Liposuction 101-By Dr. Tim Sayed
LIPOSUCTION 101- DR. TIM SAYED
Worldwide, liposuction is one of the most popular cosmetic plastic surgery procedures. Liposuction is the cornerstone of many commonly performed body contouring procedures, including Brazilian buttlifting, hi definition abdominal liposculpture, and cosmetic and reconstructive fat grafting. Liposuction is a procedure performed to reduce fat excess in troublesome body locations, in order to improve the contour or shape of the body. While not done to cause weight loss, liposuction can be part of a comprehensive plan to improve one’s physique.
Liposuction involves placing a fluid cocktail of medications into the adipose (fatty) layer of the body in the treatment area(s), and these medications and saline solution help to prepare the tissues for safe fat removal, by reducing the risk of bleeding, providing local anesthetic medications to reduce postoperative pain, and creating some separation of tissues to allow the fat to be more effectively extracted. This fluid is called tumescent fluid for the effect that it has on making the tissues swell and become somewhat firm prior to fat removal. Sometimes, liposuction is aided by the use of devices like ultrasound (we like the Vaser brand) or lasers, which deliver energy that helps break apart the fat cells. These energy modalities may also make the skin tighten up more effectively after the fat removal, giving a better skin retraction effect and hopefully a smoother result.
Liposuction must be done carefully by skilled a surgeon and team who understand the anatomy and physiology of the treatment areas. Some of the most commonly addressed problem areas that liposuction may help include:
- The abdomen (upper, central, and lower)
- The flanks
- The inner thighs, outer thighs (saddlebags) and posterior thighs (area below the buttocks)
- The bra rolls
- The upper and lower back
- The inner knees
- The armpit bulges above and outside the breasts
- The area below the chin (submental)
- The breast, especially in males with gynecomastia (abnormal male breast enlargement)
- The jowls
- The buffalo hump area at the base of the nape of the neck in patients with certain conditions
- The upper arms
Liposuction is commonly performed in combination with cosmetic surgery of other areas of the face, breast and body, including facelifts, tummy tucks, breast lifts and breast augmentation, breast reductions, brachioplasties (armlifts), thighlifts, and other procedures.
Liposuction acts by disrupting fat cells, allowing fatty tissues to be suctioned into long wand-like devices called “cannulas” (or, more properly, cannulae). These are hollow-bore sterile surgical instruments that collect fat into canisters, where the fat can potentially be processed further for reinjection into other areas in fat grafting, if desired. If fat grafting is not being performed, the suctioned fat is discarded at the end of the procedure.
Safe liposuction includes properly planning the procedure by marking the zones of treatment and accounting for the amount of fluid that needs to be introduced compared to the expected amount of fat to be removed. There are recommended guidelines for the amount of fat that can be recruited in a given procedure, which depend in part on whether other procedures are being performed.
Recovery after liposuction requires the use of special garments (think of them like medical Spanx-like girdles and body suits), which help reduce the postoperative swelling, aid in the retraction and tightening of skin, and provide a smoothing effect on the way the skin redrapes over the treated areas. In most cases, these garments are fitted preop and are recommended for up to 3 months of use. Adjustments and additional garments may be needed as swelling subsides in the recovery period.
It is critical to understand that liposuction is NOT a weight loss operation. You will not be told to expect to lose massive amounts of weight with liposuction. The purpose is for body shaping, which may give the illusion of significant weight improvement even if the reduction in weight is quite modest.
1. How do I know if I am a candidate for Liposuction surgery?
Some of our selection criteria to include you as a liposuction candidate include:
- Excessive or bulging fat in problem areas of concern, which may include the abdomen, flanks, breasts, thighs, bra lines, back, knees, submental region and other areas
- Enough fat in the treatment areas to be able to harvest enough fat to help achieve the desired outcome – some patients can only obtain a modest contouring improvement due to their minimal body fat
- General good health, meaning you do not have major uncorrected cardiovascular, respiratory, kidney or other major organ conditions, and would be able to be medically cleared for general anesthesia by an internal medicine physician if you are over a certain age
- Not pregnant or immediately planning to become pregnant
- Nonsmoker or willing to commit to NO NICOTINE IN ANY FORM for at least 3 weeks preop and for the duration of your recovery
- A body mass index below 35 and ideally below 30 for optimal results, with rare exceptions
- Available support system of friends, family, caregivers or others who can help you to keep your appointments, complete your preop and postop tasks, and emotionally bolster you through this exciting journey
* Reasonable expectations of how much contouring improvement is possible with specific techniques
2. How long does Liposuction surgery usually take?
Most liposuction procedures about 20-30 minutes per major area treated. For example, lipo of the lower abdomen is about a 30 minute procedure, but a full abdomen may be more like an hour in length. As you add areas to the treatment plan, the surgical duration will increase. More significant liposuction procedures addressing the back and abdomen, with the flanks and bra rolls, may take 3 hours or so from start to finish, especially given that the patient needs to be repositioned in surgery. A hallmark of patient safety is to try to limit the amount of total surgery time to around 6 hours or less for outpatient procedures, and most of our liposuction cases take anywhere between 1 and 3 hours.
3. What is recovery from Liposuction surgery like?
Most liposuction procedures are performed on an outpatient basis in a AAAASF-certified operating room, meaning the facility is up to very high standards of accreditation. Patients usually spend up to a couple hours in the postoperative suite before being discharged in the care of a companion, family member or friend. Dr. Sayed gives a 24 hour phone number to all patients who can reach him for urgent questions, and we also issue access to a patient engagement application that allows the patient or companion/caregiver to send SMS messages, photos, video and other content to our team in a secure, private digital format. This keeps us mutually informed on your recovery and allows us to update your instructions while requiring a respectful number of face-to-face visits in the office.
Early postop recovery findings can include pain (which feels like a heavy post-workout muscle cramping pain in most cases), mild nausea, bruising and swelling, numbness or diminished sensation in the skin, and some mental adjustment to the process of healing which most patients undergo. Some patients may develop small fluid collections called seromas in the early weeks after surgery, though we try to prevent these. Most patients are advised to take up to 2 weeks out of social circulation and we’d prefer that you not drive yourself in the first 14 days or as long as you are taking any prescription pain medication. Most sutures are dissolvable but there may be a few that need to be removed at around 14 days postop. You may or may not have drains in place (depending on the treatment areas), which are usually removed in the office at 7 to 10 days.
We ask that you abstain from exercise for 1 week and then return to light fitness routines after that. It is very important that you get up and walk even the first night following your procedure. You will be asked to wear a surgical garment for about 3 months, and it will be easiest for you if you wear tops that button down in the front in the first 3 weeks or so. Dr. Sayed and his team provide close postop care in the office and with our remote engagement tools. You will be asked to take some supplement medications to aid in your recovery, which may include medications for pain, bruising, swelling, constipation, and dietary optimization.
4. How long do Liposuction results usually last?
Remember: liposuction is not a weight loss operation.
Also: liposuction is not a weight loss operation (just checking that you are reading carefully).
Patients who are overweight related to genetic, dietary and fitness factors are not going to be “cured” by liposuction. Mild areas of problem fat may have permanent improvement, but if you gain significant weight, you may also gain weight in areas previously treated by liposuction, as the body’s fat cells have a remarkable ability to take on extra fat over time even when some of the fat cells were previously removed. This is part of the reason it is important to try to balance your goals for body physique improvement with a combination of diet and exercise modification, with liposuction serving as a “finishing touch” or occasionally as a “jumpstarter.” It is better not to think of liposuction as a weight-related procedure and rather as one for improving body self-image and possibility the ability to find better fitting clothing, as a consequence of improved contours.
5. How can I prepare for my Liposuction surgery?
- Have a reasonable expectation of what surgery can accomplish
- Have a clear idea of which areas you want and don’t want treated – we will repeatedly ask you to confirm what you want to focus on, as liposuction is often priced per area of treatment
- Don’t smoke or take nicotine in any form for at least 3 weeks and ideally longer before (and after) surgery
- Stay well rested and well hydrated and eat a nutritious diet balanced with plenty of protein
- If your diet is lacking in vitamins, take vitamin C and zinc supplementation but ask Dr. Sayed about other supplements. We have a list of ingredients we ask you to avoid in the immediate preop phase to optimize healing and minimize bleeding risk
- Designate a caretaker who can help you through the first 3-5 days after your liposuction, or longer if you have multiple areas treated
Maintain your weight at a target which we can set together based on your body mass index (BMI) – ideally, we’d like to help you get it below 30, but there is a reasonable range depending on other factors. In some cases, we may ask you to some weight preop to optimize your preoperative risk.