Liposuction

What is liposuction?

Liposuction is a surgical procedure in which fat is removed from the body. It is usually the fat that lies under the skin that is removed. Liposuction is particularly good for removing extra deposits of fat or thinning areas where the fat is disproportionately thick. Liposuction may be combined with or used as part of other procedures such as tummy-tuck, breast reduction or a facelift.

Who might consider having liposuction?

Liposuction is best for treating areas where there is an extra accumulation of fat, or where the thickness of the fat is disproportionately large compared with the surrounding area. Any area of the body may be suitable but the most frequently treated areas in women are the hips, inner or outer thighs, tummies, arms and necks. In men the breasts, hips and tummies are the most frequently treated. Liposuction can also be used to treat lipomas. Lipomas are benign overgrowths of fat that are often removed surgically as they are unsightly or troublesome due to their size. Some may be treated with liposuction which enables them to be removed with minimal scarring. If there is any doubt about the diagnosis of lipoma then liposuction should not be used.

Which areas can be treated with liposuction?

 

Upper hips (‘love handles’ and ‘muffin tops’):

Many people lay down extra fat in this area. It is very effectively treated with liposuction and is one of the most popular sites for liposuction.

Lower hips or upper outer thighs (‘saddle bags’):

Many people, especially women, deposit extra fat in this area. It is very well treated with liposuction and is one of the most popular sites for liposuction in women.

Inner thighs:

The upper inner thighs can be reduced with liposuction but the skin tends to be looser and skin irregularities are more common. Many people are very happy with the results of liposuction in this area.

Thighs:

Discrete areas of fat are well treated with liposuction. The bulge on the inside of the knee is an area that many women ask to have reduced.

Calves:

Calves can undergo liposuction.

Tummy:

As long as the skin will retract liposuction is very good for the tummy. Often if the skin is loose then a tummy tuck operation will achieve a better result.

Back:

Discrete areas of fat on the back can be treated with liposuciton.

Male breasts (gynaecomastia):

Liposuction for the male breast has become a very popular treatment to reduce breasts in men. It does not work so well if there is a significant amount of glandular tissue in the breast. Glandular tissue usually feels firmer than fat.

Female breasts:

Liposuction can be used to reduce female breast size. However it is more usual to remove skin and reposition the nipple when doing a breast reduction in a women so liposuction is not normally used. It may be used as part of a breast reduction particularly down the side of the chest.

Upper arms:

Liposuction is useful for reducing excess fat in the upper arms.

Neck:

The front of the neck often accumulates excess fat and liposuction can be an effective way of removing it.

Lipodystrophy:

Lipodystrophy is a medical condition, sometimes caused by medicinal drugs, where the body lays down excess fat. Liposuction can be useful in helping to reduce the excess. A good example is the fat that builds up in some diabetics in the area where they inject their insulin.

Lipomas:

Lipomas are benign fatty tumours which are not malignant. They are easily removed surgically but this leaves a scar. Where scarring will be unsightly or a poor scar is anticipated then liposuction is an option. It must be appreciated that not all the lipoma may be removed and there is a higher likelihood of it growing back.

What should I expect when having liposuction?

You are admitted to hospital on the day of your operation. The time you come in varies on when your operation is scheduled. The operation is most frequently carried out under a general anaesthetic (asleep) but smaller areas can be treated under local anaesthetic. The duration of the operation varies entirely with the number of areas being treated and the amount of fat to be removed. It can take a few minutes or up to 3 hours. The stitches used are absorbable (‘dissolving’) and are placed under the skin, so that you can not see them. A dressing is place over the wounds at the end of the operation. Drain tubes are almost never used. You are normally placed in a garment or elasticated ‘stocking’ at the end of the operation and it is recommended that you wear this for 4 weeks. You will be prescribed regular painkillers while you are in hospital and to take home. You are offered a dressing check one week after surgery and you have a follow up consultation with your surgeon four weeks after the operation. If you are worried at any time after you have gone home you can phone the ward, phone the cosmetic nurse advisor or the consultant’s secretary for advice. If necessary you can return to the ward at any time for a check (please phone first).

How is liposuction done?

Liposuction may be carried out under local (injection to numb the area) or general anaesthetic (asleep). The area to be treated is first infiltrated with fluid. This approach is often called the wet technique, the superwet technique or the tumescent technique depending on the amount of fluid used. The fluid is a balanced salt solution very similar to normal body fluid. To this is added local anaesthetic to numb the area and adrenalin to reduce bleeding. A small incision of about a quarter of an inch (5mm) is made next to the area to be treated. A cannula (tube) is then passed through the incision into the fat. This is connected to suction. The tube is then passed backwards and forward through the fat and the suction sucks the fat out. With wet and tumescent techniques there is usually very little bleeding. Usually each area is treated from 2 directions ideally at 90 degrees to each other. This helps to give a more even result, but does usually result in 2 scars for each area treated. The incision is closed with an absorbable (‘dissolving’) stitch.

Dry versus wet, super-wet and tumescent liposuction

The original technique for liposuction involved sucking out fat with no preparation and is now often referred to as dry liposuction. This frequently caused significant bleeding and is no longer widely used. Mr Hurren never uses dry liposuction. With modern liposuction the tissues are usually prepared with the infiltration of fluid. This fluid is a balanced solution of salts similar to the composition of body fluid. It may contain adrenalin, local anaesthetic and bicarbonate to make it less acidic. Injecting this fluid into the tissues is referred to as the wet technique. Over time the amount of fluid that surgeons inject has tended to increase as it has been found to be so effective in reducing bleeding and pain. The higher volume techniques are called the super-wet and tumescent liposuction techniques. Mr Hurren routinely uses the super-wet or tumescent techniques.

Will I put the fat back on in the same place?

Fat is a living tissue. The fat is laid down in fat cells (adipocytes) which act as storage depots. As you get fatter, so the fat cells swell up with more fat. Liposuction removes the fat and the fat cells. If you put on weight after liposuction these fat stores no longer exist and so the fat cannot be stored there. In practice, the body can make a limited number of new fat cells from stem cells but in general you are unlikely to put the fat back on in the same place.

What do the scars look like?

The scars are short, usually about a quarter of an inch or 5mm. Often they can be placed in an inconspicuous site such as the tummy button or fold under the breast. Scars usually stay pink for several months then fade to pale. Abnormal scarring is always a possibility with surgery (see scarring under risks below).

How long will I need to recover from liposuction?

People vary in the time they need to recover from liposuction. As the amount of liposuction carried varies from one person to another this also affects the recovery time. The following gives some idea. Some people will require less time and others more. If you experienced complications then recovery may take longer.

When can I go home from hospital?

Most people go home from hospital on the same day or the day after surgery.

When can I shower or have a bath?

There is usually no problem in having a shower after 48 hours. Soaking the wounds for long periods in the bath is best avoided until the wounds are fully healed, usually at least 2 weeks .

When can I start driving a car?

It is illegal to drive with in 48 hours of a general anaesthetic. Most people return to driving after 1 to 2 weeks after surgery. The most important consideration is that you feel comfortable and safe to drive. However some people feel able to drive within a day or two if they have not had a general anaesthetic. You have to be able to react appropriately in an emergency. If you are taking medication such as painkillers you need to check and consider whether these may affect your ability to drive.

When can I return to work?

Usually people return to office type work about one to two weeks after surgery, although some people will need only a few days. Some people are back sooner or work from home. More active work may require longer. Very active work may require 4 to 6 weeks off vigorous activity. You will need to be guided by your body, if you are causing pain and swelling you may be doing too much.

When can I start picking things up?

Lifting is not a particular issue following liposuction. There is no reason why you should not lift anything you would have lifted before. The best guide is your body so if it hurts or causes swelling then you may be doing too much.

When can I go back to exercise / the gym?

Walking only for 2 weeks after surgery. Light exercise 2-4 weeks. Back to normal 4-6 weeks.

When can I start swimming?

You should avoid swimming until the wounds are fully healed. You should normally avoid swimming for 2-4 weeks following surgery.

When can I have sex again?

Sex should be avoided until the wounds are fully healed and you feel comfortable and ready. Sex will not do any actual harm as long the treated areas are not squashed and the scars are not strained.

When will I be back to normal?

Most people feel they get back to normal between 4 and 6 weeks after surgery although the tissues may still be tender at this stage.

What are the risks of having liposuction?

The great majority of healthy people undergoing a liposuction have an uneventful recovery and are very pleased with the outcome of their surgery. However as with all surgery there is the potential for complications. Complications include those of having a general anaesthetic, complications that may occur with any operation and those that are particular for liposuction.

General anaesthetic.

There are the risks of having a general anaesthetic such as allergic reactions, chest problems such as a chest infection and the possibility of clots in the legs (deep vein thrombosis). Underlying medical conditions e.g. asthma can be aggravated. Where there is heart disease or the blood vessels to the brain are diseased there is the risk of heart attacks or strokes. In general if you are healthy, modern general anaesthetics are very safe. If you are concerned about your anaesthetic we can arrange for you to meet with an anaesthetist before your surgery to discuss your concerns.

Local anaesthetic:

Local anaesthetic is a drug which is injected into the tissues to stop the sensation of pain. Operations including liposuction can be carried out with local anaesthetic with the patient awake. With liposuction under local anaesthetic there is a small risk of over dose from the local anaesthetic. In practice this is very rare because the anaesthetic is used in low concentration.

Bleeding and haematoma:

Liposuction may cause bleeding. The use of wet or tumescent techniques reduces bleeding. A build up of bleeding under the skin may cause a lump called a haematoma. This may be felt as a hard tender lump. Usually these resolve over time but can take weeks or months. It would be most unusual to need a blood transfusion following liposuction.

Skin necrosis:

Liposuction can reduce the blood supply to the skin and rarely the skin overlying the treated area can die. This may result in the need for further surgery. Healing may be slow and the scarring after it has healed, poor. These complications are more likely if you are overweight, a smoker or have other medical conditions such as diabeties. In healthy non smoking people this is a very rare complication.

Infection and slow wound healing:

Infection can occur following liposuction. Most wound infections settle down with a short course of antibiotics. A serious wound infection could lead to skin necrosis as described above. Infection is more likely if you are overweight, a smoker or have other medical conditions such as diabeties. In healthy non-smoking people this is a very rare complication.

Damage to deep structures:

There have been reports of damage to structures of the body. With liposuction to the abdomen there is the risk of the cannula passing into the abdomen. This could cause bowel perforation and peritonitis. This would represent a very serious complication. With a well trained and experienced surgeon the risk should be very low. With liposuction to the upper trunk the same risk applies to the chest. Liposuction to the neck carries a particular risk of damage to a branch of the facial nerve. This can lead to asymmetry of the mouth which may be more obvious with movement e.g. smiling. Usually this is caused by stretching of the nerve and it recovers but this can take a few months.

Seroma:

Seroma is a build up of tissue fluid in the wound. This causes swelling which may need to be drained but usually resolves on its own.

Scarring:

Scars vary from one person to another. Most scars stay pink for several months then fade to pale. Some scars can be thin pale lines but this can never be guaranteed. Poor scars may stretch and be wide. Scars may stay red or become pigmented (brown). Sometimes scars become lumpy, hypertrophic or keloid.

Over or under correction:

The amount of fat to be removed with liposuction is a matter for clinical judgment. There is the possibility that too much fat is removed or that you feel not enough fat has been removed. It is generally better to remove too little rather than too much as it is easier to remove more later than to put fat back.

Skin irregularities and laxity:

The elasticity of the skin is very important in the end result from liposuction. If the skin has little elasticity it is more likely that the skin will show irregularities following liposuction. With larger amounts of fat removal there is the possibility that the skin will be loose and wrinkled following the procedure.

Lumpy tenderness:

Following liposuction the tissues under the skin tend to swell, may feel hard and be tender. This usually settles over a few weeks. In some people this may take longer but usually settles over a few months. Permanent lumpy tenderness is rare.

Unrealistic expectations:

It is important to have realistic expectations of what surgery can achieve for you. Remember you can always return for a further consultation to discuss your surgery before you actually have the operation. You must also realise that surgery does not change you as a person. You should not have surgery for or to please someone else.

Deep vein thrombosis (DVT):

Deep vein thrombosis is where the blood in the deep veins of the leg clots (thrombosis). This can follow any operation which involves a general anaesthetic or results in immobility. Liposuction carried out under general anaesthetic particualry if mobility is reduced afterwards carries a risk of DVT. A serious complication of a DVT is where a thrombus breaks off and travels to the lungs in what is called a pulmonary embolus or PE. A large PE can be fatal. During your operation and time in hospital we will take measures to protect you from DVT formation although these can not guarantee complete protection. Once you go home the best protection is regular walking.

What else should I consider?

Your weight: Ideally liposuction should be carried out when you are at the correct weight for your height and your weight is stable. Liposuction can be carried out on people who are overweight but the risks of complications are increased.

What are the alternatives?

 

Corset

A corset is a simple way of controlling extra skin and fat on the tummy. It is simpler, cheaper and risk free!

Weight reduction

Liposuction should not be considered an alternative to weight reduction with diet and exercise. It is best carried out when you are at a normal, stable weight.

Tummy tuck

If there is a significant excess of skin on your tummy then a tummy tuck or mini tummy tuck may give a better result.

Arm and thigh reduction

If there is a significant excess of skin on your arms or thighs, then an arm or thigh reduction may give a better result.