Liposuction
View Liposuction Before and After Pictures
Liposuction Information
After Surgery
Risks and Complications
Satisfaction Rates
A good candidate for Liposuction:- Is close to their ideal body weight (within 30%)
- Wants to remove specific areas of fat that are diet- and exercise-resistant (fat pockets in the abdomen, arms, knees, inner thighs, love handles, neck, outer thighs
- Weight has been stable for 6 months or more
- Has good skin tone and elasticity
- Does not have loose or saggy skin
- Does not have stretch marks
- Has realistic expectations
- Is emotionally stable
- Understands the risks of surgery
If you do not meet all of these criteria, but meet some of them, you may still be a good candidate for liposuction. The procedure is most suited to those who are close to their ideal body weight, but if you have a lot of fat in a isolated area, you may still be a good candidate. Some patients find liposuction to be a good incentive for weight loss, but it is not a remedy for obesity.
If you have good skin tone, it is more likely that your skin will respond well to the surgery. Patients with saggy skin or stretch marks are more likely not to tighten and may in some cases look worse. A thigh lift or tummy tuck (depending on your problem area) may be more effective.
Patients planning to have large volume liposuction, which involves the removal of more than 5 liters (5,000 cc's; about 11 pounds) of fat and fluid may have an overnight stay at the hospital.
You are also at increased risk for complications from liposuction if you have diabetes, poor circulation, heart, lung or liver disease, smoke, have a family history of blood clots, take certain medications, etc. You'll want to discuss your medical history thoroughly with your physician before you choose to undergo surgery.
Which type of liposuction?
There are two basic techniques used in liposuction: tumescent and ultrasonic. Both techniques share core surgical elements. In fact, even if ultrasound is used, it will be followed by tumescent liposuction.
Tumescent liposuction is also called standard liposuction, liposuction, lipoplasty, liposculpture, liposculption, and suction-assisted lipoplasty. This type of liposuction has been performed in the United States since the 1982. First, the surgeon fills the fat with tumescent fluid (a solution containing saline and local anesthetic). Then, the fat is suctioned with long thin rods. The procedure can now be performed through a few small incisions, which can be hidden with natural skin creases. The tumescent technique may reduce blood loss and alleviate pain. The local anesthesia may be supplemented with intravenous sedation or general anesthesia.
Ultrasonic liposuction also starts with filling the fat with tumescent fluid to make the fat stiff. However, the fat is not suctioned, but liquefied with high-frequency ultrasonic energy with a long thin rod that emits ultrasonic waves. The rod is inserted into the fat through a tiny incision and then, the fat is suctioned out.
There are other sub-categories of the two techniques:
Suction-assisted Liposuction (SAL): The traditional method, by which the surgeon removes fat by inserting a small, hollow tube (cannula) connected to a vacuum pressure unit, directing the cannula into areas to be suctioned through tiny incisions.
Ultrasound-assisted Liposuction (UAL): Sound waves are transmitted to the tip of the cannula to liquefy fat before it is removed by suction.
External Ultrasound-assisted Liposuction (E-UAL): External ultrasound waves alter fat cells. The area is injected with fluid containing local anesthetic to transmit ultrasonic energy and liquefied fat is removed by suction.
Power-assisted Liposuction (PAL): A cannula with a back and forth motion of the tip passes through tissue to suction out fat and fibrous or scarred tissue with reduced effort.
VASER®-assisted Liposuction (VAL): Intermittent, or continuous bursts of ultrasonic energy can be used to break up fat cells which are then removed by suction.
Source: The American Society for Aesthetic Plastic Surgery (ASAPS)
There is not a consensus among plastic surgeons as to which technique is superior. There is slightly less blood loss and a greater ability to remove fat in difficult areas with ultrasonic liposuction, but it is also associated with greater complications than tumescent liposuction such as burning and/or tingling, swelling, skin burns and seromas (fluid collecting under the skin). Discuss these technique with your surgeon. Because there are only small differences between the procedures, the technique that your surgeon is most skilled in will cause the least complications.
Anesthesia
Liposuction can be performed under general anesthesia (in which you are completely asleep) or sedation (very relaxed in a light sleep). It can be performed in the office or hospital. Depending on how many areas are being worked on, surgery lasts from 30 minutes to 5 hours. In addition to fat, the surgeon also removes body fluid in the procedure. Because of this, patients are given fluids intravenously during the operation and there is the possibility that a blood transfusion will be necessary.
After surgery, you will wear a body-compression garment. You must wear this for several weeks. After surgery, you can usually go home. You'll want to make arrangements for a responsible adult to care for you for the first 24-48 hours. If your surgeon performed a large-volume liposuction (over 5 liters) then you should stay in the hospital overnight for observation and safety.
Cellulite
Do not expect liposuction to improve your cellulite. It may actually worsen it. This is because cellulite is due to superficial fat, which liposuction does not remove. Lipo removes only deep fat.
Tummy Tuck vs. Liposuction of the Abdomen
If you have excess abdominal fat, no stretch marks and fairly good skin tone, you are a good candidate for liposuction. If you have stretch marks, loose skin and a loose inner girdle (all more likely after pregnancy), a tummy tuck is probably your best choice.
For faster recovery:- Drink adequate amounts of liquids to prevent dehydration
- Avoid alcoholic beverages for 48 hours before and after surgery
- Wear compression garments as suggested to prevent slow healing and excessive drainage
- Do NOT apply ice-packs or a heating pad to skin overlying the liposuctioned areas
- Do NOT apply hydrogen peroxide or plastic Band-Aids to incision sites
- Do NOT soak in a bath, Jacuzzi, swimming pool, or the ocean for at least 7 days after surgery in order to minimize the risk of infection
- Reduce your risk of fainting at home by: standing up slowly after urinating, remove compression garments slowly, have assistance for your first shower, sit down if you feel dizzy or lightheaded
Recovery from liposuction can be uncomfortable, but most people are back to work within 10 days. During the first few weeks most people experience varying degrees of pain, burning, swelling and temporary numbness. Pain medications can alleviate discomfort (usually taken for 2 days - 2 weeks) and a body-compression garment will minimize swelling. You will need to refrain from any exercise other than walking for about a week after the procedure. Slowly work your way back to your old exercise routine.
Consider a massage therapist for lymphatic drainage massage to relieve swelling and possible itching (discuss this with your doctor).
Although the new shape of your body usually begins to emerge in the first few weeks, some swelling may remain for several months. Major weight gain or loss after liposuction can produce skin surface irregularities. The final result may not be clear until 6 months after surgery.
Many people assume that because liposuction permanently removes fat cells, it's impossible to regain weight in the treated areas. This is only partially true. Adults have a fixed number of fat cells, and liposuction removes some of these cells permanently. The remaining fat cells can grow bigger, especially if you do not exercise and maintain a healthy diet. This means problem spots can return. However, weight gain after liposuction will usually be distributed to other parts of your body instead of settling back into the old problem areas.
List of possible complications: (not an exhaustive list)
Abnormal body contour, Anesthesia reaction, Bleeding,Death (approximately 1 in 10,000), Depression, Dimples, Discoloration, DVT (Blood Clot), Fat Embolus (less than 0.1%), Heart Failure, Hematoma, Hypothermia, Infection, Keloid (heavy scar), Nerve damage, Perforation of bowel or abdominal wall, Permanent numbness (risk is less than 1%), Puckers, Reactions to medications, Seroma (fluid collection under skin), Shock, Skin irregularities, Skin death (necrosis), Slow healing, Swelling, Tingling, Visible scar
Deaths related to liposuction surgery can happen for a number of reasons: blood clot, perforation of the abdominal wall or bowels, shock and hemodilution (blood dilution), and possibly excess amounts of lidocaine.
Blood Clots
Blood clots (or deep venuous thrombosis, a DVT) can forms in the deep veins of the pelvis or legs after any surgery. A blood clot forms after prolonged immobility (people on international flights, women on bedrest during pregnancy and patients recovering from surgery are the most susceptible to blood clots). It is important to stand often (at least once an hour), flex the feet more often and generally keep the blood flowing in your legs. If the blood pools for too long in one area, you could be at risk for a blood clot.
Perforation
Perforation of the abdominal wall or bowels is preventable during surgery. Surgeons are limited in what they can see during surgery and must take extra caution. Choosing an highly experienced surgeon can reduce your risk of such complications.
Shock and hemodilution
Shock and blood dilution can occur after a patient has had excessive amounts of fluid injected and then excessive amounts of fat and body fluid removed (over 5,000 cc's, about 11 pounds). Large volume liposuction should be considered carefully. It is generally not recommended. However there are surgeons that specialize in it (See Reuters Health article).
Lidocaine
Lidocaine use poses particular hazards, especially since experts do not agree on safe injectable levels. "If you get too much lidocaine for too long," says Bruner, "the heart muscles become lazy. On the other hand, the brain becomes very agitated at first, which may cause a seizure, before coma sets in." At least one study links possible lidocaine toxicity to liposuction deaths. People with less than normal liver function or those who have been drinking alcohol may not be able to metabolize lidocaine well.
According to the FDA, a survey conducted by the American Society of Plastic Surgeons (ASPS) of more than 1,500 plastic and reconstructive surgeons in January 1999, there was an unexpected high death rate of one in every 5,000 (or 20 out of 100,000) liposuction patients between 1994 and 1998. These high numbers may be due to an increase in unqualified surgeons performing liposuction during that period. Since 1995, the number of deaths related to liposuction have decreased dramatically, to around 1 in 100,000 (approximately 25 deaths out of 250,000 liposuction procedures per year).
A study published in the scientific journal, Dermatologic Surgery, shows that office-based liposuction may be significantly safer than hospital-based liposuction. No deaths were reported by dermatologists performing approximately 300,000 procedures from 1995 - 2000.
A review of malpractice claims from the Physicians Insurance Association of America (PIAA) showed that of the 257 claims filed from January 1, 1995 through December 31,1997, less than 1 percent were against dermatologists even though dermatologic surgeons perform more than one-third of the liposuction procedures in the United States. In addition, 89% of claims were against plastic surgeons, with patients undergoing liposuction in a hospital setting accounting for 71% of malpractice claims.
According to statistics from their respective professional organizations, dermatologic surgeons currently perform about 100,000 liposuctions annually, with plastic surgeons accounting for more than 170,000 fat removal procedures per year. "Our study found that liposuction is safest when it is performed as a solo procedure under local (tumescent) anesthesia in an outpatient setting by a board-certified dermatologic surgeon. In fact, our data shows that there have been no deaths from liposuction by dermatologic surgeons." William P. Coleman, III, MD, president of the American Society for Dermatologic Surgery.
According to Dr. Coleman, more risks are associated with:
- Extracting large amounts of fat
- Using general anesthesia in a hospital setting
- Performing multiple procedures during the same surgery
The PIAA study confirmed that patients who had liposuction performed under local anesthesia using the tumescent technique had no fatalities and fewer complications.
Source: http://www.asds-net.org/lipo_safety.html
According to a study by the ASPS Liposuction Task Force, released in October 1998, the rate of significant complications from liposuction is low. The Task Force reviewed 24,295 liposuction surgeries performed by board-certified plastic surgeons for the study and found that only .03 percent reported significant complications.
Factors that increase the risk of complications include: large volume liposuction, because of the use of greater amounts of fluid and anesthesia, as well as removal of more fat; extended length of surgery; multiple procedures; or a patient whose preoperative health is compromised.
Source: http://www.plasticsurgery.org/mediactr/homework.htm
In 1997 board certified plastic surgeons formed a task force to investigate liposuction safety. Their research led to increased efforts by ASAPS and other plastic surgery organizations to re-educate plastic surgeons about risk reduction in lipoplasty procedures. Several measures were identified as ways to increase patient safety, including: 1) using stricter patient selection criteria, 2) limiting the length of surgery, 3) avoiding pre-injection of excessive amounts of fluid and local anesthetic, 4) removing a smaller volume of fat, 5) avoiding the combination of liposuction and certain other procedures, and 6) careful postoperative monitoring.
Beginning in mid-1998, the safety record of lipoplasty performed by board-certified plastic surgeons appears to have improved dramatically. In May 2001, a major survey on lipoplasty safety was published in Aesthetic Surgery Journal, the peer-reviewed journal of the American Society for Aesthetic Plastic Surgery. The survey, covering many thousands of lipoplasty procedures performed by ASAPS members from September 1998 through August 2000, showed that the risk of death from lipoplasty performed as an isolated procedure (not in combination with any other surgeries) was 1 per 47,415 procedures, a nearly 10-fold decrease from rates suggested by earlier published surveys.
Source: http://www.surgery.org
The following tables record the data from that survey.
Nonfatal complications from lipoplasty and lipoplasty combination procedures
for 94,159 lipoplasty procedures performed by ASAPS members: Sept 1, 1998, through Aug 31, 2000
| Complication | Percent Rate | (1 complication in every __ procedures) |
| Skin slough | .0903% | 1 per 1107 |
| Ultrasound-assisted lipoplasty skin burns | 0.0712% | 1 per 1404 |
| Deep vein thrombophlebitis | 0.329% | 1 per 3040 |
| Pulmonary embolus | 0.0266% | 1 per 3759 |
| Excessive blood loss | 0.0149% | 1 per 6711 |
| Fluid overload | 0.0138% | 1 per 7246 |
| Fat emboli | 0.0053% | 1 per 18.868 |
| Cannula penetration of abdominal cavity | 0.0021% | 1 per 47,619 |
| Lidocaine toxicity | 0.0021% | 1 per 47,619 |
| Surgical shock | 0.0011% | 1 per 90,909 |
In the same study, the mortality rate was 0.0021%, or 1 death per 47,415 procedures. "Stated positively, the estimated non-mortality probability is 99.98%."
Source: CE Hughes, Reduction of lipoplasty risks and mortality: An ASAPS survey. Aesth Plast Surg 2001;21:120-127
Questionnaires were sent to 332 patients who had liposuction performed at Alia Clinic (in New South Wales, Australia) in 1999 and 2000. 123 patients responded. "87.8% of respondents were female. The mean body mass index (BMI) was 26.16. A large proportion of patients experienced positive lifestyle outcomes from the procedure: 80.5% were more confident, 74.8% noted an increase in self-esteem, and 87% were more comfortable in clothes. The time since surgery did not influence results."
Source: Goyen MR, Lifestyle outcomes of tumescent liposuction surgery. Dermatol Surg 2002 Jun;28(6):459-62
