Liposuction, also called lipoplasty, liposculpture suction lipectomy or lipo, is a type of cosmetic surgery which breaks up and "sucks" fat from various possible parts of the body, most commonly the abdomen, thighs, buttocks, neck, chin, upper and backs of the arms, calves and back.
During liposuction, the fat is removed through a hollow instrument - a cannula - which is inserted under the skin. A powerful, high-pressure vacuum is applied to the cannula.
Liposuction is the most common cosmetic operation in America and the United Kingdom. Over 400,000 procedures are carried out in the US each year.
Fast facts on liposuction
Here are some key points about liposuction. More detail and supporting information is in the main article.
- Liposuction involves sucking fat from various parts of the body
- The operation is normally carried out under general anesthetic
- Liposuction is not a weight-loss tool, it is purely cosmetic and its effects are subtle
- Over 400,000 liposuction procedures are carried out yearly
- There are a number of associated risks including infection and scarring
- Liposuction is not a treatment for obesity
- Areas that can be treated with liposuction include the thighs, stomach, neckline and upper arms
- If a patient's skin is not elastic, they might be left with baggy areas of skin
- Procedures vary and include dry, wet and super-wet liposuction.
What is liposuction?
Liposuction is not an overall weight-loss method.
Patients who undergo liposuction generally have a stable body weight, but would like to remove undesirable deposits of body fat in specific parts of the body.
It is not an overall weight-loss method - it is not a treatment for obesity. Liposuction does not remove cellulite, dimples or stretch marks. The aim is esthetic - the patient wishes to change and enhance the contour of his/her body.
Liposuction permanently removes fat cells from the body. It can alter the shape of a body. However, if the patient does not lead a healthy lifestyle after the operation there is a risk that the remaining fat cells grow bigger.
The amount of fat that can be safely removed is limited. Liposuction has a number of possible risks, including infection, numbness and/or scarring. If too much fat is removed there may be lumpiness or dents in the skin. Experts say that the surgical risks are linked to the amount of fat removed.
Medical conditions that may benefit from liposuction include:
- Lipomas - benign fatty tumors
- Gynecomastia - where fatty breast tissue has developed in men
- Lipodystrophy syndrome - a lipid (fat) metabolism disturbance in which there is too much fat in some parts of the body and partial or total absence of fat in other parts. Sometimes a side effect of some HIV medications.
Liposuction: a short history
Liposuction was invented in 1974 by two Italian-American surgeons - Doctors Giorgio and Arpad Fischer. The roots of liposuction date back to the 1920s. Dr. Dujarier, a French surgeon performed a fat removal procedure on a model in 1926 which tragically resulted in gangrene in one of her legs; consequently, interest in body contouring receded for several decades.
In the late 1960s, Leon Forrester Tcheupdjian, a European surgeon used primitive curettage techniques to remove fat - however, results were patchy, there was a lot of bleeding and morbidity was high.
What we know as 'modern liposuction' started with a presentation in 1982 by Dr. Yves-Gerard Illouz, a French surgeon. He started what became known as the 'Illouz Method" - a technique of suction-assisted lipolysis (breakdown or destruction of fats) after infusing fluid into tissues using blunt cannulae and a high-vacuum suction.
Dr. Illouz demonstrated both reproducible good results and low morbidity. During that decade several US surgeons experimented with liposuction, developing some variations from the Illouz Method, with mixed results.
In 1985, the tumescent technique was described by Drs. Jeffrey Alan Klein and Patrick Lillis, which added elevated volumes of liquid containing a local anesthetic, allowing the technique to be carried out in an office setting under intravenous sedation, rather than general anesthesia. There were concerns about the high volume of fluid and lidocaine toxicity potential with tumescent techniques, which eventually led to the concept of lower-volume super-wet tumescence.
Near the end of the last century ultrasound was introduced to assist in the removal of fat, which was initially liquefied through the application of ultrasonic energy. However, there was an increase in reported cases of complications.
In recent years laser tipped probes - which induce thermal lipolysis - have been introduced. How beneficial they are over traditional techniques still remains to be determined.
Over the last three decades, advancement in liposuction techniques have meant that a larger number of fat cells can be removed with less blood loss, risk, discomfort, and shorter recovery periods. Fat can also be used today as a natural filler (autologous fat transfer), where fat is taken from one part of the body, cleaned, and then injected into another area of the body - for example, to enhance the shape of the buttocks or reduce wrinkles.
What are the uses of liposuction?
Liposuction is cosmetic rather than health-focused.
Liposuction is mainly used to improve how a person looks, rather than providing any physical health benefits. In many cases, the patient would probably achieve the same results, and sometimes better ones if they adopted a healthy lifestyle - good diet, regular exercise and a good night's sleep every night.
Experts say that liposuction should ideally only be used if the individual did not achieve the desired results with a lifestyle change. For example, if some obstinate areas of fat that are resistant to exercise and diet.
When you gain weight each fat cell increases in size and volume. Liposuction reduces the number of fat cells in isolated areas.
How much is removed from a specific area depends on its appearance and the volume of fat. Contour changes resulting from liposuction can be long-lasting, as long as the patient's weight does not increase.
Liposuction is only done in relatively small areas of the human body, and is in no way a treatment for obesity or long-term weight loss. It should not be used if the person wants to get rid of stretch marks, cellulite, dimpling, or other skin surface irregularities.
Patients should discuss the pros and cons of liposuction with their GP (general practitioner, primary care physician) before deciding on whether to proceed. If the individual still wants to go ahead, they should talk to their surgeon sincerely about why they want to do it, what they hope to gain out of it personally, and what their expectations are.
Liposuction should only be carried out after a lot of thought. Results are never dramatic; they are subtle.
The following body areas are commonly targeted for liposuction treatment:
- Inner knees
- Flanks (love-handles)
- Neckline and the area under the chin (submental)
- Thighs - saddlebags (outer thighs), and inner thighs
- Upper arms.
According to the American Society of Aesthetic Plastic Surgery, liposuction is performed more commonly on the thighs and abdomen of women, and the abdomen and flanks (sides, love-handles) of men.
Experts say that the best liposuction candidates are those who have good skin tone and elasticity, where the skin molds itself into new contours. People whose skin lacks elasticity may end up with loose-looking skin in areas where the procedure was done.
The patient needs to be in good health - people with circulation (blood flow) problems, such as coronary artery disease, diabetes, as well as those with weakened immune systems should not undergo liposuction. Candidates should be over the age of 18 years.
Liposuction is sometimes used to treat certain conditions, including:
- Lymphedema - a chronic (long-term) condition in which excess lymph (fluid) collects in tissues, causing edema (swelling). The edema commonly occurs in the arms or legs. The fluid accumulation occurs faster than it can be drained away. Liposuction is sometimes used to reduce swelling, discomfort and pain. However, doctors tend only to use liposuction with patients who have severe symptoms. After the operation patients have to wear a compression bandage for several months, sometimes up to a year after the operation.
- Gynecomastia - sometimes fat accumulates under a man's nipples. Liposuction can remove some of the fat, reducing the swelling.
- Lipodystrophy syndrome - fat accumulates in one part of the body and is lost in another. Liposuction can improve the patient's appearance by providing a more natural looking body fat distribution.
- Extreme weight loss after obesity - if a morbidly obese person has lost at least 40% of his/her BMI (body mass index) after perhaps a gastric band or bypass procedure, excess skin and other abnormalities may need treatment. Sometimes liposuction is used to correct abnormalities.
On the next page, we look at what happens before, during and after the operation, and the associated risks.