Liposuction ($i, ooo to $2,ooo)

Liposuction (also referred to as lipoplasty) allows a doctor to remove localized collections of fatty tissue from the legs, buttocks, abdomen, back, arms, face, and neck by using a vacuum device that literally cuts up and then sucks up fat tissue. Depending on the area treated, the procedure leaves only minute scars, often as short as one-half inch in length or less.

The use of refined equipment allows removal from delicate areas such as calves and ankles. Liposuction does remove fat, but it cannot eliminate dimpling (cellulite) or correct skin laxity, which are the result of the skin’s structure and are not caused by the presence of the fat itself. In fact, the result of the procedure can actually cause an increase in the appearance of cellulite or sagging skin because the fat is no longer there to support the skin. A talented physician should know that and always leave some amount of fat in place.

For some patients whose skin has lost much of its elasticity, a plastic surgeon may also recommend a skin-tightening procedure such as a thigh lift, buttock lift, or arm lift, all of which leave more extensive scars.

Most women consider liposuction a method of weight loss, but that makes it a very high-risk, expensive way to “diet.” Plus, in terms of total fat removed, the typical amount is less than ten pounds and it is easily gained back.

Suction-assisted liposuction, where a long, needlelike tube is inserted into the skin and the fat is literally suctioned out of skin under anesthesia, remains the traditional method for body sculpting. However, newer technologies may increase efficiency, decrease surgeon fatigue (yes, doctors get tired during procedures, which increases mistakes), and minimize complications. Power-, ultrasound-, and laser-assisted devices are being used in cases where large volumes of fat tissue are being removed in areas with dense fibrous tissues as an adjunct to traditional liposuction. (Tumescent anesthesia is a method of eliminating pain during a liposuction procedure by injecting lidocaine and epinephrine into the area, causing it to become tumescent, which means swollen and firm. This makes the area easier to work on and there is no need for additional, riskier anesthesia.)

Power-assisted liposuction devices and traditional liposuction ones differ in that the tube-like tip of the power-assisted version vibrates. This vibrating vacuum moves at an ultra-high speed that generates a frequency powerful enough to emulsify fat cells, making them easier to suck up and remove from the body. This also causes less trauma and bruising to the surrounding tissues and makes the procedure easier for the physician.

Ultrasonic liposuction uses high-pulse sound waves to liquefy excess fat, which is then removed. The procedure has both advocates and detractors; some complain that the equip­ment is cumbersome, and others consider it time-consuming to use.

Laser-assisted liposuction was introduced in 2007, and the machine called the SmartLipo is the first laser to be approved by the FDA to be used for liposuction. As the laser wand is inserted into the skin, piercing the fat tissue, the laser pulses liquefy the fat. Just like power-assisted and ultrasound-assisted liposuction, laser-assisted liposuction still requires the use of tumescent anesthesia and a standard liposuction vacuum to suck up and remove the now-liquefied fat.

Interestingly enough, despite the creation of these new devices, research has shown that the effects of ultrasound-, power-, and laser-assisted liposuction basically differ from tradi­tional liposuction in only two ways: the improved initial healing process, and greater ease of use for the physician (something of value for the patient if the doctor finds the procedure less tiring to perform).

(Sources: Seminars in Cutaneous Medicine and Surgery, March 2008, pages 72-82; Plastic and Reconstructive Surgery, 2006, volume 118, pages 1032-1045; Annals of Plastic Surgery, March 2001, pages 287-292; Aesthetic and Plastic Surgery, November 1999, pages 379-385; and www. fda. gov/cdrh/pdf6/K062321.pdf.)

Overall, liposuction is considered a low-risk cosmetic procedure. An article in Plastic and Reconstructive Surgery (November 2001, pages 1753-1763) reviewed 631 liposuction cases over 12 years and found “Results showed the majority of patients to be women, aged 17 to 74 years old. Of the preoperative weights, 98.7 percent were within 50 pounds of ideal chart weight…. Cosmetic results were good, with a 2- to 6-inch drop from preoperative measurements, depending on the area treated. Ten percent of patients experienced minor skin contour irregularities, with most of these patients not requiring any additional surgical procedures. One year after surgery, 80 percent of patients maintained stable postoperative weights. No serious complications were experienced in this series. The majority of the complications consisted of minor skin injuries and burns, allergic reactions to garments, and postoperative [swelling]. The more serious complications included four patients who developed mild pulmonary edema and one patient who developed pneumonia postopera­tively. These patients were treated appropriately and went on to have [successful] recoveries. The results show that large-volume liposuction can be a safe and effective procedure when patients are carefully selected and when anesthetic and surgical techniques are properly per­formed. Meticulous fluid balance calculations are necessary to avoid volume abnormalities, and experience is mandatory when performing the largest aspirations. Cosmetic benefits are excellent, and overall complication rates are low.”

It is important to keep in mind that scraping fat out of your body is an intense medical procedure. Liposuction can be painful, and the pain can last for several weeks. Adhering to postoperative guidelines is essential for success. Touch-up work may be necessary because even the best techniques can remove fat unevenly, resulting in unwanted bulges and con­tours. Moreover, if you gain weight, depending on how your body distributes fat, it can all be added exactly where the liposuction was performed. Now that is some fat to chew on!

Updated: October 2, 2015 — 8:05 am