Liposuction

What Happens during the procedure?

While there are various techniques (detailed below), liposuction in general entails the insertion of a narrow tube (cannula) through small incisions in the skin.  The incisions are small (1-2 cm) and their site chosen to ensure minimal scarring. 

The fat layer deep beneath the skin is then manipulated by the surgeon moving the tube vigorously from side to side and by pushing and pulling it to dislocate the fat.  The liquid deposits are then sucked up through the cannula either by vacuum pump or large syringe.  There are also various other ways to suck out the fat (described below).

In nearly all procedures, fluid (a mix of saline, local anesthetic and adrenaline) is passed down the cannula to ensure patients have minimal blood loss and ensure the safety of the liposuction, which is also removing fluids (blood included) from the body along with the fat.  

The intervention takes around one to one and a half hours or perhaps more.  It depends on the size of the area treated.  If small, localised areas are worked on, the operation can be carried out under local anesthetic and the patient may return to their accommodation later on the same day.  Otherwise, you may have to remain in hospital for one to two days for nursing staff to monitor, in particular,  the effect of your fluid loss.

Liposuction techniques

It is advisable to be clear at the consultation stage with your surgeon which method is recommended for your liposuction.  Several techniques are available and they all have their proponents and detractors.  There are some heightened risks and complications that can arise from certain methods, so be well informed about the various techniques and talk openly to your surgeon about them.

Wet Liposuction

In ‘wet’ liposuction, fluids are infused in the area via the cannula.  They contain saline (salt water) and epinephrine (a chemical which has the effect of minimising blood loss in the aspirate) and a local anesthetic. This fluid ‘replacement’ makes the whole procedure generally safer and helps reduce blood loss.   You can ask which specific solution and in what amounts will be used in your procedure.  The differences between them are down to their exact mix and the volume infused into the localised area.

Regular wet technique: you receive 100-300 millilitres of fluid in each area to be treated, sometimes without the epinephrine.  With this fluid proportion, it is likely that around 20 to 25 per cent of the liquid sucked out will be blood.

Super-wet technique: this involves a far greater infusion of fluid into the area to be treated – around the same amount is infused as is removed in fat.  With this method, only around one per cent of the liquid suctioned out is blood.

Tumescent technique:  This method uses a far greater proportion of fluid than even the super-wet technique.  You will have around three to six times more fluid infused than is removed in fat (aspirate).   There are known pros and cons to this method.  It is said that the volume of fluids can aid fat removal by swelling the tissues, but there is some risk that the surgeon won’t be able to mould the area well with the swelling obscuring the natural contours.  Also, the body may not react well to the influx of such volumes of fluid, which also includes anesthestic.  This latter risk needs weighing up seriously. (see also: Safety)

Dry Liposuction

This technique is rarely used these days as it was developed before wet techniques were pioneered.  It can result in greater blood loss and bruising, and with this method, up to 45 per cent of the aspirate sucked out can be blood. 

Fat break-up & removal techniques

The methods used to break up, dislodge and suck out the fat vary, according to their position and stubbornness.  Ask your surgeon for advice on the pros and cons of each method, and ensure you weigh up the costs and benefits involved for each. 

Regular suction-assisted liposuction

The surgeon manipulates the cannula to break up the fat nodes and sucks them out using a large syringe or vacuum pump.

Ultrasound-assisted liposuction

This method is used on stubborn fatty deposits such as those located on the back area.  It involves the insertion of a special cannula via other small incisions.  This ultra-sound cannula emits waves to break up the fat making it far easier to suck out.

Vaser-assisted Liposuction

Similar to ultrasound-assisted liposuction, this method is among the latest to evolve for the procedure.  It uses a cannula to emit sound waves but far gentler, so blood vessels and underlying tissues and nerves are far less likely to be damaged in the process. 

Power-assisted liposuction

This uses a motorised cannula but acts in the same way as the surgeon manipulating the cannula. 

Laser-assisted liposuction*

Here, a laser-fibre probe is inserted to give out small pulses of energy which liquefy the fat.  It is often referred to by its brand names:

• SmartLipo, and 
• Cool Lipo

*For more information, see our dedicated section on Smart Lipo Aspiration (laser-method liposuction).

Recovery / Convalescence

What to expect immediately

Many patients are able to go home on the day of the surgery, but some remain in the hospital for one or two days.  You stay in hospital depends on the extent of the area you had treated and any immediate complications such as fluid build up under the skin, infection or excessive swelling and pain.  You may have a drain fitted during your time in hospital to remove excess fluid build-up.  Any dissolvable stitches are absorbed within 10 days, but if you find there are embedded or erupt out of the skin, inform your doctor.

On your discharge, you will likely need to wear a support or pressure bandage or garment round the clock for three weeks and will probably need to keep it on during the day for a further three weeks.   This helps reduce swelling and ensure the skin moulds to its new underlying contours.  You are encouraged to take light walks very soon after surgery so as to prevent the risk of a thrombosis (blood clot). 

Recovery time from liposuction surgery is however relatively quick.  Most people are able to be up and about and resume normal, light routine within three days, and even go back to work within a week or less. 

Long-term care

While the signs of liposuction are fast, and permanent, you will take some time still to see the full benefits as your body adjusts to its new self.  Skin in particular may take some time to smooth to the new contours.

You can expect to get back to light exercise within two to four weeks, but each individual responds differently and you may find you still have slight discomfort from swelling and bruising for anything up to a month.  Scars fade over time, but you should let your doctor know if you have any problems healing or wound leakage. 

You are advised not to take up rigorous exercise before a month and to just continue with light walking and a gentle daily routine until your swelling has subsided completely.

Remember that liposuction removes fat not excess skin, so you may need to consider further cosmetic surgery, such as tummy tuck, if you are bothered by any sagging skin after your liposuction.

Also, avoid weight fluctuations as those too can rescind the some of the benefits of your liposuction. 

Safety

Liposuction is an extremely common procedure and has a very high safety record.  Most of the complications are short term and related to pain, swelling and bruising, or the need to drain off fluids from the treated area.

There are also safety issues relating to the various liposuction techniques.  It is best therefore to make an informed decision about which type of liposuction suits your needs.  There are some other risks and complications you need to be aware of and discuss at consultation stage. 

As with most cosmetic surgery, you may also feel that the results of your liposuction were as you intended.  There are no guarantees in cosmetic surgery, but rest assured that the majority of people find the benefits of liposuction are long term and feel physically and psychologically better having opted for it. 

All cosmetic surgery carries the risk of:

• Infection
• Allergic reaction to anesthetics or analgesics (or liquids used in Liposuction).
• Lack of wound healing (excessive bleeding – hematoma)
• Blood clot (possibly deep vein thrombosis, or cardiac or pulmonary risk)
• Fluid accumulation
• Ongoing, excessive pain and/or swelling
• The need for further, possibly corrective, surgery
• Uneven healing of the scar tissue or raised scar tissue (keloids)

What are the risks in Liposuction?

This list is not comprehensive and while most risks or complications are uncommon, you need to be aware of them before contemplating liposuction.

Scarring

Scars will be bright pink at first and then fade over time for about six months. If you notice they heal over the longer term in ridges (keloids), consult your surgeon as you may need minor corrective surgery.  If you find that leakage occurs from the scars, again, consult your surgeon as you may need antibiotics to prevent infection.

Fluid build up

This can happen as fluid from the intervention needs to be released, or it can occur in any cosmetic surgery.  Drains will be put in or their period extended if you needed them immediately post-op.
Fat circulating in the blood: this can cause a blockage in the lungs, known as pulmonary embolism.  This can be fatal.

Loss of feeling

You may find local areas treated remain numb, even for up to several months.  This can, in rare instances, be permanent. 

Damage to internal organs

This may require further surgery to correct.

Destabilising of the fluid composition of you body

This is caused by the pumping in and out of the fluids during wet liposuction.  Very rarely, this can cause patients breathing difficulties and can therefore be fatal.

Uneven areas

It is possible, though rare, that the fat removal has left an uneven look to areas treated. While this is generally avoided by the skilled cosmetic surgeon, it is possible the irregularity is permanent if fat cells have died off (fat necrosis – see below) as a result of the surgical intervention. 

Fat necrosis

This occurs at trauma spots caused during surgery.  When the abdominal wall is stretched, the blood supply to the remaining fat and skin may get damaged.  While rare, this can lead to the death of fat cells, which causes raised hard lumps.  Occasionally, an internal infection can result in these areas.

Skin necrosis

This occurs when the skin is stretched and the underlying blood supply is damaged.   
Cardiac & pulmonary complications and blood clots: While they are possible risks with all surgery, it is wise to speak carefully to your surgeon about your particular likelihood of developing these complications. 

Thrombophlebitis

inflammation of the veins (not the same as thrombosis, which is a blood clot) underneath your knee and inner part of upper thigh.  This can be overcome in weeks, if these areas are treated.