Liposuction is essentially fat removal and is frequently one of the most common procedures. It has two basic elements: firstly, a narrow tube inserted beneath the skin, which dislodges fat cells. The second part is removal with suction. Patients are attracted to the concept because of both the tiny scars and, a somewhat hopeful belief that it can work wonders with general obesity.
There are some physiological facts that help to understand the limitations of liposuction:
- Number of fat cells is fixed by puberty – overall weight/body mass index is therefore determined by how full these cells are. There is only one way to reduce the number and that is surgical removal, usually with liposuction.
- Fat is a filler – liposuction can readily remove fat cells, but may not have such a good effect on the remaining skin, which may appear worse if it is in poor condition, inelastic and fails to retract satisfactorily.
- Liposuction is NOT a cure for obesity –complications, and deaths, are more frequent when large volumes (over 3L) are removed at any one time. Liposuction is far better as a targeted treatment for stubborn deposits remaining after weight loss and regular exercise. Liposuction without any lifestyle alteration often results in unexpected results as the body continues to store the excess calories. Now, however, they are in different areas because the original cells have been permanently removed.
Good indications
- stubborn/localised fat (‘lipodystrophy’)
- young, healthy patients
- good skin tone
Poor indications
- thin, inelastic or stretched skin
- obesity
- cellulite
Liposuction Techniques
Probably more than any other area liposuction is confused by an ever-changing array of machinery and technology, much of which is now marketed directly at the patient. We published a scientific review article should you wish for more detailed information.1
SAL (Suction-Assisted Liposuction) is the original technique and uses large volumes of fluid along with the surgeon’s arm to dislodge the fat for suction. There are a variety of technologies that have added some form of energy that both aids with fat breakdown and, to varying degrees, promotes skin retraction. LAL (Laser-Assisted Liposuction), RFAL (Radio Frequency-Assisted Liposuction) and PAL (Power-Assisted Liposuction) harness laser, electrical and vibration energy respectively. One of the longest established is UAL (Ultrasound-Assisted Liposuction) and it is now in its 3rd generation, better known as VASER.
Liposuction can be performed under a general (GA) or local (LA) anaesthetic, although the former is generally more comfortable and some areas are more favourable than others …
| ‘Favorable’ areas | ‘Moderate’ areas |
| § hips/outer thigh | § upper arms |
| § lower abdomen | § upper abdomen |
| § inner knee | § inner thigh |
| § gynaecomastia | § lower back |
| § beneath the chin | § buttocks |
More questions about Liposuction?
At consultation your aims and objectives will be explored. You should be in good general health and not smoking at the time of surgery (not only does smoking increase many complications, but it seems to actively target the skin’s elastic fibres).
As in every area of aesthetic practice it is vital to establish whether you have a clear understanding of what can, and cannot, be achieved. Realistic expectations are key to ultimate satisfaction in aesthetic medicine and surgery.
You will leave hospital with adhesive dressings beneath an elasticated garment. Any oozing from the incisions over the first 48 hours should not cause concern. Unless heavily soiled, the dressing should be left until your dressing clinic review after 1 week.
You should experience little pain, but avoid Aspirin, and similar drugs, which can worsen bleeding. Regular Paracetamol is very effective.
You should mobilise gently, but elevate your legs when resting if you have had any liposuction to them. Bruising is not always present, but Arnica for a week post-operatively seems to help.
Swelling peaks after a few days and then subsides so the garment may appear to loosen. It must be worn at all times thereafter – except when showering – for a further 6 weeks to both reduce swelling and assist with contouring. At this time you will be able to resume full activities such as the gym.
The final result may take many months and the treated areas can feel lumpy so massage helps: gently at first, but increasing as comfort allows. Many find that weight and any girth measurements increase initially – this is due to fluid retention and the enforced inactivity. To obtain the best results it is essential to maintain a steady weight.
Any operative intervention carries the risk of potential complication. These are rare with modern techniques,
GA is very safe, but a very small proportion may be sensitive to anaesthetic agents so it is very important to mention if any member of your family has experienced problems. Complications rise with both time under and the amount of fat removed. Side effects of LA agents include cardiac irregularities and convulsions if used in excess.
Bleeding is always possible with surgery, but usually only appears as bruising after liposuction.
Infection has been shown to be extremely uncommon after liposuction, but antibiotics will be given during the procedure.
Excessive scarring is rare. Hypertrophic scars are red and raised for longer than usual. Keloid indicates scar tissue beyond the boundaries of the original wound and remaining hard and unsightly for an extended period. Both are unusual, but more common in coloured skin and further treatment may be needed.
Seroma is fluid beneath the skin and, although extremely rare in liposuction, may require aspiration in the clinic.
Burns or skin necrosis are very rare, but most common in smokers and with the assisted energy types as above.
Sensitivity will change and is often numb after surgery. Some patients report a temporary increase in sensation, which gradually returns to normal over time.
Expectations are an essential part of cosmetic surgery and it is important that you take note of what your surgeon advises and indicates to be realistically achievable, particularly with respect to skin retraction and symmetry.
