Liposuction is an operation done by plastic surgeons to remove localized deposits of subcutaneous fat. The procedure is best suited to contouring those areas of the body that cannot be improved by diet and exercise. This is not an operation for general weight loss. Liposuction was originally developed for contouring the torso and thigh and these remain the most commonly treated areas. However, liposuction is also now used to contour many areas, including under the chin and is often used as an adjunct in face lifting.
Heredity and diet largely determine an individual’s fat distribution. After puberty an individual’s number of fat cells remains constant. With weight gain, more fat is added to these fat cells. Many people who are not overweight in their upper body may have fat deposits in the lower abdomen, thighs, or other areas which are difficult to lose or are promptly regained with any increase in weight. Liposuction can selectively remove fat from these problem areas.
The quality of skin in the areas to be operated on contributes to the result. Skin elasticity is generally good in youth and is gradually lost with aging. After liposuction the skin envelope needs to shrink to adjust to the new contour. If the skin is very loose it may not shrink adequately and will compromise the result. Individuals with very loose skin and lax musculature may need additional procedures such as abdominoplasty (tummy tuck) or a thigh lift to get an optimal result. Skin and muscle quality are evaluated during the consultation along with fat distribution.
Skin surface dimpling and irregularities (sometimes called cellulite) are not usually improved with liposuction. Striae (stretch marks), usually seen on the abdomen are not improved with liposuction.
The procedure is usually done in an outpatient operating room. Small areas, such as the neck and under the chin can be done in the office.
When one or two areas are to be suctioned, local anesthesia with sedation is used. When multiple areas or large areas are treated, I prefer to use general or regional (spinal) anesthesia.
After anesthesia is induced a salt water solution with dilute local anesthesia and epinephrine is injected into the areas to be treated (tumescent technique). Small incisions 5 mm (1/4 inch) in length are then made and a cannula (small tube with openings on its tip) is then inserted into the subcutaneous fat. The cannula is connected to a vacuum pump by tubing. The cannula is then manipulated through the fat and the fat is suctioned away.
Ultrasound-Assited Lipoplasty (UAL) UAL is a fairly new liposuction technique which uses sound waves to liquefy fat. This technique is used in conjunction with standard liposuction to remove the fat that has been liquefied, so it does take longer than standard liposuction. The incisions for the UAL cannulas are also slightly larger. UAL is useful in areas of fibrous fat such as the back, in males, and in large volume liposuctions. Dr. Snider uses the VASER UAL machine, which is the state of the art, third generation in UAL technology.
The procedure takes 30 minutes to 4 hours or more depending on the number and size of the areas being suctioned. Most patients can be discharged home within a few hours after surgery. There is the option stay in the hospital in a private room until late in the evening for no additional charge. For very large procedures it is often recommended that the patient stay overnight in the hospital.
You will be placed in a support garment that is to be worn continuously for 3 to 4 weeks. The garment may be removed for showering.
There is some pain and discomfort for the first 2-3 days, and after that moderate discomfort for 1-2 weeks. You will be provided with a prescription for pain medication to be taken as needed.
You will be seen in the office during the first week to ten days after surgery. At that time the stitches are removed from the incisions. Generally you are then seen at one month and six months following the procedure.
During the first week after the surgery you will be swollen in the suctioned areas and not notice much reduction in contour. Over the next two weeks the swelling largely subsides. The final resolution of the swelling may take 3 to 6 months to occur. The scars from the incisions are generally placed in inconspicuous body creases but some of them may be visible. They are often red and firm for 6 months and then soften and fade by 12 months. The scars are rarely troublesome, but they are permanent.
Bruising and discoloration will occur to some extent after the surgery but it resolves in 2 to 3 weeks. Some temporary numbness in the treated areas is also common. This almost always resolves in the first few weeks after the surgery.
Most individuals have some natural asymmetry. During the surgery we try to correct this but slight asymmetries are likely to persist. Irregularities and depression have been reported following liposuction. With current techniques these should be rare, but they can occur.
A small percentage of patients will require a slight revision, which can be done six months after the first surgery. This can often be done under local anesthesia and sometimes in the office.
Overall, liposuction is a very effective procedure with minimal complications when done in appropriate candidates. These results are usually very satisfying.
Specific questions and concerns should be discussed with me at the time of the consultation.