Last updated date: 01-Jun-2023
Medically Reviewed By
Dr. Seong Cheol Park
Originally Written in English
Liposuction Facts - Viewpoints from Expert Doctors
Today we are going to talk about something that people lately think will make them never go to the gym.
So, we are talking about something for weight loss that doesn’t include tiring workouts.
Today we are discussing a type of plastic surgery that can literally carve your body.
Today we are going to discuss liposuction. Have you ever heard about it?
Liposuction is a plastic surgery procedure that includes sucking fat from various parts of the body, such as the abdomen, hips, thighs, chest, back, calves, ankles, buttocks, upper arms, and neck, allowing not just fat removal but also contouring of these areas.
Liposuction is a surgical technique that is more of an art than a science. It is a skill acquired through clinical experience that includes the actual application of scientific information with accuracy and artistry. It provides as much happiness and delight to the person through it as it does to the surgeon doing the terrifying work of delivering that final result.
It is also called lipo, lipoplasty, or body contouring. The procedure uses a suction technique to remove the fat from specific parts of the body such as the abdomen, hips, thighs, buttocks, arms, or neck.
Liposuction has evolved over the last 15 years with the introduction of the tumescent and super-wet techniques, ultrasonic assisted liposuction, power assisted liposuction and laser lipolysis. These advances have made possible the removal of larger volumes of fat with negligible blood loss and relatively trifling complications.
Lately, it has become a popular cosmetic surgery option for people who want to lose weight easily. However, it is not typically considered an overall weight-loss method or weight-loss alternative because you are more likely to lose weight through diet, exercise and bariatric procedures, such as gastric bypass than you would lose from liposuction.
People usually get a liposuction procedure to improve the shape of their bodies and to remove excess fat from specific areas. They try liposuction when diet and exercise can’t do the job.
The most often used definition of ‘large volume liposuction' The term LVL refers to either the overall amount of fat removed during the surgery or the total volume removed during the procedure (fat plus wetting solution). Because many of the problems associated with big volume liposuction are connected to fluid shifts and fluid balance, categorizing the surgery as large volume based on total volume taken from the patient, including fat, wetting solution, and blood, is preferable.
Clinically, large volume liposuction refers to the removal of more than 5 liters of total volume from the patient. Gilliland et al. have properly separated and classified them as:
- Large Volume Liposuction (LVL) is an aspirate of 5000 ml
- Mega-volume liposuction as an 8000 ml aspirate
- Giganto-volume liposuction as an aspirate of 12,000 ml
The majority of adipose tissue is white fat, which is used to store triglycerides and fatty acids for the body's energy demands. Obesity is caused by an increase in fat content, and it can be hypertrophic or hyperplastic.
The hormones ghrelin, leptin, and adiponectin have been studied in relation to obesity, fat storage, and appetite. These proteins appear to have possible implications for human food consumption, obesity, and weight fluctuations. Animal studies show that liposuction reduces ghrelin while increasing leptin, reducing hunger and enhancing lean body mass. The consequences of liposuction and its aftereffects on people are still being established.
Cellulite is a popular lay word that refers to skin surface abnormalities and dimpling, most notably in the thighs and buttocks. Secondary to variations in connective tissue structure and adipose tissue biochemistry, etiologic causes have been attributed but not proven. The common layman view of higher occurrence among women has been verified by research.
Previous research investigations have identified and defined fat distribution variations between men and women. Women are more prone than males to have gynoid pattern collections, which are defined by greater deposits across the outer thigh, buttock, hips, and truncal area.
Men, on the other hand, are more likely to display android pattern collections centered in the truncal and abdominal areas. However, accumulation patterns differ according to ethnicity, age, and gender. With aging, there is a considerable reduction in the subcutaneous fatty layer and an increase in intra-abdominal fat levels.
The notion of eliminating excess fat from particular body locations to obtain comparable benefits is ascribed to Charles Dujarrier, who attempted to remove subcutaneous fat from a ballerina's calves and knees in 1921 in France using a uterine curette. The dancer's leg was amputated due to an unintentional damage to the femoral artery. This unpleasant issue halted future advancement in this sector, but it was a valiant endeavor at the time.
In 1974, Giorgio Fischer and his father Arpad Fischer, both gynecologists from Rome, Italy, developed the technique and tools for modern liposuction. They created their own tools, and their early cannulae featured a cutting blade. They ultimately created a blunt hollow cannula linked to a suction device and published their findings in 1976.
With their enhanced cannulae, they devised the technique of crossing tunnel creation from numerous access sites and exhibited good outcomes with fewer problems.
Who needs Liposuction?
So, again, as a quick recap. Why is liposuction done?
It is usually done to remove fat from areas in the body that haven’t responded to diet and exercise, including:
- Upper arm.
- Calves and ankles.
- Chest and back.
Besides, liposuction can sometimes be used for breast reduction or treatment of gynecomastia, which means enlargement of breasts in males.
But how can one decide if they are good candidates for liposuction?
Liposuction planning should begin with a comprehensive history and evaluation. Previous medical and surgical history, with a particular emphasis on cardiovascular and pulmonary condition, is essential. Current medicines and allergies can have a considerable impact on the choice to proceed, therefore they must be thoroughly examined and discussed with the patient. Previous anesthesia history might also be helpful in reducing patient risk.
Some people are good candidates for liposuction while others should avoid it. You need to have realistic expectations. For example, if you expect that you won't have cellulite after the surgery, then you are wrong.
Liposuction is, after all, a surgical procedure with its own risks. So, before you consider it, you need to be in good health. And that means you must at least:
- No smoke.
- Have firm elastic skin.
- Be within 30% of your ideal weight.
- Have good muscle tone.
- Not have a lot of excess skin.
- Not be overweight or obese.
- Have fat deposits that don’t go away with diet or exercise.
- Be in good physical shape and overall health.
On the other hand, you should avoid liposuction if you:
- Have a weak immune system.
- Have a chronic condition.
- Are overweight.
- Have saggy skin or a lot of excess skin.
- Take medications that increase the risk of bleeding such as blood thinners.
- Have a history of cardiovascular disease, deep venous thrombosis, diabetes, or seizures.
Liposuction's non-cosmetic uses were pioneered or developed by surgeons of different specialties. Liposuction may be performed to treat lipomas, angiolipomas, and hyperhidrosis. Hematoma evacuation can be aided by liposuction methods. Klein exhibited breast reduction liposuction methods. Field was a pioneer in the use of liposuction to promote flap mobility in cutaneous reconstruction, gynecomastia, and benign symmetrical lipomatosis (Madelung's disease) and Dercum's disease.
Several regions require special care, and liposuction should be avoided in these places due to the higher risk of complications. The gluteal crease, lateral gluteal depression, distal posterior thigh, middle medial thigh, and inferolateral iliotibial band are examples of such regions. Because of the lack of deep fat and the adhesion of the more superficial layer to the underlying fascia of the muscle, these regions are more prone to superficial contour abnormalities.
Is Liposuction safe?
Liposuction, like any other surgical procedure, has its own mechanism. So, let’s have a look at how it works.
When you gain weight, fat cells in your body increase in size and volume. So, liposuction works on reducing the number of fat cell in the desired area. We can’t live without fat cells; they are highly beneficial in some parts of our bodies. But when they are too many, they become a health problem.
The amount of fat removed during liposuction depends on the original shape of the area and the volume of the fat cells.
The resulting contour changes are generally permanent as long as the weight remains stable.
In addition, as we mentioned before, liposuction doesn’t improve cellulite dimpling or other skin surface irregularities. Likewise, it doesn’t conceal stretch marks.
One of the most important criteria to undergo liposuction is to have a good skin tone. Because after liposuction, the skin takes the shape of the new contour of the treated area. And if you have a good skin tone and elasticity, the results will be better, and you will have a smoother look at your skin. But if the skin is thin and loose, it will appear loose after the procedure as well.
The current suction-assisted liposuction (SAL) approach involves removing fat using blunt-tipped hollow cannulas coupled to a closed suction system. Many adjustments and modifications have been implemented throughout the years to reduce danger and improve the aesthetic outcome of the liposuction contouring process.
Types of Liposuction
There are different types of liposuction, including:
- Tumescent liposuction.
This is the most common type of liposuction. In this type, the surgeon injects a solution that consists of a mixture of salt water, that aids fat removal, an anesthetic to relieve the pain, and epinephrine that causes the blood vessels to constrict to reduce blood loss. The solution is injected into the area that is being treated and it causes it to swell the stiff. Then small cuts are done to the skin to insert the cannula that vacuums the solution together with fat cells from the body. And IV fluid is used after to replenish the body fluids.
- Power-assisted liposuction.
In this procedure, the surgeon uses a special cannula that uses tiny rapid vibrations and moves in a rapid back-and-forth motion to break down the fat cells so that they can be suctioned out of the body. The main advantage of this procedure is the smaller incision that targets the specific area they are targeting without damaging the surrounding tissue. It also allows the surgeon to remove the fat with more precision and less pain and swelling. This technique is your go-to technique if you had a previous liposuction procedure or a large volume of fat is going to be removed.
- Ultrasound-assisted liposuction.
It is sometimes used in conjugation with traditional liposuction. In this technique, the surgeon uses ultrasound waves to liquefy the fat cells in the targeted area then later remove the liquified fat cells with a specific cannula. There is a new generation of this technique called VASER-assisted liposuction. It uses a device that might improve skin contouring and reduce skin injury.
Although the American Society of Plastic and Reconstructive Surgeons has promoted ultrasonic liposuction, surgeons from other specialties have abandoned the procedure because they believe the internal ultrasound increases the risk of cutaneous burns and seroma formation and provides little additional benefit over standard liposuction.
- Laser-assisted liposuction.
This procedure uses low-energy waves delivered by a thin laser fiber inserted through a small access site. Then, the laser energy is directed on the fatty area without damaging the surrounding tissue. When the fat is liquified, it is easy to remove it with a special cannula.
What’s Liposuction Surgery?
While the patient is upright, make markings with a surgical marker to identify locations to be treated. Most surgeons employ topographic-type marks to highlight areas of greatest bulge in the center, with subsequent concentric circles farther away indicating neighboring areas where the liposuction should be gradually tapered towards the perimeter. Lipodystrophic regions get deformed and move when the patient is recumbent, making identifying the areas to be treated considerably more difficult.
As a result, prior to placement, the patient must be marked, nearly always in the standing position. If the patient understands the marks, he or she may assist confirm treatment areas and be involved in decision-making, which increases patient satisfaction. Zones of adherence and depressions are commonly painted with a different color marker to denote avoidance regions.
Most lipoplasty operations in the authors' practice are conducted under general anesthesia using the tumescent or superwet method. This enables for easier repositioning as well as the use of little or no lidocaine to avoid postoperative toxicity concerns. Additionally, where practical, the authors utilize body heaters and blankets, as well as warmed infusate solution, to assist maintain core temperature.
Pneumatic compression devices are utilized in all patients when the operation is expected to last more than one hour to help in the prevention of deep vein thrombosis or pulmonary embolism. If both legs are being treated with liposuction, these devices may also be utilized around the arm.
Patients are typically treated as outpatients unless the lipoaspirate is greater than 5 L or another concomitant operation is performed that necessitates closer monitoring. Discharge patients with a knowledgeable caregiver and instructions on how to utilize drainage and compression garments. Patients should continue to ambulate and engage in mild exercise to avoid deep vein thrombosis and its consequences.
After 2-3 days, the patient may shower and change the garment for continuous use. In most cases, the patient can return to work after one week, but should avoid vigorous exercise or working out for another two to three weeks, depending on the locations and quantity treated. Garments should be worn for at least two weeks in a row.
A safe and restricted surgical operation that produces even a minimum acceptable aesthetic shape of their profile in accordance to their body structure substantially improves the self-esteem of the obese individual. This is the primary indication and the foundation of the much-touted big volume liposuction.
The most prevalent issue is an unhappy patient as a consequence of excessive expectations before to surgery. Careful and precise communication between the patient and the surgeon allows the patient to make an educated decision and avoids several ‘fact justifying' consultations in the post-operative period.
The gluteal crease, lateral gluteal depression, distal posterior thigh, middle medial thigh, and infero-lateral ilio-tibial band are particularly vulnerable to superficial contour abnormalities due to a lack of deep fat and adhesion of the more superficial layer to the underlying fascia or muscle.
Just like with any major surgery, liposuction can pose some risks to the patients. The Possible complications associated with liposuction include:
- Reaction to anesthesia.
- Contour irregularities. The skin may appear irregular after the surgery due to uneven fat removal, poor skin elasticity and bad healing. These changes can be permanent. Besides, damage beneath the skin from the tube of the cannula that is used in fat removal can give the skin a permanent spotted appearance.
- Fluid accumulation. After the surgery, temporary pockets of fluid can form under the skin. They will need to be drained by a needle.
- Numbness. Temporary nerve irritation is possible. So, the patient might feel temporary numbness and tingling.
- Infection. Skin infections are rare but possible, a severe skin infection can be life-threatening.
- Internal puncture. Rarely, a cannula that is used to remove the fat can puncture an internal organ. This is an emergency complication.
- Fat embolism. Pieces of loose fact may get washed away and get trapped in blood vessels and gather in the lung or, worse, travel to the brain. It is considered a medical emergency.
- Kidney and heart problems. The shift in the fluid level due to injecting and suctioning fluids multiple times can pose some risks to the heart, kidneys and lungs.
- Lidocaine toxicity. Lidocaine is an anesthetic that is used during injecting fluids to manage the pain. It is generally safe, but in rare circumstances, it can cause serious heart or central nervous system toxicity.
These problems cause the patient to function at a suboptimal level, although they have not been seen to disrupt the patient's usual routine in the post-operative period. Standing after liposuction can cause postural hypotension and syncope in the first 8 to 12 hours, and patients should be warned about this.
The risk of compilations increases if the surgeon is working on a large area or doing multiple procedures altogether in the same setting.
Some risks can appear immediately after the procedure, including:
- Blood clot in the lungs.
- Too much fluid in the lungs.
- Fat clot.
- Bleeding under the skin or hematoma.
- Fluid leaking under the skin or seroma.
- Skin death or necrosis.
And as we know, every procedure has its side effects. Likewise, liposuction has some long-term side effects.
These long-term side effects can vary. The main concept of liposuction is to permanently remove fat cells from certain areas. So, if the patient gains weight after the surgery, the fat will still be stored in other parts of the body. The new fat can appear deeper under the skin. It can be dangerous it grows around the heart or liver.
In addition, some people experience permanent nerve damage and lose their skin sensation. Others might develop indentations and irregularities on their skin surface that don’t go away.
What to expect from Liposuction?
During the procedure, you will be under general anesthesia, so you won’t feel any pain. However. You can feel pain after the procedure. It is common to feel pain, swelling, bruising, soreness, or numbness after the surgery.
To minimize the pain after the surgery, your surgeon will give you some instructions, such as:
- Take all your prescribed medications including pain killers.
- Wear the recommended compression garments.
- Keep the drain after the surgery in place.
- Drink plenty of fluids.
- Avoid salt.
According to outcome studies, 80 percent of patients were pleased with their liposuction outcomes, and 53 percent evaluated their look as excellent or very good. Similarly, Papadopulos et al discovered in a questionnaire study that 6 months after undergoing aesthetic liposuction, patients demonstrated high satisfaction with the procedure's results, with significant improvement found in general quality of life, as well as health, body image, and emotional stability. Individuals also reported less anxiousness.
Weight gain is frequent following liposuction and occurs in 43 percent of patients, with the abdomen being the most prevalent site of recurrence.
Liposuction is only performed on individuals who are in good health and do not have any serious diseases. Although absolute contraindications are difficult to identify, the authors think that a substantial medical history should demand consultation with the patient's main physician and/or anesthesiologist prior to approval of any operation.
To reduce the dangers of hematoma and heavy bleeding, anticoagulants (including aspirin) should be discontinued two weeks before surgery. Herbal supplements, which may alter anesthetic risks and bleeding, require special attention from physicians. Patients who are unable to discontinue these medications, such as those with cardiac valve replacement, atrial fibrillation, or those receiving treatment for deep vein thrombosis or pulmonary embolism, should not be considered for surgery.
Patients must also comprehend and thoroughly discuss the potential dangers and consequences with their doctor. Surgeons should also document any talks with patients about prospective operation and hazards. Scars from port sites should be acknowledged by the patient and, on occasion, changed to meet the patient's unique needs.
Hemodynamic reactions after liposuction have lately been studied and shown to be not unimportant. Increases in cardiac index (57%), heart rate (47%), and mean pulmonary arterial pressure (44%) were observed in a small sample of healthy women, as were decreases in intraoperative body temperatures (35.5°C).
The maximum epinephrine elevation was discovered to be raised 5-6 hours after surgery. Although hemodynamic values were determined to be within acceptable levels, these findings highlight the need of screening patients for cardiovascular illness and preventing hypothermia during surgery if needed.
According to 2020 data, the average cost of liposuction is $3,637. This average cost is simply a portion of the overall cost. It excludes anesthesia, operating room amenities, and other associated costs.
1. Can you tell us what is liposuction?
Liposuction is an operation that removes the subcutaneous fat layer between the skin and muscles of the body through inhalation. Successful liposuction does not remove all the fat layers in the body, but it minimizes side effects and creates a pretty body shape by removing them properly.
2. Are there any differences between liposuction for men and women?
Basically, liposuction is done in the same way for both men and women. However, men prefer a way to emphasize the six-pack, and women prefer a way to emphasize the waistline. We proceed with the procedure according to this request.
3. Can people get liposuction while breastfeeding?
Women who are breastfeeding can also get liposuction. However, people who have had surgery may need to take antibiotics or anti-inflammatory drugs to reduce inflammation. If the mother takes these medications, it is recommended to avoid liposuction because the ingredients of the drug can be transferred to the breastfeeding infants.
4. Does fat reappear in the liposuction area?
Usually, you don't gain fat unless you get liposuction and later change your weight. However, a sudden increase in weight after the procedure can make the fat layer thicker because the existing fat cell size increases. However, fat cells removed through the procedure do not reappear or form new ones.
5. Can liposuction be performed on multiple areas in one surgery?
Full body liposuction can also be performed. However, the procedure can take too long, so it is difficult to proceed at once. So, we usually perform surgery 2~3 times several times. So if you want to do a full-body liposuction, you can do 3 separate places including arms, abdomen, and lower body. Alternatively, if the BMI is less than 25, you can have two procedures divided into upper and lower body procedures.
6. How long does it take to stay in the clinic after surgery?
If you have 4 hours of sleep anesthesia when you have liposuction, it takes 4 hours to recover. So if you have anesthesia for an hour, you can get a recovery care for an hour at the hospital and then leave the hospital. However, if you receive 3-4 hours of anesthesia due to prolonged surgery, you can get 3-4 hours of recovery care before being discharged. But there is no need for hospitalization.
7. Is it possible to lose sensitivity of the skin in the area of liposuction?
After liposuction, there are cases where the skin senses drop in the liposuction area. During the treatment, we usually drill 5mm to 10mm holes in the skin and only liposuction is carried out through those holes, so we cannot pay attention to all skin. Therefore, there is a possibility that the skin senses will be reduced, but the chances are very low, and even if the skin senses are reduced, they will recover after 6 months. You don't have to worry too much.
8. How long will the recovery period be for liposuction?
The recovery period varies from person to person, but it usually takes a month to 3 months. However, it takes 2~3 days to recover until daily life is possible for convenience.
9. When can patients start physical activity after liposuction surgery?
After the procedure, the pain is reduced after 2~3 days, and daily life is possible after a week. However, you can do activities such as pilates and yoga after 2 weeks, and radical activities such as PT or exercise can be done after a month.
10. What is the most common liposuction on the face?
The most preferred method for face liposuction is jaw fat removal. This is the most preferred procedure, followed by a jawline sharpening procedure. It takes less than 40 minutes to operate and the recovery time is short, so many people prefer it.
Liposuction is an operation that removes the subcutaneous fat layer between the skin and muscles of the body through inhalation. Successful liposuction does not remove all the fat layers in the body, but it minimizes side effects and creates a pretty body shape by removing them properly.Liposuction may be performed safely on appropriately selected individuals who have reasonable expectations and understand the procedure's limits. They are usually extremely pleased with the results.
The long-term outcomes of liposuction are determined by the patient's preoperative skin condition, general health and expectations, and ability to maintain a healthy weight and lifestyle postoperatively. It is advisable to be intelligent in challenging situations and for high volume liposuction, and a phased or combination treatment is safer for both the patient and the physician.
The dreaded consequences of pulmonary embolism, deep venous thrombosis, penetrating injuries, hemorrhage, pulmonary oedema, hypovolemic shock, fat emboli, medication toxicity, and death are absent in every major series of big volume liposuction. All of these situations may be attributed to a rigorous commitment to the 5 safety pillars (safe surgeon, safe anaesthesiologist, safe facility, safe co-workers and a properly selected patient).
Medically Reviewed By
Dr. Seong Cheol Park