Liposuction, a clinical procedure that should be performed by a Board Certified Plastic Surgeon, removes fat that’s resistant to diet and exercise from various parts of the body, including the thighs, back, tummy, arms, and neck.
This article provides everything you need to know about liposuction, including how it works, the downtime involved, the pain factor, best candidates, and the importance of finding a qualified person to perform this procedure.
Keep in mind that this article is not intended as medical advice. While liposuction is generally considered safe when performed by a Board Certified Plastic Surgeon, it can have negative side effects depending on each patient, such as infection, and kidney and heart problems. Before you undergo a liposuction procedure, talk to your medical provider, first.
Liposuction – also known as liposculpture, lipoplasty, and suction lipectomy – is a procedure that shapes the body by removing diet-and-exercise-resistant fat from various parts of the body, said Dr. Laurie Casas, a Clinical Professor of Surgery in the Section of Plastic and Reconstructive Surgery at The University of Chicago Medicine.
The method involves removing fat through a few small incisions using thin tubes connected to a suction machine, explained Dr. Robert T. Buchanan, a Board Certified Plastic Surgeon who has a national reputation as a leader and educator in plastic surgery.
Liposuction is “a minor surgical procedure” in which a small incision, 3mm to 4mm, is made, said Dr. Sachin M. Shridharani, a Manhattan-based plastic surgeon who is board certified by The American Board of Plastic Surgery.
A cannula – a hollow tube connected to a suction device – is then inserted to break loose and suction out unwanted pockets of fat.
The tubes connected to a suction machine are shaped to avoid injury to blood vessels and surrounding structures, explained Dr. Buchanan, who was among the first 50 Americans taught by the European innovators (before then, everyone had traveled to Europe to learn from an individual there).
These tubes are moved back and forth in a crisscross pattern within the fat that a patient wants to be reduced, Dr. Buchanan said, and this area is blended into the surrounding areas of normal thickness. “The tube, which has small holes near the end, literally sucks the fat cells from the tissue.”
The liposuction procedure varies, depending on how much fat must be removed, Dr. Buchanan said. For instance, liposuction on small to medium areas (up to about a liter of fat) is easily done under local anesthesia with no or minimal oral anxiolytics, such as a Valium.
Fat removal above two liters is best done in an accredited facility with general anesthesia or major sedation and an IV to replace fluid lost during the procedure, Dr. Buchanan added; and removal of more than 3.5 liters should entail an overnight stay for monitoring and IV fluids. “Removal of between 1 and 2 liters depends on the patient’s tolerance.”
In Dr. Casas’ practice, after she determines the patient is an appropriate candidate and the area in question will respond to liposuction, the procedure is scheduled.
“The procedure is typically done under local anesthesia and the area is anesthetized using local anesthesia, typically referred to as tumescent anesthesia, so that the patient does not feel the procedure,” said Dr. Casas, who is certified by the American Board of Plastic Surgery and has 32 years of experience with liposuction.
“Sometimes general anesthesia is used because of the patient’s desire to not be awake, or because the patient has many areas to be treated,” said Dr. Casas, adding that based on the area to be treated and the plastic surgeon’s experience, the exact type of liposuction device is then chosen.
According to Dr. Shridharani, liposuction may be used to reduce localized fat deposits of the following areas:
- Abdomen and waist
- Bra line
- Calves and ankles
- Cheeks, chin and neck
- Chest area
- Hips and buttocks
- Inner knee
- Upper arms
Liposuction can be used on any area where there is extra fat that, if removed, would improve the appearance of the area, noted Dr. Buchanan, adding that liposuction is not recommended for large areas or generalized overweight.
“It is best for treating areas that weight loss and fitness training don’t correct or areas of congenital excess, or, in the case of the neck, areas from aging.”
The best candidates are those under 35 years old who are near ideal weight with localized area or areas of fat, according to Dr. Buchanan. “People who are older can be good candidates if they are willing to accept slightly loose skin or still have unusually elastic skin. Those who are heavier can also be good candidates if they are only trying to correct a localized area.”
Liposuction is meant to remove unwanted pockets of fat that tend to accumulate in areas that are resistant to dietary changes or exercise, said Dr. Shridharani, noting that these pockets are common on the lower abdomen, the upper thighs, the jowls, and other areas on the body.
“Liposuction removes these pockets of fat, slimming the contour – this is a body-contouring procedure,” Dr. Shridharani said. “Excellent candidates are those that still have good elasticity in their skin so that the skin can tighten down to the slimmer contour once the underlying fat is removed.”
Dr. Casas will discuss the areas of concern with the patient, “and together we will determine whether liposuction is appropriate to achieve the desired result.” She will emphasize the importance of diet and exercise prior to and following surgery “since any type of liposuction cannot substitute for proper nutrition and physical activity.”
“I will only recommend liposuction if the patient understands that proper nutrition and weight management after surgery is critical if the patient wants to maintain the result,” Dr. Casas added.
“Patients must understand that liposuction permanently removes the fat cells, however, if the patient gains weight, those pounds will show up in other fat cells around the body.”
Patients who gain and lose more than five pounds of fat, and patients that do not have stable nutritional and exercise routines, should avoid liposuction, Dr. Casas said.
According to Dr. Shridharani, people who should avoid this procedure are those that have sagging, stretched, loose skin.
“Liposuction alone is not the best procedure, as it will leave an area of loose sagging skin, albeit without fat underneath,” Dr. Shridharani said. “In these cases, procedures that remove excess skin, such as a tummy tuck, are better options.”
Liposuction is not normally a treatment designed for weight reduction, said Dr. Buchanan, further noting that in specialized centers, it can be part of a weight reduction program.
“However, these are uncommon because of the increased risks entailed in removal of large amounts of fat,” Dr. Buchanan warned. “Doing so is like suffering a major 40% to 50% total body burn. The so-called ‘360 Lipo’ is much better done by weight loss and then treating any remaining localized areas of excess.”
“They all do the same thing – remove fat through a small tube,” said Dr. Buchanan, adding that despite the hype about certain methods, none are any better at removing the fat than any other. “I still use basically the same method I learned about 35 years ago as I have found it simple, safe and nothing better.”
Different methods are used depending on the patient’s unique needs, said Dr. Shridharani, who has published numerous scientific papers on the subject of liposuction.
For instance, a tumescent method is used in all liposuction procedures, where a solution of saline, lidocaine, and epinephrine is first injected into the target area.
“This solution constricts the blood vessels to create less blood loss and subsequent bruising, it anesthetizes the area, and it makes the fat easier to break loose and suction away,” Dr. Shridharani explained.
“In addition to traditional suction-assisted liposuction, there are options of power-assisted liposuction, ultrasound-assisted liposuction, and laser-assisted liposuction.”
Dr. Shridharani offers more details about the methods mentioned above, as well as others:
Suction-Assisted Lipectomy (SAL)
This is also known as “traditional liposuction.” The small cannula used in liposuction has become increasingly easy to navigate through tissue and remove fat while still maintaining the integrity of adjacent soft tissue structures.
Not only did these advancements decrease the overall complication rate, but further allowed a standardized, safer technique for surgeons with varying levels of experience to adopt.
In traditional liposuction, small incisions are made in the skin where the cannula is inserted. The cannula is connected to a suction pump through a transparent tube, allowing the surgeon to see the fat coming out of the patient and to know when to move on to a new location.
Cannulas of different diameters can be used in order to optimize control when extracting fat. The use of different size cannulas decreases the risk of forming “divots” or uneven areas after liposuction.
Also, SAL is a very useful technique to remove fat in areas such as the face or the chin when PAL may be too powerful.
Power-Assisted Liposuction (PAL)
Power-Assisted Liposuction combines traditional liposuction with a vibrating cannula. PAL has become the “gold standard” across the board for fat removal.
PAL uses a different cannula than traditional liposuction. The special cannula uses tiny, rapid vibrations to break up the fat cells, so they can be easily suctioned out of the body, which allows for less anesthesia used during surgery.
In addition, PAL has allowed for faster recovery time, and for patients to return to normal activity much quicker than before.
Ultrasound-Assisted Liposuction (UAL)
An Ultrasound-Assisted Liposuction is a form of liposculpting, which employs ultrasonic energy to allow for more selective tissue lipolysis (fat break down).
UAL emits an ultrasonic frequency to create negative pressure, which causes molecular forces between fat cells to weaken making them easier to suction out.
The energy UAL produces can even raise temperatures of tissue to cause fat cells to die and clump together, without damaging nerves. The heating may also aid in collagen reproducing in the skin, which leads to more skin tightening over time.
Laser-Assisted Liposuction (LAL)
Laser-Assisted Liposuction utilizes the principles of lasers to rupture fat cells while leaving surrounding structures unaffected. Then the fat cell remnants are suctioned out through traditional liposuction means.
With liposuction pain, swelling and bruising should be expected after the procedure and usually start to subside after 48 to 72 hours, Dr. Shridharani said.
“After the procedure, you usually need to wear tight compression garments, which help reduce swelling, for a few weeks,” said Dr. Shridharani, adding that these will be worn for 1 to 3 weeks following your liposuction procedure.
“These garments not only reduce swelling, but they also help the skin and underlying tissues adapt to their new slimmer contours. Most surgeons employ methods consisting of having the treated areas wrapped to reduce swelling, bruising, and pain.”
The area to be liposuctioned is usually injected with an anesthetic that makes the area numb for several hours, Dr. Buchanan noted. When sensation returns, the usual “pain” is a dull ache like a bad bruise, he noted, adding “it is rare that anyone requires more than Tylenol.”
“A great many of my patients return to most regular activity and even work the next day,” Dr. Buchanan said. “Patients are usually placed in compression garments, but, except for the neck, most are hidden under clothing.”
Liposuction continues to evolve into a less and less invasive procedure, said Dr. Shridharani, adding that those who undergo this procedure will have some bruising and swelling, which will take up to 10 days to clear.
“Most patients can return to work in just two or three days, unless they have had multiple areas treated – those patients may need a week off from work,” said Dr. Shridharani, adding that scarring “will be virtually invisible.”
Light physical activity may be resumed after two weeks, Dr. Shridharani recommended; intense cardio may be resumed by 3 to 4 weeks, and strength training is typically permitted at 5 to 6 weeks post-surgery.
According to Dr. Casas, the timing of your recovery greatly depends on the extent of your surgery. Patients should expect the following:
The day after surgery, you will need to move around a bit to promote blood circulation.
Your compression garments and bandages will be removed within a few days so treated areas can be examined.
Incisions are usually less than one-quarter inch and are hidden within skin folds or natural body contour lines.
You will notice swelling and bruising, which is to be expected.
You will be asked to wear special compression garments that you will typically wear for several weeks after liposuction.
“Often you may be able to return to work in just a few days,” said Dr. Casas, adding that in many instances, you can resume most of your normal activities within one or two weeks.
“I will work with you to decrease the pain associated with liposuction and will customize a plan that will allow you to resume normal activities within a few days to a week.”
Liposuction is a procedure that appears very simple and safe, “but appearances are deceiving,” Dr. Buchanan warned. “It is, in fact, one of the most dangerous cosmetic procedures done.”
The major risks are death and contour irregularities, said Dr. Buchanan, adding that there were so many deaths in Florida a number of years ago that the state medical board suspended all liposuction for awhile and instituted strict guidelines for its performance.
“Infection and wound healing problems are also relatively common,” Dr. Buchanan, noting that since the procedure is done through multiple small incisions, the largest being about a ½ inch, as the only external sign of surgery, “it appears that very little was disturbed in the body.
However, everywhere that was liposuctioned under the skin is injured extensively. Everywhere a fat cell was removed, the body replaces it with fluid and starts trying to repair the area.”
Removing too much fat in a single procedure can be dangerous for the patient, Dr. Shridharani warned, adding that liposuction is a body-contouring procedure that is meant to remove stubborn pockets of fat, not large amounts of fat.
“Some people believe they can simply remove as much fat as they want, and that liposuction could be used as a form of weight loss – this isn’t true,” Dr. Shridharani emphasized. In fact, Dr. Shridharani generally wants his liposuction patients to be within 10% of their ideal body weight.
Other dangers, according to Dr. Shridharani, include the following:
- Contour irregularities
- Fluid accumulation
- Fat embolism
- Kidney and heart problems
- Lidocaine toxicity
Dr. Buchanan said the best analogy is that liposuction is like having a third-degree burn of the area. For example, liposuction of only the abdomen is the equivalent of a third-degree burn to 10% of the body, enough to get you hospitalized.
“Fortunately, the area heals faster than a burn,” Dr. Buchanan said. “This is the reason that I have all outpatient liposuction patients drink a lot of Gatorade or give extra IV fluids.”
Additionally, there are significant drugs injected, some of which are eventually absorbed, as not all of them are suctioned from the body during the procedure.
“These can cause neurologic and heart reactions,” Dr. Buchanan warned. “These two things, both of which increase with increasing areas of liposuction are the reason for careful monitoring during the procedure and keeping the patient in the hospital with increasing amounts of fat removal.”
Dr. Shridharani noted that prices range depending on areas treated, how much anesthesia is being administered, as well as geographic location, with starting prices typically $5,000 and upwards.
In Dr. Casas’ practice, each specific area typically costs between $1,500 and $2,000; that means for bi-lateral areas, like legs and hips, this price would double.
“The cost varies by what areas are done, whether it is done in the office or an accredited facility, where in the country it is done and who does it,” Dr. Buchanan added. “Those with little training are usually the least expensive, but you get what you pay for.”
In addition, since liposuction is a cosmetic procedure, it is not typically covered by health insurance.
Dr. Casas said “excellent three-dimensional contour changes” can be expected from liposuction.
Although problems can occur no matter who does the procedure, the expectation should be an area that is smooth and blends with the surrounding body areas, Dr. Buchanan said.
“The skin should contract and be smooth unless you are 30 years old or more,” Dr. Buchanan added. “Then it could be somewhat loose, but you should have discussed this at length with your plastic surgeon before the procedure.”
Your liposuction results are immediate, although you will have swelling and bruising at the treatment sites, and as this resolves over the next 7 to 10 days, you’ll see your early results, Dr. Shridharani said.
“They will continue to improve as your skin tightens down to your new contour,” said Dr. Shridharani, adding that the final results require 6 to 12 months to appreciate.
“The fat that is removed is gone for good. If you maintain a healthy weight and lifestyle, the prior area of fat will not return, and your results will last the rest of your life. You’ll be thrilled with your slimmer contour.”
When it comes to picking the best doctor to perform liposuction, the important thing to consider is the surgeon doing the procedure, Dr. Buchanan advised. That person should be a surgeon, preferably a Board Certified Plastic Surgeon, who knows the physiology of all the drugs used and the procedure itself and is very experienced in the procedure.
“Today there are family doctors and many others who buy a machine, take a half-day course and begin doing liposuction,” Dr. Buchanan warned. “This is extremely dangerous and a great many of the results reflect the lack of extensive training.”
Also, keep in mind that the companies selling the different liposuction methods will sell to any physician and market their machine as “the best,” Dr. Buchanan noted.
“This is pure marketing and not based on any comparative studies,” said Dr. Buchanan, emphasizing that it is the person wielding the cannula that is important.
Anyone undergoing liposuction should seek a Board Certified Plastic Surgeon with many years experience doing liposuction and other body contouring procedures because they have the training to know when liposuction is the best procedure or if some other procedure is better, Dr. Buchanan emphasized.
“They also understand the drugs used and the body’s physiologic reaction to the procedure and how to handle these aspects,” Dr. Buchanan said.
Even a young plastic surgeon just out of training has two years of doing the procedure under the instruction of experts, Dr. Buchanan noted, adding that a red flag “would be anyone else, especially if they did not also do other body contouring procedures. People should avoid choosing someone to do the procedure based on price or the kind of liposuction they do.”
Credentials are everything, Dr. Shridharani emphasized.
“Many doctors masquerade as board-certified plastic surgeons by calling themselves cosmetic surgeons,” Dr. Shridharani warned. “Check to make sure your surgeon is board-certified by the American Board of Plastic Surgery.” Additionally, “confirm the procedure is being performed in an accredited facility or hospital.”
Before you undergo liposuction, Dr. Shridharani said it’s important to do the following:
- Make sure the surgeon is board certified, accredited, and reputable.
- Do your research beforehand on the practice and procedures.
- Research expected results.
- Make sure you’re a surgical candidate.
- Consider the potential risks and side effects.
- Downtime is involved, so pre-plan the surgery to accommodate your schedule.
- Make sure the procedure is within your budget.
Many people seek liposuction instead of changing their eating habits, Dr. Buchanan said. “Notice I didn’t say going on a diet, as diets don’t work. The brain continues to like what you liked before the diet and will return there after you achieve your goal.”
Instead, you need to gradually change your eating habits, advised Dr. Buchanan, adding that dietary recommendations can be found on his website.
“Therefore, the first thing to consider is your goals and how to best achieve them,” Dr. Buchanan said.
“If you wish to look better in multiple areas or all over, then dietary modification is your best path. If the goal is simply to improve some contour problems caused by localized fat accumulation, such as the neck, lower abdomen, hips…then liposuction is very reasonable.”
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