Liposuction
Liposuction is a surgical procedure used to reduce localised fatty deposits which do not respond to diet or exercise. Liposuction, also called liposculpture or suction assisted lipectomy, is a shaping procedure to sculpt your body or your contours. Liposuction is not a treatment for obesity, a method of losing weight nor an alternative to a healthy lifestyle. The surgery is best performed if you are at or close to your ideal weight for height. Your BMI (body mass index) should be less than 30 (online BMI calculator here).
Common areas treated in women include the saddlebags (outer thighs), inner thighs and knees; tummy and love handles, but other areas can be treated too. While liposuction is mostly to remove bulges, it also creates a degree of skin retraction or tightening, and for this reason I have always done 360o liposuction. So thigh liposuction will usually involve some treatment all over the thigh including the front and the back, and trunk liposuction involves the waist and often bra rolls and back. Other areas can be treated too, eg arms, neck, etc. Liposuction can be combined with fat grafting to fill or augment other areas: butt, breast, thigh dents, etc. With the butt, contouring and shaping with lipo and sometimes fat grafting can improve the appearance of the butt.
In men the common areas treated include the chest, tummy and neck.
Vaser, Laser, etc...
What about newer liposuction techniques, vaser, laser, etc., are these better than conventional liposuction? These techniques all add energy in some form with the aim of destroying fat cells and making the liposuction easier. In my opinion, adding energy is unnecessary, offers no benefit and has a number of shortcomings:
- The extra energy can cause burns to the skin or deeper structures.
- Surgery takes longer as there is the extra step to add the energy.
- Surgery costs more, not just because it takes longer, but also because of the expense of the device which will be passed on to you, the patient.
- If the fat cells are to be removed anyway with the liposuction, why would you need to disrupt them first?
- Cobblestone appearance and irregularity are also well described, probably on the basis of leaving dead or disrupted cells behind.
Liposuction is a shaping / sculpting procedure, and good results arise from the skill and artistry of the surgeon, not the device used. Adding energy is uneccessary, removes the feel and control, adds time and expense, and is more risky – that is my opinion!
Alternatives to liposuction
There are many procedures offered as alternatives to liposuction. These fall into two main groups: (1) non invasive techniques which rely on external ultrasound, radio waves, cooling and so on and (2) invasive techniques where the fat cells are first damaged, disrupted or killed and then in the second step removed with some form of conventional liposuction.
The non invasive techniques are of course the holy grail and are appealing because they avoid the need for surgery. The principle is that fat cells are damaged, destroyed or killed and that your own body will then metabolise and remove these no longer viable cells. Unfortunately the benefits achieved with these techniques are too minor to have any real clinical effect and patients are often left out of pocket, disappointed and frustrated. I have tried a variety of these techniques in my practice over the years and never found the need to adopt any of them.
The invasive techniques include laser liposuction, ultrasound assisted liposuction, vaser and so on. They are usually marketed with magnificent claims and have special names often including the word ‘sculpt’. All liposuction, of course, is sculpting. I don’t believe that these special kinds of liposuction offer any advantage, in fact I believe that they carry a number of specific disadvantages. With all these special lipos there is an additional step necessary to do whatever these machines do to the fat. This extra step adds time to the procedure (and time = risk plus expense) and these machines are expensive. That cost is passed on to you, the patient. It is completely unnecessary to damage, liquify, kill or any way modify fat cells prior to their removal. Conventional liposuction removes the fat cells just fine. The damaged, dead or otherwise disrupted fat cells still need to be removed (with some form of conventional liposuction) and there is the very real risk that a significant number of non viable cells will be left behind in you. This can prolong the recovery and ultimately make the shaping which is done with these procedures far less predictable. I have watched many of these techniques over the years, been to demonstrations and courses and the more I go, the more anti these techniques I become!
Finally, there is also mesotherapy. Mesotherapy is the injection of some substance with the aim of killing fat cells and then leaving them there for your body’s metabolism to eradicate. Mesotherapy is associated with such a high degree of unpredictability, such a high rate of creating a cobblestone effect and so many issues that it has been banned in some countries. Having said that, there is still research being conducted on it, new drugs have come out recently, but this is not mainstream, cost effective or even available in South Africa.
Liposuction procedure
Liposuction is done as day case surgery (discharge on the day of surgery), in my own clinic. On admission you will be given a pre-med to make you feel calm and relaxed. I will come and draw my marks on you. You will be given an opportunity to talk to the anaesthetist. I use mainly women anaesthetists in my practice, all experienced and some have had the procedure themselves so they understand the procedure well.
Usually liposuction is performed under conscious sedation. If you are feeling too awake you can tell the anaesthetist and she will make you deeper. In any regard you will be pain-free and for the most part sleeping. We have found it best in certain cases to used a spinal anaesthetic. This is a small injection in the back which will numb you from the waist down for about 4 hours. It is not as painful as it sounds and allows a rapid recovery. Finally I will inject large volumes of local anaesthetic. This is called the super-wet or tumescent technique and is done to diminish bleeding and assist with pain relief during and after surgery.
The liposuction is done with an instrument called a cannula, a long, thin, hollow metal pipe with a handle which attaches to the liposuction vacuum machine to extract the fat. Sometimes a syringe is used to create the vacuum and this allows the fat to be collected for fat grafting. I find no difference in accuracy whether I use the lipo machine or a syringe. The cannula has a blunt tip so as to cause minimal tissue damage. It is moved in and out to sculpt the area being treated as the fat is withdrawn. The cannula is inserted through multiple small incisions which leave inconspicuous scars.
Recovery
After surgery you will be transferred to the ward to recover. There will be quite a bit of leaking of the tumescent fluid and the nurses will do a complete dressing change before you are discharged later in the afternoon. Usually you will be given a pressure garment to wear for 3 weeks day and night and then for 3 weeks intermittently. You will be given pain medication on discharge.
For the first 24-48 hours you may continue to leak tumescent fluid. Ensure that you have adequate linen at home. Patients can get quite bruised from liposuction, but usually this resolves 2-3 weeks after surgery. The swelling takes longer but will settle too and over the next few months each little tunnel made in the fat by the cannula will shrink down (the process is called cicatrisation) and your shape will continue to improve over this period.
Driving can be resumed when you are moving easily, usually by about a week after surgery. Patients vary in the recovery period but usually for a BLT lipo a week to 10 days off from work is best. Gentle stretching type exercise and exercises to help the swelling can be done quite soon after surgery, but one should wait 4-6 weeks before more vigorous exercise or gym. Liposuction surgery is metabolically demanding and your body will need rest to recover. For a BLT lipo, overseas patients should allow about 2-3 weeks in Cape Town to allow for recovery and check ups.
Risks and Complications
All surgery carries the potential for complications. Complications are rare and if they occur then I will treat them. Systemic problems are described after liposuction. These include leg clots (deep vein thrombosis or DVT) which can break off and go to the lungs, so called pulmonary embolus (PE); fluid imbalances which can affect the kidneys or lungs and fat emboli (small globules of fat in the blood) which can affect a variety of organs.
Bleeding, infection, wound healing issues, abnormal scarring and damage to underlying or overlying structures can also occur and again, these are rare. Sometimes patients experience a period when the treated areas become hard, possibly on the basis of fat necrosis. This resolves and is usually helped by massage or manual lymphatic drainage. Seromas, pockets of fluid, have been described as possibly occurring after liposuction. It is normal to experience sensory changes and areas of numbness after liposuction. These normally recover within a few months.
Cosmetic issues such as contour irregularities (bumps or dents) can occur from inadequate or excess removal of fat in certain areas. All patients are to some extent asymmetrical. While I will try to correct asymmetries during surgery it may not be possible to always do so. Only fat that is removed with liposuction and other tissues (bone, muscle) may also be responsible for asymmetry.
The list of complications is long because liposuction is one of the most common procedures performed. Despite this long list of potential complications and problems liposuction is a safe procedure with a very high rate of positive outcome.
Following surgery, if you maintain a healthy lifestyle, a sensible eating plan (https://www.facebook.com/groups/HEALHealthyEatingandLiving, www.dietdoctor.com), perform moderate exercise and maintain your weight, you will be satisfied with the long term results and your new shape.
Download a PDF on liposuction.
Pre and post operative instructions
Last update: 16 December 2022
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