Liposuction is one of the most commonly performed cosmetic procedures worldwide and year in and year out it is the top procedure performed in terms of numbers of cases in the United States.
My experience with liposuction spans over some 15 years where I was initially taught by some of the best surgeons in the United States how to perform this procedure effectively and safely.
Liposuction currently makes up a large proportion of my practice and it is a procedure that I find can deliver very pleasing results to the right patients with minimum downtime, rapid recovery and maximum safety.
When it comes to my philosophy on liposuction, I tend to equate it to removing a volume of fat from the skin envelope just like letting air out of a balloon. If the appropriate amount of air is let out of the balloon the balloon will contract and maintained its shape and form while the size and volume are decreased. If too much volume is removed then the balloon will potentially collapse and that is where we potentially lead to ripples and unsightly outcomes in cases where liposuction is performed poorly, or in patients where liposuction was not appropriate.
Performed effectively and safely, it is a very reliable procedure for patients who are looking to improve body contouring in specific areas of the body though is not to be regarded as a weight loss program.
Patients do need to be realistic about their outcome from liposuction and it is not simply a case of removing as much fat as is possible. Patients who are on a stable diet with a good exercise program who are then troubled by a specific area with disproportionate deposition of fat, are patients who are good candidates for liposuction.
In men, the areas classically affect the abdomen, potentially the chest with the love handles being one of the most commonly treated areas. In women, the fat distribution is more likely to be disproportionate around the legs with the inner thigh, outer thigh, and knee being the commonest areas performed. Liposuction is also applicable and very helpful for patients with excess fat deposits in areas such as the neck, under the chin, in the upper arms, on the back, the upper back above the bra strap or the lower back above the belt line.
Liposuction can also be used in combination with other procedures such an abdominoplasty. A lipoabdominoplasty is a combination of a tummy tuck with liposuction and it has really become the gold standard in terms of abdominal contouring. In body contouring surgery, such as brachioplasty or arm reduction or lower body-lift and thigh-lift, liposuction is also a valuable tool that is used at the same time to maximise the outcome of those procedures.
In liposuction, a small incision is made in the skin to allow access for a liposuction cannula. These are long, thin stainless steel tubes at the end of which are small holes which have sharpened edges. As the cannula is moved backwards and forwards below the skin and applies suction, small parcels of fat will be suctioned into the holes and then with the backwards and forwards motion, those parcels of fat will be removed. Once the fat has been removed it is removed permanently. Fat cells do not split and divide and multiply after the age of puberty, so the number of fat cells you have is fixed. What they can do though is increase in volume, so, like the balloon analogy, they are either full of fat and enlarged when you are carrying excess weight, or empty and small when you are lean. Liposuction will permanently remove some of these fats from the area treated, and once these fat cells have been removed with liposuction they are removed permanently.
The permanent removal of the fat leads to some of the myths associated with liposuction. Patients may feel that the fat has ‘come back in a different area’. This is not the case as the fat cells do not move. If the patients continue to intake a large amount of calories, then the body will store these extra reserves. As the body cannot store these reserves in the fat cells that have been removed, the body will store them in fat cells in other locations. For these reasons, patients who do not maintain a good diet and exercise program and a stable weight following liposuction may feel that the fat has ‘moved to another area’.
In terms of the long terms result from liposuction, patients can expect a permanent removal of fat in the area that has been treated. They do though need to maintain a good diet and exercise program as all areas of the body will potentially be able to store fat if excess weight gain is the case. In my practice, I choose to perform liposuction that I feel will deliver patients the maximum results with the maximum predictability and importantly, the maximum safety.
Liposuction is performed for my patients in a fully accredited hospital by myself as a fully accredited surgeon. The procedure is performed under general anaesthetic provided by an anaesthetist to ensure the patient is adequately cared for while I am performing the surgical procedure. For smaller areas, other surgeons may choose to perform liposuction under a form of local anaesthetic or sedation, though in my patients, I find it more comfortable for them and more reassuring for me to know that they have been looked after by a fully trained anaesthetist under general anaesthetic in a fully accredited hospital.
The procedure will take variable amounts of time depending on the degree of liposuction that needs to be performed. Potentially for small areas such as under the chin, the procedure may take 30 to 45 minutes. For larger areas such as the abdomen, hips and flanks the procedure may take two hours and for more extensive liposuction it may well be a three-hour procedure. Following this, patients will often go home as it is a day surgery procedure though for the larger areas that have been treated, patients will potentially stay in hospital for one night for patient comfort and safety.
I am often asked what is the maximum amount of fat that can be safely removed and it is advised by multiple surgical boards internationally that 5 litres is the maximum volume that should be removed in a single surgery sitting. When you think about it this way, then it really does become clear that liposuction is not a weight reduction program, it is more one of correction of disproportionate fat distribution. When patients looked at it in this light, they usually have a clear understanding of what is possible and not possible and that is when they become valid candidates for the procedure. I do think the patient understanding is the key to a good outcome and as long as the patient is well-selected and the treatment is appropriately provided, the liposuction provides a reliable and effective outcome in the majority of crisis.
When is the patient ready for liposuction? In my practice, it is going to be when they have an understanding of the procedure, the likely outcome and the potential downside. For me, that will take an initial consultation to assess whether they are a valid candidate for the procedure where we will provide them with some information for their consideration and discussion with their family and friends. At a second consultation, I will confirm that the procedure is appropriate for them and that they are fully aware of the surgical undertaking and the likely downside and recovery time required. Once the patient has passed that test, in my mind, that they fully understand the procedure, they are a valid candidate for liposuction. As I mentioned, I will perform the procedure in hospital under general anaesthetic for maximum safety.
There are different techniques for liposuction and these have evolved since the procedure was first described in the 1960s by Dr Illouz, a French plastic surgeon, who initially used the procedure on one of his female patients. Since that time, evolution in the technique has led through dry liposuction, through wet, through superwet, to techniques that involved ultrasound as well as mechanically assisted devices. In my practice, I used a mechanical liposuction performed with a superwet technique. Surgical literature suggests that this provides the maximum safety for the patients while providing the most predictable outcome with minimum downside. Other techniques may provide faster treatment for patients but this may well come at a higher risk of complications and this is not something that I am keen to embrace for my patients. As a philosophy, I want my patients to have the best outcome with minimum risks and the maximum predictability. If that means as a surgeon, I need to do more physical hard work to achieve that outcome, it is a price I am happy to pay to ensure my patients are delivered a good outcome.
So, who is a good candidate for liposuction? I will give you three examples.
Brian. Brian is a very healthy and happy 33-year-old professional who has an excellent diet and exercise program and maintained a stable weight of 85 kg. He has always been troubled though by two areas being disproportionate deposition of fat on his love handles as well as fullness under his chin which he knows is something that runs in his family. His ‘double chin’ and ‘love handles’ constantly cause him concern socially on a daily basis and he is keen to give consideration to fixing these issues. Brian is a perfect candidate for liposuction of the submental region and the love handles to try and improve the contour. He has two specific areas that are disproportionate with the rest of his physical frame and he has realistic expectations and is a good candidate to ensure a get good outcome.
Sally. Sally is a 24-year-old girl who has always been concerned that she has disproportionately large thighs. She is trim, athletic and sporty and when she buys clothes off the rack she finds she needs to buy separates because her top half does not match her more pear-shaped lower half. She has disproportionately large lateral thigh fat pads and inner thigh fat pads and is a good candidate for liposuction as these two areas can be contoured to match her frame. With a consultation and explanation of the pros and cons of the procedure, Sally becomes a good patient to undergo liposuction and I would anticipate for her an excellent outcome.
Georgina. Georgina is a happy and healthy mother of three children. She is 35 years old and is giving consideration to an abdominoplasty to fix excess loose skin on her tummy. She also has excess deposits of fat over her hips and flanks in an hour and pear-shaped figure. Liposuction can be used in combination to address fullness on the lower back and improve the contour of her torso circumferentially while at the same time, the abdominoplasty addresses the excess skin on the front part of her torso. Liposuction in these instances is an excellent adjunct to ensure patients get the best result possible from the surgical procedure such an abdominoplasty. Patients do need to understand that liposuction is not just a surgical procedure; there is the initial consultation period and a postoperative course. During the postoperative period, patients may well be asked to wear a compression garment which is one of my preferences. The compression garment offers two major benefits. Firstly, the garment will minimise swelling and bruising which will then speed the recovery process and secondly the garment will help support the elasticity of the skin and allow faster, more even contour contraction once the volume has been removed. The compression garment will be worn for periods determined by individual surgeons and I prefer to have the patients wear the garment day and night for the first two weeks followed by night time for the following two weeks. There may well be instances where the garment period needs to be shorter and may well need to be longer depending on individual circumstances, the number of areas being treated, and the patient’s response. Patients will need to consider that during this period they may need to take some time off work and they may well require some assistance with duties around the house if they are caring for a family.
I am often asked how painful liposuction is. During the superwet technique, we will place local anaesthetic into the fluid to minimise the postoperative pain and discomfort. Most patients will go home the same day of their procedure and will be happily managed with oral analgesia ranging from paracetamol and sometimes to some stronger agents for possibly a number of days or up to a week. This will depend on individual patient needs, the number of areas treated and the extent of the liposuction performed. I do tell my patients that they can expect to see the results of their liposuction at the 6-week mark. It is true though that there were still be some swelling at this point and the potential improvement and gains can extend out to the 3 if not 6, and sometimes 12 months mark as a there is a further resolution of swelling and firmness in the tissues.
If patients are considering liposuction, my advice is to seek the opinion of an expert. From a consultation, a patient can be assessed as to whether they are an appropriate candidate. Assessment can be made as to the expectation they should have for the outcome from the procedure and then a surgical plan could be put in place. Patients will need to give consideration to potential downtime and recovery period before deciding to undertake the procedure and if the procedure is performed safely and effectively in well-trained hands, patients can expect an excellent outcome.
As I mentioned liposuction remains the number one most frequently performed procedure in most countries worldwide and year after year provides patients with long-lasting and permanent benefits in terms of body contouring surgery.
Dr Jeremy Hunt