What techniques do liposuction surgeons use to ensure that the results are even?

Question

What techniques do liposuction surgeons use to ensure that the results are even and look great? Or is it a matter of equally removing the same amount of fat per side (e.g. same cc's for left love handle and the right)

Alan Gonzalez, MD, FACS · Answer

Hello @MsGisele, thank you for your question. The most important factor to look for in a specialist is experience, knowledge and expertise. A successful surgery depends on various techniques that are used, such as using the right cannulas and technology to cause the lesser trauma to the patient. Follow all recommendations after surgery on the patient's side. Best wishes! Alan Gonzalez MD, FACS. International Federation for Adipose Therapeutics and Science” Member (IFATS), American Society of Plastic Surgery Member (ASPS), Colombian Society of Plastic Surgery member (SCCP).

Daniel Barrett, MD · Answer

Dear MsGisele,
while there is always a chance for contour irregularities with liposuction, someone who takes their time and uses the appropriate sized cannulas should give you a superb result.I have all my patients wear compression garments and I use multiple sized cannulas to feather out the result.
Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

David Hansen, MD · Answer

Liposuction under tumescent local with the micro canulas allows you to be stood up and turned in all positions during the procedure to fine tune the results so everything comes out great.  It is so easy to undergo but is a special technique which most docs don't know or aren't trained in. If your doc does lipo under general anesthesia, you will almost never get a great result since there is no way to fine tune the results unless you can stand up during the procedure occasionally to actually see what you are doing.

Garrett Jones, DO · Answer

Liposuction surgeons use various techniques to ensure even results, including:1. Tumescent Technique: Injecting a solution into the targeted area to numb it, reduce blood loss, and make fat removal smoother.2. Cannula Design: Choosing an appropriate cannula (a thin tube used for suction) design for the specific area being treated to ensure precision and uniform fat removal.3. Cross-Hatching: Employing a crisscross pattern during the procedure to prevent uneven contours and ensure a smoother appearance.4. Monitoring and Control: Regularly assessing the patient’s symmetry during the procedure and adjusting techniques accordingly to achieve balanced results.5. Aspiration Control: Monitoring the amount of fat being removed and avoiding over-extraction, which can lead to uneven contours.6. Patient Positioning: Ensuring the patient is positioned correctly to allow for consistent access to target areas and maintain symmetry.7. Skill and Experience: A surgeon’s expertise and experience play a crucial role in achieving even results, as they can adapt techniques based on individual patient anatomy.It’s important for individuals considering liposuction to consult with a skilled and experienced surgeon to discuss specific concerns and expectations.

Darryl J. Blinski, MD · Answer

Interesting question..... I am one of the first boarded Plastic surgeons ever to offer liposuction in Florida (in 1982!). I believe there are 3 qualities or reasons to obtain "even" results. #1. Experience, Experience, Experience is the paramount reason; #2. Taking your time in surgery. Never be in a rush! Like the clinics are to do volume over results!; #3. Postop massages and follow up. So maybe you can see any surgery needs a surgeon with these qualities.

Mats Hagstrom, MD (license on probation) · Answer

Liposuction should be done methodically removing tiny particles of fat in a methodical manner. liposuction should not be done randomly in a haphazard manner but rather in a structured methodical pattern.
I sometimes use the analogy of painting and drawing to describe proper technique versus technique done by providers to get poor results.
Let’s start with why some providers get poor Liposuction results.
There are plenty of YouTube videos of people actually doing liposuction where you can see for yourself how providers approach the technique.
Imagine a four year old given a crayon and a coloring book.
Most children will randomly make little circles here and there trying to cover in the area that they are coloring.
It’s not particularly artistic or talented but we are dealing with four year old children and they do the best they can.
This is a bit how does lacking skill and experience do liposuction.
They randomly suction all over the place without any structure or pattern to how fat is removed.
To get more fat removed in a shorter amount of time they turned to aggressive larger cannulas.
They continue this haphazard unstructured way of removing fat until the patient looks thinner.
You don’t really see Liposuction results at the end of the procedure. The space where the fat was located is full of fluid and swelling.
As the swelling subsides the irregular uneven fat distribution that was created becomes apparent and by three months the results are final.
If the fat was removed correctly as smooth even the contour will have been created leaving the patient looking more or less the same but like they lost a crazy amount of weight.
If the fat was removed using poor technique than an uneven fat distribution was created in a cobblestone appearance has been created based on poor technique.
To imagine liposuction done with proper technique envision a professional painter. They typically start by using tape to tape off all trim areas, by placing a dropcloth and painting is done after properly prepping the surface. painting is done starting in one corner using a brush or roller slightly overlapping each line of paint until the entire surface is evenly covered. if a second coat of paint is needed the painter begins from the beginning and repeats the process. This is how Liposuction should be done. The surgeon should advance the cannula slightly between each pass removing an even an inconsistent amount of fat from each area. Think of it like the second hand on a clock. Each pass should advance the same distance to make sure the fat layer remains consistent. this approach is done from various openings coming from different angles to maintain an even and methodical pattern of fat removal.
Cannulas should be kept small even if the process takes several hours to make sure that is removed carefully without creating contour irregularities. surgeons cannot see what the final results will look like at the end of the procedure. surgeons instead relying an experience feeling of the thickness and evenness of the subcutaneous fat layer to make sure it is an appropriate thickness and is even.
Unfortunately the feedback loop from doing Liposuction it’s a bit long.
Surgeons typically will not see the outcome of how the surgery was performed until 3 to 6 months after surgery.
At that point there’s no recollection of how the surgery was actually performed.
Surgeons make notes about the total amount of fat removed but not how they actually did the procedure.
Because it takes such a long time to see the results the feedback loop is too long for surgeons to recognize that their own technique is responsible for poor outcomes.
Surgeons to do liposuction on a regular basis have a chance to see postop patients and do surgery back to back on a regular basis.
It is really the surgeons who do liposuction on a daily basis who end up mastering the procedure.
It certainly helped if they had a mentor during their training or early in their career show them how the procedure should be performed.
During my residency none of the attending surgeons ever made a point of teaching the residence how liposuction should or should not be performed.
It was considered a simplistic operation that was inherent and did not require teaching.
This attitude towards Liposuction is in many ways why so many plastic surgeons deliver such horrific outcomes as to the point of leaving patients disfigured.
Delivering consistent quality liposuction results is much more difficult than most people believe.
The reality is most plastic surgeons are not particularly good at Liposuction.
If you ask them they will I’ll tell you that they’re good at it. in reality most plastic surgeons are not as good as Liposuction as they think.
The number of plastic surgeons who have really mastered the procedure and can accurately predict outcomes and deliver consistent quality results is relatively few.
Because liposuction results are permanent and irreversible patients should be extremely cautious when it comes to choosing providers for this procedure.
Once performed if an outcome turns out poorly it is almost impossible to improve upon The outcome. 
To find the right provider I suggest patients have multiple in person consultations.
I recommend starting with at least five but consider scheduling many more.
Start the process by pre-screening plastic surgeons based on who has the greatest number of quality results on their websites.
Compare the number of Liposuction before and after pictures do all other procedures to make sure the surgeon has sufficient skill and experience.
If a plastic surgeon has 15 tummy tucks on their website but only for liposuction results and they are probably not the person to go to for Liposuction.
In reality it’s efficiently talented provider should have hundreds or even thousands of before and after pictures to choose from.
They should have no difficulty showing you at least 50 that’s a before and after pictures of the previous patient who had similar body characteristics to you.
When reviewing before and after pictures first and foremost you need to assess the patients have the same body characteristics as you do.
Liposuction results vary based on only two variables. The two variables are patient candidacy and surgeon skill. A substantial number of people seeking Liposuction are in fact not very good candidate for the procedure.
Somebody was not a good candidate for Liposuction is not going to get great results regardless of who does the procedure.
Patients need to understand their own candidacy for the procedure.
Accessing candidacy is not straightforward and there’s two requires a skill and experience on behalf of the surgeon.
A sufficiently talented provider should not have to guess what results are going to look like.
They should be able to accurately predict outcomes based on an assessment after examining a patient.
They should then be able to turn to their before and after pictures and find multiple examples of previous patients who had the same candidacy and show exactly what someone’s results are likely to look like.
When reviewing pictures look very carefully at all areas treated with Liposuction to make sure there are no skin contour irregularities anywhere. A correctly performed procedure should not leave a skin and contour irregularities. individuals who are not good candidates for liposuction such as those who have significant skin laxity may have undesirable contour irregularities and because of their skin laxity. The skin should not look worse but may also not be improved.
Skin laxity contribute significantly to body contour and skin laxity is the number one reason the patients failed to be good candidates for Liposuction.
Ideal liposuction candidates can be described by the three words “young, tight and pudgy”.
When reviewing before and after pictures and during a consultation make sure you ask the surgeon to point out exactly what areas were treated with Liposuction and what areas were not treated. You should then look very carefully at transition zones between treated and untreated areas to make sure they look natural.
The abdomen is by far the most commonly requested area for liposuction treatment.
Personally I view the torso as a single anatomic unit and prefer to treat the entire torso when doing abdominal liposuction.
By treating the entire torso as a single anatomic unit there are no transition zones between treated and untreated areas on the torso.
A full torso includes upper abdomen, lower abdomen, love handles (all the way to the top of the hip dip), waist, full back and under arms (armpit) all the way to the side of the breast.
In the end there are only two variables that determine Liposuction result. Candidacy and The skill of the surgeon.
Patients need to have a clear understanding of their own candidacy for the procedure in order to have clear expectations of what results are possible.
Only excellent candidates have the potential for having excellent outcomes.
Excellent candidates can be left disfigured by choosing providers who lack skill and experience.
To find the right provider I suggest starting by having at least five in person consultations and consider scheduling more if needed.
Find plastic surgeons who specialize exclusively in Liposuction or work for specialty Liposuction clinics.
Plastic surgeons who are good at liposuction generally enjoy their work and should be passionate about it.
The truth is a substantial number of plastic surgeons don’t like doing Liposuction. In reality it’s not very rewarding doing procedures that don’t turn out well.
Those who eventually master Liposuction are able to distinguish between those who are good candidates and those who are not and eventually get to the point where they can consistently deliver quality outcomes. The ability to deliver consistent outcomes and to differentiate who has the potential to get those outcomes is what differentiates those who have a master procedure from the rest.
Good luck,
Mats Hagstrom MD

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