Frequently Asked Questions
- What is the history of liposuction?
- Is liposuction surgery safe?
- How does fat accumulate?
- Are there any predilections for fat accumulation in males versus females?
- Are there different layers of fat and is this important for liposuction surgery?
- What is cellulite and how can it be prevented?
- Is it true that fat cells can travel to another area following liposuction?
- What is ultrasonic liposuction?
- What is tumescent solution?
- Am I a good candidate for liposuction surgery?
- What does liposuction surgery involve?
- How do I plan for liposuction surgery?
- How do I prepare for liposuction surgery?
- What results can I expect after liposuction surgery?
- Where will my liposuction surgery be performed?
- What type of anesthesia will be used for my liposuction surgery?
- What should I expect after liposuction surgery?
- When will I be able to return to work following liposuction surgery?
- Are there any side effects I can expect following liposuction surgery?
- Are there any risks associated with liposuction surgery?
Dr. Dujarrier founded liposuction in the 1800s in Europe. Unfortunately his fist attempt was devastating as his attempt at trying to thin out a ballerina’s legs resulted in him severing a major leg vessel leading to the amputation of her leg. It is of utmost importance for clients to recognize that liposuction is a surgical procedure requiring complete knowledge of human anatomy and thus should only be performed by a qualified surgeon.
Advances in liposuction techniques over the last 5 to 10 years have allowed surgeons to provide liposuction procedure in a safe manner. One of the milestones was the development of tumescent fluid, which is infiltrated into the fat prior to initiating the actual suctioning. Injection of tumescent fluid has allowed surgeons to minimize blood loss significantly. In addition, research of the breakdown byproducts of the local anesthetic solution placed in the tumescent solution has allowed surgeons to better gauge the maximum volume of liposuction that can be safely removed in an outpatient setting. In general 3 L is the maximum volume of fat that should be removed in an outpatient setting without close overnight observation. Other important factors include: performance of liposuction by a trained plastic surgeon, the presence of an anesthesiologist who can manage shifts in body volume, and a facility that is accredited for surgery.
In your childhood, the fat volume increases by the number of fat cell multiplication, which results in more numbers of fat cells. Following adolescents, fat volumes increase by the size of the fat cells already present. An exception to the rule is a client who is overly obese, termed morbid obesity, in which the fat cells begin to multiply as they did in childhood. When a client undergoes liposuction, the fat cells are literally stripped out leaving fewer fat cells in the body. However, if the client does not watch their diet and does not alter their lifestyle, they may regain their weight and an undesired contour by virtue of the fat cells that are remaining growing in size.
Observations have been made with respect to the difference in fat accumulation in males versus females. Males tend to accumulate fat around the belly and back and have been termed androids. Females tend to accumulate fat around the hips and thighs and have been termed gynoids.
The fat underlying the skin is actually divided into two separate layers: the superficial layer and the deep layer. The superficial layer is denser and has more septa (fibrous cables which span the fat and give it more rigidity). In contrast, the deep layer contains loose fat with less septal support. Areas that have more pronounced deep layer fat include around the belly button, in the buttocks, and in the medial thigh area. Universally, liposuction is performed in the deep layer only. By maintaining a uniform and undisturbed superficial layer, clients are ensured an aesthetic result without any contour abnormalities.
Cellulite refers to the pitting of the skin that is observed in the skin especially in the thigh area of women who have undergone weight gain and/or subsequent loss. Clients who have dense vertical septa (fibrous cables which extend from the skin to the deeper muscle) are more likely to show cellulite. When fat increases in volume, it pushes against the skin, which may be tethered by these tight fibrous bands. Subsequently, if the client undergoes weight loss, the skin can loosen around these attachments resulting in cellulite. The appearance of cellulite can be avoided by breaking up areas of fibrous attachment using a special cannula or by finger fracture technique by your surgeon. In addition, there are specific sites, referred to as zones of adherence, that are known to have a high density of these fibers in which liposuction should be avoided. Recent interest in lasers and heating elements have proposed treatment for cellulite, such as endermologie, but none of these modalities has proven long-term success.
No, fat cells cannot travel to other sites. What has occurred is that the client has not followed their postoperative lifestyle recommendation and started gaining weight. Since the areas liposuctioned have fewer fat cells, when the patient begins to gain weight, they are likely to gain it in other non-liposuctioned areas, which have a full number of fat cells.
Ultrasonic liposuction uses hollow cannulas similar to standard liposuction surgery but also has an ultrasound probe at its tip, which allows for heating and “cavitation” of the fat cells. “Cavitation” refers to melting of fat cells, which presumably allows for easier evacuation of fat than the traditional mechanical suctioning using the hollow cannulas. Ultrasonic liposuction was developed to make the physical act of liposuctioning easier for the surgeon and to improve results for liposuction in more fibrous areas such as for the breasts and lower back. Overall, ultrasonic liposuctioning has not been universally accepted by the plastic surgeon community and has been noted to be associated with increased complications such as skin burns especially at the port sites.
In the evolution of liposuction, one of the obstacles was blood loss. When liposuction was performed without any infusion of fluids into the tissues, the liposuctioned fluid was noted to be 45 % blood in volume. Today a solution, termed tumescent solution, has been developed which contains lidocaine and epinephrine, molecules that decrease the pain and constrict the blood vessels, respectively. When this solution is infiltrated prior to suctioning, the estimated blood loss is 1 % of the total suctioned volume. The only disadvantage to using tumescent fluid is monitoring body fluid shifts and avoidance of fluid overload. Subsequently, performance of liposuction surgery should only be undertaken in an accredited facility with professional staff, including an anesthesiologist, who will monitor total fluids entering and leaving the client during the case.
Over 50 % of the United States residents are overweight. As you become overweight you will first accumulate excess fat and then your skin will stretch to accommodate the increased weight of the fat pockets. You are considered a good candidate if you have gained localized fat deposits but your skin has not stretched out to the point of losing its elasticity. Clients younger than 50 years of age typically have preserved the elasticity of their skin and will observe tightening of their skin following liposuction. Patients 50 years of age or older may require an excision of excess skin in addition to liposuction.
On the day of surgery you will meet with the surgical staff and surgeon and you will be marked in a standing position. You will then be taken to the operating room where anesthesia will be provided and the surgeon will be meticulous about infiltrating predetermined tumescent solution volumes in and liposuctioning appropriate volumes out. The endpoint of liposuction is determined by the surgeon who gauges the aesthetic contour of the area liposuction visually and by feel. Several liposuction cannulas may be used in order to maximize amount of removed fat. The edges of the areas liposuctioned are feathered to allow for smooth contour lines. Finger fracture technique is used to break up any septal attachments (attachments from the skin to the muscle/bone), which will result in skin tethering and contour abnormality, if not released. Finally, compression garments/girdles will be placed over the areas liposuctioned so that you can ensure a smooth and aesthetically pleasing contour.
All clients should undergo a complete history and physical examination by a qualified surgeon. Clients should be considered healthy if they have no medical illnesses, or if the patient has one or two medical problems, that they be well controlled. In general, plan to be evaluated by your surgeon at least 2 weeks prior to surgery so that the surgeon has ample time to determine your health status and to check your blood work to ensure that you are a healthy and safe client for this procedure.
Since your surgery will require either twilight, epidural, or general anesthesia, you must take several precautions prior to surgery. First, you will have to avoid eating and drinking after midnight on the day before surgery. This precaution ensures that your stomach is clear of digested foods that could potentially be aspirated and contaminate your lungs during induction of general anesthesia. Since, you will have anesthetic medications administered throughout the case, you will remain groggy for some time and will require a ride to and from the surgery center if you elect not to commit to an overnight stay at a patient care center. You should choose a caretaker who is conscientious and who can spend the first night with you.
Following liposuction surgery, patients can expect improved contour lines. Regions that are safely liposuctioned include: upper arm, armpit, abdomen, flanks, back, lateral thighs, medial thighs, knees, jowls, and neck. As your swelling resolves and when you stop wearing your girdle, you will find yourself buying a whole new wardrobe to fit your trim figure.
Since your surgery will require either twilight, epidural, or general anesthesia, it may be performed in an operating room that is part of a hospital institution or outpatient surgery center. Frequently, patients may be operated on in an in-house office based operating room, but it is of utmost importance for patients to make sure that a surgical accreditation body such as AAAASF has accredited the office facility.
Several anesthesia options are available for clients interested in liposuction surgery. These include:
- Twilight sedation, which involves a cocktail taken by mouth (an example would be a cocktail of: Valium, Vicodin, and Dramamine) and by IV fluids as needed depending on the extent of liposuction being performed.
- Epidural anesthesia is delivered much in the same way for clients during childbirth. This anesthesia is excellent for liposuction of the legs such as the medial thighs and lateral thighs.
- General anesthesia is provided to clients seeking liposuction of multiple regions and/or large volumes of liposuction.
Compressive postoperative garments/girdles are placed on clients over the areas treated at the end of surgery. These are worn to minimize postoperative swelling and to ensure a smooth and aesthetically pleasing contour. You may find the garments constricting but it is urged to wear the garments at all times for the first few weeks and up to 4 weeks if tolerable. You will feel soreness for the first 2 to 4 weeks following surgery but this discomfort is tolerable and after the 3rd or 4th day will not affect your daily activities. Expect to return to the office on day 7 to 10 to remove all porthole incision stitches. Expect to have bruising which will evolve over 2 to 4 weeks.
Following a routine liposuction case involving treatment of 2 to 3 areas, patients can expect to return to work following 1 week if their occupation is sedentary or following 2 weeks if their occupation is more physical. Clients are encouraged to let the degree of soreness dictate how much they can do; the soreness will subside gradually over 2 to 4 weeks.
Side effects are events that may be experienced by patients as a result of your surgery and should not be considered adverse events. Our patients are counseled regarding these effects and if experienced they are tolerable and often temporary in duration.
- Minor contour irregularities are not uncommon and have several causes. Patients who posses skin looseness or already demonstrate cellulite have a higher likelihood of developing contour irregularities. Release of septal attachments (tissue cables that stretch from the skin to the muscle) and feathering of the liposuctioned areas to allow for a smooth transition to non-liposuctioned areas are two means of avoiding contour irregularities. Finally, localized constricting clothes (such as a belt) may ruin an otherwise perfect liposuction surgery in the early postoperative period. Clients are recommended to wear their liposuction garments as a girdle for the first 4 weeks and to avoid any locally constricting clothes. When detected in the early postoperative period, manual message may correct minor contour irregularities. Finally, revision liposuction and fat grafting may be used to improve contour aesthetics.
- Prolonged swelling is infrequent in liposuction clients and may result from inadvertent disruption of a lymphatic vessel during surgery. Lymphatic vessels are responsible for drainage of all the extra fluid in the body. In general, liposuction surgery cannot injure lymphatic vessels to the degree needed to get prolonged swelling. Patients should be encouraged to remain active, which will stimulate the lymphatic vessels to work overtime. In addition, any client with prolonged swelling should consider getting their blood protein levels measured since they may not be absorbing extra fluid back into their blood stream due to low blood osmolarity. Prolonged swelling will eventually subside.
- Incisional scarring at liposuction port sites is a concern. In general, scarring at port sites can be eliminated by judicious attention to technique so that the cannulas are not being torqued against the skin edges. In addition, ultrasonic liposuction (which uses a heating element) is most often the cause of skin edge injury by thermal contact. When skin edges of the port sites have been traumatized, it is best to trim the skin edges prior to skin closure.
- Sensory changes are caused by trauma of the sensory nerves during the liposuction surgery. Universally, all sensation will return over 1 to 3 month period. This recovery period allows for traumatized nerves to heal themselves or for ingrowth of neighbor nerves in the event that a particular nerve was severed.
- Blistering of skin: Blistering of skin can occur from garment or tape irritation in the postoperative period. Clients should be aware of any localized skin irritation in the early postoperative period which when detected can allow for adjustment of garment/tape so that blistering is avoided. Blistering of the skin is merely a superficial injury to the skin and should heal without any difficulties with conservative care.
Risks are unwanted events that may occur during or following surgery. These events are recognized as “complications” but their occurrence is minimized by appropriate patient selection, proper surgical decision making, effective surgical technique, and thorough preoperative and postoperative patient management.
- Significant blood loss is a concern when tumescent solution is not utilized during liposuction. Since cosmetic surgeons have adopted tumescent fluid universally, the risk of blood loss is negligible.
- Fluid shifts remain a problem especially when large volume liposuction is used. Large fluid shifts can have a detrimental effect on the heart even leading to heart failure and death. As a result patients who undergo large volume liposuction (greater than 5 L) are requested to spend their first postoperative night at the surgical facility or board and care facility under the direct care of a nursing professional. It is also critical to have all liposuction patients undergo a cardiac and health evaluation prior to surgery. When patients undergo liposuction surgery at a professional setting by a professional staff complications related to fluid shifts can be avoided.
- Major contour abnormalities may arise when an unqualified physician performs the liposuction surgery. Major contour abnormalities may arise if gross miscalculations are made in the volumes liposuctioned in a particular region usually due to overaggressive liposuction. Another cause of major contour abnormalities involves liposuction of “zones of adherence”. Zones of adherence are areas that have very strict attachments of the skin to the underlying muscle and bone, which when disrupted will lead to gross distortion of the overlying skin contour. An educated decision to pursue liposuction surgery by a qualified surgeon is going to avoid such complications.
- Deep vein thrombosis (DVT) may occur in the legs immediately following surgery. DVT refers to the clotting off of leg veins which may result in compromised blood flow return from the legs; a more critical consequence may develop from this clot if it is dislodged and travels to the lungs causing a pulmonary emboli. Although rare, pulmonary emboli are the leading cause of death following liposuction surgery. Although pulmonary emboli usually arise from blood clots, due to the nature of liposuction surgery, pulmonary emboli can also arise from fat particles, called fat emboli. DVT’s are avoided with routine use tumescent solution which constricts the blood vessels and avoids entry of fat particles into the vessels, wearing of pneumatic compression boots during surgery, and encouraging patients to walk as soon as possible following surgery.