Liposuction: Considerations about body sculpting

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Liposuction: Considerations about body sculpting

Liposuction — Find out who liposuction is for, how it works, and potential risks and benefits.

The concept behind liposuction seems almost too good to be true: Unwanted fat deposits are simply sucked out from underneath your skin with a tiny vacuum. It isn't an easy fix, though. Depending on how much fat is removed, liposuction can range from a minor operation with minimal recovery time and risk to a major operation with a potentially painful recovery and risks of rare, but serious, complications — including death.

If you're considering liposuction, learn more about the procedure and the possible outcomes so that you can make the best decision for yourself.

Who is liposuction for?

Liposuction is for people who have too much body fat in specific spots, but who otherwise have stable body weight. Candidates must be in good health, without conditions such as restricted blood flow, coronary artery disease, diabetes or a weakened immune system that could complicate surgery.

Liposuction can remove fat from various areas of your body, including your:

  • Abdomen
  • Buttocks
  • Hips
  • Thighs
  • Upper arms
  • Neckline and under-chin area

The procedure can also treat excessive breast growth in men (gynecomastia).

If your doctor suspects that your skin lacks the elasticity to tighten down over a smaller body area after the procedure, you may not be a good candidate. And liposuction isn't an overall weight-loss method. If you're overweight — rather than having a stubborn belly that won't go away even though you're otherwise fit, for example — you're better off losing the weight through diet and exercise. In addition, liposuction can't remove cellulite — the rippled skin sometimes found on the buttocks.

How do you prepare for liposuction?

Before the procedure, discuss your medical history and what to expect from the surgery with your doctor. Tell your doctor about any medications, supplements or herbs you're taking and any medical conditions you have, as these may affect the success of your procedure.

If your procedure requires the removal of only a small amount of fat, the surgery can often take place in an office setting, after which you can go home. If a large amount of fat needs to be removed — or if you plan to have other procedures done at the same time — the surgery may take place in a hospital, followed by an overnight stay.

When you arrive for surgery, you may be asked to change into a dressing gown and have photographs taken of the areas the surgeon will work on — so that before-and-after photos are later available. Before surgery, the doctor may mark circles and lines on the areas of your body to undergo liposuction.

How is liposuction done?

How your liposuction procedure is done depends on the technique that's used.

Tumescent liposuction
During this most commonly used liposuction procedure, your doctor injects fluids into the area of your body being operated on, causing it to swell and stiffen. The amount of fluid can vary, depending upon your size and the area being worked on; it may be up to three times the volume of fat that's being removed.

The injected fluid is a mixture of salt water, an anesthetic (lidocaine) and a drug that causes your blood vessels to constrict (epinephrine) so that you lose less blood during the procedure. The anesthetic helps relieve pain. The salt water helps your doctor remove the fat and is suctioned out along with the fat.

The surgeon then makes small cuts into your skin and inserts a tube called a cannula — which is about as thick as a thin writing pen — under your skin. The cannula is connected to a vacuum that sucks the fat and fluids from your body.

Because you're losing fat and fluids from the suction, the doctor may replenish your body fluid through an intravenous line, also called an IV.

Ultrasound-assisted liposuction
Ultrasound-assisted liposuction (UAL) is sometimes used in conjunction with tumescent liposuction. During this procedure, your doctor inserts a metal rod that emits ultrasonic energy under your skin. This ruptures the fat cell walls and liquefies the fat for easier removal. UAL increases the possibility of surgical risks, such as skin burns and nerve damage. However, it can be useful for removing fibrous or dense fat, such as on a man's torso.

Powered liposuction
A relatively new type of liposuction, powered liposuction, uses a cannula that moves in a rapid back-and-forth motion. This vibration allows the doctor to pull out tough fat more easily. Powered liposuction causes less pain and swelling and allows the doctor to remove fat with more precision, especially on smaller areas, such as the arm, knee or ankle.

Tumescent liposuction procedure

Illustration of tumescent liposuction procedure

During tumescent liposuction, your doctor uses a thin tube (cannula) attached to a vacuum to remove fat from underneath your skin. The doctor moves the cannula around under the skin, in some cases entering through several points to work an area from different angles.

What can you expect during the liposuction procedure?

Some liposuction procedures may require only local or regional anesthesia — anesthesia limited to a specific area of your body. Other procedures may require general anesthesia, which affects your entire body and induces a temporary state of unconsciousness.

If your procedure requires only local anesthesia, the doctor or nurse gives you several numbing shots in the area to be worked on. More numbing medication is then injected deeper into the fat to prepare it for the liposuction. You may also be given a sedative in pill form — or through an IV injection — to help you remain calm and relaxed.

If you need general anesthesia, the anesthesiologist or anesthetist gives you an anesthetic medication as a gas to breathe through a mask or injects a liquid medication into a vein.

The surgical team places several monitors on your body to help make sure that your heart rate, blood pressure and blood oxygen remain at safe levels throughout the procedure. These monitors include a blood pressure cuff on your arm and heart-monitor leads attached to your chest.

If you feel anything during the procedure, it may be a dull "rasping" type sensation as the cannula moves under your skin. This is typical. If you feel real pain, tell your doctor, as the medication or motions may need adjustment.

If your procedure requires only local anesthesia, you may be asked to stand up at times during the procedure to ensure proper fat removal.

The procedure may last up to several hours depending on the extent of the surgery. After the procedure, your doctor may leave your incisions open so fluid can drain from your body. If you've been given general anesthesia, you regain wakefulness in a recovery room. You generally spend at least a few hours in the hospital or clinic so that medical personnel can monitor your recovery. If you're in a hospital, you may stay overnight. The more fat you have removed, the greater the potential risks of the procedure. Your doctor may want you to stay overnight to ensure that your body isn't dehydrated or in shock from fluid loss.

What are the results of liposuction?

After the procedure, you may need to wear tight compression garments, which help reduce swelling, for a few weeks. Your doctor may prescribe antibiotics to reduce the risk of infection.

Expect some pain, swelling and bruising after the procedure. You may need to wait a few days before returning to work, and a few weeks before resuming your normal activities and exercise. About four weeks after the procedure, when most of the swelling has subsided, the area in which fat was removed should look less bulky. Within three to six months, the area should have its new leaner, tighter appearance.

What are the risks of liposuction?

As with any major surgery, liposuction carries risks, such as bleeding, infection and an unwanted reaction to the anesthesia. And like all surgeries, complications vary depending on how large a procedure you're having. If the surgeon is working on larger surfaces of your body or doing other procedures during the same operation, the risk of complications increases.

Possible complications specific to liposuction include:

  • Contour irregularities. Your skin may appear bumpy, wavy or withered due to uneven fat removal, poor skin elasticity and unusual healing. This condition can be permanent. Cannula-induced damage beneath the skin may cause a permanent spotted appearance to your skin. Temporary pockets of fluid (seromas) can form under your skin, particularly after UAL treatment. These may need to be drained with a needle.
  • Numbness. You may feel temporary or permanent numbness in the area of the surgery. Temporary nerve irritation also is possible.
  • Infections. Severe skin infections are rare but — if they occur — may require surgical treatment with the potential for significant scarring.
  • Internal punctures. Punctures in internal organs occur very rarely when a cannula penetrates too deeply into the body. These punctures can require additional surgery to repair, and can be fatal.
  • Death. Fatalities may be caused by anesthesia or by shifts in the body's fluid levels as fluids are being injected and sucked out. The fluid shifts can cause kidney and heart problems. Death is very unlikely with tumescent procedures involving only local anesthesia.

Talk to your doctor about how these risks apply to you. Understanding what's involved in liposuction and weighing the benefits and risks can help you decide if this procedure is a good option.

Last Updated: 08/11/2006
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