The Skinny on Liposuction

How Is It Done?

Liposuction is the surgical vacuuming of fat from beneath the surface of the skin. A special fat extractor (a thin hollow stainless steel tube) known as a cannula is inserted into the fatty areas between the skin and muscle through small incisions in the skin. The cannula creates tiny tunnels, breaks up the fat cells, and loosens them so they can be removed by a high pressure vacuum attached to the end of the cannula.

Examples of liposuction techniques include:

• Tumescent liposuction—The tumescent technique, involves the injection of large volumes of salt water containing lidocaine (a local anesthetic) and small amounts of adrenaline (a naturally occurring hormone that shrinks blood vessels) prior to the removal of fat. This numbs the tissues and shrinks the blood vessels, thereby eliminating pain and reducing bleeding, bruising, and swelling.
• Ultrasound-assisted lipoplasty—This technique uses ultrasound energy provided via a probe under the skin to liquefy fat.

Satisfied Customers

Liposuction is one of the most commonly performed surgical cosmetic procedures in the country. Liposuction is a good method of spot reduction, but is not an effective method of weight loss.

Kellie, a 25-year-old salon owner from Fort Walton Beach, Florida, says, "I had 800 CCs (cubic centimeters) removed from my hips and outer thighs. My clothes fit better now and people keep asking, 'Are you losing weight?'"

Immediately following the surgery, Kellie says she experienced a burning sensation in her legs, along with some swelling, soreness, bruising, and small scars that are hardly noticeable today. The worst part of liposuction, says Kellie, was the pain, which, she adds, was not bad enough to dissuade her from doing it again. She also did not like wearing the compression garment, which is a fancy girdle that is commonly worn for a few weeks afterwards to help reduce the swelling and to shrink the skin. Four weeks after the surgery, her pants size had shrunk from a size 10 to a 6.

Kim of Kinston, North Carolina had a similarly successful outcome. At 35 years old, she had liposuction on her thighs, stomach, and waist.

"I had soft, fatty thighs and no shape in the waist," says Kim. She says the results were even better than she expected, although she did take medication to manage the pain. "The liposuction made a world of difference in how I looked, moved, wore my clothes—and in my self-esteem," she adds.

Poor Results

Leah, 42, of South Lake Tahoe, California, was not as fortunate. After losing 120 pounds, Carlson still felt her hips and thighs were out of proportion, so she signed up for liposuction.

Contrary to her doctor's promises, her first liposuction surgery did not produce noticeable results.

"I was disappointed and the doctor was disappointed and completely confounded how he could have removed so much fat without any apparent change," says Leah. "A few months later he offered to do another surgery at no charge. He thought that all of the weight that I had lost caused me to have very fibrous fat, and he wanted to try a new tool with which he had achieved excellent results."

The second liposuction procedure for Carlson proved a disaster.

"The surgeon used a cannula he was not trained to use. My lymphatic and vascular systems were destroyed, causing the tissue in both inner thighs to die," explains Leah. Eventually gangrene set in and she was fighting for her life. Corrective procedures led to more than 4 years of medical troubles, such as leg circulation problems, which make it painful to stand, and leg swelling, which makes it difficult to sit.

She is convinced the biggest factor to her botched liposuction experience was her doctor. "I believed that if a doctor was able to perform a procedure, he must be well-trained. I assumed there were laws to make sure that was the case," says Leah.

Armed With Knowledge

Finding and choosing a qualified doctor is critical. Liposuction is a buyer beware market. To improve your chances of a satisfactory experience, follow these tips:

• Check the doctor's credentials—Liposuction should be performed by a plastic surgeon who is board certified in plastic surgery. To verify that a plastic surgeon is board certified, contact the American Board of Plastic Surgery.
• Ask questions—Ask if your doctor has been trained in liposuction, and if so, when, where, and how long. Ask to see documentation that verifies training. Ask if your doctor has privileges to do the procedure in a hospital. Although most liposuction procedures are not done in a hospital, admitting privileges signify that the surgeon has been critically reviewed by other members of the medical staff, the hospital administration, and the credentialing boards.
• Check out the facility—The procedure should be performed in an accredited office facility, outpatient center, or hospital.
• Lose weight first—Liposuction becomes less safe as the amount of fat to be removed increases, so losing weight first makes your procedure safer.
• Do not overdo it —The procedure is safer when done alone and not combined with other cosmetic procedures, such as facelifts or breast augmentation.
• Have a preoperative consultation—This screening is important. The ideal liposuction candidate needs to be in good overall health and have realistic expectations. You should be a relatively normal weight but have collections of fat that do not respond to diet and exercise.

Why Take the Risk?

Before you decide to undertake the expense (most insurances do not pay) and the risk, you may want to rethink your motivation. Although liposuction may seem like a quick fix, it is still a surgical procedure that carries with it a risk of complications.

Revision Information

• Reviewer: Michael Woods, MD
• Review Date: 01/2017
• Update Date: 02/05/2015