Liposuction is a surgical procedure used to reduce localised fatty deposits which do not respond to diet or exercise. Liposuction (= liposculpture = 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 or 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.
In women I commonly treat thighs, including saddlebags, tummy and love handles, buttocks and knees in a 3 hour operation which removes 2-4 kg of fat. I do this as day case surgery and call it a BLT liposuction, butt, legs and tummy, although all three components are not always treated. It is the area extending from under the bust to the knees. Sometimes I will treat one or two specific areas, but mostly I prefer to do lipo circumferentially – around the leg or around the tummy and waist – as this allows better contraction of tissue. This is the lipo 360, the term currently in trend, but the way that I have always performed liposuction.
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:
- Increased risk of complications: The extra energy is designed to disrupt cells, but this can happen unpredictably in the fat cells and result in lumpy or irregular contour, or a cobblestone look. Also, the extra energy can damage other cells or tissues, not just the fat cells, and cause deep burns or burns of the skin. Both these complications – irregular appearance and burns – are well described with techniques which add energy.
- Increased time of surgery: Usually the energy is applied before the suctioning is done. this is an unnecessary step and simply adds extra time to the surgery and anaesthesia. Prolonging the surgery adds risk and expense.
- Increased cost: Not only does the surgery take longer, but the expense of the device is passed on to the patient, and these devices are expensive.
- Adding energy is illogical. Liposuction creates your new shape by the removal of fat cells. One does not need to kill the fat cells (with the added energy) as the fat cells are being removed anyway. Fat cells that are killed and not removed, left behind, are simply going to prolong and worsen the healing phase as these dead cells need to be mopped up.
So these procedures generally take longer, cost more and are more risky with no upside that is apparent to me. Ultimately liposuction success is not so much about the technique as about the care and artistry of the surgeon performing the procedure. You want to get through the procedure safely and be well shaped or sculpted after.
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 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 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. 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.
When I do large volume fat grafting, for breast or butt augmentation, then I do the liposuction with a syringe so that we can collect the fat for injection.
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.
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Last update: 27 August 2020
I am feeling uncomfortable and not very proud of myself! I did not get round to expressing my gratitude and appreciation to you.! Dirk, thank you so very much for all your kindness and understanding throughout my dealings with you and it has been always been a pleasure dealing with your entire practise.