Liposuction is not a low-effort alternative to exercise and diet. It is a form of body contouring with significant attendant risks and is not a weight loss method. The amount of fat removed varies by doctor, method, and patient, but the average amount 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.
As shown previously, reports of people removing 22.7 kg of fat are exaggerated. However, 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 to have given up smoking for several months.
Areas of the body where liposuction is performed
- Outer thighs (saddlebags)
- Flanks (love handles)
- Inner thighs
- Inner knees
- Upper arms
- Submental (chin),(gullet)
- Gynecomastia (male breast tissue)
Techniques In general, fat is removed via a cannula (a hollow tube) and aspirator (a suction device). Liposuction techniques can be categorized by the amount of fluid injection and by the mechanism in which the cannula works.
Suction-assisted liposuction Suction-assisted liposuction (SAL) 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 in a forwards and backwards motion, carefully through the fat layer, breaking up the fat cells and drawing them out of the body by suction.
Ultrasound-assisted liposuction In ultrasound-assisted or ultrasonic liposuction (UAL), 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. UAL is a good choice for working on more fibrous areas, like the upper back or male breast area. It takes longer than traditional liposuction, but not longer than tumescent liposuction. There is slightly less blood loss. There appears to be slightly more risk of seromas forming (pockets of fluid) which may have to be drained with a needle.
After ultrasonic liposuction, it is necessary to perform suction-assisted liposuction to remove the liquified fat, or to deposit additional fat cells, used in high definition liposuction, to create more volume where it is needed. Ultrasound-assisted liposuction techniques used in the 1980s and 1990s were associated with cases of tissue damage, usually from excessive exposure to ultrasound energy. Third-generation UAL devices address this problem by using pulsed energy delivery and a specialized probe that allows physicians to safely remove excess fat.
A 40-year-old woman undergoing a combination liposuction and abdominoplasty. Power-assisted liposuction: the cannula is inserted to about 80% of its full length.
Power-assisted liposuction Power-assisted liposuction (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 SAL.
Twin-cannula (assisted) liposuction Twin cannula (assisted) liposuction (TCAL or TCL) 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 in) rather than merely vibrating 1–2 mm (1/4 in) 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.
External ultrasound-assisted liposuction External ultrasound-assisted liposuction (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 cause less discomfort for the patient, both during the procedure and afterwards; decrease blood loss; allow better access through scar tissue; and treat larger areas. At this time however, it is not widely used and studies are not conclusive as to its effectiveness .
Water-assisted liposuction Water-assisted liposuction (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 immediate edema from the tumescent fluid.
Laser assisted A laser is used to melt the fat in the target area, making it easier to remove. This laser is administered through a fibre threaded through a microcannula. The premise is similar to UAL. It is believed that these techniques, such as SmartLipo or SlimLipo, can also reduce bruising and bleeding, as it also cauterizes to a certain extent.
Tumescent technique Main article: Tumescent liposuction Tumescent liposuction is a technique that provides local anesthesia to large volumes of subcutaneous fat and thus permits liposuction totally by local anesthesia. In the past, liposuction surgery required blood transfusions because of significant blood loss in the liposuction aspirate. The tumescent liposuction technique eliminates both the need for general anesthesia and intravenous narcotics and sedatives while minimizing blood loss.
Sutures Since the incisions are small, and the amount of fluid that must drain out is large, some surgeons opt to leave the incisions open, the better to clear the patient's body of excess fluid. They find that the unimpeded departure of that fluid allows the incisions to heal more quickly. Others suture them only partially, leaving space for the fluid to drain out. Others delay suturing until most of the fluid has drained out, about 1 or 2 days. In any case, while the fluid is draining, dressings need to be changed often. After one to three days, small self-adhesive bandages are sufficient. Doctors disagree on the issues of scarring with not suturing versus resolution of the swelling allowed by leaving the wounds open to drain fluid.
- Dr John Newton (Plastic and Reconstructive Surgeon)
- Dr Tuan Van Pham (ENT Surgeon)
- Dr Venkata Krishna Bommareddy (Plastic and Reconstructive Surgeon)
- Dr Laith Barnouti (Plastic and Reconstructive Surgeon)
- Dr Sawjin Tew (Plastic and Reconstructive Surgeon)
- Dr Justin Perron (Plastic and Reconstructive Surgeon)
- Dr Niroshan Sivathasan (General Aesthetic Surgeon)
- Assoc Prof Dean White (Plastic and Reconstructive Surgeon)