Liposuction

Liposuction, or suction-assisted lipectomy, is a surgical procedure in which unwanted fat deposits are removed. It is used to sculpt or contour localized areas of the body such as bulges under the chin, on hips, thighs, stomach, under the arm, and around the waist.

How is Liposuction Performed?

The basic procedure entails the insertion of a narrow tube, or cannula, which breaks up the fat cells and suctions them out. Anesthesia may include local, epidural, or general.

A number of variations on this procedure are now available:

Fluid injection. Originally, liposuction was performed ?dry.? However, physicians observed that the injection of a fluid mixture of saline, lidocaine (an anesthetic), and epinephrine (which contracts blood vessels) improves the outcome. In addition to helping the removal of the fat and reducing bruising after surgery, the epinephrine helps to reduce blood loss, and the lidocaine provides an anesthetic, reducing pain and the need for general anesthesia.

?Wet? technique: Today, few doctors use the dry technique. In ?wet? liposuction, surgeons inject a small amount of fluid (6 ? 8 ounces), including just small amounts of epinephrine.

*Additional information about other liposuction techniques is available at the bottom of this page.

Who is a Candidate for Facial Liposuction?

The best candidates for liposuction are healthy people within 30% of their ideal body weight who have exercised and maintained healthy diets, but wish to remove localized pockets of fatty tissue. People with firm, elastic skin will have better results than people with less elastic skin, although age is not a major consideration.

Liposuction for the Chin, Cheeks and Neck

The facial plastic surgeons in this division specialize in bringing balance to the facial features through a range of surgical procedures. Liposuction may be an effective part of a planned strategy to enhance facial balance, by reducing fatty deposits in the chin, cheeks, or neck.

Risks of Liposuction

The risks of liposuction are minimal when the procedure is performed properly. Hundreds of thousands of people have had successful procedures without complications. During facial liposuction in this division, risks are extremely low and complications very rare.

Risks of liposuction on the face and neck include:

Wavy or uneven skin: although not a medically serious problem, imperfections in final appearance are a risk. Skin may be asymmetrical, baggy, or rippled.

Infection: infections are a risk with any surgery, and may include both localized and more severe, systemic types.

Embolism: also a risk in any surgery, blood clots may form and travel through the body, posing a rare risk for life-threatening embolisms.

Other risks include edema, nerve compression, and puncture wounds from the cannula. The use of anesthesia also poses risks, as it does in any surgery.

Results

After liposuction, patients may expect a trimmer appearance of localized areas. The appearance may not be perfect, however, as the skin may appear wavy or uneven. The skin may also become discolored or pigmented for six months or more.

Selecting the right surgeon

The importance of selecting a highly qualified surgeon and appropriate facility can not be overstated. Unfortunately, consumers today are not assured that every physician who offers liposuction is qualified to perform it, or that the facility is properly equipped to handle unforeseen complications or safely administer anesthesia. Anyone with a medical degree may legally perform liposuction, even having had as little as a weekend training in the procedure.

In our division, all surgeons are certified otolaryngologists who have done additional fellowship training in facial plastic and reconstructive surgery, and are board certified by the American Academy of Facial Plastic and Reconstructive Surgery. Having limited the scope of their practice solely to the face, they offer the highest level of knowledge and experience available anywhere. Many patients come to our division for revision surgeries after a disappointing first surgery elsewhere.

* Liposuction techniques for other parts of the body:

The following liposuction techniques are used by some physicians for procedures on parts of the body other than the face or neck:

• The ?superwet? technique involves a greater amount of injected fluid ? one cc of solution per cc of fatty tissue removed. The primary advantage of increased fluid injection is that it significantly reduces blood loss. Although the injected fluid may contain lidocaine, patients also receive either general or epidural anesthesia during the ?superwet? procedure. The superwet technique is not used for facial procedures and is not performed in this department.
• Tumescent Technique. Evolving even further, the tumescent technique involves injection of up to five times as much fluid as aspirated material. Like the superwet technique, it is not used for facial procedures and is not performed in this department.
• Ultrasound-Assisted Liposuction. During ultrasound-assisted liposuction (UAL), a special cannula using ultrasonic energy is used to liquefy fat cells before they are suctioned out. UAL facilitates the removal of fat from more fibrous areas of the body, such as the upper back or enlarged male breast. This technique is controversial today because the extreme heat generated by the ultrasonic cannula can cause severe burns, and in the hands of less experienced surgeons, may be very dangerous. UAL is not used for facial procedures.

Problems during and after liposuction arise predominantly when it is performed aggressively, as in cases when physicians remove excessive volumes of fat and tissue fluids throughout the body.

The risks associated with liposuction are increased when:

• Large amounts of fat are extracted
• multiple procedures are performed during the same surgery
• general anesthesia is used

While liposuction is safe for contouring limited areas of the body, it should not be used as a weight-loss method. It is unsafe when used for the purpose of large-scale removal of fat and fluid. In the words of Dr. Gerald Imber, a plastic surgeon at this institution, liposuction for obese patients is ?a prescription for disaster? Liposuction is not meant to change a size 16 to a size 8.?

A good description of the health risks associated with aggressive liposuction may be found in Planning to Look Flab-u-less? Know the Facts about Liposuction. U.S. Food and Drug Administration?s FDA Consumer Magazine, Nov-Dec 2000.

Patients interested in weight loss surgery are advised to visit the web site of the Center for Obesity Management at NewYork-Presbyterian Hospital.