Dr. Dirk Lazarus
Plastic Surgeon

Tel: 021 424 1112
Fax: 021 424 1118

86 New Church St
Tamboerskloof
Cape Town, 8001
South Africa

Liposuction is a surgical procedure for the removal of localized fatty deposits. It is not a treatment for weight loss or obesity. Patients seeking lipo for weight loss will be disappointed as their expectations will not be met. The larger the volume of fat removed, the higher the likelihood of contour irregularities and systemic complications. I prefer to confine my lipos to around 3kg (6bs).

Liposuction is the commonest cosmetic plastic surgery procedure performed and I believe it is also the commonest procedure for which patients shop around. But remember, buyer beware.

Recently I saw a patient for lipo. I quoted her a total fee, including clinic and anaesthetist, of R17 000 for about a 3kg fat removal from her thighs, saddlebags, tummy, love handles and buttocks. When I gave her the estimate of the price, her face fell. "But I can get it done cheaper elsewhere," she responded.

One surgeon had quoted her R6 000. He had said that he would remove 300g from each thigh. That would make her price in rands per gram at R10 per gram of fat removed.

Another surgeon had estimated a total fee of R10 000 for a removal of about 700g in total. His rand per gram price was R14 per gram.

I eventually removed 3.2kg of fat from her. Her rand per gram price: R5.30.

Buyer beware.

Some surgeons blithely state that they will remove about 3kg or 3 litres. (They are equivalent). But you need to ask, 3kg of what?

The modern way of performing liposuction is to use the tumescent, wet or superwet technique. These techniques involve the injection of large volumes of local anaesthetic. This not only reduces intra-operative blood loss, but also helps alleviate post-operative pain. After the injection of the local anaesthetic, a long, thin tube or cannula is used to remove the fat. One end of the tube goes in you and the other end is attached to a powerful vacuum (either a vacuum pump or a syringe). The aspirate (the stuff sucked out of you) consists of fat, injected fluid, a little blood, body fluid, etc. The proportion of fat to other fluid can vary. The fat can be anywhere from 30% to almost 100% of the aspirate. But from a reshaping point of view, it is only the fat that is important. In the patient above, I removed 3.2kg of fat, 1.3 litres of fluid and the total aspirate was four and a half litres. Check whether the surgeon is saying 3kg (3 litres) of total aspirate or of just fat.

Buyer beware.

But it is not just about quantity of fat removed. Some surgeons remove fat only from one or two areas. I prefer to remove the fat in an harmonious and balanced way. If the thigh is being treated, then the whole thigh needs to be treated and reshaped so that the final result is a more aesthetic thigh, not just one which has had bits of lipo here and there. I recently performed a secondary liposuction on a model. A colleague had treated her saddlebags and removed 200 or 300 grams from each saddlebag, but her thighs still appeared heavy and she was dissatisfied. I took off about 2.6kg from her and her thighs are now in proportion with the rest of her body.

Buyer beware.

Liposuction is a relatively simple procedure to do (but can be difficult to do well). As a consequence many untrained practitioners offer lipo as a service. I have heard stories of practitioners doing liposuction, removing 5kg of fat and discharging a still drowsy patient who has not passed any urine to drive over four hours in a car to get home. I have heard plastic surgeons boasting that they keep one cannula, the diameter of their thumb, in the boot of their car and that is all they need for all their liposuctions. I have seen patients end up in intensive care following liposuction performed by GPs who have a certificate of liposuction following a one day's course on how to do it.

Liposuction is a surgical procedure and like all surgical procedures it should be done with due care and with proper respect for patient safety. All but the tiniest of touch ups should be performed in an operating theatre with proper equipment. Anaesthesia should be such so that the patient is pain-free and comfortable for the duration of the procedure. Adequate fluids should be given to avoid kidney failure and a good urine flow should be maintained. Cannulae used should be small (4 mm or less) to avoid contour irregularities. Patients should be discharged only when they are awake, ambulant, pain controlled, passing urine, compos mentus and into the safety of a caring adult. They should not drive themselves home from the clinic. Large volume liposuctions should only be undertaken by those experienced in the technique and in the proper environment.

Buyer beware.

I do almost all my liposuctions safely as day case procedures. An anaesthetist keeps the patients comfortable and pain-free during the procedure. Usually this is with a combination of drugs and usually patients sleep through out the procedure, but it is not a full general anaesthetic. Often patients are given a spinal anaesthetic which numbs sensation from the tummy down for about 3-4 hours. We are very careful with fluid balance. I use tiny incisions well camouflaged in selected locations. For body lipo I usually use 3 mm cannulae although I do on occasion use a 4 mm cannulae where there is a lot of fat to remove and in areas less likely to form contour irregularities. I know which areas do well, which areas do badly and which areas should not be done. For the neck I generally use 2 mm cannulae and a syringe technique. We have a good lipo vacuum pump and I can perform body lipo more efficiently with the pump than with syringes. There is also a cost saving. I usually remove no more than about 3kg of fat.

Using the above techniques I have discharged all my patients home on the day of surgery without any problems. I do not let patients travel far and they need to stay in Cape Town for at least a week afterwards.

Patients sometimes tell me that they do not want liposuction, they want liposculpture. The difference is one of marketing. Liposculpture conveys an image of artistry, liposuction conveys an image of brute surgery. Sometimes liposculpture is used to refer to syringe liposuction, but it really does not matter how the vacuum is achieved. Lipo, whether liposculpture or liposuction should be done carefully and with consideration to achieving a balanced and pleasing shape. The marketing is not important and liposculpture = liposuction.

Choosing a surgeon can be difficult. As a starting point, ensure that your surgeon is a plastic surgeon, registered as a specialist and preferably a member of the national association. Here in South Africa that the surgeon is registered as a plastic surgeon with the Health Professions Council and also that they are a member of the Association of Plastic and Reconstructive Surgeons of South Africa (APRSSA). Discuss the procedure in depth, educate yourself so you know what you are talking about, ask questions, look at photographs of his or her previous work and talk to past patients. Do your sums (see the opening paragraphs) and most importantly find a surgeon who seems to understand you and with whom you feel comfortable. There is no good way to judge the surgeon's artistry as working on patients is a completely different medium from anything else.

Good luck and remember, buyer beware