Liposuction Frequently Asked Questions
Understanding Liposuction
What is liposuction exactly?
Liposuction is a surgical technique based on a surprisingly simple concept: excess fat between the skin and muscle is sucked out through a tube connected to a powerful suction pump. A long, flat, hollow, stainless steel tube, called a cannula, is inserted at different points under the skin and pushed back and forth in a radiating pattern around the insertion point creating tiny tunnels through the fat. Excess fat is permanently removed and the area is recontoured. As the tiny tunnels heal and shrink during the recovery period, the body adopts a more pleasing contour. Intravenous fluids are administered during the procedure to replace lost body fluids. Liposuction is also known as lipoplasty or suction–assisted lipectomy.
What is tumescent or super–wet liposuction?
The tumescent, wet, and super–wet techniques involve injecting various amounts of fluid into the fat before the fat is sucked out. The fluid normally consists of saline solution (salt water), lidocaine (an anesthetic), and epinephrine (to constrict the capillaries). It is the safest and most commonly used form of liposuction today and is the technique employed by Dr. Pittman–Waller.
The tumescent and super–wet techniques limit the blood loss during the liposuction surgery and speed the recovery. Because the fluid liquefies the fat, a smaller cannula can be used thereby lessening the post–surgical discomfort. Because the epinephrine serves to shrink the capillaries, there is less blood loss and a speedier recovery from the liposuction.
In the wet liposuction technique, a predetermined volume of fluid equal to about 300 cc is injected. In the super–wet liposuction technique, the volume of fluid is about 1 times the volume of fat to be removed. In the tumescent technique, fluid up to 3 or 4 times the amount of fat is injected. Dr. Pittman–Waller normally employs the super–wet liposuction technique.
What happens to all the wetting fluid? Is it removed along with the fat?
Only some of the wetting fluid is removed with the fat. It has been estimated that about 50% to 70% remains behind and must be removed by natural body processes. This is one reason it is important to wear the elastic garment the doctor will provide, so that the body's resulting contours will adopt a pleasing shape as the fluid is removed.
What is power–assisted liposuction or PAL?
The tube or cannula is attached to a special machine which mechanically vibrates it about 4000 times per minute, greatly facilitating its movement through the tissue and fat. Less force is required, especially in areas with more fibrous tissue. The result is a faster liposuction procedure with the doctor having better control. It is easier on the surgeon and on the patient. No heat is generated by the device, so burning is not an issue as it can be in other liposuction techniques. Dr. Pittman–Waller uses a MicroAire power-assisted liposuction device.
What exactly happens during a liposuction procedure?
Dr. Virginia first numbs the skin with a local anesthetic. Once the skin has lost its sensation, she makes a series of small incisions about 1/8 to 1/4 inch in size, or about 3 to 6 mm. The entire area to be liposuctioned is then flooded with the wetting solution, which desensitizes it even further. The doctor then inserts the cannula into each incision and moves it back and forth in a radiating pattern around the incision point suctioning the fat. She then moves from incision to incision until all the area to be treated has been suctioned. The length of time of the liposuction operation depends on the amount of fat to be removed and the size of the areas to be treated, taking from 30 minutes to 4 hours.
Am I a good candidate for liposuction?
The best candidates for liposuction are in good health, have a normal weight, and have a realistic expectation of what liposuction can achieve. Liposuction can remove stubborn, localized areas of excess fat that are not in proportion to the rest of the body and are resistant to diet, exercise, and weight loss. But it is not a substitute for an overall weight management program. Patients with firm, elastic skin tend to achieve the best body contouring results. Liposuction can improve a person's appearance, but it cannot provide perfection. Liposuction can be performed at any age, but Dr. Pittman–Waller normally does liposuction on patients 18 and older.
Patients should have realistic expectations about their own role in maintaining their post-liposuction body contour. There are four basic elements for long–term successful improvement in body contour: diet, positive lifestyle changes, exercise, and successful body contouring liposuction. Ultimate responsibility for three of the four rests squarely on the shoulders of the patient. The surgeon can only affect one of the four.
Who is not a good candidate for liposuction?
- A person who expects perfection is not a good candidate. Liposuction can improve a person's appearance, but it won't achieve perfection.
- Patients who want to continue the diet and lifestyle that has resulted in widespread excess fat, but want a surgeon to take care of it for them, are not good candidates.
- Patients seeking a surgical solution for cellulite are not good candidates.
- Obese patients are not good candidates, unless there is a specific area that needs to be treated for a specific purpose. Surgery performed on obese patients carries a higher risk of complications.
- Of course, people with serious medical problems are not good candidates.
What constitutes a successful liposuction surgery?
The most successful liposuction surgery is when the patient is happy with the results. The goal of liposuction is not to remove the most fat possible, but rather to achieve a pleasing, aesthetic result. Often, the best result comes from removing a relatively small amount of fat from critical areas like a woman's saddlebags or a man's love handles, which can have a dramatic effect on a person's overall appearance.
Can exercise rid a person of specific areas of fat?
Unfortunately, there is no specific exercise that will rid the body of specific areas of fat. Exercise can help tone the body in general, reduce fat in general, and increase the size of specific muscles, but there is no exercise that will target fat in a specific location. Only liposuction can do that.
Is liposuction a good way to lose weight?
Liposuction is probably a terrible way to lose weight. The amount of fat actually suctioned out during a liposuction procedure is a relatively small amount in proportion to the whole body. The value of liposuction is in removing those localized areas of fat that have stubbornly resisted disappearing during a weight loss program. Typically, the amount of fat removed during liposuction is only a few pounds, but it is a few aesthetically critical pounds. If your intake and expenditure of calories remains the same as before the liposuction, your weight will tend to gravitate to the same level. The big difference is that your fat would be more evenly distributed. The fat you gained after the liposuction would tend to go to other areas than those that were liposuctioned.
Does the fat come back in areas where it has been removed by liposuction?
In a study of 209 liposuction patients at The University of Texas Southwestern School of Medicine at Dallas, 57% of liposuction patients reported that they either lost weight or remained stable after liposuction, while 43% of the patients reported weight gain after liposuction. Of those that gained weight, the majority gained between 5 and 10 pounds.
It is very important to remember that your doctor can only remove the fat cells present at the time of the liposuction surgery. It is the patient's responsibility to eat a healthy diet, exercise, and make lifestyle choices that will prevent further weight gain and the formation of more fat. Liposuction, in and of itself, will not prevent further weight gain. 56% of the patients in the Dallas survey reported that they did not positively change their eating habits after liposuction and 24% reported that fat returned in the liposuctioned areas. They continued the same patterns that had led to the excess weight in the first place. The most common area for fat to return was in the abdomen. Of course, 76% did not see a return of fat to the treated areas.
Those patients who eat a healthy diet are 2 times more likely to see weight loss. Those that do not eat a healthy diet are 3 times more likely to gain weight than those eating a healthy diet and those that do not exercise are 4 times more likely to gain weight than those who do.
When fat cells are removed from a specific area, they are permanently removed. But remember, not all of the fat cells can be removed and new fat cells can form. Normally, if a patient gains weight after liposuction the weight is gained in other non–treated areas or, if it is gained in the treated areas, it is part of a general weight gain over the whole body. Weight gains show up in other areas than those treated by liposuction. Perhaps surprisingly, over 70% of the patients who gained weight after liposuction were satisfied with the results of the surgery.
Only 10% of the women in the survey reported an increase in dress size.
Does the fat come back in other areas after liposuction?
Liposuction, itself, will not cause fat to form in other areas of the body. If you follow a sensible diet, exercise plan, and lifestyle, and don't gain weight, then no fat will form in other areas. If you put on additional weight, the weight will tend to show up in other areas of the body than those that were treated by liposuction.
Is liposuction a possible treatment for obesity?
Liposuction is not a treatment for obesity. It is not effective, even as a last resort. Obesity is best treated by diet, exercise, or bariatric surgery. Obese patients who have undergone large–volume liposuction almost always gain the weight back, unless there is a drastic change in their eating and exercise habits. Furthermore, obese patients are at significantly greater risk for serious surgical complications. Finally, it is not safe to liposuction more than several pounds at a time, so the quantities of fat that can be removed by liposuction are relatively small compared to the amount of weight an obese patient should lose to be normal weight. Liposuction is possible for an obese patient if there is a specific area of fat that should be suctioned for a specific reason, but not for general weight loss.
Can liposuction remove my cellulite?
Cellulite is fatty deposits just under the skin that cause an uneven, dimpled, or rippled appearance of the skin. Liposuction will remove some of the deeper fat deposits below the cellulite, but it is not likely to eliminate the cellulite. Unfortunately, there is no surefire way to control cellulite. Some women have seen improvement through a weight loss program, while other women have lost substantial amounts of weight without a noticeable difference in their cellulite.
Will liposuction tighten up loose skin?
Scar tissue will form in the deep dermis which can cause the appearance of a small degree of tightening, but the effect is not that significant. If loose skin is your main problem, you may wish to discuss other types of plastic surgery—like a tummy tuck or an arm or thigh lift—with the doctor.
Does liposuction produce permanent results?
There are two principal changes that occur beneath the skin as a result of liposuction. First, scarring occurs in the fat layer below the deep dermis which limits the amount of fat the layer can hold. Secondly, fat cells are permanently removed from the treated areas. If you follow a sensible diet and exercise plan after liposuction, then the results will be permanent. If you gain weight, the weight will be more evenly distributed and will not show up as much in the treated areas. Of course, as life moves on and the body ages there will be the usual changes associated with aging. Remember, however, that liposuction will not keep you from gaining weight if you overeat and don't follow a healthy lifestyle.
Is liposuction painful?
As with any surgery, there is post–surgical pain. Some patients describe it as feeling sore, like a big bruise. Pain medication is normally needed for a week or less for most patients. However, about 20% of patients require pain medication for more than a week. Of course, the more areas treated, the greater the discomfort is likely to be. But it can be controlled, so that you will be relatively comfortable.
How long is the recovery from liposuction?
As with most surgeries, the recovery period depends to a certain extent on the patient. Some patients recover quickly, others a little more slowly.
First few days: There will be considerable discomfort which can be controlled by pain medication. Remember, liposuction is surgery. Patients normally stay home and don't go to work. You can't drive a car or operate machinery while you are taking pain medications.
One week: Most patients can shift to milder pain medication. Some, however, about 20%, will require strong pain medication for a longer period. You can start light exercise, like walking or a stationary bike, but not running or aerobics and you can return to non–strenuous work.
Two weeks: Weights and exercise machines can be used.
Three to four weeks: The bruising should have disappeared by now. You can start running and doing aerobics and you can resume strenuous work.
Six weeks: You can stop wearing the elastic garment.
How long do I have to wear an elastic garment after liposuction?
Dr. Pittman–Waller wants her patients to wear an elastic garment for at least six weeks. It is important that the garment be worn 24 hours a day and only be removed to shower or bathe and then replaced immediately. The garment promotes the adherence of the skin to the underlying tissues that have been debulked by the liposuction. It helps promote a smoother more pleasing contour. The elastic garment is an important part of the recovery and healing process.
Are there visible scars after liposuction?
The scars are about 1/8 to 1/4 inch long. After the scars mature, they are barely perceptible.
What areas of the body are the most popular places to have liposuction?
The seven aesthetic units of the female abdomen. (Illustration: Matarasso, Alan, 2000, Plastic and Reconstructive Surgery 106:1200
Any area of the body that has an abnormal amount of fat compared to the rest of your body is a good area for liposuction. The abdomen and thighs are the most frequently treated areas. The next most common areas are the hips, buttocks, and knees. Other areas that are less frequently treated are under the chin, the breasts, the upper arms, the upper back, and the ankles.
Does liposuction cause dimpling or indentations in the skin?
Dimpling and indentations are a known risk of liposuction. Wearing the elastic garment will help the skin adhere to the underlying tissues and lessen the risk of dimpling. The use of large cannulas increases the risk of dimpling while the use of small microcannulas minimizes the risk. If a large cannula passes too close to the skin, it can create a tunnel just under the skin which will be seen as an indentation. If a microcannula passes close to the skin, it will not leave a visible tunnel or an indentation. The use of multiple small slits or holes in the skin allows the surgeon to make a criss-cross pattern of small tunnels which creates a smooth appearance.
How safe is liposuction?
Liposuction is one of the safest surgical procedures. It has been performed millions of times. The rate of complications is under 1% and mortality is exceedingly rare.
What are the risks associated with liposuction?
All surgery involves some risk. The risks associated with liposuction are infection, bleeding, asymmetry, dimpling, poor healing, skin pigmentation changes, and an adverse reaction to the anesthesia. The most serious complications are deep venous thrombosis and fat emboli, a blood clot or a globule of fat which blocks a blood vessel and, in extreme cases, can cause death. Some patients lose sensation in the area treated, but it normally returns with time. Keep in mind that the risks mentioned are very rare.
How soon will I see the results of liposuction?
You will probably see some results right after the liposuction, but your body may have some swelling at first from the wetting solution injected during the liposuction. It may take several days for the body to absorb and dispose of all of the solution, so you may not see significant results until that occurs. There will also be some swelling from the body healing and it could take up to several weeks for the body to have healed enough for the swelling to subside. Most people will notice results by the fourth week. There will be further improvement, although much more slowly, after the fourth week until the final result becomes apparent around six months after liposuction.
Can liposuction be combined with other surgical procedures?
Yes, it can be. Dr. Pittman–Waller often combines liposuction with other body contouring procedures like tummy tucks or breast reductions. However, the liposuction done in these procedures is to touch up the final contouring effect, rather than to do major liposuction. The safety of surgery is much improved if you don't try to do too much all at once. Combining major liposuction with major surgery increases the risk of surgical complications. In addition, there may be individual patient circumstances that warrant performing liposuction as a separate procedure.
How long does liposuction take?
It depends on how many areas are treated and how much fat is removed. Suctioning the fat can take from 30 minutes to more than two hours. Infiltrating the anesthetic wetting solution can take about as long as the liposuction. Typically, a total liposuction procedure will take from an hour and a half to three hours.
Is general anesthetic used?
Although many doctors use only local anesthetic, Dr. Pittman–Waller prefers to use both local and general anesthetic. General anesthesia has advantages for more complex liposuction procedures that include precise dosing, controlled patient comfort and movement, and airway management.
How satisfied are people who have had liposuction?
In an analysis of 209 patients receiving liposuction at The University of Texas Southwestern Medical School at Dallas, satisfaction rates ranged from 53% for arm liposuction, to 74% for abdominal liposuction to around 90% and more for other areas of the body, like hips, buttocks, chin, and knees. Overall, 80% of patients were satisfied with their results.
Among all liposuction patients, 80% would have it done again and 86% would recommend it to their family or friends. Among liposuction patients, 85% reported their appearance was good to excellent, 11% felt it was fair, and only 4% thought it was poor.
What might account for 24% dissatisfaction among abdominal liposuction patients?
There are three important factors which relate to the body contour of the abdominal region:
- subcutaneous fat, the fat just underneath the skin,
- visceral fat, the fat behind the abdominal wall in the interior of the abdomen, and
- the tightness of the abdominal muscles.
Of these three factors, liposuction can only treat the first, the subcutaneous fat. If your problem is visceral fat, then the only way to address it is through a weight loss program. Liposuction can only be done in the area between the skin and the abdominal muscles. If your muscles are loose because of a lack of exercise, then you need to start an exercise program. If they are loose because they have been stretched out by past obesity or childbearing, then they can often be tightened as part of a tummy tuck.
Remember, 74% of abdominal liposuction patients are satisfied with how their liposuction turned out. The other 24% may not have been realistic about how much liposuction alone would improve their abdominal contour.
Dissatisfaction is the highest for arm liposuction. What would account for that?
The results for arm liposuction are subtle. It does not tighten up loose skin on the arm and it might accentuate the loose skin once the fat is removed. It generally works best for younger patients with good skin tightness, who are looking for a better contour of the arm. If your problem is loose, hanging skin, a better solution might be an arm lift, or brachioplasty.
I've heard about other techniques which are supposedly alternatives to liposuction. Is there anything to them?
Plastic Surgery News, a publication of the American Society of Plastic Surgeons, published a review article of other supposed alternatives to liposuction in April 2008. Dr. Pittman–Waller believes that power-assisted liposuction gives the best results that are FDA approved. She does not perform techniques that are not FDA approved.
In short, the alternative techniques are:
Ultrasound: Ultrasonic energy fractionates or bursts the fat cells, which subsequently are removed with relatively low–volume suction—resulting in less trauma to tissues, according to the manufacturer.
Regulatory status: Trials being conducted, but not yet approved.
Mesotherapy: Mesotherapy, which includes LipoDissolve, involves the injection of various compounds into the skin to dissolve fat.
Regulatory status: Not approved.
Laser-assisted lipolysis: A laser fiber inside a cannula delivers energy directly to fat cells, causing them to rupture and flush naturally from the system. Simultaneously, tissue around the area coagulates, resulting in overall tighter skin tissue, according to the manufacturers.
Regulatory status: FDA approved.
Radiofrequency: Radiofrequency uses electromagnetic energy with a wavelength slightly longer than microwave to heat the dermis and subcutaneous tissues in a controlled manner without inflicting any damage to the epidermis. The physical changes reportedly are the result of stretching and smoothing of fibrous bands that cause cellulite, and lymphic drainage of the by–products of fat cells that have been reduced in size.
Regulatory status: FDA approved.
(Source: Plastic Surgery News, April 28, 2008, p. 45)
What about Mesotherapy and LipoDissolve? I've heard they're a good alternative.
In February 2005, the American Society of Plastic Surgeons issued a policy statement saying it does not endorse the use of mesotherapy, which includes LipoDissolve, because further research on safety and efficacy is needed. "The seemingly painless approach to body contouring will always be appealing to many, but without scientific evidence to verify mesotherapy's usefulness, practitioners and patients must be aware of the risks of the treatments and the lack of FDA approval of medications used in the injections," the statement reads. (Source: Plastic Surgery News, April 28, 2008, p. 45)
Although few complications have been reported, doctors using the technique have reported that some of their patients were unhappy with the results. In a recent study published in Plastic and Reconstructive Surgery, April 2008, 20 women were injected with a mesotherapy solution over a 12–week period in one thigh, while leaving the other thigh untreated. The doctors reported no difference after 12 weeks between the treated thigh and the untreated thigh.
LipoDissolve requires up to four injection treatments at 8–week intervals and its proponents claim it is best used to target small areas of fat deposits. Proponents of the technique claim success, but their claims have not been verified in independent tests.
The procedure is not FDA approved.
Is laser-assisted liposuction better than traditional suction–assisted liposuction?
A study published in Plastic and Reconstructive Surgery, September 15, 2005 found no significant differences in patient outcomes between laser–assisted liposuction and traditional suction–assisted liposuction. In fact, they found elevated levels of certain potentially harmful compounds in the blood of laser-assisted patients after the surgeries. There has been a lot of interest generated by the manufacturers' marketing efforts for their devices resulting in many articles in the popular press, but as of yet there is little independent evidence to support the claims of improved results or the higher price for the procedure. The equipment needed to perform the laser–assisted procedures is very expensive—about $135,000 per machine—and the patient must pay for that added expense, with little independent evidence that it does much good. The procedure has FDA approval.
What is the difference between ultrasound-assisted liposuction (UAL) and regular liposuction?
The ultrasound technique uses sound waves to cause the fat cells to burst, liquefy as an oil, and mix with the wetting fluid. Proponents of the technique believe that the fat can then be more easily suctioned. The advantages of the technique are not agreed on by all plastic surgeons. UAL is slower than super–wet liposuction and, because of the high energy sound waves employed, there is an increased danger of burning the skin and of nerve damage. Ultrasound equipment is expensive and the cost is normally passed on to the patient. However, ultrasound may have an advantage in breaking up fat in fibrous areas that are more difficult to treat with traditional liposuction.
What alternatives are there to liposuction?
Liposuction is never absolutely necessary, so a weight loss program may get you closer to your goal. Depending on your individual situation, it may be that a tummy tuck or an arm lift or a thigh lift may be a better choice for achieving the look you want. Dr. Virginia can help you sort through the alternatives.
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