The Smart Woman's Guide to Liposuction

Marisa Lawrence, MD

Article by
Atlanta Plastic Surgeon

Liposuction, also called lipoplasty or suction-lipectomy, is the surgical removal of localized or regional fat deposits from designated areas of the body. The goal of liposuction is to create a more proportional and sculpted body by permanently removing fat cells. It is not a method of weight loss or a substitute for proper diet and exercise. The most frequently treated areas in men are the “love handles,” breasts, abdomen, and neck. In women they include the thighs, hips, buttocks, abdomen, knees, jowls and chin. The amount of fat removed varies by doctor, method, and patient but is typically less than 5 pounds. Although many patients do notice an improvement in the appearance of the dimpled skin that appears on the thighs, hips, and buttocks after fat cells are removed, liposuction is not a treatment for cellulite.

Liposuction has become one of the fastest, most effective, and safest cosmetic surgery procedures available today. Liposuction is the only scientifically proven method for removing fat cells permanently. According to the American Society for Aesthetic Surgery, liposuction has been the top overall surgical procedure performed since 1997. It can be performed alone or in conjunction with other cosmetic or medically necessary procedures. Good candidates for liposuction surgery are healthy, within 30% of their ideal weight, have realistic expectations for their surgery, and have skin with good elasticity.

Although there are several surgical techniques that can be used to perform lipoplasty, in general the physician inserts a hollow stainless steel tube called a cannula through a small incision in the patient’s body to break up the fat cells and extract them from the targeted area with the assistance of a powerful suction device. Prior to aspirating fat, the physician usually injects large volumes of a saline solution that contains a local anesthetic and epinephrine into the fatty areas to be treated. The addition of epinephrine to the solution helps shrink capillaries and virtually eliminates surgical blood loss. This “tumescent” solution partially liquefies the fat and helps separate the fat from the overlying skin and underlying muscle fascia. The tumescent technique for liposuction is unquestionably the safest form of liposuction, provided the volume of fat removed and the number of areas treated during a single surgery are not excessive.

The size of the liposuction cannula used can influence the smoothness of the skin after liposuction. The use of large cannulas (outside diameter greater than 3 millimeters) is associated with a greater risk of irregularities and depressions in the skin. Some surgeons prefer large cannulas because it allows liposuction to be done more quickly. However, in the realm of liposuction maximum speed is not a criterion for excellence. Microcannulas with a diameter less than 3 millimeters allow fat to be removed in a smoother and more uniform fashion. A powerized cannula that moves back and forth through the fat tissue in rapid motion is also available. With Power-Assisted Liposuction (PAL) less force is required to remove unwanted fat, making the procedure easier on both patients and surgeons.

In the late 1990s, ultrasound was introduced to facilitate the fat removal by first liquefying it using ultrasonic energy. Although Ultrasound-Assisted Liposuction (UAL) successfully improved the volume of fat aspirated and the quality of skin tightening following the procedure, it increased procedure time, required larger incisions, caused skin injuries and fluid collections. To avoid these complications ultrasonic energy was applied from outside the body in External Ultrasound-Assisted Liposuction (XUAL or EUAL) but this was found to be ineffective. The latest, third generation ultrasonic liposuction technique is called VASER Liposuction and was approved for use in 2002. The VASER system’s ultrasonic energy is thought to selectively liquefy the fat cells while preserving nerves, blood vessels, and connective tissue. However, it’s proper use requires a steep learning curve and skin injuries and fluid collections continue to be reported.

Lipodissolve, also known as mesotherapy, injection lipolysis, or lipostabil, involves injections of a chemical solution that typically includes phosphatidylcholine, a soybean extract. Other ingredients may include the bile derivative deoxycholate, enzymes and plant extracts. During lipodissolve treatments the doctor injects the chemical solution into small pockets of fat causing the fat to dissolve over the course of three weeks. Several treatments, four to six weeks apart are required for optimal results. The liquefied fat may be absorbed into the bloodstream and filtered through the liver but to date no definite studies have demonstrated where the fat travels and how it may affect organs. At this time lipodissolve is experimental and is not approved by the FDA. Reported side effects include pain, scarring, and skin irregularities.

Laser-Assisted Liposuction, introduced in 2007, is one of the newest and most promising techniques in permanent fat removal. SmartLipoTM was the first laser-assisted liposuction system. Using the device, a 1064-nmNd:YAG laser is delivered through a 1-2 mm cannula below the skin to liquefy fat while coagulating blood vessels. Similar to other techniques of liposuction, laser-assisted liposuction requires the use of tumescent solution prior to lipolysis, and standard liposuction to aspirate the liquefied fat. The CoolLipoTM 1320 nm laser was next marketed designed exclusivel for fat removal in small areas such as the neck and chin.

This year SlimLipoTM - the newest and most advanced laser liposuction technology thus far – was purchased for use at Northside Hospital. SLIM stands for Selective Laser Induced Melting; this new laser wavelength of 920 nm selectively melts fat three times more effectively the Smart LipoTM and twice as effectively as the CoolLipoTM liposuction technology. It is also 5 times more selectively absorbed by blood. Therefore the SlimLipoTM body sculpting laser dissolves fat and prevents bleeding much more effectively than any other liposuction unit available. For the patient this means gentler, more thorough fat removal, less bleeding and bruising, and a much quicker recovery. The system also contains a 980 nm laser wavelength which is highly absorbed by the dermis, the deep layer of the skin that controls skin tightening. When used in conjunction with the 920nm laser wavelength, there is improved skin tightening after liposuction.

Normal activity can be resumed within 24 hours. Depending on the extent of liposuction, patients are generally able to return to work or school between two days and two weeks. A compression garment is worn for two-four weeks. Temporary side effects of surgery may include swelling, numbness of the skin and soreness in the areas treated that dissipate over several weeks. As they do, new contours and enhanced self-image are developed. The results of liposuction are maintained as long as weight remains the same and a healthy lifestyle is practiced.

A consultation with a board-certified plastic surgeon is the first step to learn how liposuction can slim and reshape specific areas of the body.