What is liposuction?

Indications and Procedures

The fat contained in
adipose tissue makes up 15 to 20 percent of the body weights of most healthy individuals. Much adipose tissue is found inside the abdominal cavity, but significant amounts are located under the skin of the abdomen, arms, breasts, hips, knees, legs, and throat. The quantity of this subcutaneous fat at any such site is based on individual heredity, age, and eating habits. When excessive eating greatly elevates body fat, a patient becomes obese, a condition that can be life-threatening. Until recently, the sole means for decreasing fat content resulting from
obesity was time-consuming dieting, which requires much patience and will power. In addition, the positive consequences of long diets can be easily obliterated if dieters begin to overeat again. Recurrent overeating is common and often followed by the rapid regaining of the fat.

Persons who have undesired, unattractive fat deposits as a result of age, heredity, or obesity may undergo cosmetic surgery, such as so-called tummy tucks, to remove them. Such major procedures, however, often remove muscle along with fat and cause considerable scarring. Liposuction is a relatively easy way to lose unattractive body fat; it also is seen as a fast way to reverse obesity and is touted as more permanent than dieting. A cannula connected to a suction pump is inserted under the skin in the desired area. Then a chosen amount of fat is sucked out, the cannula is withdrawn, and the incision is closed. The result is a recontouring of the body part. Hence, liposuction has become a very popular cosmetic surgery procedure for the abdomen, arms, breasts, hips, knees, legs, and throat; many pounds can be removed from large areas such as the abdomen.

Liposuction begins with the administration of antibiotics and the anesthesia of the area to be recontoured. Local anesthesia is safer, but general anesthesia is used when necessary. The process usually begins after a 1.3-centimeter (0.5-inch) incision is made in a fold of the treated body region, so that the scar will not be noticeable after healing. At this time, a sterile cannula is introduced under the skin of the treatment area. Next, the surgeon uses suction through the cannula to remove the fat deposits. Liposuction produces temporary tunnels in adipose tissue. Upon completion of the procedure, the incision is closed and the surgical area is wrapped with tight bandages or covered with support garments. This final stage of recontouring helps the tissue to collapse back into the desired shape during healing. In most patients, the skin around the area soon shrinks into the new contours. When this does not happen easily, because of old age or other factors, liposuction is accompanied by surgical skin removal.

Uses and Complications

Liposuction can be used for body recontouring only when undesired contours are attributable to fat deposits; those attributable to anatomical features such as bone structure cannot be treated in this manner.

A major principle on which liposuction is based is the supposition that the body contains a fixed number of fat cells and that, as people become fatter, the cells fill with droplets of fat and expand. The removal of fat cells by liposuction is deemed to decrease the future ability of the treated body part to become fat because fewer cells are available to be filled. Dieting and exercise are less successful than liposuction because they do not diminish the number of fat cells in adipose tissue, only decreasing fat cell size. Hence, when dieters return to eating excess food again or exercise stops, the fat cells expand again.

Another aspect of liposuction which is becoming popular is the ability to remove undesired fat from some body sites and insert it where the fat is wanted for recontouring. Most often, this transfer involves enlarging women’s breasts or correcting cases in which the two breasts are of markedly different size. Liposuction also can be used to repair asymmetry in other body parts as a result of accidents.

Liposuction, as with any other surgery, has associated risks and complications. According to reputable practitioners, however, they are temporary and relatively minor, such as black-and-blue marks and the accumulation of blood and serum under the skin of treated areas. These complications are minimized by fluid removal during surgery and by the application of tight bandages or garments after the operation. Another related complication is that subcutaneous fat removal leads to fluid loss from the body. When large amounts of fat are removed, shock occurs if the fluid is not replaced quickly. Therefore, another component of successful liposuction is timely fluid replacement.

The more extensive and complex the liposuction procedure attempted, the more likely it is to cause complications. Particularly prone to problems are liposuction procedures in which major skin removal is required. Hence, surgeons who perform liposuction suggest that potential patients be realistic about the goals of the surgery. It is also recommended that patients choose reputable practitioners.

Perspective and Prospects

Liposuction, currently viewed as relatively safe cosmetic surgery, originated in Europe in the late 1960s. In 1982, it reached the United States. Since that time, its use has burgeoned, and about a half million liposuction surgeries are carried out yearly. Although its first use was as a purely cosmetic procedure, liposuction is now done for noncosmetic reasons, including repairing injuries sustained in accidents. Women were once the sole liposuction patients. Men make up about 15 percent of treated individuals; liposuction is the most popular form of cosmetic surgery among men.

In the United States, liposuction is not presently accepted by insurance companies or considered tax deductible. This situation may change because several studies have found that obese people have a greater chance of developing cardiovascular
disease and cancer. It must be noted, however, that liposuction offers only temporary relief from body fat. Although it does decrease fat deposition in a treated region, lack of proper calorie intake and exercise will deposit fat elsewhere in the body.

Bibliography

Rubin, J. Peter, et al. Body Contouring and Liposuction. New York Elsevier Saunders, 2013.

Schafer, Jeffry B. A Patient's Guide to Liposuction: How to Make an Informed Decision. Denver, Colo.: Outskirts Press, 2011.

Schein, Jeffery R. “The Truth About Liposuction.” Consumers Digest 30 (January/February, 1991): 71–74.

Shelton, Ron M., and Terry Malloy. Liposuction. New York: Berkley, 2004.

Shiffman, Melvin A., and Alberto Di Giuseppe, eds. Liposuction: Principles and Practice. New York: Springer, 2006.

Wilkinson, Tolbert S. Atlas of Liposuction. Philadelphia: Saunders/Elsevier, 2005.

US Food and Drug Administration. “The Skinny on Liposuction.” Author, April 12, 2013.

Zollinger, Robert M., Jr., and Robert M. Zollinger, Sr. Zollinger’s Atlas of Surgical Operations. 8th ed. New York: McGraw-Hill, 2003.