Liposuction or suction assisted lipectomy (SAL) is the second most commonly performed cosmetic surgical procedure in the United States. According to the statistics from the American Society for Aesthetic Plastic Surgery (ASAPS ), over 240,000 patients underwent the procedure last year alone. Liposuction involves the removal of fat cells through a small tube attached to a source of suction placed in the body through very small incisions. Incisions are placed in inconspicuous locations depending upon the area to be treated. Once the fat cells are taken away, they are gone forever. Thus, patients who have persistent areas of fat, despite diet and exercise, are great candidates for liposuction. Liposuction, however, is NOT a weight loss procedure and will not take the place of a healthy lifestyle combined with diet and exercise.
We need to discuss a number of things during your consultation for liposuction. The first two concerns are the amount of excess fat and the amount of excess skin. I will also evaluate the “quality” of your skin in the areas to be treated. You need to understand that we do not treat the overlying skin and rely on your skin’s ability to contract once there is less fatty tissue beneath. We must give careful consideration of each these factors to ensure that you will have a successful result.
Additionally, if you have a significant amount of excess skin, we may have to change your treatment plan to address these issues not well managed with liposuction. For example, women after pregnancy often have a large amount of excess skin that didn’t “bounce back” after delivery of the baby. We will cover all of this with you at the time of your consultation.
Traditional liposuction techniques involve the placement of a small cannula or tube into the body at the level of the fatty tissue. This tube has small holes in it and it is connected to a suction device. This allows the fatty tissue to be disrupted and removed from the body.
Power Assisted Liposuction
Power assisted techniques are similar to standard liposuction with the addition of an air powered micro-vibration of the cannula tip. This helps me pass the cannula through more dense and fibrous aspects of the fatty tissue. I find this to be particularly helpful in the hips, flanks (“love handles”), and especially in male breast tissue. The procedure and recovery are relatively the same with only mild differences. My choice to use this device will largely depend your anatomy. Generally, it is my preferred method of performing secondary liposuction.
Ultrasound Assisted Liposuction, Vaser Liposelection
Ultrasound has been used for many years to assist in liposuction. Ultrasound produces a vibration at the tip of the cannula at a rate of up to 10,000 times a second. This acts to cause the fat cells to vibrate at such a rate that the fat cells actually rupture. This technique also preferentially acts on the fat cells prior to damaging any other supporting tissues such as nerves or blood vessels. As this technology has improved, it has become known as “liposelection” by the main company providing the technology – VASER. This technique can be used nearly anywhere in the body with good success. It has been also said to cause a greater contraction of the overlying skin and is much more successful in areas considered to be very fibrous or with scar tissue from previous surgery. It is important to remember that this technique requires an extra operative step to remove the ultrasound treated fat and this procedure will take longer than traditional techniques.
Wetting or Tumescent Solution
I routinely use a “tumescent” solution that is placed in the areas to be treated at the start of the procedure. This makes the fatty tissue temporarily larger and more easily treated. It also, contains medicine (Epinephrine) to make the blood vessels constrict which results in less bleeding and bruising after surgery. The technique can involve the placement of up to 5 liters of fluid into your body before we even start. The procedure also results in swelling, which is common. Thus, it is important to realize that at the conclusion of your surgery, you won’t look significantly different from where you started. This is normal and expected. Over your recovery, you will see the effects of your surgery as swelling decreases.
Liposuction is traditionally an outpatient surgery with the vast majority of patients going home an hour after they have recovered from their procedure. Incisions are very small and placed in areas that are very easily hidden even in a bathing suit. After surgery, you wake up wearing a garment that covers the areas treated. This is variable depending upon how many body areas that we treat at the time of surgery.
If you need large volume liposuction (over 5 liters), we generally require you to stay overnight in a facility where you are under supervised care by trained nurses. The reason this is required is that your body will have a significant amount of fluid that it must reabsorb over the next 24-48 hours. It is important that this is accomplished with your health and safety as our primary concern.
Recovery from liposuction is usually not very painful. Most patients describe the process as uncomfortable similar to an aggressive workout. As a result of the wetting solution in combination with the post-surgical swelling, results usually take six to eight weeks to become fully visible. I usually recommend wearing a post surgical compression garment during the recovery process. This starts at 23 hours a day taking the garment off to shower only, and then slowly diminishes over time. Patients tend to tolerate this very well, occasionally asking to wear it longer than prescribed. “Spotty” or “patchy” numbness is an expectation in the skin overlying the treated areas. This resolves over the course of weeks to months.
Liposuction is a wonderful procedure with many new techniques emerging every year. Some of the laser-assisted techniques have raised some concerns since their introduction. Patients have suffered skin burns from the laser damaging the under surface of their skin. As a result, I have decided to avoid this technology until the problems have been fully resolved so that my patients do not suffer unnecessarily.
Complications in liposuction are quite uncommon and the vast majority of people are very happy with their results. Issues that can result from liposuction are contour irregularities (lumps and bumps beneath the skin), prolonged swelling, fluid collections, or need for additional procedures. The vast majority of these issues resolve without the need for any further interventions.