- Liposuction is used to correct disproportionate fat deposits that are genetically acquired and cannot be corrected with diet and exercise alone
- Liposuction can be performed under local anaesthetic only, local anaesthetic + light sedation, or general anaesthetic, and the setting in which it is performed will depend on the extent of the procedure and anaesthetic
- Liposuction is performed by a variety of specialist doctors
- The timing of liposuction needs to be considered on an individual basis depending on current weight, planned weight loss, and pregnancies
- Two consultations with our doctors are required to ascertain your fitness and suitability for the procedure, to order and review pre-operative tests (e.g blood tests), fit you for a compression garment, to take pre-operative measurements and photos, and most importantly, for you to discuss your needs and concerns
- Liposuction involves the infiltration of very dilute local anaesthetic solution into the treatment area first. This allows the area to be numbed so that a cannula can pass through the area to remove the fat
- There are a variety of types of liposuction available including power liposuction, laser liposuction, ultrasonic liposuction, and water-jet assisted liposuction
- A compression garment needs to be worn post procedure
- As with all surgical procedures, there are risks and complications associated with liposuction, however, overall it is a very safe and effective procedure
What is liposuction or liposculpture?
Liposuction is a safe and effective method of reducing fat deposits from areas of the body. It is also commonly known as liposculpture, lipoplasty, liposelection, suction lipectomy or just simply ‘lipo’.
On the other hand ‘minigrafts’, tiny hair –bearing pieces of skin of one, two or three hairs, can produce a greater density since they allow for subsequent fill-ins with the ultimate density being superior to that of follicular grafts.
Genetically, we are predisposed to having certain areas of the body accumulate fat. These areas are disproportionate to the rest of the body, and these disproportions cannot be corrected with diet and exercise alone. Furthermore, these disproportions occur in people of all sizes. This can sometimes be noticed in the mismatch of clothing sizes from top to bottom for example. Areas that accumulate fat can cause a unevenness or disruption in the smooth lines of the body or its silhouette.
Men and women accumulate fat in different areas. Whilst men tend to accumulate fat in the chin, chest, abdomen, and hips, women tend to accumulate fat in the abdomen, hips, waist, thighs, arms and back.
Liposuction can be performed on almost any area of the body from the face to the ankles. In most cases, it is not intended as a means of weight loss or generalised fat reduction. Liposuction is instead a means of reshaping the body to give it more balanced proportions and a smooth silhouette. The results gained are permanent, and the area(s) treated will remain the same size if your weight remains stable. If weight gain does occur, the treated area(s) will not increase in size as quickly as it normally would, as fewer fat cells remain in that area.
t is possible to perform the procedure on one area or multiple areas. It can be done with a general anaesthetic or ‘twilight’ sedation. Most importantly, with today’s methods, it is a very safe and effective procedure.
Who can do liposuction and where can it be performed?
Although the roots of liposuction go back to the 1920s, modern liposuction was initiated in 1974 when Dr. Giorgio Fischer, a gynaecologist, developed the concept of using suction through a blunt, hollow cannula to aspirate subcutaneous fat. Surgeons Dr. Pierre Fournier and Dr Yves-Gerard Illouz further developed and promoted modern liposuction to the world. From 1977 other surgeons and dermatologic surgeons learnt the techniques from Fischer, Fournier, and Illouz and in 1982 The American Society of Plastic Surgeons sent a task force to Paris to investigate the technique. In 1985, Dr. Jeffrey Klein, a dermatologic surgeon, invented tumescent liposuction, a technique that uses large volumes of local anaesthetic to allow liposuction to be done in a doctors office without general anaesthesia. This technique has been used widely throughout the world currently.
In today’s society, liposuction is performed by a variety of doctors, including cosmetic surgeons, plastic surgeons, dermatologists, and other surgeons. When choosing a surgeon for liposuction, it is important not to only consider their qualifications (ie the letters after their name), but also to consider their experience with liposuction, their surgical skills, if they have an eye for detail and an understanding of the ideal body shape, good judgment, as well as their reputation.
Liposuction can be performed in a variety of settings. Liposuction is commonly performed in hospital operating suites, day procedure centres, and in doctors clinics. With modern techniques, it is possible to have liposuction performed without a general anaesthetic and therefore a hospital operating theatre is not always required. Furthermore, most liposuction is done as day surgery, so overnight stays in hospital are not usually required. Government accreditation of a facility helps to ensure certain criteria have been satisfied, and that the facility will be of a certain standard. Most importantly, the setting in which liposuction is performed must be more than adequate to accommodate the type of anaesthesia required, the extent of the liposuction, and the patient’s medical requirements. For example, a small liposuction of inner knees under local anaesthetic only in a fit and healthy person may be done in a doctor’s office procedure room, whereas a large liposuction of multiple areas under a general anaesthetic will require an accredited operating theatre.
At The Skin Life Clinic, we perform our liposuction in our accredited day surgery centre.
What is involved with having liposuction?
When should I have liposuction?
Liposuction is a body shaping procedure rather than a procedure to produce weight loss per se. Therefore, it is suitable for those who have areas that are not proportionate to the rest of their body. As this can happen at an early age and as shape is inherited, it may be logical to commence liposuction earlier rather than later. Skin elasticity is also better the younger you are. However, as liposuction is a major cosmetic procedure, it is important to consider the person as a whole rather than a disproportionate body part, and to balance the risk of the procedure with the possible benefits or outcome. Mentally, one also must be prepared for the possibility of complications, the recovery period and the procedure itself. Overall, liposuction is a procedure that is performed on a very large age range of patients.
Often patients ask if they should have liposuction before or after weight loss. This is a difficult question to answer, and should be judged on a case-to-case basis. For those who are extremely overweight, it may be prudent to lose the weight first, especially if this means that the procedure will be a safer one. For those who are a little overweight, but have accumulations of fat in certain areas even when they have been lighter, may be best to have liposuction before attempting to return to their ideal weight. This way, the fat layer is larger and easier to remove. It is important to remember that the skin’s elasticity can be compromised by rapid changes in the underlying fat. This can be a result of excess fat removal from liposuction as well as extremely quick weight loss or gain before or after liposuction.
Secondly, the other question that is often asked by females is, ‘should have liposuction before or after pregnancy?’. As with most cosmetic procedures, liposuction is contraindicated during pregnancy or breastfeeding periods. However, it is reasonable to suggest that females contemplating liposuction should have the procedure prior to pregnancy rather than delaying it until after. The integrity and elasticity of the skin is better prior to pregnancy in most cases, and this will allow for better results. Also, by removing the fat stores prior to pregnancy, these fat stores are less likely to expand during pregnancy and cause undue stress and stretch on the skin.
Who cannot have liposuction?
Those who are pregnant, breast-feeding, have blood clotting disorders or bleeding disorders, and those who have significant medical problems such as cardiac or respiratory problems, that may increase the risk of the procedure or recovery period.
It is also important to have any significant abdominal or inguinal hernias surgically repaired prior to liposuction of this area.
The consultation process
The first step is to have a consultation with one of our doctors. During this consultation, the practitioner will review your medical health, fitness, weight, medications, allergies, previous anaesthetics and operations. This will help to determine if you are medically fit for surgery. There are some medical conditions that may preclude you from having surgery. Also, some medications can interact with the local anaesthetic used, and may require temporary cessation prior to the procedure.
Once your suitability for liposuction has been determined, you will be able to discuss your areas of concern with the doctor, and the doctor will help you decide what is feasible as well as what areas to treat in order to achieve the best outcome.
In order for you to be fully informed about making the decision to have liposuction, and to allow for time to prepare for the procedure, usually two consultations are required. You will also be examined during the procedure and have the opportunity to discuss and point out the areas that concern you. The doctor will assess your shape and fat distribution to advise you what areas might be best treated to ensure that your proportions are balanced after liposuction. You may have some preliminary markings on the areas to help demonstrate the areas that would be treated. Photos and measurements will be taken so that post-liposuction changes can be objectively assessed.
An assessment of the skin’s elasticity may also be performed. Generally, the tighter and more elastic the skin, the better the skin retraction and the more fat that can be removed without causing skin laxity or skin irregularities. Liposuction is usually a balance between removing too much fat and causing skin disturbances or increased skin laxity, and taking out too little fat. The process of liposuction however, does stimulate the skin to retract to a degree. Your doctor will discuss with you how much fat can be removed safely and effectively and to ensure that the final result is aesthetically pleasing.
Before the procedure, depend on your health and the areas to be treated, you may also be required to have some test including;
- Blood tests – to examine your haemoglobin levels, platelet counts, kidney function, liver function, thyroid function, cholesterol, blood sugar level, hepatitis B, C and HIV status, and your blood’s clotting function. A pregnancy test may be performed if you are a female of child bearing age.
- ECG or stress ECG – for those with a history cardiac problems or for those over 60
- Imaging studies (e.g ultrasound or x-rays) – an ultrasound may be performed in those undergoing liposuction for ‘man boobs’ to determine the amount of fat and glandular tissue present, and a chest x-ray may be performed for those with pre-existing respiratory concerns or pre-general anaesthetic.
You will be measured and fitted for a compression garment that needs to be worn after the procedure. You will also be given a script for prophylactic antibiotics (cephalexin), anti-inflammatories (prednisolone), and analgesics (Panadeine Forte) to be taken post-operatively.
Choice of anaesthetic
Liposuction can be performed under local anaesthetic alone (fully awake), local anaesthetic with ‘twilight’ sedation (partially awake), or with a general anaesthetic (fully asleep). The type of anaesthetic used will depend on patient choice, the areas treated, and the extent of the liposuction.
Liposuction under local anaesthetic only was first devised by a dermatologist named Jeffrey Klein over 20 years ago. This method of liposuction is called ‘tumescent liposuction’ and relies solely on the infiltration of local anaesthetic to provide relief from the discomfort of the liposuction process. It is a popular liposuction method due to the fact that a general anesthetic is not required. The technique relies solely on the local anaesthetic infiltrated into the area to provide adequate anaesthesia for the liposuction to occur. Once the local anaesthetic is infiltrated, the procedure is usually painless, and may feel like a deep massage.
However, there is usually a small amount of discomfort associated with the infiltration of the local anaesthetic, and as a result, ‘twilight’ sedation is commonly used for this procedure. This form of sedation is called ‘twilight sedation’ as you are still able to respond verbally, but feel relaxed, calm and comfortable. With these medications, your memory of the procedure also becomes hazy. This form of sedation can be administered intravenously. The advantage of not being under a general anaesthetic is that you are able to be positioned more easily, you are able to constantly communicate how you are feeling, and you tend to recover quicker post-procedure. One of the limiting factors in having liposuction under local anaesthetic (with or without twilight sedation) is the total amount of local anaesthetic that can be used. There is a maximum limit based on your weight, and this will limit the amount of areas that can be treated in one session. If multiple areas are to be done, or if the whole body is to be done, it may need to be split up into various sessions.
General anaesthetic is another option for those who undergoing liposuction. There is still some local anaesthetic infiltrated into the treatment areas, however, the amount used per area can be reduced (due to the fact that the general anaesthetic is providing a part of the analgesia and anaesthesia) and a larger number of areas can be done in one session. Liposuction under general anaesthetic needs to be performed in a hospital or an operating theatre where general anesthetic can be performed, whereas liposuction under local anaesthetic (with or without sedation) can be performed in a theatre or a procedure room within a clinic. A general anaesthetic may also be a choice for those who do not want to be awake during the procedure. There are usually added costs, including theatre fees and anaesthetist fees.
You will be required to fast for certain time prior to the procedure. In cases performed under local anaesthesia with or without sedation, fasting is required 6 hours or more prior. Those performed under general anaesthetic will require fasting from the night before if performed in the morning. You will need to arrange for a family member or friend to drive you in and home, or we can arrange transport for you also if required.
On your arrival, you will have a final pre-operative consultation with your doctor before the procedure. Your doctor will mark and photograph the areas to be treated.
A pre-medication is sometimes given. This is a tablet that helps reduce pre-operative anxiety before the procedure. Furthermore, an intravenous cannula will be inserted into the back of you hand, and this will allow your doctor to give you some sedatives and analgesics intravenously for the procedure.
As liposuction is a sterile procedure, your skin is cleaned with antiseptic solution. Small incisions are made in the skin to allow access to the fat to be removed. These incisions are very small. In most cases, they are made in inconspicuous areas such as a skin crease, so they cannot be seen once healed. The number of incisions made will usually depend on the area treated, and the access required. Most areas need 2 access points to ensure even fat removal.
From these incisions, the local anaesthetic solution is infiltrated into the fat of the treatment area. The local anaesthetic solution is a mix of;
- (very dilute) local anaesthetic – to provide pain relief during and after the operation
- sodium bicarbonate – this reduces the discomfort from the administration of the local anaesthetic
- hyaluronidase – a product that helps to spread the local anaesthetic through the treatment area
- and adrenaline – this helps to constrict the surrounding blood vessels. By doing so, this reduces bleeding, bruising and keeps the local anaesthetic from being absorbed into the systemic circulation.
Once the local anaesthetic solution has been infiltrated into the fat, the area becomes swollen, and the fat layer becomes expanded, allowing for easier fat removal. The skin overlying the area becomes blanched from the adrenaline in the local anaesthetic solution. A cannula (a thin metal tube with a blunt tip and small holes at the end) is used to pass through the area to systematically to remove some of the fat. Light suction is provided by a machine or syringe (with its plunger pulled back) at the end of the cannula. The removal of fat relies mostly on the rasping action of the cannula’s holes rather than the suction.
Your doctor will constantly be assessing the areas treated for fat thickness and evenness by visual examination and pinching the area. The end-point for liposuction is not when all the fat is removed, but when enough fat is removed to provide a smooth contour and shape.
The entry points are then sutured or left open for drainage of the infiltrated local anaesthetic, dependent on their position and surgeon preference.
Once the procedure is finished, a foam dressing is adhered to the skin. On top of this, the compression garment is fitted. The foam provides even compression and significantly reduces the amount of bruising in the area. The compression garment, that now needs to be worn for 3 or more weeks helps reduce swelling, bruising, and importantly help the skin retract after the removal of the fat.
The various means of performing liposuction and techniques used
There are various methods of liposuction performed. These include:
Tumescent technique* – This is a commonly used technique for performing liposuction nowadays. It was first invented by Dr. Jeffrey Klein over twenty years ago now. It involves the infiltration of large amounts of local anaesthetic solution (containing adrenaline and bicarbonate) into the area to be treated. This helps to expand the fat layer for easier liposuctioning, constrict the blood vessels (adrenaline) to help reduce blood loss, and to help reduce post-operative pain. The fluid is usually allowed to drain naturally after the procedure by leaving the small entry points open afterwards.
The tumescent technique is designed especially for use with minimal or no sedation. It cannot be used in conjunction with a general anaesthetic, as general anaesthetic agents can reduce the metabolism (breakdown) of the local anaesthetic infiltrated leading to toxic levels of local anaesthetic.
Dry technique – No longer used nowadays due to the large amount of blood loss associated with this technique. No local anaesthetic solution is infiltrated into the area prior to liposuctioning, and this necessitated the use of general anaesthesia for the procedure.
Wet and superwet techniques* – This involves the use of local anaesthetic solution with adrenaline, but in much smaller volumes to the tumescent technique described above. This technique is commonly used in association with a general anaesthetic.
There are also various techniques used for liposuction;
Suction assisted liposuction* – The most basic and commonly performed technique of liposuction, it uses a cannula attached to suction, usually provided by a vacuum device.
Syringe liposuction* – In this case, the suction is provided by a syringe with its plunger pulled back. The advantage of this technique is the fact that the room is quiet and that fat is collected in syringes that can then be reinjected into other areas including other parts of the body or face.
Power assisted liposuction* – this technique involves the use of an oscillating cannula that is powered by an electric motor or compressed air. The tip of the cannula moves back and forward by a few millimetres in addition to the larger back and forth movements created by the surgeon. The advantages of this technique is less operator fatigue, easier and smoother fat removal, and less trauma to the tissues treated as the oscillating tip passes through fibrous tissues easier.
Laser assisted liposuction – Uses laser energy to break down the fat rather than the rasping action of a cannula to remove the fat. It is suited to very small areas of fat (like the chin) where there may be some added benefit of skin tightening from the laser also, but is not so efficient at removal of larger areas of fat. As with any laser, burns can occur to the skin.
Ultrasound (internal) assisted liposuction – Include machines such as the Vaser. An ultrasound probe is firstly inserted into the area to be treated. Ultrasound energy helps to break down the fat and help to reduce blood loss during the procedure. The disadvantage of this procedure is the added time/expense required, as well as the possibility of full thickness skin burns. There is an increased rate of seroma formation (fluid accumulations that require drainage – see complications section below). It is also purported that the ultrasound energy used at this level may cause damage to the DNA of cells and cause mutations (ie cancer), although this is not proven.
Ultrasound (external) assisted liposuction – Ultrasound is used externally to avoid the burns produced with internal ultrasound, however, its effectiveness has yet to be proven and this modality is not commonly used.
Water-jet assisted liposuction – A relatively new modality of liposuction that uses a special cannula to spray a jet of local anaesthetic solution and loosen the fat cells before being aspirated by the same cannula that releases the water.
After the procedure, you will be discharged home when appropriate, and you will need to arrange transport home as you will not be able to drive.
After liposuction, there may be some drainage from the wounds. Usually this fluid is absorbed by pads that are placed inside the compression garment. They may need to be changed, depending on the degree of drainage.
You may take analgesia such as Panadeine Forte or an anti-inflammatory such as Ibuprofen after the procedure, but not Aspirin. Usually the local anaesthetic given during the procedure takes a few hours to wear off, so you may not require any pain relief for some time after the procedure. The pain from liposuction is often likened to muscle soreness after a heavy workout, and in most cases still permits you to do light activities. Your normal exercise routine can be resumed usually after a week or more, once the discomfort has settled down. You will be able to return to work in most cases after a few days, but this depends on the number of areas treated, your recovery speed, and your line of work. Most people who have office jobs can return to work after 2 days.
You will need to commence your antibiotics and prednisolone the day after the procedure and continue this for one week.
The compression garment needs to be worn full time for one week post procedure. The foam dressing under the garment can be removed after 72 hours and needs to stay dry and adhesive. It is important to have someone assist you when removing the garment for the first time as you will feel dizzy when removing your garment after having worn it for so long. After the 6th day, you are able to remove your compression garment up to twice a day for one hour. Usually we recommend wearing the garment for 3 weeks in total.
The first review appointment with your doctor occurs 7 days after the procedure. At this appointment, you will be assessed to make sure that your recovery is in line with our expectations, and also to have any stitches removed.
Further follow up appointments are made at 3 and 6 months, and should any touch ups be required, we advise you wait 6 months post procedure to allow for the swelling to subside so that a proper assessment can be made.
During any time during the post-operative period should you require medical attention, you will be able to contact the doctor who performed the procedure at The Skin Life Clinic.
Possible complications arising from liposuction
As with any surgical or cosmetic procedure, there are risks as well as benefits to the procedure. Overall, done properly, liposuction is a safe and effective procedure that leads to aesthetically pleasing results.
Complications from liposuction can be broadly categorised into cosmetic complications and medical or surgical complications. These include;
- Cosmetic complications are usually from over or under liposuctioning or a particular area and result in outcomes that may not be satisfactory to the surgeon or patient.
- Proper patient selection is an important part of reducing cosmetic complications, for example, a patient with poor skin elasticity may not achieve the results they desire due to poor skin retraction post procedure. Also, it is important for the surgeon to properly manage the patient’s expectations prior to the liposuction, and give them realistic expectations of what can and cannot be achieved.
- Skin irregularities – this is usually caused by over-liposuctioning, uneven liposuction, or too superficial liposuctioning or an area or areas.
- Skin laxity – Over-liposuctioning of an area can lead to a reduction of fat that the skin cannot retract enough over. The looser the skin to begin with, the more likely this will happen. If a larger fat deposit needs to be removed, sometimes it is done over two sessions to give the skin a better chance to retract.
- Missed areas – which are larger than surrounding areas and require further liposuction to correct.
- Cosmetic complications are usually managed by a ‘touch-up’ procedure. This may involve a small amount of liposuction to an area that is irregular or protruding after the initial liposuction, or transfer of fat from another part of the body to fill in a defect that has occurred from over-liposuctioning of a particular area. It is important to note that the final shape from liposuction is not usually achieved for 6 months, and that tissue remodelling occurs for about 1 year. Therefore, touch ups are usually best left for at least 6 months after the initial procedure.
- Medical or surgical complications make up a much smaller percentage of the complications that occur from liposuction, as liposuction done properly is a very safe procedure.
- Liposuction performed under general anaesthetic or sedation carry the usual, albeit small risks, associated with the use of anaesthetic agents.
- Excessive blood loss with today’s modern liposuction techniques is extremely uncommon.
- Infection after liposuction is again extremely uncommon, due to the fact that a sterile field is always maintained during the procedure, prophylactic antibiotics are given immediately before the procedure and are taken by the patient for a week after the procedure, as well as the fact that the anaesthetic solution given to numb the fat is antibacterial.
- Lignocaine toxicity – lignocaine is the local anaesthetic agent that is used in most liposuctions and this is safe up to a certain level that is based on the patient’s weight. Some drugs taken by the patient, including conventional medications and herbal medications, may interfere with the metabolism of lignocaine, and therefore it is important to disclose any medications you are taking to your doctor.
- Haematoma – also known as a collection of blood under the skin. Usually modern compression garments and the foam applied post-surgically prevent these, but they may require drainage
- Seroma – A collection of fluid under the skin that requires drainage, usually on a daily basis. Again compression garments help to significantly reduce seroma formation. They are more common with ultrasonic liposuction than other liposuction technques.
- Deep vein thrombosis / pulmonary emboli – this complication can result from any surgery due to the fact that surgery in association with the relative reduction in movement after surgery can promote blood clots e.g in the legs. These clots can then embolise to the lung (pulmoary emboli). You need to let your treating doctor know if you have a history of deep vein thrombosis so that appropriate measures can be taken. Liposuction done under local anaesthetic has a lesser chance of causing deep vein thrombosis than liposuction done under general anaesthetic as your still can use your muscles during liposuction under local anaesthetic, and this helps to promote circulation and prevent stasis of blood.
Overall, although complications cannot be avoid completely, with proper patient counselling, patient selection, and surgical technique, most complications can be reduced or avoided.
What else can be treated with liposuction other than fat deposit removal?
Liposuction can also be used to treat lipomas which are benign fatty tumours. The usual method of removal of lipomas is with surgery, and liposuction offers the advantage of a smaller scar than conventional surgery.
Liposuction is also used to treat underarm sweating. This is done by performing very superficial liposuction to the dermis of the underarms. This disrupts the sweat glands in the dermis and help to reduce sweating there.