INTRODUCTION Liposuction is a technique that removes superficial fat deposits to improve body contour and reduce size. The surgeon, through a tiny incision, introduces a thin hollow tube beneath the skin called a cannula, which vacuums out unwanted fat. New techniques in liposuction in the past decade have improved the obainable results and the safety. In general, liposuction is useful for removing superficial fat deposits. In women, the most common areas operated on are the abdomen, hips, thighs, arms, and beneath the chin. Men more commonly request liposuction of the abdomen and flanks (love handles).

BEFORE LIPOSUCTION AFTER LIPOSUCTION CLICK ANY IMAGE TO ENLARGE AND FOR ADDITIONAL PATIENT EXAMPLES

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AM I A GOOD CANDIDATE FOR LIPOSUCTION?
The ideal candidate for liposuction is a person of normal stable weight who has stubborn fat pockets that don’t go away with diet and exercise. For example, a typical patient might be an athletic woman who has an upper body of size 8 and a lower body of size 10 due to heavy thighs. She would have liposuction of her thighs and hips to improve her proportion. Some patients with major body disproportion may be candidates for larger volume liposuction.

Ideally the best candidate for liposuction is the patient who is normal weight or slightly overweight (< 50 pounds above ideal body weight) and who has had a stable weight for over one year. Otherwise, if a patient has been steadily gaining weight and has liposuction, she will most likely continue to gain weight afterwards, as the surgery has not addressed the cause of the weight gain. People who gain weight after liposuction may retain their new proportion, but they may gain weight in other parts of their bodies where they do not normally deposit fat.

The patients who get the best results are people with good eating and exercise habits prior to surgery and who maintain these healthy habits after surgery.

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HOW LIPOSUCTION IS PERFORMED
Liposuction can sometimes be done under local anesthesia for smaller fat removals. Patients who are having larger volumes of fat removed will need general anesthesia to provide the utmost in safety. Tumescent technique: In our practice, all liposuction is done using tumescent technique (or super-wet technique), regardless of whether local or general anesthesia is used. This is really important as the tumescent technique adds a tremendous amount of safety to the operation.

This is how it works. Prior to beginning the liposuction, the surgeon injects the fat pocket to be suctioned with the "tumescent" fluid. This consists of saline solution, a local anesthetic agent called lidocaine (similar to novocaine used at the dentist) and epinephrine. The saline plumps up the fat cells, making removal easier. The local anesthetic numbs the area (this is even used when the patient is under general anesthesia as it lasts after surgery and reduces post-operative discomfort). Finally, the epinephrine makes the blood vessels in the fat shrink temporarily, so there is very little bleeding. This is what makes modern liposuction so safe today. Back in the 1980’s (prior to tumescent technique) liposuction caused a lot of bleeding and bruising and very little fat could be safely removed. Now, in certain circumstances, even large volumes of fat (10–20 pounds) can safely be removed with very little blood loss.

Once the tumescent solution has been put in and has taken effect, the liposuction is started. Through the same small incision, the liposuction cannula is inserted into the fat and the excessive fat is vacuumed out. In our practice we use very small cannulas to do the surgery. These small cannulas offer several advantages. They are more precise and greatly reduce the risk of skin irregularities. Also, the scar is tiny and difficult to see once it completely heals. However, the surgery may take a little longer and require more effort on the surgeon’s part, but we believe that it is well worth the extra time spent to get a better long term result.

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AFTERCARE
When the surgery is finished, the surgeon puts a compression garment over the operated areas. These garments are very important for safety as they reduce swelling and bruising. They also help the skin to shrink as much as possible. Some patients who have had larger volumes of fat removed require 2 layers of garments. Generally the garments are worn for 2 weeks to 2 months and occasionally longer.

Activity: We recommend gentle walking beginning the day of surgery. Most patients can resume their exercise programs 2–3 weeks after surgery.

Time off work: This varies according to each patient/ Small-volume patients can usually return to work in a few days; larger volume patients sometimes need 7 – 10 days of work.

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SMALL VOLUME LIPOSUCTION
We generally define small volume liposuction as having less than 2000 cc of fat and fluid removed. This translates to approximately 1–3 pounds of fat. Very small cases can be done with local anesthesia only, but many patients are more comfortable having some sedation. We always have a healthcare professional (nurse or anesthesiologist) monitoring all liposuction patients to create as safe an environment as possible.

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MEDIUM VOLUME LIPOSUCTION
We classify medium volume liposuction as ranging from 2000–5000 cc removed. (Approximately 3–7 pounds of fat). These cases are often done in the office operating room. These patients do best with either monitored sedation or epidural anesthesia. Monitored sedation involves intravenous relaxing medication given by either a registered nurse or anesthesiologist. Epidural anesthesia is administered by an anesthesiologist. This works by numbing the lower body during the surgery and is very effective.

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LARGE VOLUME LIPOSUCTION
This is defined as any case when over 5000 cc’s of fat and fluid are removed. (Generally 7 pounds or more). We perform all of these operations at the hospital. In fact, this is required in California. These cases usually require general anesthesia and an overnight stay in the hospital for utmost safety. The surgeon performing these cases should have experience and training in large volume liposuction. This operation is very safe when performed properly in a hospital setting by a well trained and experienced plastic surgeon.

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PRO’S OF LIPOSUCTION
Liposuction is a simple and effective way to remove stubborn fat deposits, improving body shape, proportion, and size. The down time is minimal compared to other surgeries, and there is minimal scarring.

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CON’S OF LIPOSUCTION
Liposuction is not a cure for an eating problem. People can still gain weight even if they have liposuction. We recommend that our patients have stable, healthy eating patterns prior to surgery. These patients get the best long term results, which can be permanent because actual fat cells are removed.

Liposuction is not a skin shrinking operation. Most patients’ skin contracts well and looks natural after surgery. Some patients, however, can get some loose skin following liposuction surgery. This is similar to losing a lot of weight on a diet. Furthermore, liposuction does not cure cellulite. Actually, nothing cures cellulite. Cellulite is the dimpling of the skin, and liposuction removes fat beneath the skin. Sometimes lipo can improve the appearance of cellulite a little bit, but we tell our patients not to count on it.

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POTENTIAL COMPLICATIONS
Surgery is surgery, even something described in a magazine as “a little lunch time lipo.” Properly performed liposuction is very safe, but even in the best of circumstances, rare complications can occur.

Bleeding: Major bleeding requiring a blood transfusion is extremely rare since the advent of tumescent liposuction.  To minimize the risk of bleeding, you should avoid all aspirin containing products and NSAIDS (Advil, Motrin, Alleve, etc.) for 3 weeks before surgery. Tylenol is fine to take for aches and pains and will not cause bleeding.
Infection: This is also very unusual. We routinely give all patients antibiotics during and after surgery to prevent this problem.

Blood clots: This is very rare in small and medium volume liposuction cases, but can occur up to 1% of the time in larger volume liposuction cases. If a blood clot (otherwise known as DVT for deep venous thrombosis) does occur, it needs to be treated promptly to prevent it from breaking off and going to the lung.

Skin irregularities: Although most patients’ skin looks normal after liposuction, some patients can develop skin irregularities. This is generally due to skin looseness. Every patient has unique skin, and the ability for skin to shrink following surgery depends upon many factors—age, sun damage, skin thickness, body location, amount of fat removed, and genetics. Before surgery, the doctor should advise each patient individually about potential skin irregularities.

Asymmetry: Occasionally slight asymmetry can occur even in the best of hands. However, if you are asymmetrical before surgery, you will most likely be a little asymmetric after surgery. Some post op asymmetries can be improved by a minor touch up procedure.

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SAFETY
Liposuction has gotten a lot of bad press recently in the wake of several tragic occurrences. The plastic surgery community is very concerned about these incidents and has taken steps to educate doctors and patients so preventable problems can be avoided.

Most of the deaths which occurred after liposuction, unfortunately, were preventable. Some problems resulted from untrained doctors performing liposuction, and some occurred after too much surgery was attempted under local anesthesia. Some problems occurred when patients failed to inform the surgeon of medical problems.To maximize your safety, we recommend the following guidelines:

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LONG TERM RESULTS
Liposuction can be permanent if the patient maintains his or her weight because the fat cells are permanently removed. People who gain weight after liposuction can sometimes regain in the operated area. Some can gain in other parts of the body. The more weight one gains, the higher the chance of fat redistribution.

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