What is Liposuction?

Liposuction was developed in France in the late 1970's, and was introduced into North America in 1982. Since then, several hundred thousand people have chosen to have the procedure done. Liposuction is an operation that reduces localized collections of fat by means of a tube passed within the fatty tissue beneath the skin. The tube or "cannula" loosens the fat, which is then collected by a suction process. It is an operation that can be performed alone or in combination with direct skin and fat excision. Liposuction when used alone reduces the underlying fat and relies on the elasticity of normal youthful skin to contract and take up the slack. In some patients where there is poor skin elasticity such as severely stretched skin (e.g. after pregnancy or severe weight gain) or due to the loss of skin tone with advancing age, removal of only the fat results in wrinkling or sagging of the lax overlying skin. To prevent this in these situations the excess skin is surgically excised at the same time to tighten the skin as well or at a later date as a secondary procedure.

Who can benefit from the operation?

Liposuction is not a substitute for weight reduction that can be accomplished through dieting and exercise, nor is it a cure for generalized obesity. It is a surgical technique suitable for carefully selected patients. The optimal patient is someone who is generally slender however despite diet and exercise has a localized area of fat that cannot be lost (e.g. the thighs). Areas suitable for liposuction alone are fat collections of the thighs, buttocks, abdomen, arms, knees, calves, upper torso, neck and under the chin. In combination with direct surgical skin excision it is useful in the facelift, in breast reductions, in "tummy tucks", and other situations with lax skin. Due to technical limitations only 75% approximately of the fat in a given area can be removed at one time. While it is impossible to remove all the fat, some patients may benefit from repeat liposuction sessions to remove further fat.

How is Liposuction performed?

The surgery may be performed as daycare surgery under local or general anesthesia depending on the extent of the surgery. Small incisions (one to two cm.) are made about the involved area. A narrow, blunt-ended tubular instrument (cannula) with an open side port is inserted through the incision. A suction unit is attached to the cannula end. The surgeon moves the cannula back and forth through the fatty tissue beneath the skin loosening the fat, which is to be removed. High vacuum pressure is then applied and the fat is suctioned away. If to be combined with skin excision the excess skin is removed following the liposuction. Although it may sound like a relatively simple operation, special training and skills are required to perform the operation successfully.

What about scars?

Scar tissue is the normal product of the body's healing process, so surgery is not possible without scars. However, the incisions are made as small and obscure as possible. Patients requiring skin excision as well will have more significant scars. These can be discussed with Dr. Horton. You must follow postoperative activity and wound care instructions to promote healing.

The recovery period

There is some pain or discomfort for a week or two following surgery and usually requires use of medication for the first few days. Most patients notice a dull, muscular-type ache or a burning sensation. Numbness or discomfort may be experienced for varying periods of time. You will experience some bruising for two to four weeks and swelling that usually subsides in six to eight weeks.

You should be up and around in a few days for short periods of time. Most people return to work in about 3-7 days, depending on the extent of the surgery and the type of work they perform. The majority is back to most activities within two to three weeks. With most operations a compression garment (e.g. girdle) must be worn 24 hours a day for several weeks to months depending on the skin quality.

What results can I expect?

Patients with young, healthy elastic skin and who are of reasonably normal weight with localized areas of fat, are the best candidates for the operation. Overweight patients must be willing to accept a greater possibility of contour irregularities and poor skin re-draping in exchange for looking better in clothing. Persons with loss of skin elasticity may require surgical removal of excess skin as a secondary procedure to achieve maximum results, but a significant improvement should be visible.

Perfection and symmetry are not possible. The skin surface may not be completely smooth. If the skin is dimpled with "cellulite" before liposuction, this dimpled appearance may not be improved by the surgery and may be worse. It may not be possible to remove all unwanted fat.
The change in contour and proportion is permanent, but if you were to gain a great deal of weight, the treated area would enlarge along with the rest of the body.

What are the more common complications?

The basic mechanisms of infection, bleeding, delayed healing (circulatory compromise) and poor scar formation are complications in any surgery.
The complications of anesthesia, whether local or general, are part of the risk of even minor surgery. The most serious complication of anesthesia, which can occur, with any surgery is when blood clots form in the leg veins and dislodge travelling to the heart or lungs. This fortunately is very rare but can be fatal.

The most common problems are persisting contour defects or asymmetry. There is the possibility that the skin over the treated area will have rippled or uneven effect. If surface imperfections such as cellulite are present before the procedure, they will remain after the procedure. In some cases, permanent sagging of the skin may occur when the fat removed from the area exceeds that capacity of the skin to contract. "Touch up" liposuction may be required in some patients to improve contour irregularities. Fluid collection (old blood and/or serum) has a tendency to collect under the skin in some patients. This can be drawn off with a syringe until it stops forming. Rarely the bruising can result in permanent brown pigmentation, usually occurring on the ankles or inner thigh.