The best candidates for liposuction are patients who are close to the ideal body weight and in reasonably good shape. They must be committed to a consistent regiment of diet and exercise to maintain their improvement in body countouring. Although the fat removed will not return in the treated areas, the procedure is not a free ticket to stray from your diet as fat can accumulate in other areas. Like many plastic surgery procedures, the thinner you are and the better shape you're in, the better your result.

About the Procedure
Liposuction concentrates on specific hard to lose areas. Even very thin patients who exercise religiously often have problem areas which are very hard to lose, particularly as they get older. These fat bulges are out of proportion to the surrounding areas and can be quite noticeable. In women, the most popular areas for liposuction are the lower abdomen, hips, inner thighs, outer thighs or saddlebags, back of the thigh below the buttock crease and the inside of the knees. In men, the most common areas treated are the flanks or love handles, abdomen and back. I see many patients in consultation who are at least 20 lbs. overweight but who want liposuction. These patients have too much total body fat instead of isolated areas of fat. Typically they do not see a significant improvement postoperatively and will be disappointed with the result. Since I don't want unhappy patients, I usually recommend that they get down to within 10-15 lbs. of their ideal weight before I perform liposuction so that a significant improvement in contouring will be achieved.

Tumescent Liposuction
The most common technique used today. A large volume of fluid containing a local anesthetic and adrenaline is injected into the areas to be suctioned. This allows for better postoperative pain control and less bleeding so that larger amounts of fat can be removed without the need for transfusion.

Ultrasonic Liposuction
Ultrasonic liposuction is used in addition to tumescent to help remove fat in difficult areas such as the breast and back. This creates even less bleeding than tumescent liposuction so that even larger volumes of fat can be safely removed without transfusion. By using sound waves to break up the fat rather than high pressure suction there is less trauma to the tissue and theoretically less postoperative swelling and bruising.

Type of Anesthesia
I typically use general anesthesia for patients having a significant amount of fat removed. Most of my patients don't want to be awake during the procedure. Patients have no recollection of the procedure and they are able to go home in about an hour. General anesthesia is very safe in healthy patients. Liposuction of smaller volumes of fat can often be safely and comfortably performed with local anesthesia and intravenous sedation. The procedure can frequently be performed in the office and patients can usually go home sooner.

Recovery
Patients are placed in a postoperative compression garment or girdle which is to be worn for one week without removing it. Wearing the garment as instructed is critical to keep swelling to a minimum. The crotch is cut out for hygiene purposes and patients must sponge bathe. Limited activity is recommended for the first week. Patients may then resume normal activity but should wait 2 weeks to resume exercise.

After the first week there is moderate bruising and swelling which usually resolves in a week or two. The sutures come out in 7-10 days. At that time patients are asked to wear a compressive garment such as spandex shorts or a panty girdle to help eliminate any residual swelling. All of the swelling takes about 3-4 months to completely resolve before a final result can be seen. During this time patients are encouraged to wear the garment as much as possible, particularly while on their feet.

Complications
Scarring - Small incisions about the size of a pencil eraser are made adjacent to each area to be suctioned. The resultant scars fade in time and in a few months are minimally visible.

Hematoma – A collection of blood under the skin where fat was removed can make the area appear extremely swollen. This usually completely resolves in 2-3 weeks without the need for drainage.

Numbness – Most patients will develop some loss of sensation where fat is removed. Sensation usually returns to normal in a few weeks.

Infection – Less than 1%. All patients receive preoperative intravenous antibiotics.

Contour Irregularities – While swelling is still present the suctioned areas feel firm and uneven. It takes 3-4 months for the areas to smooth out and firmness to resolve. About 15% of patients may have some permanent contour irregularities or unevenness which can easily be corrected by a touch up procedure.

For more information about Liposuction, before and after pictures, and to view a Liposuction procedure in 3D, visit the American Society of Plastic Surgeons website by clicking here.