Procedures : Liposuction

What type of Liposuction does your practice use?

Ultrasound Assisted Liposuction and Standard Tumescent Liposuction:

Ultrasound assisted liposuction is always done in conjunction with standard tumescent liposuction, but not vise versa. To explain further, tumescent liposuction is the installation of saline fluid (salt fluid) with the appropriate amount of Lidocaine (anesthetic) to enhance anesthesia, as well as Epinephrine to shrink the blood supply and decrease the blood loss during the case. With standard tumescent liposuction the blood loss is minimized, thus maximizing the amount of fat that can be removed. There is a limit to the amount of fat that can be suctioned at any one particular time, and that depends on the patient’s height and weight and the blood loss during the case.

Ultrasound assisted liposuction is used exclusively by some plastic surgeons. It is not used at all by others. I use ultrasound-assisted liposuction judiciously for certain areas. It helps break up fibrous tissue. It actually melts the fat in difficult areas allowing an easier extraction. Although that may seem appropriate to use in all patients, I have found that not to be the case as it also has the potential for some mild discomfort that is not seen with standard liposuction techniques. Nerves have fat around them and if the fat on these nerves is melted it sometimes leads to some minor discomfort. In some patients, ultrasonic liposuction may cause increased swelling; therefore its usage is selected carefully. I use ultrasound-assisted liposuction for all men and gynecomastia (breast liposuction in males). I also use it in all upper backs and upper abdomens where the fibrous tissue is more dense. I also use it in any repeat liposuction where there is scar tissue. I usually avoid ultrasound-assisted liposuction on lateral thighs and lower abdomens. I believe that each patient should be individualized and we administer and teach these techniques; therefore, we use them only when appropriate and individualize the treatment for each patient.

Should I consider having liposuction and what are the age considerations?

The ideal candidate for liposuction is someone who has localized unwanted fat deposits despite stable weight and participation in an exercise program.

In females these fat deposits are primarily located on the love handles or waist area, the abdomen, and lateral and medial thighs. Areas such as the medial knees are done as well, and there is a high degree of success of liposuctioning the back below the shoulder blades in certain patients. A very popular spot that gives a great benefit in selected patients is the submental area just below the chin. In a young patient who has a cherubic face with a congenital fatty deposit underneath the chin liposuction in this area gives a very pleasing outcome. Areas that are difficult to liposuction would be the calves and ankles. These are done on rare occasions, but the post-operative swelling is significant. These areas are difficult to compress post operatively; therefore, the swelling leads to skin stretching, which decreases the eventual cosmetic outcome. Another dangerous area to liposuction is the inner thigh. It is done frequently; however, the patient must realize that a conservative approach to this area is the most prudent because over suction in this area can lead to mild to significant contour irregularities. Having described the ideal patient, there are certain patients who are contraindicated. Patients who are obese are not good candidates, and those with wildly fluctuating weights are also not good candidates. Liposuction is not a weight control program.

Most patients fall somewhere between the ideal candidates and the patients who are obese and cannot undergo liposuction. They are the patients whose weight is fairly stable and have a moderate exercise program who desire liposuction. These are handled on a case-by-case basis. A consultation in the office can determine whether or not you are a reasonable candidate for this procedure.

What will Liposuction do for me?

The goals of liposuction are to improve the body contour. Ideally there are localized deposits of fat (noted above under Indications that are isolated and suctioned to a balanced, smooth contour. It is important for the patients to know that liposuction is not a weight loss program and one must be careful not to over-suction any area. It is critical to understand that liposuction will not improve cellulite and, in fact, may very well worsen cellulite appearance on the lower extremities in particular. Liposuction will not tighten skin in any way. In fact, the skin will absolutely be somewhat looser after liposuction. If one thinks about this, it is intuitively obvious that if the skin envelope is a certain size and the volume of fat is reduced underneath that skin envelope, then there will be skin laxity. The younger the patient, the better the skin “snaps back”, and the older the patient the less the skin snaps back.

The goal is to do a prudent liposuction specifically targeting areas of concern without being overly aggressive so as to maintain contour.

What are the possible complications?

  • Contour irregularities: The risks of liposuction include contour irregularities. Certainly over-aggressive technique could result in contour irregularities; however, the most common reason for these irregularities is the fact that there is trauma to the fat with the liposuction cannula itself that is unavoidable. The contour may be very appropriate at the end of the procedure, but the cannula traumatizes the fat and some of the fat may atrophy due to the trauma itself. As a result, in the long term there may be minor depressions or irregularities. These can be touched up in a majority of instances and even though I mention this here it is very unusual for a patient to have a secondary touch up procedure in our office.
  • Skin Loss: Although I have not had skin loss in my practice, it has been reported more commonly with ultrasound assisted liposuction versus standard tumescent suction assisted lipectomy.
  • Deep vein thrombosis, pulmonary or fat embolus: The most serious complication of liposuction would be a blood clot within the vein or a particle of fat that would get in the bloodstream and break off and go to the lung. Every precaution is taken to avoid this, as every patient with liposuction has compression garments placed during the procedure. This essentially creates the effect of massaging the patient’s legs throughout the procedure. This has drastically reduced the overall incidence of this complication. Another measure taken to reduce this risk is limiting additional procedures when doing liposuction. The risk of thrombosis or pulmonary or fat embolus is low but is something you need to consider when making the decision to undergo this procedure.

What can I expect during recovery?

There is probably nothing as variable in recovery as liposuction. It certainly depends on the areas treated, as the legs tend to be more sore and have more discomfort than the abdomen. When the love handles and back are suctioned, low back pain and aching are noted by patients on occasion. The patients describe the pain after liposuction as if they had just run 5 miles for the first time all year. It is more a soreness than an acute pain. However, there are exceptions to every rule, and there are some patients who bounce back very quickly within a day or two while others seem to still be somewhat slow to recovery as much as 10 days out. Typically patients should be able to return to work with most liposuction cases in 10 days; however, they will need to wear a girdle 1 week for each decade of their age, i.e., a 24 year old would wear the girdle 2 to 2-1/2 weeks, a 45 year old, 4 to 4-1/2 weeks, etc. Drains are not used for pure liposuction, although they are used when associated with other procedures, but this is rare. Swelling is routine after liposuction and is the reason that the girdle is worn. The swelling maximizes on the 3rd or 4th day and begins to abate several days thereafter. The patient is encouraged to drink plenty of water during the recovery phase as it flushes the system. It seems counterintuitive to push fluids when one is swelling, but it is absolutely critical and actually decreases the swelling. We encourage at least 64 ounces of water per day and would encourage more if able to do so. Bruising and swelling can be quite extensive with liposuction. It is not unusual for liposuction that is limited to the upper thigh to have bruising down in the calves, ankles, and in rare cases even the soles of the feet.

What are the costs?

We do not feel that it would be appropriate or ethical to post prices for procedures on the internet. We do, however, understand that cost is a factor you must consider. We would be happy to speak with you about this so that you may determine whether the procedure you are considering falls within your budget. Our pricing structure is based on the time, complexity, and surgical costs involved. Please feel free to call our office at 214-823-1978 and speak with Leah for more details.

Click here to see before and after photos of this procedure.