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You are here: Anti-Aging Skin Treatments > Invasive Methods >
Most species, especially carnivors and omnivors, tend to efficiently convert excess food energy into body fat. This is understandable: when food supply is precarious, it is advantageous to have a body that can store up any surplus for future use. Humans are no exception. For millennia, and until very recently, our food supply tended to be scarce and unreliable. Hence our bodies evolved to efficiently accumulate food energy in the form of body fat, which helped survive in all-too-frequent lean times. Unfortunately, today this "wonderful" adaptation is usually a disadvantage.
In the modern world, at least in the developed countries, food is plentiful, relatively affordable and always available. Unfortunately, our physiology has not kept up with these rapid changes in our environment. Our bodies try to accumulate fat as if starvation is just around the corner. Furthermore, due to technological progress, our jobs are now less physically demanding and our commute rarely requires walking, leaving us fewer chances to burn excess calories. As a result, we gain too much weight, mostly as unsightly fat tissue, which, in the long run, is also potentially detrimental to health.
The situation is not hopeless though. We can watch our diet and add exercise to our daily routine as an artificial substitute for essential chores of our skinnier ancestors. These methods can help us lose weight and reduce those fat reserves. However, pockets of fat in certain parts of the body are very tenacious and hard to get rid of with a regimen of diet and exercise alone. This is where liposuction may have a role to play.
Liposuction, or lipoplasty (which translates as "suction-assisted fat removal" and "fat modeling") is a cosmetic surgery procedure that removes excess fat from different areas on the body, including thighs, buttocks, abdomen, breasts, upper arms and parts of the face and neck. It sculpts the body, making its contours more aesthetically appealing and eliminating unsightly pockets of fat.
Liposuction involves several small incisions through which a thin metal tube (a cannula) is placed into subcutaneous fat to remove it by suction (suction-assisted liposuction, or SAL). This creates tunnels within the fat layer, which later collapse, reducing subcutaneous fat deposits. With some techniques, fat can be treated by ultrasound or cannula movement to make removal easier. Despite recent improvements in liposuction techniques and their increased safety, only a limited amount of fat can be removed during a single operation. Generally, the larger the amount of fat removed, the greater the risk of complications. Although unverified claims have been made of larger amounts of fat lost by liposuction, the safe maximum (depending on the individual, the surgeon and on the technique used) is about 8 pounds of fat removed per operation. This means that liposuction cannot be a substitute for diet and exercise, nor can it be a weight-loss technique.
However, well-performed liposuction can remove fat from critical areas of the body making it look as if a larger amount of fat has been lost. As an additional benefit, fat removed by liposuction is gone permanently. Even if a person were to gain weight after liposuction, the treated areas would not accumulate fat because the fat cells are removed, and the individual would still look better after liposuction. New fat cells can develop in the body if the person gains more than 10% of his or her body weight.
Liposuction is the most commonly performed type of cosmetic surgery, with hundreds of thousands undergoing liposuction in the US each year.
A common argument goes something like this. Too much fat in the body is bad for your health. Liposuction removes some fat. Therefore liposuction should be good not just for your self-image and love life but for your health too. Unfortunately, the reality is more complicated. Not all body fat is created equal. The fat with the most negative impact on health is the so-called intra-abdominal fat, i.e. the fat wrapped around the major organs in the abdominal cavity. Removing intra-abdominal fat via liposuction is too dangerous and is never performed. Conversely, the fat between the skin and the muscle, i.e. the one targeted by liposuction, has relatively minor impact on overall health.
Furthermore, a 2011 University of Colorado study found that fat removed by liposuction comes back within about a year, albeit to different areas of the body (see our article on this downside of liposuction).
If you are considering liposuction, it should be for the right reasons, i.e. to improve your appearance. If your goal is to reduce the risk of disease related to excess body fat, diet and exercise remain your best option.
Liposuction was first developed in mid-1970s as "dry" liposuction and was a safer and more effective improvement over earlier surgical fat-removal techniques. Dry liposuction did not involve injections of liquid or local anesthetic in the area treated. However, it required general anesthesia, and up to 45% of the bodily tissue removed was blood. Surgeons often asked prospective patients to donate blood several weeks before liposuction because a transfusion would be required. An IV drip would also replace other bodily liquids lost during liposuction. Dry liposuction was a fairly risky procedure and is no longer used today.
The "wet" technique was a slight improvement: a relatively small amount (about 100 cc) of liquid local anesthetic is injected in the treated area, unsettling fat cells and making their removal easier. The blood loss was still significant (up to 20% of tissue removed) and general anesthesia was necessary. By the 1980s, the amount of liquid injected was increased to approximately the amount of fat to be removed in the so-called "super-wet technique", which cut the blood loss to 1% - 8% of total tissue removed. Super-wet liposuction is sometimes preferred for removal of large volumes of fat.
In a further development, the amount of liquid injected was increased to three or more times the amount of fat to be removed. The liquid contains local anesthetic and a vasoconstrictor (blood vessel narrowing agent). General anesthesia is now no longer needed, and less than an ounce of blood is lost. If done correctly and in moderate amounts, this technique, known as "tumescent liposuction" (from the Latin word meaning "swollen and firm"), is very safe and one of the most commonly used methods of liposuction. However, tumescent liposuction may not be appropriate for removal of large amounts of fat because it could lead to liquid overload and an overdose of anesthetic. Wet liposuction can be used for more extensive removal of fat.
More recently, laser-assisted and ultrasound-assisted liposuction (UAL) have been developed. However, laser is used only to make incisions, which does not provide any extra benefit vs. other surgical instruments. And UAL has been found to cause burns on skin and tissues from ultrasound paddles and probes. UAL was in vogue for several years, but currently many surgeons do not find it appealing.
The cost depends on the area treated and on how much fat is removed. Also, men have tougher fat than women do, which is more difficult and therefore more expensive to remove. The surgical fees for liposuction on one area usually range between $1,500 and $7,500, with jowls, neck, arms, back, flanks, buttocks, thighs and knees less expensive ($1,500 - $5,000 per area), and abdomen and breasts costing more ($3,000 - $7,500). Note that cost of general anesthesia and facility fee may be added to the surgical fees.
The cost of liposuction will also depend on the local cost of living and on the surgeon's skill and experience. The latter factors are very important for patient satisfaction and good results, so hunting for bargains may not be a good idea.
Individuals can go home about 30 minutes after tumescent liposuction, or two-three hours if general anesthesia was involved. There should be no pain in the first day after the surgery because of lingering local anesthetic effect; soreness may persist for up to four days, and then decline steadily. Lymph fluid may accumulate in the areas treated by liposuction, and seromas (accumulations) may form, causing swelling and pain. Some surgeons do not close the incisions completely, allowing serum to drain, which speeds up the recovery. Patients should wear elastic compression garments for up to six days to encourage drainage. They usually can retain to most activity within three days. Swelling should be mostly gone, and results apparent, within four weeks with tumescent liposuction, closing incisions with sutures extends the recovery time to 8-12 weeks, while UAL may cause swelling to persist even longer. Lipo incisions are usually small or hidden in natural folds and therefore should not become an aesthetic concern.
It is important to follow up with the surgeon a few days after liposuction to make sure no complications develop, which may include dangerous change of liquid balance, fat clots in the blood stream, or friction burns. Treated body areas may have a lumpy appearance at first, but become smoother after several weeks. Lumpiness, skin discoloration and skin necrosis are relatively minor complications, but they should be discussed with a physician to prevent them from becoming more severe problems.
Some people, especially those with below average skin elasticity, may develop skin sag in the areas where liposuction was performed. This may be addressed by skin tightening methods, such as skin needling or radiofrequency procedures.
A number of modifications/enhancements of the liposuction procedure have been developed in an attempt to minimize risks & side effects, reduce recovery time, and achieve other improvements.
One notable development is to enhance liposuction with targeted ultrasound. Ultrasound is used to break cellular membranes of fat cells without releasing fatty acids from triglycerides, thus minimizing damage to the surrounding tissue. Ultrasound-assisted liposuction reportedly has fewer side-effects and shorter recovery times. An example of commercial system based on this principle is VASER Lipo.
Another approach is based on bursting fat cells using a high-powered laser beam delivered via a thin (less than 2 mm diameter) probe. This approach is also said to be safer than conventional liposuction, with minimal downtime. Also, it can be performed with local rather than general anesthesia. The limitation of laser-assisted liposuction is that it appears suitable only for relatively small fat deposits, whereas major fat removal jobs do not qualify. An example of commercial system based on this principle is SmartLipo.
At least some of the modifications/enhancements of liposuction appear promising and address some of the shortcomings of the conventional procedure. However, there are relatively few studies comparing them to the conventional alternatives. It remains to be seen which liposuction enhancements, if any, will become mainstream.
After coming into its own with super-wet and tumescent techniques, liposuction became the golden standard of fat removal – a fairly safe and efficient procedure for eliminating persistent pockets of fat not affected by diet and exercise. By removing relatively small amounts of fat in critical areas, a surgeon may be able to achieve results as dramatic as loss of a much larger part of body weight. Effects of liposuction are permanent (those pesky fat cells are gone forever from the treated area) and even a moderate weight gain would not override them.
Liposuction is not a good treatment for weight loss because the amount of fat removed is relatively small, and may come back to other body parts anyway. Besides, the unhealthy intra-abdominal fat is not eligible for liposuction. Also, liposuction is not an effective treatment for cellulite because it does not affect skin and subcutaneous tissue. It works best as a cosmetic, body-sculpting procedure in individuals in good health and with good skin elasticity.
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