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Information, costs, and side effects
Good
candidates for liposuction:
- Is close to their ideal body weight (within 30%)
- Wants to remove specific areas of fat that are diet and exercise-resistant
- Weight has been stable for 6 months or more
- Has good skin tone and elasticity
- Does not have loose or saggy skin
- Has realistic expectations
- Is emotionally stable
- Understands the risks of surgery
If you do not meet all of these criteria, but meet some of them,
you may still be a good candidate for liposuction. The procedure is
most suited to those who are close to their ideal body weight. If
you have a lot of fat in a isolated area, you may still be a good
candidate. Some patients find liposuction to be a good incentive for
weight loss, but it is not a remedy for obesity.
If you have good skin tone, it is more likely that your skin
will respond well to the surgery. Patients with saggy skin or stretch
marks are more likely not to tighten and may in some cases look
worse. A thigh lift or tummy tuck (depending on your problem area)
may be more effective.
Patients planning to have large volume liposuction, which involves
the removal of more than 5 liters (5,000 cc's; about 11 pounds)
of fat and fluid may have an overnight stay at the hospital.
You are also at increased risk for complications from liposuction
if you have diabetes, poor circulation, heart, lung or liver disease,
smoke, have a family history of blood clots, take certain medications,
etc. You'll want to discuss your medical history thoroughly with
your physician before you choose to undergo surgery.
The
average cost of liposuction
Liposuction Cost Range: $2,000-$10,000
Average Total Cost: $8,500
Surgeons fee: $5,000
Anesthesiologist: $1,200
Facility fee: $1,700
Hospital fee: $600
Initial
consultation
At the initial visit, your doctor will likely ask you to describe
in detail what you would like improved. Be specific about what you
would like done. If your surgeon fully understands your expectations,
they'll be able to determine whether your goals are realistic. Your
physician will evaluate your overall weight, your skin and muscle
tone, and the distribution of fat deposits to determine which techniques
will be employed, where incisions will be made and what results
can be achieved. Your skin type, thickness and texture, your age,
if you are a smoker, and pre-existing sun damage will all effect
the final result.
Basic
procedures and techniques
Anesthesia: General or Sedation
Location: Hospital, surgical center or office
Surgery time: 30 minutes-4 hours
Quick Fact: Women have softer, less fibrous fat than men
- making it easier to perform lipo
Which type of liposuction?
There are two basic techniques used in liposuction: tumescent and
ultrasonic. Both techniques share core surgical elements. In fact,
even if ultrasound is used, it will be followed by tumescent liposuction.
Tumescent liposuction is also called standard liposuction, liposuction,
lipoplasty, liposculpture, liposculption, and suction-assisted lipoplasty.
This type of liposuction has been performed in the United States
since 1982. First, the surgeon fills the fat with tumescent fluid
(a solution containing saline and local anesthetic). Then, the fat
is suctioned with long thin rods. The procedure can now be performed
through a few small incisions, which can be hidden with natural
skin creases. The tumescent technique may reduce blood loss and
alleviate pain. The local anesthesia may be supplemented with intravenous
sedation or general anesthesia.
Ultrasonic liposuction also starts with filling the fat with tumescent
fluid to make the fat stiff. However, the fat is not suctioned,
but liquefied with high-frequency ultrasonic energy with a long
thin rod that emits ultrasonic waves. The rod is inserted into the
fat through a tiny incision and then, the fat is suctioned out.
There are other sub-categories of the two techniques:
Suction-assisted Liposuction (SAL): The traditional method, by which
the surgeon removes fat by inserting a small, hollow tube (cannula)
connected to a vacuum pressure unit, directing the cannula into
areas to be suctioned through tiny incisions.
Ultrasound-assisted Liposuction (UAL): Sound waves are transmitted
to the tip of the cannula to liquefy fat before it is removed by
suction.
External Ultrasound-assisted Liposuction (E-UAL): External ultrasound
waves alter fat cells. The area is injected with fluid containing
local anesthetic to transmit ultrasonic energy and liquefied fat
is removed by suction.
Power-assisted Liposuction (PAL): A cannula with a back and forth
motion of the tip passes through tissue to suction out fat and fibrous,
or scarred tissue with reduced effort.
VASER-assisted Liposuction (VAL): Intermittent, or continuous bursts
of ultrasonic energy can be used to break up fat cells which are
then removed by suction.
There is not a consensus among plastic surgeons as to which technique
is superior. There is slightly less blood loss and a greater ability
to remove fat in difficult areas with ultrasonic liposuction, but
it is also associated with greater complications than tumescent
liposuction such as burning and/or tingling, swelling, skin burns
and seromas (fluid collecting under the skin). Discuss these technique
with your surgeon. Because there are only small differences between
the procedures, the technique that your surgeon is most skilled
in will cause the least complications.
Anesthesia
Liposuction can be performed under general anesthesia (in which
you are completely asleep) or sedation (very relaxed in a light
sleep). It can be performed in the office or hospital. Depending
on how many areas are being worked on, surgery lasts from 30 minutes
to 5 hours. In addition to fat, the surgeon also removes body fluid
in the procedure. Because of this, patients are given fluids intravenously
during the operation and there is the possibility that a blood transfusion
will be necessary.
After surgery, you will wear a body-compression garment. You must
wear this for several weeks. After surgery, you can usually go home.
You'll want to make arrangements for a responsible adult to care
for you for the first 24-48 hours. If your surgeon performed a large-volume
liposuction (over 5 liters) then you should stay in the hospital
overnight for observation and safety.
Cellulite
Do not expect liposuction to improve your cellulite. It may actually
worsen it. This is because cellulite is due to superficial fat,
which liposuction does not remove. Lipo removes only deep fat.
Tummy Tuck vs. Liposuction of the Abdomen
If you have excess abdominal fat, no stretch marks and fairly good
skin tone, you are a good candidate for liposuction. If you have
stretch marks, loose skin and a loose inner girdle (all more likely
after pregnancy), a tummy tuck is probably your best choice.
Recovery
Pain Level: Varies depending on procedure (ranges from
mild to severe); 3-14 days of pain medication
Swelling: 2 weeks-2 months or more
Bruising: 2 days-2 weeks
Numbness: lasts several weeks
Bandages: Changed in 1-2 days
Work: Return after 1-3 weeks
Exercise: Wait 2-4 weeks
Final result: Seen after 1-6 months
For faster recovery:
• Drink adequate amounts
of liquids to prevent dehydration
• Avoid alcoholic beverages
for 48 hours before and after surgery
• Wear compression garments
as suggested
• Do NOT apply ice-packs
or a heating pad to skin on the liposuctioned areas
• Do NOT apply hydrogen
peroxide or plastic Band-Aids to incision sites
• Do NOT soak in a bath,
Jacuzzi, swimming pool, or the ocean for at least 7 days after surgery
in order to minimize the risk of infection
Reduce your risk of fainting at home by: standing up slowly after
urinating, remove compression garments slowly, have assistance for
your first shower, sit down if you feel dizzy or lightheaded.
Recovery from liposuction can be uncomfortable but most people are
back to work within 10 days. During the first few weeks, most people
experience varying degrees of pain, burning, swelling and temporary
numbness. Pain medications can alleviate discomfort (usually taken
for 2 days - 2 weeks) and a body-compression garment will minimize
swelling. You will need to refrain from any exercise other than
walking for about a week after the procedure. Slowly work your way
back to your old exercise routine.
Consider a massage therapist for lymphatic drainage massage to relieve
swelling and possible itching (discuss this with your doctor).
Although the new shape of your body usually begins to emerge in
the first few weeks, some swelling may remain for several months.
Major weight gain or loss after liposuction can produce skin surface
irregularities. The final result may not be clear until 6 months
after surgery.
Many people assume that because liposuction permanently removes
fat cells, it's impossible to regain weight in the treated areas.
This is only partially true. Adults have a fixed number of fat cells,
and liposuction removes some of these cells permanently. The remaining
fat cells can grow bigger, especially if you do not exercise and
maintain a healthy diet. This means problem spots can return. However,
weight gain after liposuction will usually be distributed to other
parts of your body instead of settling back into the old problem
areas.
Risks
and complications
Deaths related to liposuction surgery can happen for a number of
reasons: blood clot, perforation of the abdominal wall or bowels,
shock and hemodilution (blood dilution), and possibly excess amounts
of lidocaine.
Blood Clots
Blood clots (or deep venuous thrombosis, a DVT) can forms in the
deep veins of the pelvis or legs after any surgery. A blood clot
forms after prolonged immobility (people on international flights,
women on bedrest during pregnancy and patients recovering from surgery
are the most susceptible to blood clots). It is important to stand
often (at least once an hour), flex the feet more often and generally
keep the blood flowing in your legs. If the blood pools for too
long in one area, you could be at risk for a blood clot.
Perforation
Perforation of the abdominal wall or bowels is preventable during
surgery. Surgeons are limited in what they can see during surgery
and must take extra caution. Choosing an highly experienced surgeon
can reduce your risk of such complications.
Shock and hemodilution
Shock and blood dilution can occur after a patient has had excessive
amounts of fluid injected and then excessive amounts of fat and
body fluid removed (over 5,000 cc's, about 11 pounds). Large volume
liposuction should be considered carefully. It is generally not
recommended. However, there are surgeons that specialize in it (See
Reuters Health article).
Lidocaine
Lidocaine use poses particular hazards, especially since experts
do not agree on safe injectable levels. "If you get too much
lidocaine for too long," says Bruner, "the heart muscles
become lazy. On the other hand, the brain becomes very agitated
at first, which may cause a seizure, before coma sets in."
At least one study links possible lidocaine toxicity to liposuction
deaths. People with less than normal liver function or those who
have been drinking alcohol may not be able to metabolize lidocaine
well.
According to the FDA, a survey conducted by the American Society
of Plastic Surgeons (ASPS) of more than 1,500 plastic and reconstructive
surgeons in January 1999, there was an unexpected high death rate
of one in every 5,000 (or 20 out of 100,000) liposuction patients
between 1994 and 1998. These high numbers may be due to an increase
in unqualified surgeons performing liposuction during that period.
Since 1995, the number of deaths related to liposuction have decreased
dramatically, to around 1 in 100,000 (approximately 25 deaths out
of 250,000 liposuction procedures per year).
A study published in the scientific journal, Dermatologic Surgery,
shows that office-based liposuction may be significantly safer than
hospital-based liposuction. No deaths were reported by dermatologists
performing approximately 300,000 procedures from 1995 - 2000.
A review of malpractice claims from the Physicians Insurance Association
of America (PIAA) showed that of the 257 claims filed from January
1, 1995 through December 31,1997, less than 1 percent were against
dermatologists even though dermatologic surgeons perform more than
one-third of the liposuction procedures in the United States. In
addition, 89% of claims were against plastic surgeons, with patients
undergoing liposuction in a hospital setting accounting for 71%
of malpractice claims.
According to statistics from their respective professional organizations,
dermatologic surgeons currently perform about 100,000 liposuctions
annually, with plastic surgeons accounting for more than 170,000
fat removal procedures per year. "Our study found that liposuction
is safest when it is performed as a solo procedure under local (tumescent)
anesthesia in an outpatient setting by a board-certified dermatologic
surgeon. In fact, our data shows that there have been no deaths
from liposuction by dermatologic surgeons." William P. Coleman,
III, MD, president of the American Society for Dermatologic Surgery.
According to Dr. Coleman, more risks are associated with:
- extracting large amounts of fat
- using general anesthesia in a hospital setting
- performing multiple procedures during the same surgery
The PIAA study confirmed that patients who had liposuction performed
under local anesthesia using the tumescent technique had no fatalities
and fewer complications.
Source: www.asds-net.org
According to a study by the ASPS Liposuction Task Force, released
in October 1998, the rate of significant complications from liposuction
is low. The Task Force reviewed 24,295 liposuction surgeries performed
by board-certified plastic surgeons for the study and found that
only .03 percent reported significant complications.
Factors that increase the risk of complications include: large volume
liposuction, because of the use of greater amounts of fluid and
anesthesia, as well as removal of more fat; extended length of surgery;
multiple procedures; or a patient whose preoperative health is compromised.
In 1997 board certified plastic surgeons formed a task force to
investigate liposuction safety. Their research led to increased
efforts by ASAPS and other plastic surgery organizations to re-educate
plastic surgeons about risk reduction in lipoplasty procedures.
Several measures were identified as ways to increase patient safety,
including: 1) using stricter patient selection criteria, 2) limiting
the length of surgery, 3) avoiding pre-injection of excessive amounts
of fluid and local anesthetic, 4) removing a smaller volume of fat,
5) avoiding the combination of liposuction and certain other procedures,
and 6) careful postoperative monitoring.
Beginning in mid-1998, the safety record of lipoplasty performed
by board-certified plastic surgeons appears to have improved dramatically.
In May 2001, a major survey on lipoplasty safety was published in
Aesthetic Surgery Journal, the peer-reviewed journal of the American
Society for Aesthetic Plastic Surgery. The survey, covering many
thousands of lipoplasty procedures performed by ASAPS members from
September 1998 through August 2000, showed that the risk of death
from lipoplasty performed as an isolated procedure (not in combination
with any other surgeries) was 1 per 47,415 procedures, a nearly
10-fold decrease from rates suggested by earlier published surveys.
Scars
Surgical scars are permanent. However, usually only two
small incisions (less than 1/4") are made for each area. Incisions
are often placed in natural skin creases, are hidden in pubic hair,
or inside the belly button so that they are not normally noticeable
except on very close observation. Certain areas are easier to hide
than others.
To keep scar tissue soft and minimize their appearance, massage
them with scar minimizing/reduction creams such as Mederma, and
keep them out of the sun.
Scars by area:
Abdomen: at the belly button, bikini line, each side of
the abdomen
Arms: along the arm
Breasts: in the breast crease (under the breast)
Chin: under the chin and behind each ear
Knees: usually two tiny incisions per knee, in skin creases
Thighs: depends on fat location, usually on the edge of
suctioned area
Source:
www.surgery.org
For more information, view liposuction
before and after photos.
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