Of all of the medical aesthetic treatments that have become household names over the last century, none seem quite so familiar as liposuction. With what other plastic-surgery procedure are we all on a first-name—or rather, prefix— basis? Only lipo has earned that level of acquaintance.
“Lipo remains one of the most popular cosmetic procedures performed in the U.S., as well as the world,” says Grand Rapids, MI plastic surgeon David R. Alfonso, MD. However, despite how much it remains in-demand, an ever-advancing medical landscape means that questions about the surgery—how it works, who should undergo it, what to expect—persist.
Among one of the common misconceptions: that because liposuction removes fat, it’s used to help a patient lose weight. “Liposuction is intended ideally for exercise-resistant fat and not for weight loss,” says Des Moines, IA plastic surgeon David Robbins, MD.
“Liposuction, or in layman’s terms, a procedure of sucking fatty tissue from under the skin, can be performed everywhere there is subcutaneous adipose tissue stored,” explains Houston, TX plastic surgeon Olga Bachilo, MD. “It took some trial and error to master a method that is safe and effective, but today’s liposuction is very different from where it started. In the 1970s, advances such as the introduction of numbing agents, compression garments and perfecting locations of the incision sites made liposuction more marketable.” Dr. Alfonso adds that, thanks to advancements like less invasive cannulas, more delicate areas like the ankles can now be refined.
Smaller cannulas, compression garments and numbing agents are far from the only ways liposuction has evolved since its introduction. Dr. Alfonso notes that the addition of tranexamic acid to the tumescent fluid used during the procedure also means less bruising. “Other advances in technology include utilizing ultrasound-assisted as well as power-assisted liposuction. These technologies work differently, but both help the fat to be removed more efficiently and provide less fatigue to the surgeon.”
During the Procedure
Liposuction should only be performed at an accredited office based in a surgical facility, licensed ambulatory surgery center or a hospital. When the surgery is set to begin, Newport Beach, CA plastic surgeon Sanjay Grover, MD explains that the patient is placed on an appropriately padded operating table and kept warm with warm-air blankets. “The areas to be treated will be cleansed, and sterile drapes will be applied,” he says. At this point, the tumescent fluid—typically consisting of saline, lidocaine and adrenaline or epinephrine—will be introduced into the fatty tissue.
The actual procedure is performed through tiny incisions that are typically concealed in skin folds and heal almost invisibly, Dr. Alfonso says. Then, as Dr. Bachilo adds, a thin cannula is inserted through the incisions to loosen excess fat using a controlled back-and-forth motion. “The dislodged fat is then suctioned out using a surgical vacuum or syringe attached to the cannula.”
“It’s a common misconception that liposuction requires general anesthesia,” Dr. Bachilo says. “Although it is an invasive procedure, a lot of times patients opt for a local one if the areas to be treated are fairly small.” However, she would not recommend local anesthesia for more extensive liposuction, such as of the back, abdomen or multiple areas on the same day. “With the patient being under general anesthesia, they are able to be completely comfortable as we contour.” Dr. Alfonso says he tends to use general anesthesia more often than local or twilight anesthesia due to the length of surgery time and areas of the body being treated.
About 85 percent of the body is fair game for liposuction or body contouring. “Common areas that are contoured include the abdomen, love handles, back, thighs, knees and double chin areas,” says Dr. Grover.
Another factor: when procedures are coupled. “Many patients get liposuction with an abdominoplasty [tummy tuck], and that requires general anesthesia,” Dr. Robbins says.
Once the fat is removed, it’s disposed of as medical waste. However, “Fat can be removed and then grafted to another area of the body to add volume, reconstruct or rejuvenate the area where the fat is being injected,” Dr. Bachilo says. This has become especially in-demand for increasing volume at the buttocks and lateral hips, though the breasts, face and hands are also options.
“The fat transfer approach has become extremely popular for patients, as they get the best of both worlds: fat removed from areas that are too full and re-injected into other areas that lack volume and shape,” Dr. Alfonso says.
Before you undergo liposuction, it must be determined if you’re an appropriate patient. “The ideal candidate for liposuction is someone who is in excellent health, at their ideal body weight, and has stubborn, resistant areas of excess fatty tissue,” explains Dr. Grover. Skin elasticity is also a factor and can be assessed during a consultation. “The patient’s medical history will be reviewed as well as the areas of concern. Examination will be performed to evaluate the patient’s condition and whether they have targeted areas of excess adipose tissue and have good elasticity for the skin to retract back properly following their liposuction procedure.”
Your surgeon will also discuss reasonable expectations about the results with you. “We make sure patients have a realistic goal and expectation from the procedure and understand this is a body-contouring procedure and not one intended for weight loss,” Dr. Robbins reiterates.
Closer to the surgery dates, you’ll be asked to avoid aspirin, anti-inflammatory drugs, and certain supplements that can increase bleeding, and you should refrain from tobacco use for at least several weeks prior.
During your consultation, you’ll also be made aware of potential complications, though they are rare, especially when liposuction is performed by an appropriate expert.
That said, according to Dr. Bachilo, risks may include infection during surgery or recovery, adverse reaction to anesthesia or allergy to lidocaine, blood clots, collection of fluid below the skin, extended or permanent loss of sensation at the incision site, and delayed healing.
Dr. Alfonso adds that some contour irregularities and lumpy areas may occur, but “these tend to smooth out over the subsequent two to three months following surgery.”
In order to avoid complications, some surgeons consider certain areas off-limits. “I do not remove fat from the face. This facial padding is what gives us that plump, youthful appearance, and we do not want to eliminate that natural ‘filler,’” says Dr. Bachilo (although many surgeons will judiciously suction small amounts from the face and neck in the right patient). She also doesn’t perform liposuction where visceral fat is found. “The infamous beer belly is the perfect representation of visceral fat. Although some improvements can be made to contour it, the only way to get rid of it is healthy diet and exercise.
“Recovery after liposuction remains one of the easier kinds compared to other cosmetic surgery procedures,” says Dr. Alfonso, who finds that most of his patients are up walking the day of surgery and can be back to basic, normal activities within one or two days. He encourages staying active, as well as wearing compression garments for up to three weeks.
Although it’s relatively easy to get back into the swing of things, there still may be some discomfort. “The patient can expect to be sore post-op with swelling and bruising,” Dr. Bachilo says, adding that it may be apparent for up to four weeks. Furthermore, “It is normal to have itchiness and/or numbness post-operatively. This can subside in two to three months,” though numbness has been known to last as long as nine months. It’s also not uncommon to feel a sharp shooting pain along the incisions, as this is a normal sign of nerve regeneration.
Many plastic surgeons offer recovery regimens that don’t necessarily involve prescription painkillers. “I rarely give any narcotics to patients after surgery, especially since I have adopted the ERAS [Expedited Recovery After Surgery] protocols,” Dr. Alfonso says. “This involves pre-op care as well as post-op care designed to minimize pain and avoid narcotics.” Dr. Bachilo, on the other hand, offers patients sessions of Venus Legacy, a radio-frequency and massaging device that helps with swelling and bruising. “In addition, I give my patients arnica gel and arnica pills to help the healing process,” she says.
Although Dr. Bachilo says your final results will be apparent in six to 12 months, you may see a difference much sooner. “Early changes in shape and contour can be visualized at two to three weeks, but it takes at least three to five months to reach the earliest stages of the final shape,” Dr. Alfonso says. “Different areas of the body also swell to different extents, so some areas may look better more quickly than others.”
With a number of noninvasive and less invasive fat-reducing treatments, like Emsculpt Neo, CoolSculpting and Kybella (which is not recommend for larger areas), available, it can be confusing when trying to decide if you should choose liposuction. And, in some cases, the nonsurgical treatments are the obvious way to go. “If a patient has health problems and is fearful of anesthesia, these are often good options,” says Dr. Alfonso. However, they require more than one treatment and cannot be used on all areas of the body. “For people who are wanting to treat fat over larger areas of the body or want a more dramatic contour, I would recommend liposuction,” Dr. Bachilo says.
The bottom line: “The sculpting ability a surgeon has with a cannula cannot be duplicated with the nonsurgicals,” says Dr. Alfonso. “Ultimately, patients weigh the pros and cons of both approaches and decide what method is best for them.”