Liposuction

Liposuction is a form of invasive surgery in which localised deposits of fat are removed to reshape or reduce one or more areas of the body. It can be done for reconstructive or cosmetic reasons. Common areas treated include the thighs, buttocks, abdomen, arms, neck and under the chin.

This operation is also known as suction-assisted lipectomy, liposculpture or lipoplasty. It is not a substitute for weight loss and will not improve your general health. It is not an effective treatment for cellulite (dimpled skin that typically appears on the thighs, hips and buttocks) or for loose, saggy skin.

Why people consider liposuction#

Body image concerns are the main reason people consider liposuction. Some people who are within their healthy weight range have localised pockets of fat that do not respond well to diet or exercise. These fat deposits may be due to family traits rather than a lack of weight control or fitness.

Liposuction slims and reshapes these specific areas of the body by removing excess fat and improving body contours and proportion. Less commonly, it is used for reasons such as treating contour problems caused by repeated insulin injections, removing excess male breast tissue (gynaecomastia), or treating post-traumatic pseudolipoma (swelling that resembles a lipoma, a slow-growing fatty lump under the skin).

Where surgery should be performed#

For safety, surgery such as liposuction should be carried out only in a registered, licensed and accredited hospital or day-procedure facility. In many places, regulations require that procedures involving sedation or more than a low dose of local anaesthetic are performed in such facilities, and that larger-volume fat removal is not done in unregistered premises.

To check whether a facility is properly registered, you can ask to see its certificate of registration, which is usually displayed where consumers can see it easily. If you have concerns or suspect that a service is operating illegally, you can contact the relevant health regulator in your area.

Who liposuction suits#

Liposuction is best suited to people with a healthy weight and firm, elastic skin who have pockets of fat in certain areas. To be suitable, you should:

• be physically healthy
• have realistic expectations
• be aware of the limitations of the operation

Liposuction is most appropriate for bulges that persist despite a healthy diet and exercise. Although age is not a major concern, older people may have less skin elasticity and may not achieve the same results as a younger person with tighter skin.

Things to consider beforehand#

It is not a substitute for weight loss. If your skin is dimpled before liposuction, it will probably still be dimpled afterwards. If the “extra” skin does not contract (tighten) after surgery, you may need a further procedure to remove excess skin. The final results may take a few months to appear, so it is important to wait before deciding whether further surgery is needed.

Think about the financial cost. Cosmetic surgery does not usually qualify for rebates from public health programs or private health insurers. Ask your medical practitioner about any out-of-pocket costs you can expect and whether any rebate may apply.

Smokers are at increased risk of complications. To reduce this risk, and for your general health, try to quit smoking before having surgery. You may also wish to ask another medical practitioner for a second opinion. It is important to have as much information as possible before deciding to go ahead.

Finding a qualified practitioner#

At your first consultation, ask the medical practitioner about their training and experience. Liposuction is not a recognised medical specialty in many places, and specialised training may not be formally required, so it can be performed by a range of registered medical practitioners. It is preferable to have the procedure done by someone who is specially trained in liposuction and has considerable experience with the operation.

Your medical status#

Before having liposuction, discuss your current medical status with your medical practitioner, including:

• your physical health and past medical history, such as illnesses, surgeries, immunisations, and your current diet and exercise habits
• your blood pressure, temperature, heart rate and rhythm, oxygen saturation and respiratory rate
• your mental health, including any conditions and their treatments
• medications you currently take, including vitamins and supplements
• any allergies and past reactions to medications

From this discussion, your practitioner can assess the risks and possible complications for you, and explain what preparations will help your recovery go smoothly. A registered anaesthetist should be present to manage any adverse reaction to the anaesthetic.

What happens during surgery#

Liposuction can take place under either a local or general anaesthetic. The length of treatment depends on the technique chosen and the amount of fat to be removed. If only a small amount of fat and a limited number of sites are involved, it can be done under local anaesthesia, which numbs only the affected areas. Some people prefer general anaesthesia, particularly if a large volume of fat is being removed.

In general, the steps include:

• A tiny incision (cut) is made.
• A sterile fluid solution may be infused to reduce bleeding.
• A cannula (thin, hollow tube) is inserted and moved back and forth through the fat layer to break up the fat cells.
• The dislodged fat is suctioned out using a surgical vacuum pump or a large syringe attached to the cannula.
• Intravenous fluids are given during and after surgery to replace fluid lost when the fat is removed.

Depending on the number of areas treated, the procedure can take up to two hours. Liposuction is sometimes performed alone and sometimes combined with other surgery such as a facelift, breast reduction or abdominoplasty (“tummy tuck”). Follow-up surgery to reduce excess skin may be recommended, usually when large amounts of fat (often more than five litres) are removed.

Specific techniques include:

• Tumescent: fluids containing a local anaesthetic and saline are injected into the fat pocket; epinephrine helps constrict blood vessels and limit blood loss and bruising.
• Super-wet: the practitioner injects roughly the same amount of fluid as the amount of fat to be removed.
• Ultrasound-assisted: an ultrasound device is used to liquefy the fat to make it easier to remove.

Immediately after liposuction#

After the operation, you may expect:

• to be asked to start walking around as soon as possible to reduce swelling and help prevent blood clots in the legs
• bruising and swelling, with possible numbness and minor pain
• to wear a pressure garment over the treated area, often for about a week, to control swelling and help the skin adjust to its new shape
• to be given antibiotics to prevent infection
• a small drain to remain in place for a few days to prevent fluid build-up

Potential complications#

All surgery carries some degree of risk. The risks of liposuction increase if many areas are treated at once, or if the treated areas are large. Possible complications include:

• excessive fluid loss, which can lead to shock, or a build-up of fluid (including fluid in the lungs if too much is given)
• thermal or friction burns and other damage to skin, nerves or deeper tissues
• lignocaine toxicity if the solution’s lignocaine content is too high
• infection, which is serious because infections in fatty tissue are difficult to treat
• delayed healing and significant scarring
• irregular skin surface, uneven contours, rippling, or asymmetric or “baggy” skin
• changes in skin sensation, numbness, pigmentation changes or discolouration
• damage to deeper structures such as nerves, blood vessels, muscles, lungs and abdominal organs
• ongoing pain
• allergic reactions to medications
• blood clots or fat clots that may travel to the lungs and cause death, persistent leg swelling, deep vein thrombosis, and cardiac or lung complications

Further surgery may sometimes be needed to address complications. This is not a complete list; your medical history or lifestyle may put you at increased risk of certain complications, so speak to your medical practitioner for more information.

Self-care after liposuction#

Be guided by your medical practitioner. General suggestions include:

• take a few days off work to rest
• avoid strenuous activity for about a month as the body continues to heal
• see your practitioner about 7-10 days after surgery to have stitches removed
• continue wearing your pressure garment for several weeks if advised
• report any bleeding, unusual symptoms or severe pain promptly

Long-term outlook#

Your improved body contour appears as the swelling and fluid retention subside, which may take several months. Usually the extra skin will tighten after liposuction, although in some cases a procedure to remove excess skin is also needed.

Liposuction is considered permanent, but substantial weight gain afterwards can lead to further build-up of fatty tissue and affect the result. To keep enjoying the results in the longer term, control your weight and maintain a healthy lifestyle, such as eating a low-fat diet and getting enough exercise.

Alternatives to liposuction#

Alternatives can include:

• talking to a counsellor or psychologist, which may help you overcome concerns about your appearance, or help you decide that you like yourself the way you are
• eating a healthier, low-fat diet
• exercise
• massage

Key points#

• Common areas treated include the thighs, buttocks, abdomen, arms, neck and under the chin.
• Body image concerns are the main reason people consider liposuction.
• Smokers are at increased risk of complications.
• It is important to have as much information as possible before deciding to have liposuction.
• The length of treatment depends on the technique chosen and the amount of fat to be removed.

Where to get help#