have diminished skin elasticity. Although they may be considered appropriate candidates for the procedure, they may not experience the same results as younger patients with tighter skin. Frequently a procedure to tighten lax skin is more appropriate, or needed in combination with liposuction.

Liposuction may also be used for certain noncosmetic conditions associated with the accumulation of excess fat. For example, it may be used to treat hyperhidrosis (excessive sweating) and fatty, benign tumors called lipomas. It may also be used to treat gynecomastia (enlargement of the breasts in men).

It usually takes one to two months after the procedure for improvement of physical appearance. However, it may take up to six months after the procedure before results are complete in some treatment areas, like the chin.

The decision to undergo liposuction should be carefully considered. Like any surgical procedure, liposuction poses a risk of rare but serious complications, and recovery may be painful.

The tumescent technique is the most common method of liposuction. This procedure involves the injection of a large amount of solution into a fatty region. The solution combines the following:

• 50 milliliters (ml) of a local anesthetic (lidocaine) to numb the region during and after liposuction. This is often the only anesthesia required for the procedure.
  
  
• 1 ml of epinephrine (a drug that contracts the patient’s blood vessels) to reduce blood loss, bruising and swelling that accompanies liposuction.
  
  
• An intravenous (I.V.) salt solution to make fat removal easier.

Following the injection, the surgeon will make one or more small incisions in the skin and insert a tube (cannula) attached to a vacuum into the fat mass. The vacuum device suctions out the excess fat. Tumescent liposuction typically takes longer than other liposuction methods, but results in less bleeding and bruising and fewer skin irregularities. It also has a quicker healing time.

A new method of tumescent liposuction, called power-assisted or powered tumescent liposuction, involves a motorized cannula, which moves back and forth in short strokes at 800 to 10,000 repetitions per minute for increased precision, reduced bruising and an even faster recovery time.

The super-wet technique is a variation of the tumescent procedure. The difference is that a smaller amount of the solution is injected into a fatty region. The amount of solution injected equals the amount of fat to be removed. The super–wet technique is less time consuming than the tumescent technique, but often requires I.V. sedation or general anesthesia, which increases the risk of complications.

Another relatively new liposuction procedure is ultrasound-assisted lipoplasty (UAL). UAL uses a special tube that generates ultrasound energy (high-frequency sound waves) to break down fat cell walls. This turns the fat cells into liquid, which is then suctioned from the body. UAL can be performed externally (above the skin’s surface using a special emitter) or internally (beneath the skin’s surface using a small, flexible, heated tube).

UAL is not commonly practiced by most plastic surgeons, but may be useful for removing fat from areas of the body that are dense and fibrous (e.g., the upper back). It may be combined with the tumescent technique for enhanced precision or follow-up procedures. UAL is generally more time consuming than the super-wet technique.

Patients considering liposuction will meet with a plastic surgeon for an initial consultation. A dermatologist certified and trained in liposuction may also be consulted. During this meeting, the surgeon will evaluate the areas of the body to be suctioned. Initial photographs of the patient may be obtained at this time, and the patient will typically have an opportunity to view results from previous surgeries and/or illustrations of the procedure. In addition, the patient may be shown a computer-generated image that illustrates how the procedure will likely alter their appearance.

During the initial consultation, the surgeon will explain the procedure and any associated risks. Alternative treatment options (e.g., changes in diet, abdominoplasty, reduction mammaplasty) will also be discussed. The patient will then be given the opportunity to ask questions. If the patient decides to undergo liposuction – and is deemed an appropriate candidate for the procedure – a pre-liposuction evaluation will be scheduled.

Patients who elect to have liposuction are usually evaluated approximately two weeks before the procedure. During the evaluation, they will be asked to detail their complete medical history, including current medications. The collection of a thorough medical history is essential because there are a number of conditions (e.g., current infection, history of edema or bleeding disorders) and medications (e.g., anticoagulants) that effect wound healing and blood clotting.

Patients will also have a psychological and physical examination, including blood tests and urine tests. Physical examination of the patient will involve observation and palpitation (feeling) of the area(s) to be suctioned. The surgeon will look for abnormalities including scars, asymmetries, hernias, loose skin and dimples. In addition, a “pinch test” in which the physician pinches the skin to determine the thickness and firmness of any underlying fat will typically be performed. Measurements and additional photographs will also be taken. Depending on the patient’s medical history and the results of the physical exam, additional tests (e.g., electrocardiogram) may be required. Patients may also be asked to give an informed consent at this time.

Prior to the liposuction procedure, patients may be instructed to take or refrain from using certain medications. For example, the physician may instruct the patient to avoid certain pain relievers (e.g. aspirin, ibuprofen) for a minimum of seven days before undergoing liposuction. Patients may also be advised to refrain from eating, drinking alcohol or smoking for a certain time period before the procedure. They may also be instructed to pick up an elastic compression garment for use after the procedure, and arrange for transportation home from the facility.

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.

After the liposuction is completed, the patient will be transported to a recovery area. Cannula insertion sites may be treated with antibiotic ointment and dressings will be applied to the treated area(s). The patient will also be given an elastic compression bandage or garment(s) to wear for approximately one month after the procedure to aid drainage and minimize bruising.

Most tumescent liposuction patients are alert after the procedure, and individuals may even be encouraged to walk immediately following liposuction to promote healing. The patient will typically be observed for at least an hour before being discharged to a friend or relative, who will be instructed to monitor the patient for the next 12 to 24 hours if possible. Swelling, bruising, numbness and tingling are normal. Tumescent liposuction patients may experience mild pain after the anesthetic wears off (approximately 24 hours after the procedure), which can often be relieved with an over-the-counter painkiller, such as acetaminophen. Non-tumescent liposuction patients, however, often require stronger prescription medications. Antibiotics may also be prescribed in some cases to reduce infection risk.

Liposuction patients typically experience significant postoperative drainage for up to 48 hours after the procedure. Therefore, it is recommended that individuals cover their bed linens, furniture, car seats and other surfaces with a plastic (e.g. trash bags) or similar barrier.

Dizziness may occur following liposuction, especially when the patient removes the garment(s) or uses the restroom for the first time after the procedure. Therefore, it is recommended that patients be carefully monitored during these activities.

Liposuction patients are typically instructed to shower and then change the dressings the morning after the procedure. Individuals can normally return to work and resume light exercise within approximately 48 hours of the procedure, but this varies according to the extent of liposuction performed and type of work. More strenuous activity should be avoided for approximately one month.

Follow-up appointments normally take place one day, one week, three months and six months after the procedure. If cannula sites were sutured, the stitches will typically be removed five to 10 days after the procedure. Swelling and bruising typically subsides within three weeks of liposuction. However, residual swelling can continue for several months. Patients are advised to carefully follow all postoperative instructions from their surgeon.

Patients are able to permanently maintain the results of liposuction by eating a sensible diet and exercising regularly. Individuals who gain weight after the procedure may have fat return to the area that was treated, or to other sites.

The main benefit of liposuction is improved physical appearance, which can also positively impact an individual’s self-esteem. The procedure may also be useful in treating certain conditions, such as hyperhidrosis and lipomas (fatty benign tumors).

Side effects and complications of liposuction are rare, especially when tumescent liposuction is performed by a qualified plastic surgeon using local anesthesia. However, the use of general anesthesia poses greater risks including thrombophlebitis (a blood clot forms in a vein, often resulting in inflammation), pulmonary embolism (a blood clot enters the lungs), respiratory failure and death (rare).

The American Academy of Dermatology released guidelines of care for liposuction. The recommendations include:

• Procedures that remove a large amount of fat are not advised.
  
  
• Use of general anesthesia in tumescent liposuction is not recommended.
  
  
• Ultrasound-assisted lipoplasty carries more risks and may not be advised.
  
  
• Liposuction performed along with other procedures is not recommended.

Other risks associated with liposuction may include:

• Asymmetry and other irregularities of the skin (e.g., rippling, dimpling, lumpiness, bagginess, pigmentation changes)
  
  
• Shock (normally from inadequate replacement of fluid during the procedure)
  
  
• Excess fluid
  
  
• Infections
  
  
• Bleeding
  
  
• Blood clots
  
  
• Fat embolism (obstruction of blood flow to the tissues by small masses of fat)
  
  
• Skin, tissue, nerve or organ damage, including:
  
• • Numbness or other changes in sensation
  • Burns (ultrasound-assisted lipoplasty)
  • Visceral perforations (puncture wounds in the organs)
    
    
• Skin necrosis (skin death)
  
  
• Adverse reactions to lidocaine or other drug reactions
  
  
• Scarring

It should be noted that the risk of complications increases when liposuction is performed on a larger surface. 

Patients should seek immediate medical care if they experience any of the following:

• Potential infection
• Feeling faint
• Shortness of breath
• Severe pain
• Extreme bleeding
• Chest pain

Preparing questions in advance can help patients to have more meaningful discussions with their physicians. Patients may wish to ask their doctor the following liposuction-related questions:

1. Am I a good candidate for liposuction?
   
   
2. Can you explain the procedure to me in detail?
   
   
3. What results can I expect after the procedure?
   
   
4. Will I experience pain during or after the procedure?
   
   
5. How long can I expect the procedure to take?
   
   
6. What preparations, if any, should I make before the procedure?
   
   
7. Will I require hospitalization following the procedure?
   
   
8. What risks do I face by undergoing the procedure?
   
   
9. Will I have scarring after the procedure?
   
   
10. How long will it take before I can return to normal activities following liposuction?
    
    
11. How many liposuction procedures have you performed?
    
    
12. Do you follow the guidelines of care for liposuction recommended by the American Academy of Dermatologists?