In one fell swoop, liposuction removes stubborn, hard-to-lose fat—on the chin, neck, arms, thighs, abdomen, buttocks, and even calves and ankles— through a vacuum apparatus. “In an ideal world, liposuction is best for problem areas that are out of proportion with the rest of the body, such as isolated saddlebags or a little pooch in the lower abdomen,” says Nashville plastic surgeon Mary Gingrass, MD. “It’s a body-sculpting procedure, not a weight-loss procedure.”
Today, in addition to traditional liposuction, the procedure can also be done using different energy-emitting technologies like ultrasound, radio frequency and lasers, which work to enhance the clinical outcome over traditional liposuction. Despite the use of other modalities, the procedure is still surgical, or at times minimally invasive, and can require general, deep, monitored sedation or local (tumescent) anesthesia.
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Las Vegas plastic surgeon Julio Garcia, MD notes that no matter which type of liposuction is performed, the training and experience of the doctor performing the procedure will affect the outcome. “Ask to see before-and-after cases, the surgeon’s board certification and the accreditation of the surgical facility. Do the homework ahead of time and you’ll get the best results.”
There’s More Than One Type of Lipo
There are so many brand names for different types of liposuction, which can be confusing, but Barcelona, Spain plastic surgeon Dr. Ahmad Saad says to think of liposuction modalities as different “families” under which the various brand names fall. “The first family is traditional, suction-assisted liposuction. The second family is ultrasound, which separates the fat from the collagen matrix in the tissues. Then there are lasers and radio frequency, which are also thermal and heat the fat. And lastly, there is power-assisted liposuction, which involves the cannula moving with reciprocation (or rotating).” According to Dr. Gingrass, a surgeon can employ more than one type of liposuction during the same procedure: “You really shouldn’t shop for the modality of liposuction; you should shop for a thoughtful, experienced surgeon, and then let them decide what technique or device they would use in order to get the best surgical result. I will frequently use various types of liposuction for different areas on the same person.”
This 27-year-old patient wanted a better contour for her thighs. Atlanta plastic surgeon Carmen M. Kavali, MD sculpted the legs using liposuction to give the thighs a slimmer shape.
The traditional version is best for those with localized fat deposits and good skin tone.
How It Works: Hollow metal tubes called cannulas are used to remove fat from areas of the body.
Benefits: It’s most effective in areas where the tissue is less fibrous. This tried-and-true form of liposuction has years of research backing its safety and effectiveness.
Limitations: Maintaining realistic expectations is crucial. Some surgeons feel that traditional liposuction does not work well in secondary cases.
This method is useful in primary and repeat procedures for treating larger areas of fat, or in combination with other surgical body-contouring procedures.
How It Works: Ultrasound liposuction is a two-step process. High-frequency energy from ultrasound waves liquefy fat so that it can be suctioned out.
Benefits: It works well on fibrous, fatty areas like the back, hips and stomach.
Limitations: Some patients report that their skin is left feeling numb during recovery. If too much ultrasound is used, there is a greater chance of postoperative seromas, which may require aspiration of the fluid.
While laser liposuction has been marketed as a better technique, accurate scientific studies fail to show a clear benefit from laser energy used to heat tissues.
How It Works: Fiber-optic lasers heat up tissues to break down fat.
Wanting to contour her arms with a minimally invasive method, this 47-year-old patient underwent a Smartlipo (laser-assisted liposuction) procedure with Miami plastic surgeon Sean Simon, MD.
Benefits: Purportedly less swelling and bruising than other techniques, but this is not supported by scientific data.
Limitations: Laser lipo still requires traditional liposuction to remove fat. There’s the possibility of burns and tissue injury (firmness and swelling).
This option (BodyTite and FaceTite) is fairly new and claims to tighten and tone.
How It Works: Performed under local anesthesia, a small incision is made in the area to be treated and a radio frequency–transmitting electrode is inserted. Radio-frequency waves are guided through the fatty tissue to liquefy the fat, which is immediately suctioned from the body with a cannula.
Benefits: It purportedly tightens loose skin by stimulating the production of collagen.
Limitations: Patients may experience redness, bruising, swelling and uneven skin.
This option makes use of special equipment to give the cannula the power necessary to dislodge fat.
How It Works: A power-assisted liposuction (PAL) cannula moves back and forth to suction out fat. This technique is also the most similar to traditional lipo.
Benefits: Less force is needed, so some doctors claim that tissues aren’t damaged as much, but there is no data supporting this.
Limitations: There are limitations to all liposuction procedures, so realistic expectations are key.
What to Expect
Before and During
A small incision will be made at or near the designated area(s). A solution of saline and anesthetics or epinephrine, called tumescent fluid, is first injected to break up the fat cells and allow them to be easily removed with a cannula. The fat is then suctioned out and the area(s) is stitched up.
The First Few Days
The skin will be bruised and swollen for the first few days, but expect to be up and walking right away. Good circulation is essential to prevent blood clots. Compression garments and foam pads are used to diminish swelling and bruising.
The First Few Weeks
A noticeable difference can be seen and there should be no bruising.
The First Few Months
The final results will be visible and may continue to improve over the next six months.
It will vary based on the areas being treated.
Three to 21 days, depending on the treatment and area treated; plan to avoid strenuous activity for three weeks.
Results Are Permanent, Sort Of
Once removed, fat cells in the treated area(s) do not grow back; however, if you gain weight, it is still possible to gain fat in the treated area.
Average Treatment Cost
$3,000–$15,000, depending on the number of areas being treated
Is the Fat Really Gone Forever?
A consultation is key to learning more about the benefits and limitations of liposuction, but asking the experts a few burning questions doesn’t hurt.
Do I have too much fat for liposuction?
“The ideal candidate is within 20 percent of his or her ideal weight and has good skin tone and limited amounts of fat,” advises Dr. Saad. “Those with lax skin or stretch marks may not respond well because their skin may not recoil when the fat is removed.” Eugene, OR plastic surgeon Mark Jewell, MD cautions: “Patients with large bellies, where there is limited fat under the skin and large amounts of fat inside the abdomen, cannot achieve a good outcome through liposuction.”
Can I lipo more than one body part at a time?
“It’s actually uncommon to suction just one area at a time,” says Dr. Gingrass. “If a patient would benefit from liposuction of several areas, we would typically do them all in the same operation.” In some cases it may be prudent to perform larger combinations of procedures in stages in order to maximize results.
Will my fat return after liposuction?
“We remove the majority of the fat cells,” says Dr. Garcia, “but we don’t remove all of the fat because we want to leave a nice, smooth layer there. So, if the patient gains weight, the fat cells that were left can grow in size.”
Unable to achieve a flat tummy with diet and exercise alone, this 27-year-old patient sought Newton Centre, MA plastic surgeon Joseph A. Russo, MD for liposuction and a Thermi250 treatment.
Is there a limit to how much fat you can take?
“There isn’t an exact limit,” says Dr. Gingrass, “but the American Society of Plastic Surgeons advises that risks significantly increase when more than 11 pounds are removed in one sitting. But, every situation is different. In cases where more fat is removed or combined with other surgical procedures, it may be best that the patient is observed overnight in a proper postoperative facility.”
Doctor, Is This Normal?
These six side effects typically accompany a liposuction procedure. Here’s what to expect:
Sacrs Because liposuction incisions are so small, they are rarely visible to someone other than the patient.
Swelling and Bruising The lower extremities are more susceptible to fluid retention. Swelling decreases rapidly; however, bruising may persist for up to three weeks.
Hyperpigmentation Occasionally, there may be some darkness in the skin where lipo has been performed. “This is caused by hemosiderin, a pigment produced when red blood cells break down,” says Dr. Jewell. “This may take a few months to go away.
Hypersensitivity Expect to feel slight discomfort. Any severe pain is reason to immediately call your doctor.
Uneven Appearance Contour irregularities can occur as remaining fat settles. Massage, topical creams and external ultrasound may help. “I have my patients undergo a lymphatic drainage massage after one week, then at 10 days, and again after that,” advises Dr. Saad.
Numbness This temporary side effect is normal and results from disturbing the small nerve fibers below the skin. Only in very rare instances is numbness permanent.
Shaping a New, Beautiful Butt
This 37-year-old patient wanted a BBL alternative. Los Angeles plastic surgeon Peter Lee, MD injected 10 vials of Sculptra Aesthetic into each buttock during her first visit, and five vials per side at her second visit.
More than likely, the popularity of the peach emoji shape is thanks to the Brazilian Butt Lift (BBL). Utilizing harvested fat taken from the body during liposuction, fat transfer is performed and placed back into the derrière to create a rounder, fuller shape. “It has been a key part of my Mommy Makeover procedure for more than a decade,” says Shreveport, LA plastic surgeon Simeon Wall Jr, MD. “I take the SAFELipo fat, and using Expansion Vibration Lipofilling (EVL), place it into the part of the buttock that gives it a rounder, fuller, more athletic appearance. Most of my patients want the smallest waist possible with a higher, tighter buttock and a proportional silhouette.”
While the BBL remains one of the most popular procedures, it also comes with risks. If performed incorrectly, injecting fat into the buttock can lead to vital problems, including a fat embolism. If fat enters the bloodstream, it can block the lungs, leading to death.
La Jolla, CA plastic surgeon Robert Singer, MD says more patients are becoming aware of the risks: “While extensive research into making the procedure safer is being carried out, patients should be aware of potential complications—not only the benefits—before undergoing this, as well as any procedure.” As a result, doctors are utilizing BBL alternatives like thread lifts; radio-frequency treatments; Emsculpt muscle toning, and Sculptra Aesthetic injections (thread lifts and Sculptra Aesthetic have not been FDA-approved for this use) to temporarily plump the butt. Dr. Jewell stresses that these new modalities have not yet been proven: “The clinical outcomes have never been studied with regards to long-term aesthetics, safety or patient satisfaction.”
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