Liposuction uses high pressure suction to remove fat from undesired areas and thick deposits on the body, most commonly from the hips, buttocks, knees, abdomen, thighs, back, upper arms, chin, or neck. Liposuction is not a substitute for weight loss, as the amount of fat that can be safely removed and the ability of the skin to shrink down are limited especially after previous skin expansion with pregnancy and significant weight fluctuations. 

As with all cosmetic procedures, patient expectations must be reasonable and patients must understand that the goal of liposuction is restoring a more desirable shape and contour to the body, not removing all fat below the skin.  In all liposuction techniques, small incisions are made near the area to be suctioned in a crease or covered area.  Each area is usually suctioned from multiple directions in a cross-tunneling technique with metal cannulas to obtain a smooth result. 

In “dry” liposuction, no fluid is added and volumes are limited due to blood loss. During “wet” liposuction, “super wet” liposuction, and “tumescent” liposuction, one of many various formulas of crystalloid, local anesthetic, and vasoconstrictive agents is added prior to liposuction, reducing damage to lymphatic and circulatory vessels, which reduces bruising, swelling, and blood loss and allows for a greater volume of fat removal.  In addition, the local anesthetic may make anesthesia or heavy sedation unnecessary and the fluids provide necessary resuscitation. Some patients have enough excess fat that treatment requires multiple sessions in order to maximize safety. Ideally, this is determined before surgery but on occasion, an unplanned second procedure is necessary.

Several supplemental techniques are available for specific situations. 

Power-assisted liposuction (PAL) uses a powered cannula to assist with breaking up the fat and increasing its removal.

Ultrasound-assisted liposuction utilizes ultrasonic waves to damage fat and the deep layer of the skin to assist the liposuction and promote contraction of the skin. 

Internal Ultrasound-assisted liposuction  (UAL, i.e. Vaser®), also referred to as ultrasonic liposuction, transmits ultrasonic vibrations and heat directly to the fat and skin with a specialized cannula prior to traditional suction lipectomy and it is particularly beneficial in removing denser fibrofatty areas, such as the chest wall in men with gynecomastia, the upper back, and repeat liposuction. 

External ultrasound-assisted liposuction (XUAL) utilizes ultrasonic energy applied from outside the body, through the skin, but it is less efficacious. 

Laser-assisted Liposuction, Smartlipo®, introduced in 2007, uses an Nd:YAG laser which is passed through the subcutaneous plane to create energy to lyse fat cells and improve fat removal and contraction of the overlying skin.

The procedure
The facility and type of anesthesia used will vary depending on surgeon preference and the volume of fat to be removed. Most liposuction can be safely performed in an approved outpatient surgical facility. Small liposuctions can be done with local anesthesia and mild sedation. Larger volume liposuctions require tumescent technique and intravenous sedation, general anesthesia, or regional anesthesia with an epidural or spinal block. Monitoring, safety precautions, and overnight observation may be necessary as larger fluid shifts affect blood pressure, heart rate, and kidney function. In order to ensure a safe environment and a good result, the procedure should be done by physicians and facilities trained in plastic surgery and even more specifically, in liposuction procedures. The operation time can vary 1 to 5 hours depending on the volume aspirated and the number of body sites and positions addressed. 

After your procedure
The wetting solution limits postoperative pain for up to a day, but even then most patients only suffer moderate discomfort that diminishes over the first week. There is always some bloody drainage from the incisions. Most patients can return to work and casual activities at a week. After liposuction, avoiding strenuous activity and compression are important to limit swelling and prevent fluid collections. Bruising and swelling are significant for several weeks, but are limited with form fitted garments that also help the skin re-contour without dimples or creases. Swelling needs to resolve before the true results can be appreciated. 

Be aware
Many of the serious life-threatening complications discussed in the media have occurred in the hands of poorly trained or equipped doctors and risks can be limited by choosing a properly trained and certified plastic surgeon and facility.  However, even under these circumstances, there are potential complications such as dehydration, infection, bleeding, contour irregularities, fat recurrence, fat emboli, and deep venous thombosis/pulmonary emboli, which require treatment.

All of the descriptions for the various procedures are condensed from the text of the upcoming textbook written by Dr. Christopher Park and Dr. Malcolm Marks and are copyrighted, "The Artistry of Plastic Surgery: Exploring the Experience” .