The popular cosmetic surgical procedure liposuction was first used successfully in 1982 in France. In its modern form, the method, which has been continuously refined, involves minimal bleeding, pain and discomfort, and potential for complications. Also known as lipoplasty, liposculpture, or suction lipectomy, liposuction is not a weight loss method. It is a way to sculpt the body by removing deposits of fat in individuals who are 10 to 15 pounds from their goal weight and have been unable to address the problem areas through diet and exercise.

Fat or adipose tissue forms deposits on the human body in locations that vary by gender. Men are most likely to have problems on their chests, abdomen and buttocks while women cope with issues on their abdomen, hips, waist, buttocks, and thighs. Liposuction can successfully contour these regions for an improved appearance and is also used for the removal of abnormal but benign fat tumors called lipomas. In the average cosmetic procedure, less than 10 lbs. of fat will be removed.

Humans have two layers of fat, deep and superficial. In liposuction, a hollow, stainless steel tube called a cannula is inserted via a small incision (approximately 1/4 to 1/3 of an inch in length) to reach the deep fat layer. Removing this layer greatly lessens the chance of damaging the patient’s skin. One of the requirements for a successful liposuction is good skin elasticity. In the absence of this elasticity, abdominioplasty or other “tucking” procedures may be required in conjunction with liposuction to achieve the desired level of improvement.

There are various methods used to liquefy the fat cells to allow for easier removal. In wet liposuction a solution of lidocaine (a local anesthetic), epinephrine (to contract the adjacent blood vessels), and saline is used. In a “super wet” procedure the volume of liquid used is roughly equal to the amount of fat to be removed. In tumescent liposuction the volume of fluid used will be 3 to 4 times the volume of fat so that greater space is created giving the cannula more room to work. There are also laser and ultrasound-assisted versions of the procedure where the fat is emulsified by either a diode laser emitter on the tip of the cannula or with ultrasound vibrations.

Regardless of the method used, the cannula is pushed and pulled through the layer of fat while an aspirator or suction device removes the loosened material. Depending on the number of areas to be treated, the method selected by the surgeon, and other factors relative to the patient’s overall health and physical condition, liposuction may be performed with a local anesthetic (and generally a mild sedative) or with a general anesthetic. (Generally a fluid IV is used in either case as it is important to maintain the patient’s correct fluid levels.) If the patient is awake they will feel mild sensations of movement and rasping in the area and will be able to hear the suction device. The length of the procedure can vary from one to three hours depending on the specific technique employed.

Patients who are smokers are counseled to quit two to three months prior to the procedure as nicotine in the body will cause greater bleeding. No anti-coagulants (such as aspirin, warfarin, or heparin) may be taken two weeks prior to liposuction. Individuals with poor circulation, diabetes, or coronary problems should first consult with their primary physicians.

On the day of the liposuction the patient will receive an antibiotic an hour before or after the procedure. Targeted areas will be marked with the individual standing and a sterilizing solution applied followed by the administration of the chosen form of anesthesia. Blood pressure and heart rate will be monitored. The surgeon may or may not suture the incisions when the work is completed. Some prefer to leave the incisions open for one or two days to allow for drainage. When any drainage has ceased, adhesive bandages are sufficient to cover the small wounds. (The incisions should not be soaked as in a tub bath until they are fully healed.)

Patients should expect to be asked to wear compression garments for two to three weeks following the procedure but will generally be up and walking the same day. If a general anesthetic has been used, a night in the hospital may be required. Normally only over-the-counter pain medications are needed with bruising and swelling subsiding in two weeks. Be aware that the final results of the procedure will not be completely evident for up to six months although a noticeable difference will be apparent within days.

With modern liposuction techniques the overall risk of complications is 0.7 percent (0.57% for minor and 0.14% for major complications.) The most serious potential complications would be allergic reactions, infection, skin damage or mottling, skin necrosis (dead skin), the puncture of an internal organ, irregular contouring, thromboembolism and fat embolisation (clots), burns, lideocaine toxicity, and fluid imbalance. All of these complications, however, are extremely rare.

Although the cost of the procedure will vary by region, surgeon selected, and amount of work to be done, on average for a single body area expect to pay from $2,000 to $7,000. The addition of a second region of the body will increase the cost by $1,200 to $4,000. Additional fees will apply for such things as lab tests, anesthesia, and post-surgical supplies like compression garments. In general, liposuction is not a procedure covered by insurance policies.