Several “revolutionary” changes have come to liposuction over the years; however, most plastic surgeons typically perform “traditional liposuction” which does not rely on any of these new technologies.  The first such change came with ultrasonic liposuction.  One of the great advantages attributed to ultrasonic liposuction was that it would cause tightening of the skin after the procedure but that did not stand the test of time.  Ultrasonic liposuction is still used in certain cases in areas where the fat is relatively dense and fibrous such as on the back.  It is also used in some cases where liposuction is performed a second time in the same location and where scar tissue may be present.

More recently, several companies have produced liposuction machines which incorporate lasers.  While lasers have been utilized for many years in many different fields including surgery I believe they are still perceived as futuristic.  There is always a certain amount of hype initially started by the company producing the equipment and in some cases there are early adopters who feed this hype and there is no shortage of media outlets where plastic surgery procedures enjoy prominent placement.  Unfortunately, careful scientific evaluation of these machines and procedures have failed to demonstrate any significant evidence that there is in fact any skin tightening as the marketing would lead you to believe.  For this reason, traditional liposuction remains the primary form of liposuction for body contouring.

Liposuction is not a weight loss procedure.  Ideally patients having liposuction are close to or at their comfortable body weight.  The problem is we are all genetically programmed to have fat in certain areas.  The problem is that diet and exercise alone may not allow loss of fat in the particular area or areas desired.  Liposuction allows these areas to be contoured since further weight loss and exercise will probably not work.  While we can focus exercise on certain muscle groups we would like to strengthen we cannot do the same with fat. When we lose a pound of fat we lose it where we are genetically programmed to lose it, which may not be where we would like to lose it.  Liposuction allows us to direct the contouring to the precise location we want to change.

When contemplating liposuction there are certain questions you should consider.  In addition to focusing on the fat you should also focus on the skin.  Patients with good skin elasticity will have a better result because the skin will be better able to conform to the new contours created by the liposuction.  Poor skin tone or poor skin elasticity will not allow the skin to adapt to the new contour and the skin may be loose after liposuction, which may require a secondary procedure.  Your doctor should be able to assess your skin tone and decide which procedure will be best for you.  In addition, your doctor should provide you with information with regard to your recovery because there are certain measures which can be taken to provide improved results such as proper use of a compression garment after the procedure and possibly massage.

In addition, you should be well aware of the credentials of your surgeon.  Ideally, your surgeon should be a board certified plastic surgeon with experience performing liposuction.  In addition, you should be aware of the accreditation of the surgical facility where your procedure will be performed and also you should be aware of the credentials of the anesthesia provider.  Being knowledgeable about the credentials of the staff and of the accreditation of the facility are important aspects of preparing not just for liposuction but for any cosmetic surgical procedure.

Each year, the American Society for Aesthetic Plastic Surgery compiles data regarding the number and type of cosmetic procedures performed in the United States including both surgical and non-surgical procedures.  The total number of surgical and nonsurgical cosmetic procedures performed in the United States in 2009 numbers nearly 10 million.  The procedure I would like to discuss today is liposuction.  Liposuction is the second most common cosmetic surgical procedure performed in the United States.  The most common procedure is breast augmentation.

Liposuction is often misunderstood.  It is not a procedure to substitute for weight loss or a proper diet and a proper lifestyle which includes exercise.  It is a procedure to contour the body ideally in a patient who is close to or at their comfortable body weight.  Typically we address certain areas which need further improvement and which are resistant to further diet and exercise.  Results are optimal in this group of patients.  Liposuction can be performed as a primary procedure, but it is often used in conjunction with other procedures such as an abdominoplasty or tummy tuck to contour adjacent areas improving the overall result.  Liposuction is also utilized in conjunction with breast surgery and facial surgery, where it is commonly used to assist in contouring the neck.

Liposuction was developed in Italy and France in the early 1970s.  The procedure quickly gained popularity in the United States and in fact around the world.  The procedure was refined over the years both with regard to the type of instruments used and with regard to the type of anesthesia utilized.  Over the years, the liposuction instruments referred to as cannulas have become gradually narrower.  Today, most instruments utilized are in the 3-4 mm diameter range, which has greatly decreased the chance of developing visible irregularities in the areas treated.

Typically, liposuction is performed as an outpatient under either IV sedation or general anesthesia depending on the extent of the procedure and the area or areas to be treated.  Along with that type of anesthesia the particular area to be addressed is treated with tumescent solution.  This is sometimes called tumescent anesthesia.  This is a method of placing a solution of fluid into the area to be treated to accomplish several goals.  The primary objective is to decrease bleeding during the procedure, which results in less bruising and less swelling after the procedure.  In addition, the fluid contains a local anesthetic which makes the postoperative recovery less uncomfortable.  In addition, the fluid contains saline solution, which is the same solution patients receive through an IV.  This makes the fat firmer and makes the liposuction more efficient.

Liposuction can be performed in almost any patient of any reasonable age, however, the procedure relies on good skin quality and good skin elasticity in order for the skin to conform and adapt to the new contour created by the liposuction.  If this is not the case, loose skin will be the result and in some cases a secondary procedure may have to be performed in order to remove the excess skin.  In most cases that is not necessary.  A certain amount of time is necessary for the bruising and swelling to subside and for the skin contraction to take place and I usually inform patients that it takes about 2-3 months for the final result to be fully evident.  In some cases, there are subtle changes that occur even months after that.

In women, the primary areas treated include the outer and inner thighs.  The abdomen and hips are often treated as well either as a separate procedure or at the same time.  In male patients, the lower abdomen and flanks or “love handles” are the primary areas treated.  Most patients are healthy and active and close to a comfortable body weight.  Most patients have a relatively rapid recovery; returning to most activities with in one-week.  A compression garment over the area treated is utilized for about 6 weeks in order to control swelling and to control contour.  Small incisions are made for this procedure each measuring about ¼ – ½ inches in length.  After complete healing these are very inconspicuous.