Liposuction: Facts Vs. Myth

ABC7’s The More in the Morning team spoke with Dr. Michael K. Kim, Board-Certified Plastic Surgeon, to examine liposuction and some surprising things you may not have known about plastic surgery’s most common procedure.

When thinking about plastic surgery, liposuction is one of the first procedures that comes to mind. It is by far, one of the most common surgeries performed by plastic surgeons after breast enhancements and rhinoplasty. Liposuction is a surgical procedure that uses a suction technique to remove fat from specific areas of the body, such as the abdomen, hips, thighs, buttocks, arms, or neck. Liposuction also shapes (contours) these areas. Other names for liposuction include lipoplasty and body contouring. In light of such popularity, it is surprising how many misconceptions about it persist.

History and Origin of Liposuction

The roots of liposuction can be traced back as far as the 1920s when French surgeon Charles Dujarier first introduced the concept of body contouring and fat removal. However, after a procedure performed by Dujarier caused gangrene in the leg of the model, interest in the concept of body contouring was lost in the decades following.

In 1974, interest in liposuction was reignited, when doctors Arpad and Giorgio Fischer working in Rome, Italy, developed the blunt tunneling technique from which modern liposuction evolved. Consistency of results using this technique could be assured.

However, liposuction truly became popular in the 80s. First, in 1982, a French surgeon called Dr. Yves-Gerard Illouz presented the “Illouz Method,” demonstrating a suction-assisted method for removing fat cells, using cannulas to inject fluid into various tissues to break up the fat deposits that were subsequently sucked away. The results of this technique demonstrated high reproducibility and lower risk. Following this, the introduction of lidocaine as a local anesthetic, as well as modifications to the surgical techniques and using compression techniques after surgery, made the procedure less painful. And then finally in the 1980s, American physicians started to experiment with surgical techniques and sedation methods that eliminated the need for general anesthesia, making the surgery much safer.

A huge development in the late 1990s was the introduction of ultrasound use for liquefying fat for easier removal. Developments such as this have led to improvements in the liposuction technique that mean fat can now be removed more easily and with less pain, blood loss, and other associated complications. Liposuction was now becoming mainstream and more accessible.

The Experts

Most people would know that liposuction is performed by board-certified plastic surgeons. But less well-known is the fact that Dermatologists and many other types of surgeons with appropriate training and certifications can also perform this procedure. It is for this reason, however, very important for patients to do their due diligence and obtain appropriate physician background information, credentials, and/or second opinions.

Not Just One but FOUR Types of Liposuction

How your liposuction procedure is done depends on the specific technique that's used. Your surgeon will select the appropriate technique based on your treatment goals, the area of your body to be treated, and whether you have had other liposuction procedures in the past.

  • Tumescent liposuction: This is the most common type of liposuction. The surgeon injects a sterile solution — a mixture of salt water, which aids fat removal, an anesthetic (lidocaine) to relieve pain and a drug (epinephrine) that causes the blood vessels to constrict — into the area that's being treated. The fluid mixture causes the affected area to swell and stiffen. The surgeon then makes small cuts into your skin and inserts a thin tube called a cannula under your skin. The cannula is connected to a vacuum that suctions fat and fluids from your body. Your body fluid may be replenished through an intravenous (IV) line.
  • Ultrasound-assisted liposuction (UAL): This type of liposuction is sometimes used in conjunction with traditional liposuction. During UAL, the surgeon inserts a metal rod that emits ultrasonic energy under your skin. This ruptures the fat-cell walls and breaks down the fat for easier removal. A new generation of UAL called VASER-assisted liposuction uses a device that may improve skin contouring and reduce the chance of skin injuries.
  • Laser-assisted liposuction (LAL): This technique uses high-intensity laser light to break down fat for removal. During LAL, the surgeon inserts a laser fiber through a small incision in the skin and emulsifies fat deposits. The fat is then removed via a cannula.
  • Power-assisted liposuction (PAL) This type of liposuction uses a cannula that moves in a rapid back-and-forth motion. This vibration allows the surgeon to pull out tough fat more easily and faster. PAL may sometimes cause less pain and swelling and can allow the surgeon to remove fat with more precision. Your surgeon may select this technique if large volumes of fat need to be removed or if you've had a previous liposuction procedure.

Permanence, Fat Distribution, and Skin

Liposuction is "permanent," in that once the fat cells are suctioned out, they will not grow back. However, there will still be some remaining fat cells that can grow in size and expand the area if one's calorie intake is excessive. The best way to prevent this and protect the desired resulting contour changes after liposuction is to maintain a stable weight via a healthy diet and exercise regimen. For example, if you gain weight after liposuction, your fat distribution may change, and although the spot reduction of fat in the target area is retained, other areas may see an accumulation. Your body may be accustomed to a certain amount of fat storage available and so, some surgeons may try to offset any disproportionate effects by redistributing the removed fat into other desired areas such as buttocks or breasts, thereby maintaining the body’s fat storage capacity. This may assist in unwanted accumulation in undesired areas, such as arms and legs.

Another misconception is the assumption that liposuction is the ultimate solution to belly fat. Liposuction targets only subcutaneous fat – the kind that is located below the skin and above the muscle. An abdomen that protrudes due to fat under the muscle and around the internal organs (known as visceral or intra-abdominal fat) will not be improved with liposuction. Appropriate exercise and diet are the only effective methods to combat visceral fat.

After liposuction, the skin molds itself to the new contours of the treated areas. If you have good skin tone and elasticity, as an ideal candidate, the skin is likely to appear smooth. If your skin is thin with poor elasticity, however, the skin in the treated areas may appear loose.

Liposuction doesn't improve cellulite dimpling or other skin surface irregularities. Cellulite is not simply an irregular pocket of fat – it occurs when subcutaneous fat pushes connective tissue bands beneath the skin, causing those characteristic dimples and bumps. Because liposuction is only able to remove soft, fatty tissue (and does not directly affect the skin or other tissues), the fibrous connecting bands causing cellulite are not altered. Likewise, liposuction doesn't remove stretch marks. In cases of sagging skin with reduced elasticity, your surgeon may recommend a skin tightening procedure instead of (or in conjunction with) liposuction, as liposuction alone may result in a deflated appearance. These other skin procedures will often either contract the skin or promote collagen and/or elastin production.

A final surprise is that almost always final results take more time than is often assumed to present in the new contours of the body. Often drainage, compression wear, or bandages are required for some time after. Also, during recovery, expect some contour irregularities as the remaining fat settles into position.

Candidate Eligibility

Considered a cosmetic rather than a health-focused procedure, liposuction is not a treatment for weight loss or obesity. To be a good candidate for liposuction, you should be within 30% of your ideal body weight. Liposuction removes localized fat deposits that have not responded to exercise and diet. This candidate has spot-specific fat accumulation but otherwise has a stable body weight. This type of fat is more likely due to genes than lifestyle. To benefit, you should be fit, active, and a nonsmoker. If weight loss is the primary goal, diet, exercise or bariatric procedure should be explored first.

Additionally, as stated earlier, liposuction works best for people with good skin tone and elasticity for the skin to mold well to the new contours of the body, for an aesthetically pleasing result. Also, to be a candidate for liposuction, you must be in good health without conditions that could complicate surgery — such as restricted blood flow, coronary artery disease, diabetes, or a weak immune system.

And finally, liposuction is not just for women. Men also frequently request liposuction – in fact, it was one of the top five most popular cosmetic surgeries American men received this past year, according to American Society of Plastic Surgeons statistics. Common areas for treatment include the abdomen, love handles, and chest, as well as a solution for gynecomastia.

Risks & Concerns

As with any major surgery, liposuction carries risks, such as bleeding and a reaction to anesthesia. Possible complications specific to liposuction include:

  • Contour irregularities. Your skin may appear bumpy, wavy, or withered due to uneven fat removal, poor skin elasticity, and unusual healing. These changes may be permanent. Damage beneath the skin from the thin tube (cannula) that's used during liposuction may give the skin a permanent spotted appearance.
  • Fluid accumulation. Temporary pockets of fluid (seromas) can form under the skin. This fluid may need to be drained with a needle.
  • Numbness. You may feel temporary or permanent numbness in the affected area. Temporary nerve irritation also is possible.
  • Infection. Skin infections are rare but possible. A severe skin infection may be life-threatening.
  • Internal puncture. Rarely, a cannula that penetrates too deeply may puncture an internal organ. This may require emergency surgical repair.
  • Fat embolism. Pieces of loosened fat may break away and become trapped in a blood vessel and gather in the lungs or travel to the brain. A fat embolism is a medical emergency.
  • Kidney and heart problems. Shifts in fluid levels as fluids are being injected and suctioned out can cause potentially life-threatening kidney, heart, and lung problems.
  • Lidocaine toxicity. Lidocaine is an anesthetic often administered with fluids injected during liposuction to help manage pain. Although generally safe, in rare circumstances, lidocaine toxicity can occur, causing serious heart and central nervous system problems.

The risk of complications increases if the surgeon is working on larger surfaces of your body or doing multiple procedures during the same operation. Talk to your surgeon about how these risks apply to you.

Disease-Fighting Stem Cells Derived from Fat Cells During Liposuction

New research is showing that those fat cells targeted in liposuction might prove valuable in the future. That's because fat cells obtained from liposuction are an excellent source of mesenchymal stem cells, a type of stem cell that can be programmed to create bone, cartilage, muscle, and other tissues. Some early studies suggest that stem cells from fat may help people with heart disease, diabetes, and neurological disease.

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