One of the risks of all types of liposuction is contour irregularities of the skin. When a patient thinks about their ideal result from liposuction, they imagine a nice, smooth, flat or gently curved contour to the skin surface. In order to accomplish that goal, plastic surgeons performing liposuction direct their attention to deep pockets of fat, near the underlying muscle, which is where most patients gain their excess weight. When very superficial fat is removed, the void created allows the overlying skin to fall inward creating an indentation or contour irregularity, which can be difficult to correct.
On most areas of the body, human beings have two layers of fat. One is more superficial, just under the skin. The other is deeper, near the muscle. Separating these two layers is a micro-thin membrane, which has connections to the overlying skin. These connections have vital structures going to the skin such as small blood vessels and nerves. When fat collects in the superficial layer, these connections prevent the skin from bulging outwards, creating small indentations which are commonly referred to as cellulite.
Since liposuction is directed at the deeper fat level, the superficial layer remains essentially unchanged; therefore, any cellulite looks about the same as it did before surgery. Various techniques have been invented to improve the appearance of cellulite without any reliable success. One such procedure, which was popular when it first was introduced several years ago, involves numerous repeated sessions of a rolling vacuum along with a strict diet and high water intake. Recently this has fallen out of favor due to unreliable outcomes.
It is not uncommon to hear of various products or procedures that are ‘FDA approved’ for getting rid of cellulite. Unfortunately, the FDA is more concerned with safety than it is about efficacy. ‘FDA approval’ means that the FDA has deemed the procedure or product safe; it does not mean that it will be successful or provide reliable results.
Over the past few years numerous new liposuction techniques have been developed, many of them with claims that, in addition to removing fat, they can tighten the overlying skin, which presumably could improve the appearance of cellulite. Some of these include laser liposuction and ultrasonic liposuction (e.g. VASER); however, no reliable study has yet to be done to prove that any liposuction technique actually tightens the skin. In situations where considerable fat is going to be removed and skin that is being pushed outwards is going to cover a smaller area after the fat is gone, you would expect the skin to be looser, not tighter. That, in fact, is the case with many liposuction procedures; particularly with larger volume liposuctions or in cases where there is less than adequate skin elasticity in the areas to be treated. It is hard to imagine any form of liposuction that could improve cellulite in a situation where the skin is expected to be looser after surgery.