Liposuction is the removal of unwanted pockets of fat through small incisions using a narrow wand (canula) and vacuum suction.
2. Who is the ideal candidate for Liposuction?
The ideal patient for Liposuction is someone who is healthy, has elastic skin, is close to their ideal body weight and has a few unwanted bulges that do not respond to diet and exercise. Not everyone needs to be the ideal candidate, but the closer you are to the ideal the better results you get from Liposuction. Liposuction is not a weight loss program. If you are significantly over weight, you should get down to a reasonable weight before considering plastic surgery. Even with a large Liposuction of 5 liters of fat, you only lose about 10 pounds.
3. Who is qualified to perform Liposuction?
True plastic surgeons are the only physicians who learn Liposuction as part of their required surgical training. There are many untrained surgeons and actually many physicians who are not even surgeons trying to perform plastic surgical procedures such as Liposuction. This can be very dangerous! Most of them only do the procedures in their office or their own surgical suite because they are not trained to perform the procedure and, therefore, cannot be credentialed to perform the operation at a hospital or legitimate surgical center. In these offices is where most of the serious complications occur. Neither the internet nor the telephone book care about your safety, the truth, adequate training or credentials. If you’re going to spend money on plastic surgery, do not take unnecessary chances. At least make sure that your surgeon is trained and experienced in plastic surgery and is not just dabbling in something in which they have no expertise.
When selecting a surgeon, at least make sure that he or she has had adequate training. Your surgeon should be certified by the American Board of Plastic Surgery. It is the ONLY legitimate plastic surgery board. It is the only one that evaluates a surgeon’s prerequisite training, plastic surgery training, practice performance and requires passage of rigorous written and oral examinations. You can contact the American Board of Plastic Surgery at (215) 587-9322. Another way to find out if your surgeon is trained is to see if your surgeon is a member of the American Society of Plastic Surgeons, Inc. (ASPS). Visit their website at www.plasticsurgery.org or call 1-888-4PLASTIC. All members of the ASPS are certified by the American Board of Plastic Surgery.
I would also recommend that you go one step further. To make sure that your surgeon specializes in aesthetic surgery and, therefore, is not only well trained, but is also very experienced, make sure that he or she is also a member of the American Society for Aesthetic Plastic Surgery (ASAPS). Surgeons that are members of ASAPS are all certified by the American Board of Plastic Surgery, members of ASPS, and have a practice that is dedicated to aesthetic surgery. Their web site is www.surgery.org and phone number is 1-888-ASAPS11.
Would you let a plumber do the electrical work on your house? Would you have a mechanic do your taxes? How about an orthopedic surgeon operate on your heart? Then why have an untrained physician, maybe not even a surgeon perform cosmetic surgery on you? If you wind up in someone’s office that does not have the above credentials, do not walk but run out of that office. And forget the consultation fee. They do not deserve to be paid for trying to deceive you.
4. Is Liposuction dangerous?
Liposuction should not be dangerous if it is done for the right reasons, by trained professionals (see question 3), and in the proper setting. Since 1997, Liposuction has been one of my most common procedures and I have never had a serious problem with a Liposuction patient. I believe that Liposuction is one of the safest of all plastic surgery procedures.
5. Does the fat grow back after Liposuction?
Liposuction does not change your physiology. If you take in more calories than you burn off, you will grow more fat. The fat cells that are removed with Liposuction are permanently removed. You don’t grow new fat cells unless you gain a tremendous amount of weight. This does not mean, however, that you cannot gain weight. The remaining fat cells that you have can grow much larger, so it is important for you to maintain your weight after surgery. It has been shown, however, that patients who gain weight after Liposuction generally do not put on fat as much in the areas that they used to prior to their procedure. The fat tends to go more to areas that were not treated, so it is usually more evenly distributed.
6. Does Liposuction get rid of cellulite?
Unfortunately, there is no effective treatment for cellulite at this time. Cellulite is the collection of superficial fat creating bulges and dimpling of the skin. Liposuction treats the deeper fat pockets and, therefore has no beneficial effects on cellulite. Do not waste your money on advertised creams, lotions, pills or expensive vacuum rolling treatments offered by many spas and even some physicians, they do not work.
7. What is the average recovery period for Liposuction?
The recovery from Liposuction is easy compared to many plastic surgery procedures. Most patients have relatively little pain. Many say that they feel like they had done a huge workout after being very out of shape. About 40 % of my Liposuction patients don’t even fill their prescription for pain pills.
8. How long does it take for all the bruising to go away?
For most patients, the bruising is at its worst 5-7 days after surgery. Surprisingly, almost all of it is normally gone by two weeks. Those with severe bruising may take a little longer.
9. I only had Liposuction of my thighs, why do I have bruising down to my knees?
Blood in the tissues runs down hill with gravity along natural tissue planes. So bruising of the skin is seen in areas dependent to the areas treated with Liposuction. This means, that abdominal Liposuction my result in bruising and swelling of the groin. It is not painful or cause any problems; it just looks very strange for a few days. Those with the worst bruising and swelling may see it in their feet and ankles after Liposuction of their thighs.
10. What can I do to reduce the amount of bruising from Liposuction?
At the time of your consultation or at your preoperative visit when you receive your instructions prior to surgery, you should receive a list of medications to avoid for two weeks before surgery. Most importantly, you should avoid aspirin and any aspirin containing products. You should also avoid most of the anti-inflammatories like ibuprofen. Take this list very seriously. After surgery, ice packs may help for a few days and you should avoid warm baths or hot tubs for several weeks. Showering is not a problem. Also, keep your activity down for several days after surgery.
11. What is tumescent Liposuction?
Tumescent (too-mess-sent) Liposuction is a technique where the areas to be treated are first infiltrated with a solution containing sterile saline, dilute epinephrine and lidocaine. The epinephrine constricts blood vessels in the area to be treated to reduce bleeding during surgery. Lidocaine is a local anesthetic to reduce pain during and after the procedure. There is almost no reason not to perform the tumescent technique. There is, however, a limit to the amount of tumescent solution that can be used. Excessive amounts of lidocaine can be toxic and even lethal. Less of this fluid is necessary when the Liposuction is performed under general or epidural anesthesia, particularly for larger cases. These are also best done at an accredited surgery center or hospital rather than trying to cut costs and do it in an office setting.
12. How do I know whether I need a tummy tuck or if Liposuction alone will suffice on my stomach?
If you have a lot of stretch marks or a considerable amount of excess skin on your abdomen, Liposuction will not likely help very much and you should probably consider some type of tummy tuck. A standard tummy tuck removes a considerable amount of excess skin and tightens the abdominal wall muscles without performing Liposuction. With a mini-tummy tuck, Liposuction is done first, less skin is removed and just the lower abdominal muscles are tightened. There are also multiple other variations on the tummy tuck depending on what is appropriate for you. Liposuction, obviously, is a less extensive procedure and has a shorter recovery period.
Only a true, board certified plastic surgeon can tell you what your options are and help you decide which procedure will give you the best result. This is another reason why you should avoid seeing a dermatologist for Liposuction. He or she cannot perform a tummy tuck (and should not be performing Liposuction) so they will not likely give you that option, even if it is the best procedure for you. I have seen many patients who have seen a “dermatologic surgeon,” who offered them only Liposuction when a tummy tuck would have given them a much better result. When the only tool you have is a hammer, the world begins to look like a nail.
13. What is ultrasonic Liposuction and how is it different from standard Liposuction?
Standard Liposuction removes small clumps of fat using a hollow, stainless-steel canula where the energy is provided by vacuum suction. The ultrasonic technique uses a special machine and a titanium canula that vibrates at 10,000 cycles per second. This ultrasonic vibration ruptures the fat cells causing liquid fat, like oil, to ooze out of the cells so the fat is removed as a liquid rather than as solid clumps of fat. Standard Liposuction is done at the end of ultrasonic Liposuction to remove the fat that has been liquefied. The advantage to the ultrasonic technique is that it can remove “tough fat” from areas that may be somewhat resistant to standard Liposuction. These include male breasts for treatment of gynecomastia (female-like breast), areas previously treated with Liposuction, and sometimes, the “love handle” area. Ultrasonic Liposuction also tends to have less bleeding than standard Liposuction.
Disadvantages to ultrasonic Liposuction is that it is a slower process and, therefore takes longer; it is a little more painful; the energy from the vibrating canula can create burns to the skin; to protect the skin from burns, a slightly longer incision may be necessary; and the internal “burn” creates more swelling that takes longer to resolve.
14. What is the risk of infection with Liposuction?
The risk of infection with Liposuction should be very small, less than one percent. It is generally less when done in an accredited surgery center than in an office OR. I prefer to place patients on antibiotics prior to surgery and for several days after. I have yet to have a single infection from Liposuction.
15. How would I know if I was getting an infection?
The first sign of infection after Liposuction is pain beyond what is normally expected after the procedure that gets worse rather than better. Other signs would be fevers, chills, redness of the skin and tender swelling of the areas treated.
16. How long does it take for the numbness in the skin to go away after Liposuction?
During Liposuction, blunt trauma occurs to the sensory nerves of the skin resulting in temporary loss of or diminished sensation. Since the nerves have only been injured and not severed, sensation gradually returns over three to four months. It is possible to have some areas of permanent decreased sensation though this is unusual and is rarely noticeable.
17. How much swelling will I have and how long does it take for it to go away?
The swelling and bruising pretty much go hand in hand. The more bruising you have, the more swelling you have. The swelling is almost always less than what you started with and the majority of it is normally gone in less than three weeks. Depending on which areas were treated and how much was done, it can take three to four months for it to completely resolve. The calves and ankles, however, can take much longer to recover. The swelling after ultrasonic Liposuction usually takes a little longer to resolve.
18. How long do I have to wear the garment after surgery?
You are supposed to wear the compression garment for at least three to four weeks after surgery, 24 hours a day. You may remove it to shower, go to the bathroom or to wash it the first day after surgery, but it must be put back on immediately. If, after three to four weeks, you still have swelling that occurs when you take the garment off, it is best to keep it on for another week. Most patients will wean themselves off of the garment by wearing it just during the day or just at night for their final week. There is no harm in wearing it longer.
19. I hear that some people have a lot of drainage, how long does it last?
Even though the small incisions from Liposuction are sutured at the end of the procedure, drainage may still occur for up to 24 hours after surgery. The drainage is mostly the tumescent fluid along with a little bit of blood which makes it look red. You may place gauze over the incisions under your garment to absorb the drainage until it stops.
20. What is done to avoid indentations of the skin with Liposuction?
The key to avoiding skin indentations, or contour irregularities, is to select the proper patients and to use proper technique. Skin that has lost its elasticity, as evidenced by multiple stretch marks, generally does not respond well to Liposuction. On the stomach it is better treated with a tummy tuck rather than Liposuction. Proper technique involves careful marking of the areas to be treated prior to surgery and feathering the periphery of the Liposuctioned area by gradually performing less surgery from where the most is done to where the least is done. This helps to provide a smooth, even contour. From a patient’s standpoint, it is important to choose a knowledgeable, well trained, experienced plastic surgeon (see question 3).
21. What is the risk of shock with Liposuction?
Shock can occur with very large Liposuction procedures when a lot of fat is removed. This can cause shifting of fluids between body compartments resulting in a drop of blood pressure and inadequate perfusion of the tissues. Liposuction is not a weight loss program and removing large volumes of fat can be risky. Weight loss should be done through diet and exercise before considering surgery. If you are turned down for Liposuction because of your weight, do not go “doctor shopping” to find someone who is willing to take a chance on you. Once again, make sure you are seeing a qualified surgeon who will perform the procedure in the proper setting (see question 3).
22. I’ve heard that you can get lung problems from Liposuction, how does that happen?
Your fat is made out of oil, your blood is water based so the two don’t mix. Whenever Liposuction is done, some fat that is not removed is liquefied and gets absorbed into the blood stream. Since the two are not compatible, small fat droplets form in the blood which get trapped in the lungs, cause inflammation and, if numerous, can cause difficulty breathing. This is called a fat embolus. Fat embolism generally only occurs to any significant degree with very large Liposuctions. Keeping to a reasonable volume helps to keep Liposuction safe and avoids problems such as fat embolism. Other lung problems include pneumonia and blood clots from the pelvic or leg veins (pulmonary embolus).
Pneumonia is possible, but rare in young healthy patients, after any type of surgery. The risk of pneumonia is higher in smokers who undergo general anesthesia. It is best if you cut down or quit smoking prior to any surgery. It is important for you to know that secondary smoke is almost as bad as smoking cigarettes directly.
The risks of blood clots can be reduced by being active after surgery; even moving your feet and legs while sitting or laying down can be beneficial.
23. Is it possible to have other procedures done at the same time as Liposuction?
It is very common to have other procedures done at the same time as Liposuction such as breast augmentation, breast lift, a tummy tuck or even cosmetic facial surgery. There is generally a significant cost savings in combining procedures.
24. What is “Liposculpture”?
The term “Liposculpture” is a catch-phrase use by some surgeons to attract patients by implying that their form of Liposuction is more advanced or technically superior to standard Liposuction. In fact, most Liposuction procedures involve sculpturing the fat to give a flatter, smoother or more pleasing contour.
25. What is Vaser® Liposuction?
Vaser® is a trademark name for a brand of ultrasonic Liposuction equipment. The name was created to rhyme with “laser” as a gimmick. It makes people think that it involves laser technology, which it does not. There is no significant difference between Vaser® and other forms on ultrasonic Liposuction.
26. What is laser Liposuction?
At this time, there is no true laser Liposuction. There is a laser that is used to liquefy fat, however, unlike true Liposuction, that fat is not removed. This creates concerns about what happens to the fat after it has been liquefied. Since human beings have no inherent system to remove or dispose to liquefied fat under the skin, this fat is most likely absorbed and deposited elsewhere in the body. Likely places include other places where fat is stored, the liver and even the lungs. Obviously, this uncontrolled re-deposition of fat raises medical concerns and is one of the main reasons why it is used by so few physicians.