Liposuction

Page last reviewed: 13/07/2011

Liposuction, also known as liposculpture or suction-assisted lipectomy, is a treatment to remove excess body fat. It is carried out on areas of the body where deposits of fat tend to collect, such as the buttocks, hips, thighs and abdomen. Other popular areas for liposuction are under the chin, neck, upper arms, breasts, knees, calves or ankles.

Liposuction permanently removes fat cells and can alter body shape. But the remaining fat cells can grow bigger, so weight loss is not necessarily permanent if a person continues to lead an unhealthy lifestyle after the operation.

Liposuction is not a treatment for obesity, and it will not remove cellulite or stretch marks. There is a limit to the amount of fat that can be safely removed, and the surgery carries a number of risks, such as infection, scarring and numbness.

Liposuction may also be used to treat some medical conditions, such as:

  • lipomas: non-cancerous tumours of fat
  • gynaecomastia: fatty breast tissue development in men
  • lipodystrophy syndrome: where fat is gained in one area of the body and lost from another as a side effect of some medicines that treat HIV

Page last reviewed: 13/07/2011

Liposuction is a cosmetic procedure carried out to improve a person's appearance, rather than their health. Many people find they can lose weight, tone up and reduce fatty areas with a combination of healthy eating and exercise.

Liposuction is only recommended if you have tried changing your lifestyle but it has not helped. The aim of the procedure is not to reduce weight but to improve your figure.

Liposuction is not a treatment for obesity. It can only be carried out on relatively small areas of your body and is not a long-term solution for weight loss. It is also not an effective method for removing cellulite or stretch marks.

Before choosing to have liposuction, discuss other options with your GP. Think carefully about why you think liposuction may benefit you.

If you choose liposuction, talk to your surgeon about what you are hoping to gain and what you can realistically expect before you decide to have the operation. While most people are generally pleased with the outcome of liposuction, the effects are often subtle rather than dramatic. The procedure should only be undertaken after a lot of thought.

Liposuction is occasionally used as part of the treatment of certain conditions, including the ones outlined below.

Lymphoedema

Lymphoedema is a condition where fluid (lymph fluid from the lymphatic system) accumulates in body tissue rather than being drained away. This causes swelling, numbness, discomfort and, sometimes, infection. It is most common in the arms and legs.

Lymphoedema is caused by an impaired lymphatic system. This can be a problem from birth, or caused by damage later in life through surgery, infection, radiation or injury.

The most common form of chronic lymphoedema in these isalnds is in women who have had treatment for breast cancer, such as removal of the lymph nodes or radiotherapy to the lymph nodes in the armpit. This causes their arms to swell.

Liposuction can be used to reduce the pain, discomfort and swelling of lymphoedema, but is only advised for the most severe cases. People who have this procedure have to wear a compression bandage for up to a year after the operation.

Gynaecomastia

Sometimes, fatty swellings that look like breasts can develop under a man's nipples. This condition is called gynaecomastia, and it is caused by a hormone imbalance or some forms of drug therapy. Liposuction can be used to remove these swellings.

Lipodystrophy syndrome

This is a condition where fat is gained in one area of the body and lost from another. It is a side effect of some medicines used to treat HIV (antiretrovirals).

The redistribution of fat can cause obvious physical changes and may be traumatic and stigmatising for some patients. Liposuction may be used as part of the treatment to improve the patient's appearance.

Extreme weight loss

This is where a person was morbidly obese (has a body mass index of 40 or more) but has lost a significant amount of weight as a result of a controlled dieting programme or surgery, such as a gastric band or bypass surgery. In this case, more surgical procedures may be needed to remove excess skin or correct any scarring or other abnormalities. Liposuction may be used as part of this process.

Page last reviewed: 13/07/2011

Any kind of cosmetic surgery, including liposuction, should not be undertaken lightly. You may feel it will improve your appearance, but it can be expensive and time-consuming, and there are a number of risks. The decision to have liposuction should only be taken after careful thought and questioning.

Do your research

If you feel that you will benefit from liposuction, it is important that you are as well informed as possible.

Talk to your GP to get information and general advice on the procedure. Look into the hospitals and clinics that perform liposuction. Do not be nervous about asking for information.

If you decide to find out more about liposuction, the Department of Health has a checklist of questions that can help you get all the details you need to make an informed decision on whether cosmetic surgery is right for you. See www.dohc.ie/cosmetic_procedures for more information.

Choosing a surgeon

To perform liposuction, a surgeon should be trained in both general and plastic surgery.

Surgeons who are trained in general surgery should have FRCSI (Fellow of the Royal College of Surgeons of Ireland ), or FRCS after their name. Surgeons who are also considered to be suitably trained in plastic surgery are listed on the Specialist Register of Plastic Surgeons, kept by the Medical Council ((www.medicalcouncil.ie).

When you find a surgeon, be honest and clear about your expectations of the procedure. Find out if liposuction can really give you the results you want. A surgeon should provide full details of the procedure before you decide to go ahead with it.

Arranging for surgery

You will be asked to sign an agreement before your liposuction procedure. Make sure you understand and are happy with the agreement before you sign.

The agreement should include details of cost. Make sure you understand what this covers, especially in terms of aftercare and any revision surgery (surgery to rectify any complications or problems) that may be needed. There may also be financial penalties if you decide to cancel the agreement.

Your records

The provider of your procedure, a private clinic or hospital for example, will retain a record of your treatment that may contain before and after photographs of you. Think about whether you would mind the provider showing these to other potential patients. The provider should ask your consent before showing any part of your records to other patients.

Page last reviewed: 13/07/2011

Before the operation

You will be asked to have general health tests before the operation to check that you are fit to undergo surgery.

Avoid aspirin and anti-inflammatory drugs for two weeks before your surgery. For women having an extensive operation, a surgeon may advise you to stop taking the contraceptive pill as well. If you are anaemic, taking an iron supplement may be recommended.

Before your operation, you will be asked to sign a consent form. This is to confirm that you understand the risks, benefits and possible alternatives to the operation.

The operation

The treatment area will be marked out on your body with a pen. You may be asked to have a photo taken of the area so that the results of the operation can be compared to how you looked before surgery.

Most liposuction operations take between one and four hours and are performed under general anaesthetic (when you are asleep). For treatments on the lower body, an epidural may be used, similar to that used for women in labour. This numbs the lower part of the body but leaves you awake.

A local anaesthetic (where only one area of the body is numbed and you are awake) is only suitable when liposuction is performed on very small areas of the body.

The surgeon will start by preparing the area where the fat is to be removed. Depending on the procedure, they will use one of the following techniques: 

  • Tumescent (wet) liposuction. This is the most common technique. A liquid solution is injected into the area being treated. It contains a mixture of local anaesthetic to numb the area, salt solution, and epinephrine (a drug that makes the blood vessels contract and reduces blood loss, bruising and post-operative swelling). The amount of liquid injected can be up to three times the volume of fat being removed.
  • Super-wet liposuction. This other method is known as the super-wet technique. This is similar to tumescent liposuction, but uses less fluid. With this technique, the surgeon injects a volume of solution equal to the amount of fat being removed. Super-wet liposuction may require you to have a separate anaesthetic, either intravenously (through a drip), or a general anaesthetic by injection.
  • Dry liposuction. This is when fat is removed without any fluid being injected first. This kind of liposuction can cause more bleeding and bruising. It is not used very often.
  • Ultrasound-assisted liposuction (UAL). Ultrasound-assisted liposuction was established as a liposuction preparation technique in 1996. Ultrasonic vibrations are used either above or below the skin to turn fat into liquid before it is sucked out. This is particularly useful for stubborn fat deposits. This technique may lengthen the time of the procedure, as it is often done in combination with tumescent liposuction.

After a preparation treatment has been given, the surgeon will make a small cut in the skin of the area to be treated. If the area being treated is large, several cuts may have to be made. 

A suction tube called a microcannula, which is attached to a specialist vacuum machine, is then inserted into the cut. The tube is first used to loosen then suck the fat out of the area.

When all the required fat has been sucked out, the surgeon drains out any excess fluid and blood using small drainage tubes. This may have to be done several times after the procedure.

Anaesthetic
Anaesthetic is a drug used to either numb a part of the body (local), or to put a patient to sleep (general) during surgery.
Blood
Blood supplies oxygen to the body and removes carbon dioxide. It is pumped around the body by the heart.
Blood vessels
Blood vessels are the tubes in which blood travels to and from parts of the body. The three main types of blood vessels are veins, arteries and capillaries.
Intravenously
Intravenous (IV) means the injection of blood, drugs or fluids into the bloodstream through a vein.
Local anaesthetic
A local anaesthetic is a drug that is injected by needle or applied as a cream, which causes a loss of feeling in a specific area of the body.
Numb
Numbness refers to a lack of sensation in a part of the body.
Ultrasound
Ultrasound scans are a way of producing pictures of inside the body using sound waves.
Swelling
Inflammation is the body's response to infection, irritation or injury, which causes redness, swelling, pain and sometimes a feeling of heat in the affected area.

Page last reviewed: 13/07/2011

Anaesthetic

If a general anaesthetic is used, you may have to stay in hospital overnight. If a local anaesthetic is used, it is possible to have liposuction as a day procedure. Following a general anaesthetic, you will not be able to drive and will need help at home for the first 24 hours.

Support bandages

After the procedure you will be fitted with an elasticated support corset or bandages for the treated area. This helps to reduce swelling and bruising, and should be worn for several weeks after the operation. They can be taken off to be cleaned. Your surgeon will advise on how long you need to wear it for.

Medication

You may have to take antibiotics straight after the procedure to reduce the risk of infection. Most people also take mild painkillers (analgesics) to ease the pain and swelling afterwards.

Aftercare

You will be given advice on aftercare for your stitches and bandages. You should be given a follow-up appointment to have your stitches removed.

Bruising and numbness

There will be considerable bruising to the area treated. The larger the area, the greater the bruising. Deep bruising and swelling may last for up to six months. There may also be some numbness in the area, which should go away in six to eight weeks.

Results

The difference to the shape and size of the area is most obvious once the swelling has gone down, but it may take up to six months for the area to settle completely. During this time, you might notice smaller changes and subtle differences to the area.

Numbness
Numbness refers to a lack of sensation in a part of the body.
Swellings
Inflammation is the body's response to infection, irritation or injury, which causes redness, swelling, pain and sometimes a feeling of heat in the affected area.

Page last reviewed: 13/07/2011

Like all surgical procedures, when you have liposuction, there are possible side effects and the risk of complications.

Side effects

Side effects of liposuction can include:

  • bad bruising, especially in patients who have a tendency to bleed or who have been taking aspirin or anti-inflammatory drugs
  • swelling, which may not settle for up to six months
  • inflammation of the treated areas and fluid oozing from the incisions (cuts)
  • scars from the incisions
  • thrombophlebitis (an inflammation of the veins), which is common inside the knee and on the inside of the upper thigh when these areas are treated
  • swollen ankles

Complications

Any major operation runs the risk of infection and excessive bleeding. Antibiotics may be needed to help prevent infection.

Other complications specific to liposuction include:

  • thrombosis, the clotting of blood within a blood vessel, which can obstruct or stop the flow of blood
  • lumpy and uneven results after the fat has been removed
  • bleeding under the skin, known as haematoma
  • pulmonary embolism, a potentially fatal blockage in the lungs caused by fat getting into the blood vessels and travelling to the lungs
  • numbness in the treated area that may last for months
  • damage to the internal organs from the procedure
  • a build-up of fluid in the lungs, known as pulmonary oedema, which can occur as a result of the fluid injected into the body
  • if the ultrasound method is used, there may be changes in skin colour and a loss of normal feeling in the area treated.
Swelling
Inflammation is the body's response to infection, irritation or injury, which causes redness, swelling, pain and sometimes a feeling of heat in the affected area.

Content provided by NHS Choices www.nhs.uk and adapted for Ireland by the Health A-Z.

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