What is Liposuction?
Liposuction is a surgical procedure intended to remove fat deposits and shape the body. Fat is removed from under the skin with the use of a vacuum-suction canula (a hollow pen-like instrument) or using an ultrasonic probe that emulfusies (breaks up into small pieces) the fat and then removes it with suction.
Persons with localized fat may decide to have liposuction to remove fat from that area. Liposuction is a procedure for shaping the body and is not recommended for weight loss.
Liposuction may be performed on the abdomen, hips, thighs, calves, arms, buttocks, back, neck, or face. A liposuction procedure may include more than one site, for instance, the abdomen, back, and thighs all on the same day.
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Liposuction is also used to reduce breast size in men with large breasts (gynecomastia) or to remove fat tumors (lipomas) but it is most commonly used for cosmetic body shaping.
Who Performs Liposuction & Where is Liposuction Performed?
Many liposuction surgeries are performed by plastic surgeons or by dermatologists. Any licensed physician may perform liposuction. While some physicians' professional societies may recommend training before performing liposuction surgery, no standardized training is required. As a result, there will be differences in experience and training in physicians performing liposuction. You can ask your physician to tell you whether he or she has had specialized training to do liposuction and whether they have successfully done liposuction before. |
But remember, even the best screened patients under the care of the best trained and experienced physicians may experience complications as a result of liposuction. Liposuction may be performed in a
• doctor's office.
• surgical center.
• hospital.
Because liposuction is a surgical procedure, it is important that it be performed in a clean environment. Emergencies may arise during any surgery and access to emergency medical equipment and/or a nearby hospital emergency room is important. These are things that you should ask your physician before the liposuction.
How can I find the right doctor for me?
Here are some things that you may consider:
• Ask questions. If you decide to take the step to talk to a doctor about liposuction, be sure that you ask questions and understand what happens during the liposuction procedure and what you can expect. Your physician should also answer any and all questions you have about potential problems with liposuction. Remember that you are purchasing a service when you pay a physician to do a liposuction procedure and you shouldn't feel embarrassed to ask hard questions about the procedure or about the physician's experience in performing liposuction.
• Advertising. Be wary of advertisements that say or imply that you will have a perfect appearance after liposuction. Remember that advertisements are meant to sell you a product or service, not to inform you of all the potential problems with that service.
• Don't base your decision simply on cost and remember that you don't have to settle for the first doctor or procedure you investigate. The decision you make about liposuction surgery is an important one but not one that you must make right away.
• Read. You should learn as much as you can about liposuction. It is important for you to read the patient information that your doctor provides.
• Don't be pressured. Do not feel that because you speak to a physician about this procedure that you must go through with it. Take your time to decide whether liposuction is right for you and whether you are willing to take the risks of undergoing liposuction for its benefits.
What Does the FDA Regulate?
The Food and Drug Administration (FDA) regulates the sale of medical devices, such as the equipment (canulas, pumps, collecting containers, ultrasound probes, etc) and drugs (anesthesia) used for liposuction.
The FDA does not have the authority to:
- Regulate a doctor's practice. In other words, FDA does not tell doctors what to do when running their business or what they can or cannot tell their patients.
- Set the amount a doctor can charge for liposuction surgery.
- "Insist" that patient information be provided to the potential patient.
- Make recommendations for individual doctors, clinics, or liposuction centers. FDA does not maintain nor have access to lists of doctors performing liposuction.
- Recommend a physician to you.
- Conduct or provide a rating system on medical devices it regulates.
When is Liposuction not for me?
You are probably NOT a good candidate for liposuction surgery if:
- You are not a risk taker. Certain complications are unavoidable in a percentage of patients, and there are no long-term data available for current procedures.
- Cost is an issue. Most medical insurance will not pay for cosmetic liposuction. The cost for liposuction may be significant.
- You are overweight or obese and trying to lose weight. Liposuction is a procedure for shaping the body and is not recommended for weight loss.
- You have a disease or are on medication that affects wound healing. These include current infection or past medical history of bleeding, emboli, thrombophlebitis, edema, or if you are taking medication(s) that may affect your wound healing or blood clotting (such as aspirin, nonsteroidal anti-inflammatory agents, warfarin, heparin, or other anticoagulants) or are taking medication that may interact with the drugs used during liposuction.
- Your skin elasticity is not adequate. Your doctor will evaluate the skin at the site where you are considering liposuction to determine if skin is elastic enough to shrink after liposuction. If it is not, it will be baggy after liposuction.
What are the Alternatives to Liposuction?
Liposuction is usually cosmetic surgery so is not considered medically necessary (there are rare exceptions to this). Because of this, it is you who will decide whether or not you will undergo this procedure. You may decide that liposuction is not right for you. You may make this decision without consulting a physician or after consulting with a physician. A consultation with a physician does not obligate you to have liposuction if you decide that you do not want to.
Some of the alternatives to liposuction are:
- Change diet to lose some excess body fat.
- Exercise.
- Accept your body and appearance as it is.
- Use clothing or makeup to downplay or emphasize body or facial features.
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What are the Risks or Complications Associated with Liposuction?
Risks
Most patients are pleased with the outcome of their liposuction surgery. However, like any other medical procedure, there are risks involved. That's why it is important for you to understand the limitations and possible complications of liposuction surgery. Before you have liposuction, you should be aware of these risks and should weigh the risks and benefits based on your own personal value system. Try to avoid being influenced by friends that have had the procedure or doctors encouraging you to do so. Decide for yourself whether you are willing to take the risks involved in liposuction.
Take your time deciding if you are willing to accept the risks inherent in liposuction. Because it is usually a cosmetic procedure, and not medically necessary, there is no reason to rush. Gather as much information as you can so that you make an informed decision about whether liposuction is right for you. Don't believe that complications "only happen to other people." It is important for you to understand what the risks are and decide if you are willing to accept the possibility that it might happen to you.
Complications
- Infections. Infections may happen after any surgery and may occur after liposuction. Some physicians prescribe an antibiotic to all patients undergoing liposuction but other physicians do not. It is important to keep the wound(s) clean but even if you do, infections may sometimes occur from the surgery. Sometimes, infections may be serious or life threatening such as in cases of necrotizing fasciitis (bacteria eat away at the tissue) or with toxic shock syndrome, a serious, sometimes fatal infection caused by a bacteria, that is associated with surgery (you may have heard of toxic shock syndrome occurring in women using tampons, also).
- Embolism. Embolism may occur when fat is loosened and enters the blood through blood vessels ruptured (broken) during liposuction. Pieces of fat get trapped in the blood vessels, gather in the lungs, or travel to the brain. The signs of pulmonary emboli (fat clots in the lungs) may be shortness of breath or difficulty breathing. If you have the signs or symptoms of fat emboli after liposuction, it is important for you to seek emergency medical care at once. Fat emboli may cause permanent disability or, in some cases, be fatal.
- Visceral Perforations (puncture wounds in the organs). During liposuction, the physician is unable to see where the canula or probe is. It is possible to puncture or damage internal organs during liposuction. This may happen, for instance, if the intestines are punctured during abdominal liposuction. When organs are damaged, surgery may be required to repair them. Visceral perforations may also be fatal.
- Seroma. After liposuction, there may be a pooling of serum, the straw colored liquid from your blood, in areas where tissue has been removed.
- Nerve Compression and Changes in Sensation. You may experience "paresthesias" which is an altered sensation at the site of the liposuction. This may either be in the form of an increased sensitivity (pain) in the area, or the loss of any feeling (numbness) in the area. If these changes in sensation persist for a long period of time (weeks or months) you should inform your physician. In some cases, these changes in sensation may be permanent.
- Swelling. Swelling or edema may occur after liposuction. In some cases, swelling may persist for weeks or months after liposuction.
- Skin Necrosis (skin death). The skin above the liposuction site may become necrotic or "die." When this happens, skin may change color and be sloughed (fall) off. Large areas of skin necrosis may become infected with bacteria or microorganisms.
- Fluid Imbalance. Fat tissue, which contains a lot of liquid, is removed during liposuction. Also, physicians may inject large amounts of fluids during liposuction. This may result in a fluid imbalance. While you are in the physician's office, surgical center or hospital, the staff will be watching you for signs of fluid imbalance. However, this may happen after you go home and can result in serious conditions such as heart problems, excess fluid collecting in the lungs, or kidney problems as your kidneys try to maintain fluid balance.
- Toxicity from Anesthesia. Lidocaine, a drug that numbs the skin, is frequently used as a local anesthetic during liposuction. You may have had a similar drug, novocaine, to numb your mouth at the dentist. Large volumes of liquid with lidocaine may be injected during liposuction. This may result in very high doses of lidocaine. The signs of this are lightheadedness, restlessness, drowsiness, tinnitis (a ringing in the ears), slurred speech, metallic taste in the mouth, numbness of the lips and tongue, shivering, muscle twitching and convulsions. Lidocaine toxicity may cause the heart to stop. Of course, this can be fatal. In general, any type of anesthesia may cause complications and is always considered a risk during any surgery.
- Fatalities Related to Liposuction. There are numerous reports of deaths related to the liposuction procedure. Although it is difficult to be sure how often death from liposuction happens, there are several studies that estimate how often patients undergoing liposuction die during the procedure or as a result of it. None of the studies is perfect so the results are just estimates.
Some of the studies indicate that the risk of death due to liposuction is as low as 3 deaths for every 100,000 liposuction operations performed. However, other studies indicate that the risk of death is between 20 and 100 deaths per 100,000 liposuction procedures. One study suggests that the death rate is higher in liposuction surgeries in which other surgical procedures are also performed at the same time. In order to understand the size of the risk, one paper compares the deaths from liposuction to that for deaths from car accidents (16 per 100,000). It is important to remember that liposuction is a surgical procedure and that there may be serious complications, including death.
What can I Expect Before, During, and After Liposuction?
Before...
Before you undergo liposuction, you should undergo a complete physical exam so that your doctor can determine if you are an acceptable candidate for liposuction. It is important for you to discuss any medical conditions that you have and to tell your doctor about any medications that you are taking including any herbal or other non-prescription ones. If your doctor decides that you can have liposuction, discuss the procedure thoroughly with him or her before deciding if you want to go through with the procedure. Just because a physician says that you may have liposuction does not mean that you must decide to have liposuction. You may still change your mind even after discussing the procedure with a physician.
Your physician should be able to answer any questions that you have about liposuction including questions about what to expect during and after liposuction and the complications or problems that sometimes occur with liposuction. Some physicians will provide written information about liposuction. You may also take information from this website to your appointment to discuss with your physician.
You may want to have someone drive you to your appointment for liposuction. You may be tired or uncomfortable after liposuction and unable to drive yourself home. Discuss this with your physician before the day of your procedure.
Your physician may prescribe an antibiotic drug for you to take before and after the surgery. This is to prevent infections.
During…
On the day of the liposuction surgery, the physician will mark your body with a pen to indicate where the fat is to be removed. Then you will receive anesthesia, that is medicine that prevents you from feeling pain. Some physicians use only local anesthesia, that is, anesthesia that they inject with a syringe or pump into the area where they will do the liposuction. The anesthesia medicine is injected along with a lot of fluid, usually buffered salt water and epinephrine, a drug to reduce bleeding. Large volumes of liquid may be injected, until the skin is very firm. If your physician uses only this kind of local anesthesia, also sometimes called tumescent anesthesia, then you will be awake during the procedure. Other physicians use local anesthesia and a sedative that can be taken by mouth or injected from a syringe. Still others prefer to use general anesthesia, that is to use anesthesia that will put you to sleep during the procedure. This is usually done in a hospital.
Once the anesthesia is working, the physician will make an incision (cut) in the area where the liposuction will be performed. A canula, a hollow tube that is about the size and shape of a skinny pen, will be inserted into the incision. The physician moves this canula back and forth to suction out the fat. The fat, and liquid that has been injected, are collected in a flask. The physician will monitor the amount of fluid and fat that are removed. Because you will be losing liquid and fat from your body, it may be necessary to replace some of that fluid. This is done with an intravenous (i.v.) line for the replacement of fluid.
After…
Depending upon the amount of fat removed and the location of the surgery (doctor's office, surgical center, hospital), you may leave the doctor's office soon after the surgery or you may spend the night in the surgical center or hospital. Ask your doctor how long it will be before you should be able to return to your normal level of activity or if you will need to miss work after liposuction.
The cuts where the doctor inserted the canula may be leaky or drain fluids for several days. In some cases, the doctor may insert a drainage tube to drain fluid away from the wound.
You will wear special tight garments to keep your skin compressed after the liposuction procedure. Your doctor will tell you how long to wear these, usually for weeks. Some doctors provide these garments but others will tell you where to purchase them before your surgery.
Your doctor will also probably give you some after-surgery instructions. This will include information about wearing compression garments, taking an antibiotic if that has been prescribed, and the level of activity that is safe for you after your liposuction procedure. You should also have information about signs of problems that you should be aware of, for instance the signs of infections or other problems that you need to know about.
When the anesthesia wears off, you may have some pain. If the pain is extreme or of a long duration, you should contact your physician. You will also have some swelling after the surgery. In some cases, this swelling will remain for weeks or even months. If you have pain and swelling, this may be the sign of infection and you should contact your physician.
You will have scars, usually small, where the physician cuts your skin and inserts the canula to remove fat tissue.
Will I look the way I want after liposuction?
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While medical complications are important, the reason that people have liposuction surgery is for cosmetic reasons. The cosmetic effect after liposuction may be very good and many patients report being satisfied. However, it is possible that the cosmetic effect will not be what you expected. In other words, your appearance after liposuction may not be what you expected or wanted. Some physicians counsel their patients that reasonable expectations are important. It may be difficult to have reasonable expectations after reading advertisements and looking at pictures of women and men who have had liposuction. Remember that advertising is made to make you want to purchase a product or service. Advertisements do not usually tell you about problems or shortcomings of the product or service.
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Some cosmetic shortcomings after liposuction include:
- There may be scars at the site where the doctor made the cut to insert the liposuction canula. These scars are usually small and fade with time but in some people, scars may be larger or more prominent.
- The liposuction site may have a wavy or bumpy appearance after liposuction.
- Liposuction results may not be permanent. If you gain weight after liposuction surgery, the fat may return to sites where you had liposuction or to other sites.
- Results may be less dramatic than what you were expecting and this can be disappointing.
Liposuction Surgery Checklist
Know what makes you a poor candidate for liposuction
Know all the risks and procedure limitations
Understand all the answers to your questions about liposuction
Know what to before during and after the liposuction operation
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