Liposuction (or lipoplasty) is a body-sculpting procedure to remove fat that is unresponsive to dieting and exercising.  This procedure can be applied to nearly any area of the body and is commonly used on multiple areas during an operation.  Liposuction results in a better proportioned figure.  Liposuction is used effectively to reduce love handles, saddlebags,  a bulge around the waistline, or other unsightly fatty deposits in order to develop a better shape and create a more beautiful body.

Reasons for Considering Liposuction:

• Create a more proportioned figure
• Improve contour where fat is in excess and skin is elastic

Liposuction is not a replacement for proper exercise and diet.  Instead, liposuction is a reduction procedure for localized stubborn areas where fat accumulates.  Ideal surgical candidates are not very overwieght and have good skin tone, but have stubborn areas that do not respond to diet and exercise.

General Procedure

L                   Liposuction is usually best performed under general anesthesia.  Through tiny incisions, a narrow tube or “cannula” is inserted and used to vacuum out the fatty tissue beneath the skin.  The surgeon determines the amount of fat to be removed by inspection and manipulation of the tissue.  After eliminating the excess fat, the incisions are closed, and a compression garment is applied in order to, reduce swelling and support the affected area.

There are several different types of liposuction procedures, such as tumescent or ultrasound liposuction, power-assisted lipo, and "Smart lipo".  Together the patient and the surgeon can discuss these during the initial consultation.  The liposuction procedure can last from thirty minutes to several hours, depending upon the amount of fat to be removed, and the number of areas treated.  Liposuction surgery is an excellent procedure that can benefit those who want to remove localized unattractive fatty deposits.

Recovery Process

The length of the recovery will depend the extent of the operation.  Generally, post-operative instructions call for plenty of rest and limited movement in order to speed up the healing process and reduce the recovery time.  A support garment needs to be worn for several weeks after the surgery, depending upon which area(s) are selected to utilize the liposuction procedure.  Pain is usually not as severe as one would expect, and it is usually adequately controlled with oral medication.  While complications are unusual, patients can minimize the risk for potential problems by carefully following the directions given after surgery

 The following article was written to inform other types of doctors.

     LIPOSUCTION

 This article will give an overview of the issues which I discuss with each prospective patient during an initial consultation regarding liposuction.  I expect that many readers will gain some perspective by briefly “stepping back” from the dentition, and even from the face.  Most likely, even those of you who have had the procedure performed on yourselves will learn something from this article.
 Competition for patients has resulted in a variety of marketing techniques such as calling the procedure “liposculpture”, lipoplasty, body contouring”, etc..  And some doctors emphasize their “superior” laser, ultrasonic or pre-suctioning fluid infusion techniques.  Ads often show patients who have lost significant weight, or the postoperative photos are taken from farther from the patient.  Because of the confusion created in the advertising media, I will discuss who is a good candidate for liposuction, how it works, what are the risks and side-effects, and what the recovery is like.
 Liposuction is a popular technique of contouring the body by removing localized areas of excess adiposity.  Unfortunately, such localized fat collections are rather resistant to total body weight loss.  Liposuction is certainly not a substitute for weight reduction, dietary discretion, or exercise.  An attempt to reduce total body weight by the use of liposuction would be dangerous.  In fact, the safety of the procedure is largely proportional to the volume of fat removed. Removal  of more than about five to eight pounds of fat at one time (depending on which source you read) constitutes “large volume” liposuction, and incurs risks of needing a transfusion, hospitalization, etc. 
 A good candidate for liposuction is generally healthy, has stable weight, and isolated area(s) of excess adiposity.  Skin elasticity decreases with age, and elasticity must be sufficient to allow the skin to contract to the new contour.  For example, liposuction under the chin and jawline works best for patients under thirty years of age, and liposuction of the abdomen is mainly used for those under about fifty years of age.  Liposuction on the face and neck should be quite conservative because there is a tendency to lose facial fat with age, and, as you will see later in this article, the risks of contour problems are greater on the face.
 Liposuction is performed by placing small incisions in cosmetically acceptable areas and repeatedly thrusting a partly open ended hollow metal cannula deep into the adipose tissue.  The cannula is connected to a suction which pulls fat off of its connective tissue framework.  Because the fat is rather friable there is relatively more damage to the fat than to blood vessels and nerves.  Much of the fat which ultimately leaves the area of suctioning is that which is drawn out into the cannula.  But a fair amount of the fat which is left behind has been injured, and it is ultimately redistributed to other areas of the body.
 The risks and possible complications of liposuction are not insignificant, and they should not be “brushed over” by the consulting doctor.  Contour irregularities such as depressions, lumps, asymmetry, and “waviness” are related to the imprecise nature of the technique and to late fat redistribution.  Interestingly, each area of the body (and each individual) has a different predisposition to such contour problems.  The face, neck, and the medial upper thighs are notorious for contour problems, which may not become evident for months.  On occasion, a secondary “touch-up” procedure is warranted.  When a fair amount of fat is removed from an area, paresthesia of that area is expected, and such paresthesia can be permanent, but people usually tolerate this well.  Nerve damage can less often result in isolated spots of “sharp” dysesthesias.  Fortunately, it is rare for such neurological problems to interfere with activities such as sitting down or wearing a belt.  The risk of infection is thought to be about one percent or less, but it can be severe enough to cause hospitalization and major deformity.  When fat is removed close to the skin surface it can not only cause irregular contours, but it can also result in loss of circulation to the skin, causing skin necrosis.  Interference with lymphatic drainage can give rise to a “seroma” which may require aspiration every few days for weeks.  A few people have persistent edema.  Rather rarely, the bruising gives way to a long-lasting hyperpigmentation.
 Most doctors require their patients to wear a rather tight garment over the surgical area for two to three weeks to assist in skin redraping.  (This is less enjoyable during a heat wave.)  Swelling after the procedure increases for about three days.  Much of the swelling dissipates over the next few days , leaving the patient not much changed from pre-op in many cases.  The remainder of the swelling and tissue redistribution occurs over a period of several months.  Most people can return to work after three or four days, depending on how many areas were treated, how much fat was removed, and the amount of activity their job requires.  Aerobic activity results in thrombolysis, and this can cause bleeding and more swelling if such exercise is performed within approximately the first five postoperative days.
 There have been some deaths from liposuction, and the causes for these deaths have been investigated.  Large amounts of fluid infused into the surgical site, combined with overhydration via intravenous infusion, can result in pulmonary congestion and cardiac failure.  Inadequate replacement of fluid and blood, which can be lost into the (large volume) surgical site, can lead to severe dehydration or critically serious anemia.  The fluid infused preoperatively into the surgical site usually contains dilute local anesthetic and epinephrine.  Even ten times the “maximum dose” of local anesthesia can usually be used safely because fat is relatively hypovascular, and some of the infusate is removed by the subsequent liposuction.  But serum levels of the local anesthetic can peak more than ten hours postoperatively (when the patient is home), and some deaths have resulted from local anesthesia overdose.  In large volume liposuction, enough small particles of fat can find their way into the venous circulation to result in significant pulmonary fat embolism.
 Liposuction is popular because it addresses localized fat deposits which are resistant to other forms of therapy, and patients feel that the results are nearly always a sufficient improvement to justify the risks.  Our techniques and results will continue to improve, but a “new, cutting-edge of technology” method cannot compensate for appropriate surgical training, good judgment, and attention to detail.