Liposuction

Treatment Overview

Liposuction removes fat from your body using suction. During liposuction, small, thin, blunt-tipped tubes (cannula) are inserted through tiny cuts in the skin. Fat is suctioned out through these tubes as the doctor moves the tubes around under the skin to target specific fat deposits.

In recent years, improved techniques have made liposuction safer, easier, and less painful. These newer techniques include:1

  • Tumescent liposuction. First, you are given a local anesthetic to numb the area of your body where the tube will be inserted. Next, a large amount of an anesthetic solution containing lidocaine and epinephrine is injected into the fatty tissue before traditional liposuction is performed. The solution makes the fat expand and become firmer, which allows the tubes to move more smoothly under the skin. It also causes the blood vessels to temporarily shrink (vasoconstriction), which greatly reduces blood loss during the procedure. With the large volume of anesthetic solution injected, tumescent liposuction may not require general anesthesia (which makes you sleep through the procedure) and thus does not carry some of the risks of traditional liposuction. It also reduces bruising, swelling, and pain after the procedure.
  • Ultrasound-assisted (ultrasonic) tumescent liposuction. This newer technique uses energy created by ultrasound to liquefy the fat before it is removed. The tubes move more smoothly under the skin after the fat has been liquefied, so this technique may be particularly helpful in areas where the fat is very firm or fibrous—such as the sides, the back, male breasts, and the area around the navel—or when removing large amounts of fat. Ultrasound-assisted liposuction may take 2 to 4 hours longer than standard tumescent liposuction.
  • Laser-assisted tumescent liposuction. This technique uses a laser to liquefy the fat before it is removed. Similar to ultrasound-assisted liposuction, this helps the surgeon remove the fat from under the skin. A laser also may be used to tighten the skin over the area where the fat was removed.

Liposuction is usually done as an outpatient procedure in a properly equipped doctor's office, ambulatory surgery center, or hospital. In general, it does not require an overnight hospital stay unless a large volume of fat is being removed. But liposuction of large areas of the body should only be done in a hospital or licensed surgical center.2Local anesthesia is used in some cases, and you may or may not be given a sedative to help you relax. If a large area or volume of fat is being treated, general anesthesia or deep sedation with a local anesthetic may be used.

What To Expect After Treatment

After the procedure, the area of the body that was treated is firmly wrapped to help reduce swelling, bruising, and pain. Elastic bandages and tape, support hose (such as those used to treat varicose veins), a special girdle, or another type of firm-fitting garment may be used, depending on which part of the body was treated. You may have to wear the compression garment or wrap for 3 to 4 weeks. Expect a lot of bruising and swelling for at least the first 7 to 10 days.

Fluid may drain from the incision sites for several days. In some cases, you may be given antibiotics to reduce the risk of infection.

Most people are able to get up and move around as soon as the treatment is finished and after the effects of the anesthesia and any sedation have worn off. You can return to your normal activities as soon as you feel comfortable, although this may take several days to a few weeks. Most people can return to work within a few days. Recovery may take longer if large areas were treated.

Why It Is Done

The main purpose of liposuction is to reshape one or more areas of your body, not to reduce body weight. Liposuction is typically used on "problem" areas that have not responded well to diet and exercise. These areas are often on the outer thighs and hips on women and the waist and back on men. The face, neck, abdomen, back, buttocks, legs, and upper arms are all commonly treated areas.

Liposuction is sometimes used in combination with other cosmetic surgery procedures, such as a "tummy tuck" (abdominoplasty), breast reduction, or face-lift.

Liposuction may also be used to treat certain medical conditions, including:

  • Benign fatty tumors (lipomas).
  • Abnormal enlargement of the male breasts (gynecomastia or pseudogynecomastia).
  • Problems with metabolism of fat in the body (lipodystrophy).
  • Excessive sweating in the armpit area (axillary hyperhidrosis).

Liposuction is not used to treat obesity. It will not get rid of cellulite or stretch marks.

How Well It Works

Liposuction is usually very effective at removing fat deposits in small areas. But if you regain weight after having liposuction, the fatty bulges that were removed are likely to return or may appear in a different place.

Some improvement in body contour is usually noticeable right after surgery, and improvement may continue for several weeks or even months as the swelling goes away. The full effects of having liposuction may not be visible for several months to a year.

Liposuction generally does not tighten the skin over the treated area. After fat has been removed, the skin around the area may be somewhat loose. It may take up to 6 months for the skin to tighten around the treated area. Some people's skin is very elastic and retracts more quickly than other people's skin. Younger skin tends to have greater elasticity than older skin.

People who expect liposuction to help them lose weight are usually disappointed.

Risks

Liposuction performed by an experienced doctor in a properly equipped facility is usually safe.3 Having more than one area treated, or having a very large area treated, may increase the risk of complications during or after the procedure.

Common side effects of liposuction include:

  • Temporary swelling, bruising, soreness, and numbness in and around the treated areas.
  • Irritation and minor scarring around the incision sites where the cannulas were inserted.
  • Baggy or rippling skin. The skin will usually tighten and retract after a few months. But in some people the skin may remain somewhat loose.

Less common side effects include:

  • Permanent color changes in the skin.
  • Uneven skin surface over the treated area.
  • Damage to the nerves and skin. The heat generated during ultrasonic or laser liposuction may burn the skin or damage the tissue under the skin.

Dangerous complications

Although death is very rare with liposuction, it can happen. If you are having a large amount of fat removed, are obese, or have health problems, your risks go up. You will be watched closely for several hours or overnight after a liposuction. Staying in the hospital is sometimes best.2 Possible complications include:

  • Excessive blood and fluid loss, leading to shock. But this is extremely unlikely.
  • Fat clots or blood clots, which may travel to the lungs (pulmonary embolism) and become life-threatening.
  • Buildup of fluid in the lungs (pulmonary edema). This is most likely to occur when a large volume of fluid is injected into the body.
  • Infection. In some cases, antibiotics may be given before or after liposuction to help prevent infection.
  • Toxic reaction to the injected solution (lidocaine toxicity).
  • A puncture into the cavity containing the abdominal organs or damage to an organ such as the spleen.

Liposuction should not be done in people with severe heart problems, blood-clotting disorders (such as thrombophilia, a disorder in which the blood clots easily or excessively), or during pregnancy.1

What To Think About

Liposuction should be done only by a doctor who has special training in liposuction and surgery of the skin and in how to respond to complications during surgery. You will also be at less risk for complications if liposuction is not done at the same time as other cosmetic procedures.1

If you are trying to lose weight, liposuction is not a substitute for exercise and a balanced diet. In fact, most cosmetic surgeons agree that the best candidates for liposuction are healthy people who are at or close to a healthy weight but who have stubborn fat deposits that do not respond to exercise. The results of liposuction can be long-lasting if you exercise regularly, eat a balanced diet, and maintain a healthy weight after the procedure. When people gain weight after having liposuction, the fatty bulges that were removed often return.

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References

Citations

  1. Coleman WP III, et al. (2001). Guidelines of care for liposuction. Journal of the American Academy of Dermatology, 45: 438–447.
  2. American Society of Plastic Surgeons (2003). Practice Advisory on Liposuction: Executive Summary. Available online: http://www.plasticsurgery.org/medical_professionals/Policy_Statements/loader.cfm?url=/commonspot/security/getfile.cfm&PageID=7658.
  3. Leonard AL, Hanke CW (2008). Liposuction. In K Wolff et al., eds., Fitzpatrick's Dermatology in General Medicine, 7th ed., vol. 2, pp. 2378–2380. New York: McGraw-Hill Medical.

Last Updated: August 4, 2008

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