Liposuction Q and A

Here are the basic pointers that will make you familiar with liposuction: 

1. What is liposuction?

Liposuction is a surgical procedure performed to eliminate fat located in specific areas of the body. It is indicated for patients who have good skin elasticity. Liposuction objectively improves the body contour and outline. However, it should not be confused with a weight loss method. It is widely accepted more as a body contouring surgery.

2. How is liposuction done?

The liposuction begins with micro-incision (two to five millimetres wide) in the skin, through which fat is sucked out using special cannula and apparatus. Once the incision is done, the surgeon infiltrates fluid with various additives like adrenaline, sodium bicarbonate, hyaluronidase, etc. to soften up the fat. After waiting for the action of the infiltrate to set in, the surgeon then proceeds to remove the fat using a negative pressure vacuum device attached to long, narrow instruments called cannulas. The size of the cannulas can range from one to five millimetres in diameter. The size is chosen depending on the area to be treated, the size of fat in the location, etc. This process can last from 30 minutes to five hours depending on the area to be treated. The end point of liposuction is when adequate correction is achieved. The other important factor a surgeon is aware of is the safe limit of liposuction. 

It is generally accepted that removing more than 15 litres of fat in a session of liposuction is unsafe. It leads to various electrolyte imbalances and considerable blood loss. So, the target is to remove well below the 15-litre limit.

3. Am I a Good Candidate for Liposuction Surgery?

A good candidate for liposuction is someone who has realistic expectations, is in reasonably good health and is likely to be happy with the results of liposuction. Although liposuction can often provide very substantial improvements, it is not always that liposuction results can be perfect. Following liposuction, the new body’s shape is more or less permanent. If a patient does gain a moderate amount of weight after liposuction, then the figure will simply be a larger version of the new body shape. Fat cells that are removed by liposuction do not grow back. 

It does not, however, mean that after the procedure the patient can forget about having a reasonable diet and exercise schedule. Though the amount of fat removed may never come back, it is, however, possible that the results obtained after the surgery may not last exactly how it had been immediately after recovery. The reason is that, though the fat cells may not multiply, they can increase in size to an extent if there is no adherence to a decent diet and exercise regimen. It is also important to bear in mind that a good candidate is someone who has stubborn areas of fat that cannot be eliminated with diet or exercise.

4. What is BMI and why is it important?

Body Mass Index (BMI) is a person’s weight in kilograms divided by the square of height in metres. A high BMI can be an indicator of excess body fatness. BMI is used to screen for weight categories that may lead to health problems but it is not diagnostic of the body fatness or health of an individual. For adults (20 years old and older), BMI is interpreted using standard weight categories. These categories are the same for men and women of all body types and ages.

The standard weight status categories associated with BMI ranges for adults are shown in the following table.

5. Who is not a good candidate for liposuction?

The obvious bad candidates are those with unrealistic expectations. That, however, can be subjective and sometimes difficult to understand. Another clear method of identifying if someone is not suitable for the procedure is if the person is not inclined towards a healthy lifestyle and is looking for a short way out. People with stubborn pockets of fat even upon losing weight may now be candidates for liposuction. 

People with a BMI over 30 should be careful while choosing liposuction, the main reason being that they may usually need multiple sittings of liposuction for a reasonable outcome. Someone with a BMI above 35 and with associated health problems like diabetes, arthritis or other metabolic diseases merits a bariatric surgery. The same holds for someone with a BMI over 40 even without the associated disorders.

6. What is bariatric surgery?

Bariatric surgery is a modality that provides a significant weight loss for morbidly obese patients, with resultant improvement in obesity-related disorders. Surgery for obesity should be considered as a treatment of last resort after dieting, exercise, psychotherapy, and drug treatments have failed.

7. Is liposuction safe?

This is probably the most important question that one needs to ask before jumping in. Liposuction is a relatively safe procedure. But there are risks and potential complications associated with any surgery and liposuction is no different. It is imperative to discuss long and hard about these with the surgeon. 

Possible liposuction Risks are infection, extended healing time, allergic reaction to medication or anaesthesia, fat or blood clots (clots can migrate to the lungs and lead to death), excessive fluid loss (fluid loss can lead to shock and, in some cases, death), fluid accumulation/Seroma (fluid must be drained), friction burns, scarring, numb skin, changes in skin pigmentation, damage to the skin or nerves and damage to vital organs.

Severe complications associated with liposuction are fortunately extremely rare but should be taken into consideration when deciding whether liposuction is right for you. These complications include adverse reactions to anaesthesia, cardiac arrest, cardiac arrhythmia, internal blood clots, excessive bleeding, severe drug interactions, allergic reactions to medication, permanent nerve damage, seizures and brain damage from anaesthesia.

The most common dangers of liposuction include risks associated with removing too much fat from targeted areas at once, as well as having too much liposuction performed in a single day. Excessive liposuction can cause problems including dents, lumps, and sagging skin. To minimise surgical complications and the side effects of overexposure to anaesthesia, when patients are looking to remove larger portions of fat, they should schedule multiple liposuction procedures at least several weeks apart.

8. How can you minimise the risks?

You can minimise your risk for severe complications by disclosing your entire medical history to your doctor and discussing all prescriptions and medications you take regularly. You and your surgeon should also make sure you are a good candidate for liposuction and fully understand what is involved in this procedure.

To maximise the success of liposuction surgery and minimise your risks, always follow your cosmetic surgeon’s instructions for surgical preparation and post-operative care. If you smoke, your cosmetic surgeon will advise you to stop two weeks before and also following liposuction surgery. You may also choose another avenue for fat removal. There are non-surgical liposuction alternatives available to patients who are not good candidates for liposuction or simply prefer other methods.

9. What are the sequelae after liposuction?

Some sequel following liposuction is often referred to as ‘temporary side effects.’ In addition to the risks mentioned above, liposuction does cause some common side effects, which typically dissipate within a few weeks of the procedure and are hence sequelae.

Swelling: Liposuction will cause some swelling afterward, although some techniques cause less than others. During follow-up visits with a doctor, a patient needs to inform the doctor of any changes in the amount of post-liposuction swelling. Significant increases in swelling can be a warning sign of other complications. Swelling in the ankles and treated areas are common, along with a temporary lumpy appearance that will typically fade within six months. If the thighs are treated, inflammation of the veins may occur, but this should also go away after a few weeks.

Bruising: Another liposuction side effect is bruising. Treated areas may become discoloured and be tender to the touch, but they usually disappear after three to four weeks. Like swelling, the particular type of liposuction used can help mitigate any bruising that may occur. The status of the bruises should also be discussed with the doctor in post-surgery check-ups.

Discomfort: Following liposuction, patients often experience some soreness and tenderness in the treatment area. This can usually be controlled by pain medication. However, this discomfort is typically minimal and patients can return to work about two days after their procedures. If they experience severe discomfort or if the soreness gets worse after several days, patients should alert their doctors.

10. What is the duration of the surgery?

Most surgeries are between 45 minutes and two and a half hours, depending on the target area and method of liposuction.

11. How many areas can be done during liposuction in one sitting?

Usually, between three to four areas can safely be done with a single liposuction procedure. If additional areas are needed, they can be scheduled later.

12. What are the different types of liposuction?

There are several techniques that a surgeon can use to eliminate fat. At your consultation, the doctor will help you choose the right one for your needs. Liposuction procedures are many and are best chosen by an experienced surgeon. 

Manual Techniques

Although manual liposuction does not utilise lasers, these treatments still use cutting-edge technology to minimise risks and provide stunning results. Manual options include:

Traditional Liposuction: In traditional liposuction, the surgeon uses a thin tube called a cannula, connected to a powerful suction pump or high suction syringes. After inserting the cannula through a small incision, the plastic surgeon helps break up the fat by manipulating the cannula and injecting fluid into the area. Although it does carry some risks, traditional liposuction is very effective in taking out fat and it is still one of the most popular forms of the procedure.

Tumescent Liposuction: Tumescent liposuction is similar to traditional liposuction but experts often hail its innovative use of medication and reduced risks for complications. During tumescent liposuction, the doctor will inject a special solution (a mixture of saline, local anaesthetic and adrenaline) into the layer of fat. The amount of fluid is usually three times the amount of fat being removed. The solution swells the fat cells, making them easier to isolate and remove. It also shrinks blood vessels and, because it contains local anaesthesia, it can help ease discomfort without the risks associated with general anaesthesia. Any minimal risks involve how much of the solution is injected, and how much lidocaine it contains.

Super-wet Liposuction: Super-wet liposuction is a variation of the tumescent technique that uses less fluid injection. The amount of fluid is usually equal to the amount of fat being removed. A general anaesthetic is required for this type of liposuction.

Ultrasonic Liposuction: This popular form of liposuction uses a specialised cannula that emits ultrasonic sound waves into the fat deposits to liquefy fat cells and make them easier to remove. By utilising ultrasound technology, the doctor can remove larger and denser fat deposits and he or she can tighten the surrounding skin. However, there is a small risk of burns and scarring due to the heat from the ultrasound waves.

LipoSelection®: This specialised form of liposuction, emulsifies fat cells with ultrasound and breaks them up even further with the LipoSelection probe. The doctor can then easily remove the fat with liposuction tubes, leaving the surrounding blood vessels, nerves and other tissue virtually unaffected.

Power-Assisted Liposuction: By employing a cannula that has a vibrating tip, surgeons can break up fat cells for easier removal. Power-assisted liposuction also allows further fat removal, smaller incisions and reduced recovery time. This procedure is quite safe since the cannula can be moved with smaller, more exact movements. In some cases, however, patients may have looser skin than they desired.

Types of Laser Liposuction

Advanced surgical lasers can loosen fat cells and make them easier to remove. Although they are typically more expensive than manual liposuction techniques, many patients feel that these procedures are worth the extra cost, since they typically enjoy less discomfort and a faster recovery time. Laser liposuction procedures include:

CoolLipo: This minimally invasive technique is designed for sensitive areas like the neck, jowls, arms and underneath the chin. CoolLipo also tightens skin with minimal bruising and utilises only local anaesthetic.

SlimLipo: SlimLipo lasers melt the fat cells before they are removed, reducing the discomfort and swelling associated with traditional liposuction. Some patients can even go to work the day after the procedure.

SmartLipo: This technique creates minimal scarring and is used for fine-tuning, removing only up to eight pounds of fat at a time. As with SlimLipo, patients can often return to work a day or two after their procedures.

13. Which method of liposuction should I choose?

The choice of the method depends on various factors like the area and quantity of fat to be removed, the associated side effects and recovery time, the surgeon’s preference, cost, etc. Before surgery, it is important to decide on the method of liposuction after a detailed discussion on the pros and cons of each method.

14. When can I exercise?

You will be up and moving the day of your surgery. It is recommended that one should start a light physical activity as soon as possible the next day. Most patients return to their regular exercise routine between one to two weeks, although they may engage in mild exercise before that.

15. When can I see the results?

Final results usually take between one to four months but most patients see the beginning of results within one month. Usually, by three weeks much of the swelling is down and most patients are looking better than before the surgery and can wear a proper fitting dress.

16. Can I combine liposuction with other procedures?

In general, it is possible to combine other cosmetic procedures with liposuction. It is, however, important to take into consideration the extent of liposuction. If liposuction is a major one that may involve long surgical time or long recovery period it is not advisable to combine any other procedure. They can always be scheduled later.

17. What happens at my first consultation?

During the initial consultation, you may be asked to look in a mirror and point out exactly what you would like to see improved. This will help your plastic surgeon understand your expectations and determine whether they can realistically be achieved. A determination of the elasticity of the skin will also occur. Once this is over the surgeon will go over your surgical plan, ask any remaining questions and schedule your surgery and pre-op appointment.

18. What happens before surgery?

Once you have elected to move forward with surgery, a pre-op appointment will be scheduled anywhere from two weeks to ten days before your surgery date. This appointment will include blood tests, ultrasound scans, pre-op consents, pre and post-op instructions and garment measurements. You will also meet with your surgeon one more time so he can answer any remaining questions you may have.

19. What happens after surgery?

After liposuction, patients may feel nausea, grogginess and the sedate feeling that comes with general anaesthesia. You should be able to walk out of the surgery centre and be driven home by a companion or nurse to relax for the remainder of the day. You can usually return to work within two days. Physical exercise generally can be resumed three to seven days after liposuction. You will most likely come for a follow-up appointment within a week after surgery to check on incisions and make sure the healing process is going as planned. A long-term check-up is usually scheduled to check the final results.

20. How much fat is typically removed?

During liposuction, enough fat is removed to get a proportionate and natural result. It depends on your specific case and the areas being tackled. The goal is not to remove as much fat as possible, but rather to remove just the right amount in the right areas. It may be as little as half a litre, or it may be up to 15 litres.

21. What are the limitations of liposuction?

One thing that should be clear is not to use liposuction as a method for overall weight loss. It is solely a shaping/contouring procedure for areas where genetic fat deposits have proven to be resistant to diet and exercise. The best results from liposuction occur in body areas where there is a reasonable muscle tone, where the skin has a good elastic quality, and where fat is not overtly excessive. In cases where there is a significant loss of elasticity, proper cosmetic results may require a combination of both liposuction and surgical skin tightening to remove the excessive loose tissue. For example: Tummy Tuck.

22. What is the most amount of fat that can be removed?

The safe limit for one surgery is less than 15 litres. But more importantly, it is not the amount of fat that limits the surgery but how many areas can be safely done during a single surgery taking into consideration various patient factors.

23. At what age can a patient have liposuction performed?

As long as all physical criteria are met for liposuction candidacy, liposuction can technically be performed on anyone 15 to 78 years old. However, skin elasticity is a primary consideration when performing liposuction. As one’s age advances, skin elasticity gets weaker and weaker. If the surgeon feels the skin’s elasticity is poor, he may recommend other procedures to reach the cosmetic goals.

24. How painful is liposuction?

The pain factor depends primarily on the type of anaesthesia (local or general anaesthesia) and the extent of surgery. Most patients report minimal discomfort during liposuction under local anaesthesia. The first step of such a procedure is injection of local anaesthetic, which takes about 15 to 30 minutes to set in. During this time, patients report a mild pinching sensation. Once the local anaesthetic has taken root, patients report no pain at all. 

Liposuction under general anaesthesia is painless as the individual is fully anesthetised.

25. What happens on the Day of Liposuction Surgery?

Medications are administered for your comfort during the surgical procedure. Frequently, local anaesthesia and intravenous sedation are used for patients undergoing liposuction surgery, although general or spinal anaesthesia may be desirable in some instances. For your safety during the operation, various monitors are used to check your heart, blood pressure, pulse and the amount of oxygen circulating in your blood.

When surgery is completed, you will be taken into a recovery area where you will continue to be closely monitored. You will most likely be wearing a compression garment or a tight dressing, usually used to help “shrink” the skin. Concerning post-operative pain, many patients state that the area feels sore as if they underwent a vigorous workout. You probably will be permitted to go home after a short period of observation, although some patients may stay overnight in the hospital or surgical facility.

26. Is liposuction better before or after pregnancy?

Because liposuction works best on areas of good skin tone, it is generally better to have it done before pregnancy. However, each case is unique and the surgeon can recommend which procedure will best suit your needs, before or after pregnancy. It also depends on the area that needs liposuction and the skin tone.

27. Will I have loose skin after liposuction?

You will not have loose skin following liposuction if your skin tone is good to begin with. When liposuction is done properly, the skin re-drapes and retracts to conform to the underlying tissue. Skin elasticity is vital to a good procedure. For this reason, the surgeon will perform a thorough examination to determine your skin elasticity. If he finds it may not support the new contours following liposuction, he may recommend other treatments. 

28. What happens if I gain weight after liposuction?

When liposuction is performed correctly, the contours of the body should be permanently improved. In other words, if you gain weight, your new contours and proportions should remain more or less the same as they were after liposuction. Weight gain will simply make these contours a little less visible. If you then lose the weight again, your contours should resume their post-liposuction size and shape.

29. How are the post-liposuction scars?

Each incision is usually between one to five millimetres in length. This is usually small enough to prevent the need for stitches following surgery. Multiple incisions may be needed to adequately treat the target treatment areas. However, these are usually well-hidden and heal without incident. In a rare case that an incision becomes unsightly, many techniques are available to help reduce their appearance.

30. Can I go home on the same day?

Yes, you go can home very shortly after surgery. However, it is necessary to have a friend or family member drive you. It is recommended that you don’t drive for the first 24 hours after surgery. It is also recommended that you have a companion with you for the first several hours after surgery. Most liposuctions are day care procedures but, when done extensively, there may be a need for an extended admission.

31. Is it normal to be anxious before having liposuction surgery?

Yes. Almost everyone has some degree of anxiety before having a surgical procedure, including liposuction. Some people have more anxious than others. You may be administered medications to lower your stress levels.

32. How does abdominal liposuction differ from a ‘Tummy Tuck’?

A tummy tuck (abdominoplasty) is a more major surgical procedure requiring general or spinal anaesthesia and involves liposuction and excision to remove fat, plus removal of a large area of skin. In many patients (but not all), liposuction of the abdomen can often provide equivalent or better results than a tummy tuck. Because liposuction is safer and causes less scarring compared to tummy tucks, abdominal liposuction is now far more common than are tummy tucks. However, Tummy Tuck is definitely indicated in people with excess loose skin especially following pregnancy.

33. What about touch-ups?

With liposuction in general, there is a chance for the requirement of revisions. However, the requirement depends on the areas that were operated upon, surgical expertise, etc.

34. What are the chances of irregularities, dimples, or asymmetry occurring after liposuction?

The chance of defects or flaws after liposuction when done by an experienced surgeon is very low. He/she would everything in his power to achieve a smooth, natural result and a happy patient. If the surgeon feels your chances of irregularities are high due to poor skin elasticity or skin tone, he/she should discuss this with you extensively and may recommend another treatment option.

35. What are the post-procedure instructions?

Following the procedure, the patient is prescribed antibiotics, pain killers, antacids, medication to reduce swelling and nausea. But the main post-surgical care involves the use of compression garment and massage of the operated area. The patient is also prescribed antiseptic ointments to be applied to the incisions.

36. How long do I need to wear a compression garment?

Patients are generally asked to wear the compression garment for at least six weeks full-time after surgery. The duration again depends on the skin laxity, size of the gland and other factors.

37. How does massage help after liposuction?

The benefits of massage after liposuction lack consensus. However, it is better to start massage once the pain is tolerable after the procedure. It should be done using a copious amount of moisturiser/oil and in circular fashions with moderate pressure. Lymphatic massage may also be advised in some cases. Occasionally, some people feel comfortable getting them done by a therapist. The massage also should be continued for at least three weeks and done thrice daily. 

38. When can I fly?

In most cases, you may fly two days after the surgery as long as you can walk around every hour while on the plane.

39. How much does liposuction cost?

Many factors are taken into account when quoting liposuction costs. The factors include—degree of difficulty, amount of fat to be removed, number of areas to be treated, operating room fees, anaesthesiologist fees, type of liposuction, etc.

Each of these factors will be assessed before your procedure and you will be given a number. The number may change slightly through the course of the procedure depending on your stay and recovery course.

40. Does insurance cover liposuction?

No, because it is a purely cosmetic procedure.