ABC7’s The More in the Morning team spoke with Dr. Michael K. Kim, Board-Certified Plastic Surgeon, about liposuction and what people need to know before having the procedure done. Most people know that liposuction involves removing fat from certain parts of the body to create a more streamlined shape. But how exactly does it work?
It's important to note that liposuction is NOT a weight-loss technique; it is merely a reshaping technique. Only nutritious diet and exercise can result in real weight loss.
Because not everyone benefits from the same type of surgery, and some people aren't good candidates at all, every liposuction procedure starts off with a consultation. Dr. Kim will evaluate your health (both physical and psychological) and determine whether your skin elasticity and fat placement makes you a good candidate.
Before the procedure, Dr. Kim will mark the skin to indicate from which area(s) the fat will be removed. Then, as with most types of surgery, liposuction requires anesthesia. But the type of anesthesia depends upon how much of the body is being worked on. For small areas, Dr. Kim can use local anesthesia (which numbs only the area involved). Usually, Dr. Kim administers a sedative (either orally or via injection) along with the local anesthesia to relax the patient.
There are two layers of subcutaneous fat: deep and superficial. During a liposuction procedure, Dr. Kim makes a tiny incision and inserts a hollow, stainless-steel tube (called a cannula) into the deep fat layer. Working on this layer is safer than working on the superficial layer, because there is less risk of injuring the skin. In a typical procedure, Dr. Kim will push and pull the tube through the fat layer (a new technique, power liposuction, automates the movement). As the cannula moves, it breaks up fat cells, and a vacuum pump or syringe removes the fat with suction.
Developed by plastic surgeons in the 1980s, this has become the most popular liposuction method. It is also considered safer than other methods because it limits blood loss and does not usually require intravenous fluid replacement afterwards.
In this procedure, the doctor injects a large volume of anesthetic-containing fluid (as much as five times the fluid and tissue that is removed) into the areas containing fatty deposits. The fluid contains a local anesthetic (lidocaine), a drug that constricts blood vessels to reduce blood loss (epinephrine) and a salt solution to allow for easier fat removal. The fluid causes the fatty tissue to swell up and harden (become tumescent), making it easier to remove with the cannula. Because the fluid contains quite a bit of lidocaine, this procedure is usually performed under a local anesthetic. Although it tends to take longer than other techniques -- as many as four to five hours -- the tumescent technique has the advantages of reducing postoperative swelling, bruising and pain.
Ultrasound-assisted liposuction (UAL)
This relatively new technique uses a special cannula that vibrates very rapidly and gives off ultrasound energy. As the cannula passes through the fat cells, that energy liquefies the fat cells, which are then suctioned out. The ultrasound can be administered either above the skin (with a special emitter) or below the surface of the skin (with an ultrasound cannula).
History of Liposuction
Although the first known use of suction to remove fat from the body was performed by French surgeon Charles Dujarier in the 1920s, the development of modern liposuction is credited to father and son Italian gynecologists Arpad and Giorgio Fischer who in 1974 invented a blunt, hollow surgical instrument called a cannula that allowed them to create tunnels between major blood vessels of the body while sucking out fat.
Prior to this time, many physicians had attempted to sculpt fat build-up using a curette, a surgical tool designed for scraping, which often caused blood clots, abscesses, skin unevenness, and other health complications. Other doctors of the era tried to reshape the body by surgically removing both fat and skin, resulting in unsightly scarring, and with time, re-accumulation of fat around the incision sites leading to physical deformity.