Liposuction or suction assisted lipectomy (SAL) is a procedure that results in the removal of unwanted fat from specific regions of the body that may not respond to diet or exercise.  It is an effective contouring procedure and the most common cosmetic procedure performed in America. 

Liposuction may be performed alone or in combination with other cosmetic procedures.  Areas commonly treated include the abdomen, the flanks, the middle and outer thighs and the legs, the chin and neck, the arms, the back, the buttocks and for the removal of excess fatty tissues in the chest area of men, which is called male breast reduction. 

Liposuction improves body contour by removing fatty deposits though it is not considered to be a substitute for weight loss.  Patients with strong skin elasticity may expect a pleasing result, yet if skin elasticity is a concern, discussing this issue with a cosmetic surgeon is the best possible way to decide on what treatment option is best for certain body or skin types.

Who is a candidate for Liposuction?

The best candidates for liposuction are of average weight, have firm, elastic skin, and pockets of unwanted excess fat.  Physical and psychological health is important, as well as stable and realistic expectations.  Those advanced in age may have diminished skin elasticity and may not achieve the same results as a younger patient with tighter skin, which should be considered by those seeking this procedure.

Liposuction carries greater risks for individuals with medical problems such as diabetes, significant heart or lung diseases, poor blood circulation, or those who have recently had surgery near the area to be contoured.

Who is not a candidate for Liposuction?

• Those overweight or obese and trying to lose weight.
  Liposuction is a procedure for shaping the body and is not recommended for weight loss.
• Those suffering from a disease or taking medication that affects wound healing.
  These include current infections or a past medical history of bleeding, emboli, thrombophlebitis, edema, or if you are taking medication(s) that may affect wound healing or blood clotting (such as aspirin, nonsteroidal anti-inflammatory agents, warfarin, heparin, or other anticoagulants) or are taking medication that may interact with the drugs used during liposuction.
• Those with inadequate skin elasticity.
  The surgeon will evaluate the skin at the site to be treated to determine if skin is elastic enough to shrink after liposuction.  If it is not, skin may hang loosely without support after liposuction leading to an unsatisfactory result.
• Those unable to afford the procedure.
  Most medical insurance will not pay for cosmetic liposuction. The cost for liposuction may be significant.  Consulting with a cosmetic surgeon in your area can help to answer cost concerns.

How is Liposuction performed?

Liposuction is generally performed as an outpatient surgery under a general anesthetic although small areas may be suctioned under a local anesthetic with accompanying intravenous sedation.  Small incisions are made in cosmetically convenient skin folds wherever available.

The tumescent liposuction technique is used to minimize bruising, swelling, and post-operative pain.  The tumescent technique utilizes large volumes of saline (physiologic salt solution) that contains dilute lidocaine (local anesthetic or "numbing" agent) in combination with epinephrine (adrenaline).  Adrenaline temporarily constricts (closes) the small blood vessels in the fat in order to prevent bleeding.  This also helps prevent post-operative bruising.  In addition, dilute sodium bicarbonate (baking soda) in the solution helps to minimize further the unpleasant stinging otherwise associated with the lidocaine and epinephrine.

After the tumescent is injected into the designated area, a narrow metal tube that is connected to a plastic hose and then to an aspirator machine, called a cannula, is passed back and forth through the area of excess fat.  When liposuction is performed, the cannula is passed through the fat and assists in breaking it down.  The fat cells are then gradually removed from the body.  In addition, the motion of the cannula damages the remaining fat and other fibrous cells.  These remaining damaged cells may take weeks to be absorbed or repaired by the body, which is important to consider due to risks of removing too much fat or tissue.  If too much fat is removed, large dents or scarred-down portions in the skin can result.  Only the layer of fat between the skin and the underlying muscle (the amount you can pinch before surgery) should be suctioned.

The tunnels which are created throughout the area of previous fatty excess fill with blood and bodily fluids thus creating the bruising and swelling which are seen after the operation.  Bruising usually subsides within one to two weeks. However, the swelling dissipates anywhere from two weeks to three months depending on the patient and the area treated. 

What should I expect after surgery?

Depending upon the amount of fat removed and the location of the surgery (doctor's office, surgical center, hospital), you may leave soon after the surgery or you may spend the night.  Discussing the healing process and recovery time with the cosmetic surgeon is very important to gain a better idea of how long it will be before a normal level of activity should resume.

Incisions which were made for the insertion of the cannula may drain fluids for several days and a drainage tube to help remove fluid may be used.

Tight garments to keep the skin compressed after the procedure should be worn for several weeks to promote healing.  Some surgeons will provide these garments but others will tell you where to purchase them before your surgery.

When the anesthesia wears off pain may occur and if the pain is extreme, the surgeon should be contacted.  Pain medication can be prescribed for discomfort as necessary.

What are the risks and concerns involved?

With any operation certain risks are involved and understanding these risks is a very important part of the entire process.  Having realistic expectations and an awareness of the need to alter lifestyle and diet goals can assist with satisfaction. 

Liposuction is not weight loss surgery and is not meant to help patients lose weight as much as it assists with shaping the body in conjunction with healthy lifestyle goals.  Careful and accurate communication between patient and surgeon can minimize unrealistic expectations and help patients to fully understand what the procedure can reasonably accomplish when it's followed up with a healthy lifestyle.

Excessive removal of necessary fat or tissues can result when surgery includes 1) removal of an excessive volume of fat by liposuction on a single day, 2) liposuction of an excessive number of body areas on the same day, 3) combinations of liposuction and other unrelated surgical procedures which involves excessive surgical trauma and prolonged exposure to general anesthesia.  Each of these scenarios should be guarded against and discussing this issue and understanding its effects is important.

Common & Minor Complications

Common & minor complications are conditions that do not threaten a patient's life, normal body functions or the ability to work.  These include superficial irregularities of the skin, seromas, hematomas, focal skin necrosis, allergic reactions to drugs, visible or disfiguring scars, discoloration of the skin, fainting during or after surgery, temporary bruising, numbness or nerve injury, and temporary adverse drug reactions.  Most of these complications can be considered minor; however some may become quite serious.  Post-liposuction fainting the next morning at home, especially after urinating is not rare.  This can be serious if the patient falls and experiences a head or neck injury.  

Rare & Severe Complications

Rare & severe complications associated with liposuction include problems with anesthesia, blood clots in the leg or lung, injury to the abdominal organs, excessive intravenous fluids, excessive blood loss, excessive loss of body heat (hypothermia), infections, allergic drug reactions, aspiration pneumonia (most likely under general anesthesia), heart attack, cardiac arrest and potentially fatal cardiac arrhythmias, and permanent nerve damage. 

Risks of Local Anesthesia

Lidocaine is the safest of local anesthetics available for liposuction.  At higher concentrations, patients might experience some toxicity.  Blood concentrations of lidocaine in excess of 12 milligrams/liter can produce serious cardiac toxicity.  The maximum recommended dosage of lidocaine for tumescent liposuction is 50 mg/kg (50 milligrams/kilogram of patient weight).  The most extraordinary aspect of the tumescent technique is its unprecedented safety record when used as directed. 

The tumescent technique is dangerous in the hands of surgeons or anesthesiologists who have not had specific and accurate training.  There has never been a reported death associated with tumescent liposuction totally by local anesthesia.  Discussing anesthesia with the surgeon is important to understand any risks as well as the technique that the surgeon uses when performing liposuction.

Risks of General Anesthesia

General anesthesia for liposuction can be considered safe when 1) the general anesthesia is administered by a board certified anesthesiologist, 2) liposuction is not performed with other unrelated surgical procedures, and 3) there is no excessive liposuction.

The most dangerous aspects of general anesthesia are respiratory depression and impairment of protective airway reflexes. The risks of general anesthesia include human error, unsuspected inherited hypersensitivity to anesthetic drugs, accidental overdose of anesthesia, any undetected airway disconnection or airway blockage.

General anesthesia, which increases the risk of vomiting and impairs protective airway reflexes, can cause aspiration of stomach contents. Because general anesthesia impairs the ability to breathe, when a complication does occur it can lead to disaster.

If taken soon before having liposuction, drugs that increase bleeding can cause liposuction complications such a hematoma (a large collection of blood trapped beneath the skin), or excessive bleeding that might require hospitalization.  Among the more common drugs that can interfere with normal clotting of blood are aspirin, ibuprofen (Motrin, Advil), and warfarin (Coumadin).  Even vitamin E, red wine, and some herbal remedies can cause prolonged bleeding.

This information is provided to acquaint you with the risks as well as the benefits associated with this procedure.  Of course, it is not possible to advise you of every conceivable complication and other problems can occur which are unexpected.  It should be noted that the complications associated with this procedure are frequently related to the amount of fat removed from the patient and the patient's age.

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Disclaimer: This information is intended only as an introduction to this procedure. This information should not be used to determine whether you will have the procedure performed nor does it guarantee results of your elective surgery. Further details regarding surgical standards and procedures should be discussed with your physician.

By OnlineSurgery Staff & Dunya Atisha, M.D.
Updated: September 29, 2008