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Liposuction
(liposculpture, lipoplasty, or suction
lipectomy)
Liposuction is a surgical technique to remove fat. It is not an alternative to weight loss; it is a method for removing fat that does not respond to a healthy diet and regular exercise. The abdomen, buttocks, thighs, flanks, hips, knees, calves and upper arms are commonly treated areas. Today, a number of new techniques, including ultrasound-assisted lipoplasty (UAL), power assisted liposuction (PAL), the tumescent technique, and the super-wet technique are used.
How much does it cost?
In general, the average cost for liposuction in the US is $2000 per body area. Cost varies from surgeon to surgeon and according to where they practice. In Canada, a single site costs $3,500 CDN and up. There may be additional costs such as anesthesia, operating room facility, prescription medicines, etc.
What happens during the procedure?
The procedure is usually performed in an outpatient surgical center, either operated by your surgeon or a hospital facility, and takes 1-2 hours, but depending on the extent of the procedure, it can take longer. Overnight hospitalization is generally not necessary, but if you are having more than one procedure, it may be required.
Liposuction can be performed under local anesthesia, along with intravenous sedation, or general anesthesia depending on your health and the extent of the procedure. Normally, during the procedure, a hollow suction tube, or "cannula," is passed through small skin incisions and manipulated to break-up unwanted fat. It is then transferred through the tube by the attached vacuum machine. While fat is removed by suctioning it through small tunnels, the skin remains connected to the underlying muscles. This helps preserve the nerves and blood vessels supplying the skin and also helps to decrease the laxity of the skin. The surgeon also leaves a thin blanket of fat attached to the skin to prevent the cannula from getting too close to the skin and causing excessive rippling or other irregularities.
Some of the latest techniques used to perform liposuction are:
The super-wet technique, in which a saline solution containing a local anesthetic and adrenaline is injected into the area to be treated, which makes the fat deposits easier to break up and extract. This extra fluid also minimizes trauma to the surrounding tissue, reducing swelling and post-operative pain. The administration of adrenaline also decreases bleeding during surgery, further reducing risks.
The tumescent technique, in which even larger amounts of liquid solution are injected, has similar benefits.
A newer method, ultrasound-assisted liposuction (UAL), uses sound waves to liquefy the fat after the injection of fluids. UAL also minimizes trauma, causing less bruising and blood loss. UAL is particularly useful on fibrous areas of the body, such as the male breast, the upper abdomen, and the upper back, which are difficult to treat with traditional techniques.
The latest method, power assisted liposuction (PAL) is a technique where the cannula eases through the fatty tissue (even fibrous) with none of the risks of burns associated with the UAL techniques. This new machine uses a special high-speed "linear reciprocating" suction cannula. The newer cannula allows surgeons to perform more effective, high-volume liposuction in a shorter time, without as much trauma, especially in more fibrous areas. The PAL system moves through these areas faster, with less work and strain for the surgeon and less pain and a faster recovery in patients.
Are there risks or potential side effects?
As with all surgeries, there is always a possibility of complications, including infection, a reaction to the anesthesia, hematoma, seroma, nerve damage and the occurrence of asymmetries or irregularities. Should infection occur, your surgeon will prescribe a treatment of antibiotics.
With liposuction, in particular, imperfections in the final appearance can occur. The skin surface may be irregular, wavy, asymmetric, or even "baggy," especially in the older patients. Numbness and changes in pigmentation are also possible. Often, revision surgery is performed to improve the appearance. Ultrasound-assisted liposuction carries the risk for burns to the skin and deeper tissues. In addition, the long-term biological effects, if any, of ultrasound energy are not known.
The risks increase if larger areas or a greater number of areas are treated at one time. Removal of large volumes of fat and fluid may require sizable volumes of pre-injection fluid and longer operating times, resulting in greater hazards for infection, delays in healing, improper fluid balance, injury to vital organs (especially perforation), shock, and unfavorable drug reactions. As with any surgical procedure, blood clots may form in the veins with risk of migration to the lungs, which can be fatal.
Another risk of liposuction is Pulmonary Thromboemboli, blood clots that can break free and travel to the lungs. This can trigger adult breathing distress and subsequently cardiac arrest or coma that can result in a vegetative state from loss of oxygen to the brain. Although rare, this can happen within three (3) weeks of the surgery but will most likely show symptoms of shortness of breath and fatigue within the first 72 hours.
Another risk is Pulmonary Edema (or fluid in the lungs) from over hydration. This can occur when extreme amounts of saline are intravenously supplied with the purpose of replenishing fluids that were taken out. Some surgeons try for "twice the amount in as removed, just to be safe". This is most seen with tumescent and super-wet techniques. Ask your surgeon how much fluid he or she returns to the patient's body.
What to expect post-procedure?
The extent of the post-operative swelling and bruising is dependent on whether you tend to bruise or swell easily. The amount you can expect varies for each individual but past surgeries or injuries should be a good indication. Keep the treated area elevated, above the level of your heart. Applying cold compresses, or small ice packs will reduce swelling and relieve discomfort. Many patients use a water-tight plastic sandwich bag filled with frozen berries or peas. Regular icing is the key to relieving swelling and the resulting pain.
You will feel tender and sore for a few days to several weeks after surgery. Some fluid may drain from your incisions post surgery. To prevent fluid build-up, a small drainage tube may be inserted beneath your skin for a few days. Antibiotics to prevent infection may also be prescribed. To control swelling and to help your skin adjust to its new contours, you will be fitted with a snug, elastic garment to wear over the treated area for a few weeks. Your surgeon will likely request follow-up visits to review your progress.
As with any surgery, it is also sometimes normal to feel anxious or depressed in the days or weeks following the operation. If there is heavy bleeding or increased pain, be sure to inform your surgeon.
How soon does normal life resume?
Recovery is individual and varies from person to person. After liposuction, however, you will begin to see a noticeable difference in the shape of your body almost immediately with additional differences occurring during the following 4 to 6 weeks as the swelling subsides.
Although you may not feel like it, you should try to walk as soon as possible to reduce swelling and prevent blood clots from forming in your legs. Strenuous activity should be avoided for 4 to 6 weeks. Although most bruising and swelling will disappear within 3 weeks, some swelling may remain for 6 months and up to a year.
Will the fat cells grow back?
The fat cells that are removed by liposuction do not grow back. If you gain or lose additional weight, the change will be distributed among the remaining fat cells. Long-term body weight is not influenced by liposuction.
Are you a good candidate?
As with all elective surgery, good health and realistic expectations are prerequisites, but if you want to eliminate localized areas of fat, then liposuction may be appropriate, especially if:
- You have firm, elastic skin which is able to "bounce back".
- You tell your surgeon about any and all medical conditions and any allergies you may have as well as all medications, herbal supplements or natural supplements you are taking (both prescription and non-prescription).
- You are not prone to scarring problems such as keloids.
- You have a good understanding of the healing process and the limitations of the procedure.
When larger areas are treated, excess skin removal may also be necessary with an arm or thigh lift. Discuss you goals with your surgeon so that you may reach an understanding with what can realistically be achieved.
The above is only a partial
How to prepare for this procedure?
Your doctor will give you specific instructions to prepare for surgery but here are some general guidelines:
- Avoid aspirin, any aspirin containing medication or any other non-steroidal anti-inflammatories (NSAID), such as MotrinŽ or AdvilŽ, for two weeks prior to treatment. Because aspirin thins the blood, it can interfere with normal blood clotting and increase the risk of bleeding and bruising.
- Smoking inhibits the healing process, so stop smoking before your procedure and if you start again, make sure it is after you are completely healed.
- Avoid drinking alcohol a few days before your surgery.
- Make sure to follow any fasting instructions the night before and morning of your surgery. Your doctor may insist on an empty stomach depending on the type of anesthesia.
- Make sure that you arrange for someone to bring you home and to help you out for 24 hours after surgery.
Are there alternatives to this procedure?
Arm, thigh or buttock lift can improve the skin quality and appearance but cannot eliminate excess fat to the same extent and are limited in terms of the area treated. A tummy tuck, however, can both remove fat and tighten the skin around the abdomen. These procedures also produce scarring, whereas, liposuction does not. Exercise, especially weight lifting, however, can significantly improve the shape and tone of body, including that of the loose skin and should always be considered as an alternative to surgery.
Locate a certified physician with our Doctor Locator.
To view Personal Stories about this procedure contributed by our members, Click Here.
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