What is Liposuction Surgery, and What Can Go Wrong?

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Brace yourself for both the expense and the graphic description! Ranging from $1,500 to $7,500 depending on the area treated, liposuction is a general term for a procedure where excess fat is removed from the thighs, calves, ankles, buttocks, abdomen, back, arms, face, neck, and chin using a thin tube that literally sucks it out. Sometimes this fat is just sucked away and discarded and sometimes it can be reused on parts of the face to improve facial contour and plump up lines.

Read on to learn about the various types of liposuction and what to expect.
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What is Liposuction?

Simply put, lipo means "fat" and suction, well, that's self-explanatory! So, liposuction is a surgical procedure wherein various methods and tools are used to suck (OK, vacuum) unwanted fat from various parts of the body. Liposuction is most often used as a means to remove excess fat from the things, buttocks, abdomen, back, calves and ankles ("cankles") and upper arms. The ideal person for liposuction is someone who is within 30% of their ideal weight, with relatively elastic skin and good muscle tone. It is also sometimes used to remove excess deposits of fat that haven't responded to changes in one's diet or exercise habits. According to the American Society for Aesthetic Plastic Surgery, liposuction was the #1 cosmetic surgical procedure performed in 2013, taking the top spot from breast augmentation. Let's go over the most common types of liposuction.

Tumescent Liposuction

This is a refined version of the dry liposuction method. It involves injecting a sterile saline solution into the area about to be worked on. The saline stretches the fat cells before suctioning with a tube known as a cannula begins, allowing a greater volume of fat to be removed. To minimize bruising, bleeding, and discomfort, the saline solution is mixed with xylocaine (a local anesthetic) and epinephrine, which constricts blood vessels.

Ultrasound-assisted or Ultrasonic Liposuction

This method uses high-pulse sound waves to liquefy excess fat, which is then removed by the same vacuum device used in other liposuction procedures. Ultrasonic liposuction is thought to be more effective for loosening the fat cells attached to muscles or organs and is also useful in breaking down fat cells so they are easier to suck up into the cannula (tube). Risks for Ultrasonic liposuction were once believed to be higher than for other liposuction procedures, but current research indicates that it appears to have benefits and risks similar to the tumescent method.

Powered Liposuction

A relatively new type of liposuction, powered liposuction, uses a cannula that moves in a rapid back-and-forth motion. This vibration allows for easier removal of more stubborn or "tough" fat. Powered liposuction causes less pain and swelling and allows a more precise procedure which is especially helpful on smaller areas, such as the arm, knees or ankles.

What Can Go Wrong

As easy and helpful as all this sounds (and the results can be truly impressive), it is important to keep in mind that sucking fat out of your body (especially a lot of fat) is an intense medical procedure. Liposuction is an operation that can be painful, the pain can last for several weeks, and there is risk of complications that can range from mild to serious.

Adhering to postoperative guidelines is essential for success. "Touchup" work may be necessary because even the best techniques can remove fat unevenly resulting in unwanted bulges and contours. And please keep in mind that liposuction absolutely does not take the place of a diet or a healthy lifestyle. If someone is obese, gains and loses weight frequently, or has an eating disorder, he or she is not a candidate for liposuction. This surgical procedure is not a quick fix for instant weight loss, despite often being characterized as such.

When it comes to complications there are several issues and concerns you must discuss with your physician:

  • Liposuction does remove fat, but if too much fat is removed your skin will stick unnaturally to the underlying muscle and tissues creating an abnormal appearance.
  • Liposuction cannot eliminate dimpling (cellulite).
  • It cannot correct skin laxity (sagging or loose skin from aging or extreme weight loss).

For some patients whose skin has lost much of its elasticity, the plastic surgeon may also recommend a skin-tightening procedure such as a thigh lift, buttock lift, or arm lift, all of which leave scarring that can be more extensive.

Depending on the area treated, other side effects may include scarring and numbness in the area treated. Infection can also be a serious risk and there are studies showing this is more common in countries where discount liposuction procedures are performed. In short, liposuction isn't something you should get done for the lowest possible price!

An article in Plastic and Reconstructive Surgery reviewed 631 liposuction cases over 12 years and found "Results showed the majority of patients to be women, aged 17 to 74 years old. Of the preoperative weights, 98.7 percent were within 50 pounds of ideal chart weight... Cosmetic results were good, with a 2- to 6-inch drop from preoperative measurements, depending on the area treated. Ten percent of patients experienced minor skin contour irregularities, with most of these patients not requiring any additional surgical procedures. One year after surgery, 80 percent of patients maintained stable postoperative weights. No serious complications were experienced in this series. The majority of the complications consisted of minor skin injuries and burns, allergic reactions to garments, and postoperative swelling. The more serious complications included four patients who developed mild pulmonary edema and one patient who developed pneumonia postoperatively. These patients were treated appropriately and went on to have successful recoveries. The results show that large-volume liposuction can be a safe and effective procedure when patients are carefully selected and when anesthetic and surgical techniques are properly performed. Cosmetic benefits are excellent, and overall complication rates are low."

Another study published in Dermatologic Surgery reviewed current data and found that "The overall clinical complication rate... was 0.7% (5 of 702). There was a minor complication rate of 0.57%. The major complication rate was 0.14% with one patient requiring hospitalization. Seventy-five percent of the patients reported no discomfort during their procedures. Of the 59% of patients who responded to a 6-month postoperative survey, 91% were positive about their decision to have liposuction (rating of 4 or 5 on a scale of 1-5) and 84% had high levels (4 or 5 on a scale of 1-5) of overall satisfaction with the procedure. Conclusions. Our findings are consistent with others in that tumescent liposuction is a safe procedure with a low complication rate and high patient satisfaction."

Is Liposuction Permanent?

If you gain weight, depending on how your body distributes fat, it can all show up exactly where the liposuction was performed. The good news is that adults only have a set number of fat cells and liposuction can remove a certain amount of them. You won't add more fat cells but the remaining fat cells can grow bigger, which can return the liposuctioned area to its previous appearance. Now that is some fat to chew on!

Sources: Plastic and Reconstructive Surgery, June 2008, pages 396-403;www.mayoclinic.com; Dermatologic Surgery, May 2008, pages 709-716; Clinical Infectious Disease, April 2008, pages 1181-1188; Journal of the European Academy of Dermatology and Venereology, January 2008, pages 30-35; Seminars in Cutaneous and Medicine Surgery, March 2008, pages 72-82; Current Diabetes Reviews, November 2006, pages 367-73; Dermatologic Surgery July 2004, pages 967-978; Aesthetic Plastic Surgery, March-April 2003, pages 146-153; British Journal of Plastic Surgery, April 2003, pages 266-271; Plastic and Reconstructive Surgery, December 2002, pages 1748-1751; Plastic and Reconstructive Surgery November 2001, pages 1753-1763.

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About the Experts

Paula Begoun is the best-selling author of 20 books on skin care and makeup. She is known worldwide as the Cosmetics Cop and creator of Paula's Choice. Paula's expertise has led to hundreds of appearances on national and international television including:

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The Paula's Choice Research Team is dedicated to helping you find the absolute best products for your skin, using research-based criteria to review beauty products from an honest, balanced perspective. Each member of the team was personally trained by Paula herself.

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