Liposuction or lipoplasty is the removal of fat tissue from specified areas including the thighs, hips, abdomen, neck, face, knees, chin, buttocks, and arms.  Liposuction can be done using different techniques, but is not used to decrease weight; it simply removes pockets of fat that are not eliminated by more traditional means such as diet and exercise. In recent years, liposuction has benefited from several refinements including ultra-sound assisted lipoplasty (UAL), the super-wet technique, and the tumescent technique. These advances are helping plastic surgeons provide their patients with stronger results and a much faster recovery time. 

How It's done

Though there are different techniques, all forms of liposuction involve a large tube, called a cannula, inserted through tiny incisions in the skin.  The cannula breaks apart fat deposits and sucks out fatty tissue with the use of vacuum suction.  During surgery fluid is lost when fat is suctioned out.  This fluid must be replaced following surgery in order to keep the body from going in to shock.  In addition, many doctors require that their patients donate blood prior to surgery in the event that there is significant blood loss.

Technology

Aside from traditional liposuction, different techniques have been developed that allow patients to benefit by having a shorter surgery, quicker recovery time, the opportunity for better results, or other advantages depending on which type is used.  Three commonly used techniques are tumescent liposuction, super-wet liposuction, and Ultra-Sound Assisted Lipoplasty (UAL).

Tumescent Liposuction

During the tumescent technique, the areas that are to undergo liposuction are treated with local anesthesia in the form of large amounts of lidocaine and epinephrine.  The anesthetic causes the fat in the treated areas to become swollen and firm.  The doctor will then wait 30 to 60 minutes, allowing the swelling to subside slightly, and then begin removing fat with the cannula. Because the fat tissue in target areas become swollen and large, they are easier to distinguish since any missed areas of fat are more prominent due to swelling.  This usually results in a smoother and more even end result.  Total surgery with this technique can last as long as 4 to 5 hours.

Super-wet Technique

The super-wet technique is similar in nature to the tumescent technique, except it uses significantly less lidocaine and epinephrine; about a third as much.  Because of this the area on which surgery will be performed does not become properly anesthetized, and an intravenous sedation or general anesthetic is required.  The other result of using less local anesthetic is doctors do not have to wait to allow swelling to go down, and the surgery can be performed in about 1 to 2 hours.  In addition, under general anesthetic doctors have the option to perform other surgeries in addition to liposuction if the patient so desires: an option that would not be available with the tumescent technique.

UAL

During UAL a special cannula that emits ultrasonic energy is passed through areas of fat.  The energy liquefies the fat, allowing for more precision in less fatty areas that have high amounts of muscle and tendons.   The resultant liquid fat is then removed through traditional methods of liposuction.  Total surgery with this technique lasts longer than traditional liposuction but is shorter than tumescent liposuction.

Recovery / Post Op Expectations

Liposuction is a major surgery.  Pain and discomfort should be expected.  Medication is prescribed to help alleviate pain, and patients are often instructed to wear post surgical garments or bandages to help hold the area firm while it heals.  Many patients experience fluid drainage and may have a tube inserted to allow this process for the first few days of recovery.  Some bleeding should be expected as well as swelling and temporary numbness.

After about ten days stitches are removed or dissolve and within that time, or slightly longer, most patients begin to return to normal as far as their physical strength and health are concerned.  Return to work depends on the patient's occupation but generally takes a few days.

Complications

Like any major surgery, liposuction has many risks and complications associated with it that should be taken into consideration before surgery is decided upon.  Most commonly complications occur due to too much or too little fat being removed, too much anesthesia, or excessive trauma due to many surgeries or areas on which liposuction is performed at one time.  Many of these are preventable if the patient is well educated on the procedure and takes the time to find a qualified, experienced surgeon that makes the patient feel comfortable.  Some of these complications include:

• Skin depressions
• Indentations due to excessive liposuction          
• Permanent blotchy discoloration due to injured blood vessels
• Hematoma
• Blisters
• Hyperpigmentation
• Temporary lumpiness

In other cases severe and life threatening complications can occur due to patient reaction, surgical error, or improperly sterilized instruments.  Some of these include:

• Blood clots
•  Damage to internal organs
• Hypothermia
•  Severe blood loss
•  Infection
• Heart failure
• Nerve or brain damage
• Seizure

Am I A Candidate?

A candidate for liposuction should be at least 18 and acceptable of surgical risks. Patients are usually of a normal or average body weight, but have pockets or areas of fat that they wish to have removed.

Cost

Depending on the area on which liposuction is being performed and how many different spots are treated, the surgical fees of liposuction can range as low as $2,000 up to $10,000 or more.  In 2006 the American Society of Plastic Surgeons (ASPS) stated that the national average surgeon's fee was $2,697 for suction-assisted liposuctions and $2,979 for ultra-sound assisted liposuction. and can be higher when additions such as anesthesia are factored in. It should be noted that the total cost of any cosmetic procedure may include additional fees for anesthesia, facility fees, or even a hospital stay.