Liposuction is invasive surgery in which deposits of fat are removed to reshape or reduce one or more areas of the body. It can be performed for therapeutic or cosmetic reasons. Common areas targeted include thighs, buttocks, abdomen, arms, neck and under the chin. This operation is also known as suction-assisted lipectomy or lipoplasty.
Liposuction is not a substitute for weight reduction or a cure for obesity. Having liposuction will not help prevent cardiovascular disease or improve your general health and wellbeing. It is also not an effective treatment for cellulite (dimpled skin that typically appears on the thighs, hips and buttocks) or for loose, saggy skin.
Body image concerns are the main reason people consider liposuction. Some people of normal weight have localised pockets of fat that don’t respond to diet or exercise. These areas of fat deposits may be due to family traits rather than a lack of weight control or fitness. Liposuction slims and reshapes these specific areas of the body by removing excess fat deposits, and improving body contours and proportion.
Some people with diabetes may seek suction-assisted lipolysis to treat contour problems from repeated insulin injections. Other people have liposuction performed on them to remove breast tissue (gynaecomastia) or treat posttraumatic pseudolipoma (swelling that resembles a lipoma).
Suitability for liposuction
Liposuction is best suited to people with a healthy weight and firm, elastic skin, who have pockets of fat in certain areas.
To be suitable for liposuction you must:
- be physically healthy
- be psychologically stable
- be aware of the limitations of this operation
- have realistic expectations.
Although age is not a significant concern, older people may have less skin elasticity and may not achieve the same results as a younger person with tighter skin.
Things to consider before liposuction
Before you choose liposuction, there are some important issues to keep in mind, including:
- Liposuction is suitable if you have bulges that persist despite a healthy diet and exercise. It is not a substitute for weight loss.
- If your skin is dimpled before the liposuction, it will probably still be dimpled afterwards.
- If the ‘extra’ skin doesn’t contract (tighten) after liposuction, you may need a further procedure to remove excess skin.
- The final results may take a few months to emerge, so it is important to wait before making any decisions about the necessity for further surgery.
- Think about the financial cost. Cosmetic surgery does not usually qualify for rebates from Medicare or private health insurance companies.
- Smokers are at increased risk of complications. If you are serious about undergoing cosmetic surgery, you should try to quit smoking.
Finding an appropriate healthcare professional
Ask your doctor for advice on a suitable and reputable specialist or hospital where liposuction is performed. At your first consultation, you should ask the specialist about their training and experience.
Although liposuction is not a medical specialty and no specialised training is currently required (in fact, it can be performed by any registered doctor, such as a general practitioner, a plastic surgeon or a dermatologist), it is preferable to have this procedure done by a reputable professional who is specially trained to perform liposuction and has a lot of experience in carrying out this operation.
Medical issues and liposuction
Before the operation, you need to discuss a range of medical issues with your doctor or surgeon. They will talk to you about your:
- Physical health – an examination will help your doctor or surgeon decide if the treatment is appropriate.
- Medical history – some pre-existing medical conditions and surgery you’ve had in the past may influence decisions about this operation, including the type of anaesthetic that is used.
- Risks and possible complications – it is important that you understand the risks and complications so that you can weigh up whether liposuction is right for you. Liposuction carries greater risk for people with medical problems such as diabetes, significant heart or lung disease, poor blood circulation or those who have recently had surgery near the area to be treated.
- Medications – tell your doctor and surgeon about any medications that you take on a regular basis or have recently taken, including over-the-counter preparations such as fish oils and vitamin supplements.
- Past reactions to medication – tell your doctor and surgeon if you have ever had a bad reaction or side effects from any medications, including anaesthetics.
- Preparation for surgery – your surgeon will give you detailed instructions on what you should do at home to prepare for surgery. For example, you may be advised to take a particular medication or alter the dose of an existing medication. Follow all instructions carefully.
Liposuction can take place under either a local or general anaesthetic. The length of the treatment will depend on the technique chosen and the amount of fat to be removed.
If only a small amount of fat and a limited number of body sites are involved, liposuction can be performed under local anaesthesia, which numbs only the affected areas. Some people prefer general anaesthesia, particularly if a large volume of fat is being removed.
The exact operation will depend on the specific liposuction technique used but, in general, the steps include:
- A tiny incision (cut) is made and a sterile liquid solution is given (infused) directly into the vein to reduce bleeding and trauma.
- A cannula (thin, hollow tube) is inserted.
- The cannula is pushed and pulled through the fat layer using a controlled back and forth motion to break up the fat cells.
- The dislodged fat is then suctioned out of the body using a surgical vacuum pump or large syringe attached to the cannula.
- The person continues to be given intravenous fluids (directly into the vein) during and immediately after surgery to replace the fluids lost when the fat is removed.
- Depending on the number of areas receiving treatment, the procedure can take up to two hours.
In some cases, liposuction is performed alone. In other cases, it is used with other surgeries such as a facelift, breast reduction or ‘tummy tuck’.
A follow-up operation may sometimes be recommended to reduce excess skin. This may occur when large amounts of fat – usually more than five litres – are suctioned.
Specific techniques include:
- Ultrasound-assisted – an ultrasound device is used to melt the pockets of fat to make them easier to remove.
- Tumescent – fluids containing a local anaesthetic, epinephrine and saline is injected into the fat pocket. Epinephrine helps to constrict blood vessels and limit blood loss and bruising.
- Super-wet – the surgeon injects approximately the same quantity of fluid as the amount of fat to be removed.
Immediately after liposuction
After the operation, you may expect:
- bruising and swelling
- possible numbness and minor pain
- to be given antibiotics to prevent infection
- insertion of a small drainage tube – this may be inserted beneath the skin for a couple of days to prevent fluid build-up
- to start walking around as soon as possible – your doctor may advise this to reduce swelling and help prevent blood clots from forming in your legs
- to wear a pressure garment – this may need to be worn over the treated area for about a week after surgery to control swelling and help the skin adjust to the new underlying shape.
Complications of liposuction
All surgery carries some degree of risk. The risks of liposuction increase if a large number of body areas are treated at the same time or if the areas operated on are large in size.
Some of the possible complications of liposuction may include:
- (from ultrasound-assisted liposuction) thermal burn or other heat injury to the skin or deeper tissues from the ultrasound device that is used to liquefy fat cells
- (from tumescent and super-wet liposuction with complications caused by the injection of anaesthetic fluid) lignocaine toxicity (if the solution’s lignocaine content is too high) or collection of fluid in the lungs (if too much fluid is given)
- excessive fluid loss, which can lead to shock
- fluid accumulation
- infection – this is a serious complication, as infections that develop in fatty tissues are difficult to treat
- delayed healing
- friction burns or other damage to the skin or nerves
- irregular skin surface, uneven contours or rippling
- asymmetric or ‘baggy’ skin surface
- change in skin sensation or numbness
- skin pigmentation changes, skin discolouration or swelling
- unacceptable scarring
- damage to deeper structures such as nerves, blood vessels, muscles, lungs and abdominal organs
- pain, which may be ongoing
- allergic reactions to medications
- formation of blood clots or fat clots, which may migrate to the lungs and cause death
- persistent swelling in the legs
- deep vein thrombosis, cardiac and pulmonary complications.
Further surgery may be necessary to address complications.
This is not a complete list. For example, your medical history or lifestyle may put you at increased risk of certain complications. Speak to your surgeon for more information.
Self-care after liposuction
Be guided by your surgeon, but general self-care suggestions include:
- You may need to take a few days off work to rest.
- Avoid strenuous activity for about one month as the body continues to heal.
- See your doctor seven to 10 days after surgery to have your stitches removed.
- You may need to continue wearing your pressure garment for several weeks.
- Report any bleeding, unusual symptoms or severe pain to your doctor.
Long-term outlook after liposuction
Your improved body contour will appear when the swelling and fluid retention subside. It may take several months for the swelling to fully disappear. Usually, the ‘extra’ skin will contract (tighten) after liposuction. In some cases, however, a procedure to remove excess skin may also be needed.
Liposuction is considered to be permanent, yet substantial weight gain after surgery can lead to further build-up of fatty tissue, spoiling an otherwise permanent result. To continue to enjoy the results of liposuction in the longer term, it is important to control your weight and maintain a healthy lifestyle (such as eating a low-fat diet and getting enough exercise).
Alternatives to liposuction
Alternatives to liposuction can include:
- eating a healthier, low-fat diet
- accepting yourself as you are – talking to a counsellor or psychologist may help you overcome your concerns about your appearance and you may decide that you like yourself the way you are.
Where to get help
- Your doctor
- Plastic surgeon
- Australian Society of Plastic Surgeons Information Hotline Tel. 1300 367 446
- Royal Australasian College of Surgeons Tel. (03) 9249 1200
Things to remember
- Liposuction is a form of invasive surgery in which localised deposits of fat are removed to reshape or reduce one or more areas of the body.
- Liposuction is most likely to be successful for people with a healthy weight and firm, elastic skin, who have pockets of excess fat in certain areas.
- Liposuction is not a substitute for good diet and regular exercise.
- Talk with your surgeon about the risks and benefits of liposuction and what results you can expect.