Plastic Surgery Briefing: Liposuction
Liposuction is a surgical technique used to contour the body by removing unwanted areas of fat. During the procedure, a hollow suction tube, or "cannula," is passed through small skin incisions and manipulated in such a way that the unwanted fat is broken up and transferred through the tube by the attached vacuum machine. Patients may be given general anesthesia or merely sedated to undergo liposuction and generally do not need to remain hospitalized overnight. Improvements in body contour are usually permanent with this procedure.
From its introduction into the United States in 1982, liposuction has grown to become the nation's most frequently performed cosmetic plastic surgery procedure. In addition, its techniques have been adapted for such non-cosmetic purposes as tumor surgery, breast reduction and flap contouring. A recent modification of the technique, ultrasound-assisted liposuction (UAL), substitutes high-frequency ultrasonic energy for mechanical energy, to remove localized areas of fat.
The tumescent technique allows surgeons to inject large amounts of fluid into the areas of fat before performing liposuction. The fluid, containing local anesthetic(s) and blood vessel constricting drugs, can reduce blood loss, alleviate pain and lessen the need for general anesthesia. The local anesthesia is usually supplemented with intravenous sedation or general anesthesia when liposuction is performed by plastic surgeons.
With the "super-wet" technique, lesser amounts of fluid and local anesthetic are injected and blood loss is similarly reduced. The procedure is usually done under general or spinal anesthetic.
The American Society of Plastic Surgeons (ASPS) believes that liposuction is generally safe, provided that patients are carefully selected, the operating facility is properly equipped, and the physician has basic (core) accredited surgical training with special training in body contouring. Patients should be aware that lipoplasty to remove more than five liters (5000cc's) of fat and fluid requires a high level of surgical skill and a provision for prolonged monitoring after the procedure.
ASPS believes that ultrasound-assisted liposuction (UAL) is an acceptable alternative to traditional liposuction in some circumstances because it offers the potential of easier removal of fat in more fibrous areas. However, because the heat generated by ultrasonic energy creates a risk for burns to treated areas, plastic surgeons should complete a CME category 1 approved training program in UAL before using the technique clinically.
ASPS believes that pre-injection methods (including "tumescent" and "super-wet" techniques) usually decrease blood loss and reduce the need for transfusion. Surgeons who use these techniques to remove large volumes of fat and fluid must have a background of surgical education in the principles of fluid management.
ASPS does not recommend liposuction for individuals with complicated diabetes, poor circulation, significant heart or lung disease, or those with recent surgery in the region to be treated.
Because there are no federal or state laws governing the scope or quality of specialty education a physician must attain to designate him/herself a specialist, patients should exercise care in selecting a surgeon. In particular, ASPS recommends that individuals seeking liposuction inquire whether privileges to perform liposuction have been granted to a particular surgeon at an accredited hospital because hospitals must examine credentials carefully before granting specialty privileges to staff physicians.
If the procedure is to be performed outside a hospital, patients may inquire whether the surgical facility is accredited by an organization such as the American Association for Accreditation of Ambulatory Surgical Facilities (AAAASF). This organization (847-949-6058) requires maintenance of strict quality standards for facilities that achieve its accreditation.
The ideal candidate for liposuction is a healthy adult man or woman with localized areas of unwanted fat beneath firm, elastic skin. Although patients of all ages may benefit from liposuction,
the loss of skin elasticity with advancing age may limit the degree of improvement in older patients. Women usually seek liposuction to improve contour in the hips, thighs, abdomen, legs, buttocks, and face-neck area. Men most frequently seek improvement in the waist and abdomen.
Limitations, Risks and Complications
Liposuction cannot compensate for deficiencies in diet and exercise. It is generally not a suitable method for weight loss, nor will it tighten loose skin or eliminate the shallow surface
irregularities popularly termed "cellulite."
Imperfections in final appearance are not uncommon after liposuction. The skin surface may be irregular, asymmetric, or even "baggy," especially in the older patient. Numbness and
pigmentation may occur. Sometimes additional surgery may bring further improvement.
As noted, ultrasound-assisted liposuction carries the risk for burns to the skin and deeper tissues. In addition, the long-term biological effects, if any, of ultrasound energy are not known.
Though serious medical complications from liposuction are rare, the risks increase if a greater number and size of areas are treated at one time. Removal of large volumes of fat and fluid may require sizable volumes of pre-injection fluid and longer operating times than in smaller operations. The combination of these factors can create greater hazards for infection, delays in healing, improper fluid balance, injury (especially perforation) to vital organs, shock, and unfavorable drug reactions. As with any surgical procedure, blood clots may form in the veins with risk of migration to the lungs, which can be fatal.
All patients experience some degree of discomfort after liposuction, though most begin to feel better during the first week. Pain, swelling, discoloration, and numbness should be expected,
and a drain tube may occasionally be placed beneath the skin for a day or more. Ordinarily, patients are instructed to wear a snug elastic garment over the treated area for a few weeks. With
the garment in place, many are able to return to work within a few days and to resume strenuous activity within the first month. Although most of the discoloration and swelling usually disappear
by six weeks, some may persist for six months or longer.
A nationwide survey of ASPS member plastic surgeons in 1996 has disclosed the following facts:
This briefing paper on liposuction for plastic surgery patients and consumers was developed by ASPS which formed a task force to review the history and physiology of liposuction. The task force includes representatives from ASPS, the American Society for Aesthetic Plastic Surgery and the Lipoplasty Society, Inc.
- Liposuction is the most popular cosmetic plastic surgery procedure in the United States. ASPS members performed 109,353 liposuction procedures in 1996.
- 97,169, or 89%, of these patients were women.
- The greatest demand for liposuction is seen on the Pacific coast, including the states of Alaska, California, Hawaii, Oregon, and Washington.
- Despite some regional variation, the average surgeon's fee for liposuction to a single site is $1,710.