The Art of Liposuction

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Liposuction: Facts and Myths
James J. Romano MD

Liposuction can absolutely be performed to remove any collection of fat beneath the skin surface.

But, let me explain there are many facts and myths and tradeoffs behind this. The popularity and widespread use of liposuction has exploded since it was first brought into the United States in the early 1980’s. Dr. Illouz, a gynecologist, discovered liposuction in Paris. I learned this technique in 1985 as it was part of my core Plastic Surgery training at Johns Hopkins, like it is for all plastic surgeons. Many doctors other than plastic surgeons also perform this procedure.

The details of the theory and practice of liposuction are well described by me elsewhere. In essence the fat cells are loosely connected between the skin surface and underlying muscle in an area conveniently devoid of most blood vessels and nerves and easy to remove by suction cannulas placed through small incisions. The skill and success lies in removing the fat artistically followed by the skin ability to mold down around the reduced fatty framework.

Best candidates are patients with localized fatty deposits unresponsive to diet or exercise with stable weight. These are patients where we can truly perform “body sculpting” and make changes in shape, contour and sillouette. Other patients that are overweight, even slightly obese, can get a results but in these cases it is more a size reduction surgery rather than body sculpting.

Surgery is very safe and healing is quite rapid because liposuction does not involve much blood loss, can be done under local anesthesia, and does not involve cutting nerves. As an example, most patients can have a surgery on Friday and resume the majority of activities Saturday, and return to work on Monday. Most patients can recover at home alone and certainly are not bedridden. There are areas of the body the respond best to liposuction such as the trunk and thighs. Other areas can be difficult such as the face and legs and arms.

Because liposuction removes fat cells in these certain areas, these cells do not grow back and the ones left over do not multiply or divide. So, your result is permanent. One byproduct of this, however, is that if you gain a lot of weight it will be seen in the areas where there are the normal number of fat cells and it will look like all your fat went to areas not liposuctioned. This explains the biggest “myth”. Liposuction is very technical and if too much is removed or not enough you can heal with dents or bumps. These can be fixed. Liposuction success relies on your skin elastic and collagen fibers shrinking down around a reduced fatty foundation. So, if you have loose skin, stretch marks, or scar tissue you may end up with folds or irregularities.

There are a number of liposuction technologies but most of the practice and technique of liposuction is unchanged in principal since the 1980’s. Ultrasonic and laser liposuction has not proved to add any benefit and most discerning doctors do not use these. There are some non-surgical alternatives that work pretty well but are less predictable and still expensive like Cool Sculpting. The technology for freezing fat is evolving and a possibility. Fat grafting is a very real option for using your suctioned fat to graft into buttocks or other areas and works well. Adding your hormones or stem cells to fat graft is also becoming a reality and stimulating lots of research.
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San Francisco Plastic Surgeon