Liposuction, also known as lipoplasty ("fat modeling"), liposculpture or suction lipectomy ("suction-assisted fat removal") is a cosmetic surgery operation that removes fat from many different sites on the human body. Areas affected can range from the abdomen, thighs, buttocks, to the neck, backs of the arms and elsewhere.
Liposuction is not a low-effort alternative to exercise and diet. It is a form of body contouring with significant attendant risks[1] and is not a weight loss method. The amount of fat removed varies by doctor, method, and patient, but is typically less than 10 pounds (5 kg).
There are several factors that limit the amount of fat that can be safely removed in one session. Ultimately, the operating physician and the patient make the decision. There are negative aspects to removing too much fat. Unusual "lumpiness" and/or "dents" in the skin can be seen in those patients "over-suctioned". The more fat removed the higher the surgical risk.
While reports of people removing 50 pounds (22.7 kg) of fat are exaggerated , the contouring possible with liposuction may cause the appearance of weight loss to be greater than the actual amount of fat removed. The procedure may be performed under general or local ("tumescent") anesthesia. The safety of the technique relates not only to the amount of tissue removed, but to the choice of anesthetic and the patient's overall health. It is ideal for the patient to be as fit as possible before the procedure and not to have smoked for several months.
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Relatively modern techniques for body contouring and removal of fat date back to French surgeon, Charles Dujarier. A tragic case that resulted in gangrene in the leg of a French model in a procedure performed by Dr. Dujarier in 1926 set back interest in body contouring for decades to follow.[2]
Liposuction evolved from work in the late 1960s from surgeons in Europe and was pioneered in the United States by the European surgeon Leon Forrester Tcheupdjian using primitive curetage techniques which were largely ignored, as they achieved irregular results with significant morbidity and bleeding. Modern liposuction first burst on the scene in a presentation by the French surgeon, Dr Yves-Gerard Illouz, in 1982. The "Illouz Method" featured a technique of suction-assisted lipolysis after infusing fluid into tissues using blunt cannulas and high-vacuum suction and demonstrated both reproducible good results and low morbidity. During the 1980s, many U.S. surgeons experimented with liposuction, developing some variations, and achieving mixed results.
In 1985, Klein and Lillis described the "tumescent technique", which added high volumes of fluid containing a local anesthetic allowing the procedure to be done in an office setting under intravenous sedation rather than general anesthesia. Concerns over the high volume of fluid and potential toxicity of lidocaine with tumescent techniques eventually led to the concept of lower volume "super wet" tumescence.
In the late 1990s, ultrasound was introduced to facilitate the fat removal by first liquefying it using ultrasonic energy. After a flurry of initial interest, an increase in reported complications tempered the enthusiasm of many practitioners.
Technologies involving the use of laser tipped probes (which induce a thermal lipoysis) have been introduced in recent years and are being evaluated to examine any potential benefit over traditional techniques.
Overall, the advantages of 30 years of improvements have been that more fat cells can more easily be removed, with less blood loss, less discomfort, and less risk. Recent developments suggest that the recovery period can be shortened as well. In addition, fat can also be used as a natural filler. This is sometimes referred to as "autologous fat transfer" and in general, for these procedures, fat is removed from one area of the patient's body (for example, the stomach), cleaned, and then re-injected into an area of the body where contouring is desired, for example, to reduce or eliminate wrinkles.
Removal of very large volumes of fat is a complex and potentially life-threatening procedure. The American Society of Plastic Surgeons defines "large" in this context as being more than 5 liters.
Most often, liposuction is performed on:
According to the American Society for Aesthetic Plastic Surgery liposuction was the most common plastic surgery procedure performed in 2006 with 403,684 patients.
Not everybody is a good candidate for liposuction. As stated earlier, it is not a good alternative to dieting or exercising. To be a good candidate, one must be:
Diabetes, any infection, or heart or circulation problems usually nullify one's eligibility for the procedure.
In older people, the skin is usually less elastic, so it does not tighten so readily around the new shape. In this case, other procedures can be added to the liposuction, such as an abdominoplasty (tummy tuck).
The basic surgical challenge of any liposuction procedure is:
As techniques have been refined, many ideas have emerged that have brought liposuction closer to being safe, easy, painless, and effective.
In general, fat is removed via a cannula (a hollow tube) and aspirator (a suction device). The vast majority of these procedures are conducted using "reusable" cannulas. The same reusable cannula is often used over many years and on dozens if not hundreds of different patients. The reusable cannula is cleaned and sterilized before each use by the doctor or his/her staff. One time use disposable cannulas are also available for these procedures. These devices are provided to the doctor in sealed and sterilized packages. They are intended to be used on only one patient and for only one procedure and then discarded. One time use disposable cannulas are disposed of in the same manner that other one time use medical devices are disposed of, such as needles and syringes.
Liposuction techniques can be further categorized by the amount of fluid injection and by the mechanism in which the cannula works.
The dry method does not use any fluid injection at all. This method is seldom used today.
A small amount of fluid, less in volume than the amount of fat to be removed, is injected into the area. It contains:
This fluid helps to loosen the fat cells and reduce bruising. The fat cells are then suctioned out as in the basic procedure.
In this method, the infusate volume is in about the same amount as the volume of fat expected to be removed. This is the preferred technique for high-volume liposuction by many plastic surgeons as it better balances hemostasis and potential fluid overload (as with the tumescent technique). It takes one to three hours, depending on the size of the treated area(s). It may require either:
Tumescent liposuction is the precursor of wet liposuction. The surgeon injects a solution containing a local anesthetic and vasoconstrictor (often lidocaine and epinephrine respectively) directly into the subcutaneous fat to be removed. The volume of fluid creates a space between the muscle and the fatty tissue allowing more room for the cannula. Despite a potentially large total volume of local anaesthetic injected into the tissue, absorption by the body is spread over 12-36 hours because of the vasoconstrive effect and systemic toxicity from lidocaine is rare.
Laser assisted liposuction which uses thermal energy to affect lipolysis has involved either of the Erchonia or Nd:YAG powered devices.
Suction-assisted liposuction is the standard method of liposuction. In this approach, a small cannula (like a straw) is inserted through a small incision. It is attached to a vacuum device. The surgeon pushes and pulls it carefully through the fat layer, breaking up the fat cells and drawing them out of the body by suction.
Also referred to as ultrasonic liposuction. A specialized cannula is used which transmits ultrasound vibrations within the body. This vibration bursts the walls of the fat cells, emulsifying the fat (i.e. liquefying it) and making it easier to suction out.
After ultrasonic liposuction, it is necessary to perform suction-assisted liposuction to remove the liquified fat.
PAL uses a specialized cannula with mechanized movement, so that the surgeon does not need to make as many manual movements. Otherwise it is similar to traditional UAL.
Twin cannula (assisted) liposuction uses a tube-within-a-tube specialized cannula pair, so that the cannula which aspirates fat, the mechanically reciprocated inner cannula, does not impact the patient's tissue or the surgeon's joints with each and every forward stroke. The aspirating inner cannula reciprocates within the slotted outer cannula to simulate a surgeon's stroke of up to 5 cm. (2") rather than merely vibrates 1-2 mm (1/4") as other power assisted devices, removing most of the labor from the procedure.
Superficial or subdermal liposuction is facilitated by the spacing effect of the outer cannula and the fact that the cannulas do not get hot, eliminating the potential for friction burns.
XUAL is a type of UAL where the ultrasonic energy is applied from outside the body, through the skin, making the specialized cannula of the UAL procedure unnecessary.
It was developed because surgeons found that in some cases, the UAL method caused skin necrosis (death) and seromas, which are pockets of a pale yellowish fluid from the body, analogous to hematomas (pockets of red blood cells).
XUAL is a possible way to avoid such complications by having the ultrasound applied externally. It can also potentially:
At this time however, it is not widely used and studies are not conclusive as to its effectiveness.
WAL uses a thin fan-shaped water beam, which loosens the structure of the fat tissue, so that it can be removed by a special cannula. During the liposuction the water is continually added and almost immediately aspirated via the same cannula. WAL requires less infiltration solution and produces less edema from the tumescent fluid. The utility of this technology is under study and is currently not widely used.
Since the incisions are small, and since the amount of fluid that must drain out is large:
In either case, while the fluid is draining, dressings need to be changed often. After one to three days, small self-adhesive bandages are sufficient.
Before receiving any of the procedures described above:
In all liposuction methods, there are certain things that should be done when having the procedure:
Depending on the extent of the liposuction, patients are generally able to return to work or school between two days and two weeks. A compression garment or bandage is worn for two to four weeks. If non-absorbable sutures are placed, they will be removed after five to ten days.
The patient should:
The suctioned fat cells are permanently gone. However, if the patient does not diet and exercise properly, the remaining fat cell neighbors could still enlarge, creating irregularities.
A side effect, as opposed to a complication, is medically minor, although it can be uncomfortable, annoying, and even painful.
There could be various factors limiting movement for a short while, such as:
The surgeon should advise on how soon the patient can resume normal activity.
As with any surgery, there are certain risks, beyond the temporary and minor side effects. The surgeon should mention them during a consultation. Careful patient selection minimizes their occurrence. Their likelihood is somewhat increased when treated areas are very large or numerous and a large amount of fat is removed.[5]
During the 1990s there were some deaths as a result of liposuction, as well as alarmingly high rates of complication. By studying more and educating themselves further, surgeons have reduced complication rates.
A study published in Dermatologic Surgery (July 2004, pp. 967-978), found that:
The more serious possible complications include:
The cosmetic surgeon should give the participant a written list of symptoms to watch for, along with instructions for post-op self-care.
Liposuction is not a good tool for tightening the skin. The removal of quantities of fat from under the skin can leave the skin even more loose. When drooping skin and fat are the issue, then lift such as a rhytidectomy (facelift), mastopexy (breast lift), abdominoplasty (tummy tuck), or lower body lift, thigh lift, or buttock lift are better tools and may include liposuction during surgery to refine the sculpture. SAL in combination with other surgery is common, but may have higher complication rates. When done simultaneously, SAL is done minimally in the areas of the undermined tissues to minimize further insult to the blood supply.