Liposuction (also called suction assisted liposuction or lipoplasty) is a surgical procedure that "vacuums" fat from areas of localized fat about the body, neck and face.

Patients who have struggled for years with localized excess body fat, that has resisted stringent exercise and low-fat eating, often find great satisfaction from liposuction procedures. Today, liposuction is the most commonly performed cosmetic surgery. Dr. Lugger is always careful to point out to patients that it is a surgical procedure used to contour and remove unwanted areas of localized fat.

Dr. Lugger stresses to patients that liposuction is not an accepted method of weight loss and is not a substitute for exercise, reasonable diet, and a healthy lifestyle. It will also not tighten loose skin or improve cellulite-shallow surface irregularities. In addition, after liposuction, imperfections in final appearance are not uncommon, such as skin surface irregularities, asymmetries, and "baggy" changes in older individuals. Pigmentation and numbness may also occasionally occur. Additional surgery may offer further improvement. Serious medical complications are rare but risks increase with increased size and numbers of areas treated at the same time, which results in larger volumes of pre-injection fluid, aspirates, and longer operating times.

Ideal Candidates for Liposuction

Ideal candidates for liposuction have localized fat deposits under firm, elastic skin. As skin becomes more lax, the results may vary. However, in recent years, with the use of smaller cannulas, the fears of large areas of "hanging" skin have lessened. Women most often seek liposuction to improve contour about the hips, thighs, abdomen, face/neck and legs. Men usually seek improvement about the hips ("love-handles") and abdomen.

Surgical Techniques

Liposuction can be accomplished with general or local anesthesia, and it does not usually involve an overnight stay. Improvements in body contour are usually permanent. Liposuction has also been used for non-cosmetic purposes such as flap contouring, tumor surgery, and breast reduction.

A more recent technique called UAL (ultrasonic assisted liposuction) uses ultrasound energy to remove the fat rather than the mechanical energy of traditional liposuction surgery. The American Society of Plastic Surgeons (ASPS) believes UAL is an acceptable alternative in some circumstances to traditional liposuction as it offers the potential for easier removal of fat in more fibrous areas. However, as heat is generated by the ultrasonic energy, it creates a risk for burns and plastic surgeons using this technique need to have completed an approved training program.

Both traditional and ultrasonic liposuction involve the use of a tumescent technique in which surgeons inject large amounts of fluids into areas to be treated prior to liposuction. This fluid contains a local anesthetic and blood-vessel constricting drugs, which can reduce blood loss, lessen the need for anesthesia, and alleviate pain and post-op bruising.

Recovery

Most patients will experience some degree of discomfort after liposuction that usually improves in the first week, with full activity anticipated within four weeks. A compression garment is usually prescribed to be worn for a number of weeks following the surgery to assist with the swelling and enhance the result. Results can be appreciated best about 3-6 months following surgery, although many patients see immediate improvement despite the post-op swelling.

Safety Issues

ASPS believes that liposuction is generally safe when patients are carefully selected and the surgeon has accredited basic surgical training with specialized training in body contouring. Five thousand (5000 cc-around 5 quarts) of fat and fluid is about the outpatient limit generally accepted for outpatient surgery. If more aspirates are planned, arrangements may need to be made for post-op observation, and fluid monitoring. Surgeons who perform larger volume procedures must have a background of surgical education in basic principles of fluid management.

ASPS does not recommend liposuction for patients with significant heart/lung disease, those with recent surgery in the treated area, and those with poor circulation or complicated diabetes.

As there are no state or federal laws covering the scope or quality of specialty education, ASPS recommends that potential liposuction patients exercise care in selecting a surgeon. They recommend that patients check whether a surgeon has privileges to perform the liposuction at an accredited hospital because hospitals examine credentials before granting specialty privileges to their staff physicians.

If the procedure is performed in a facility other than a hospital, patients should see if the facility is accredited by a recognized state or federal accrediting body.

By choosing an ASPS surgeon (or an ASPS surgeon who is a member of ASAPS) certified by the American Board of Plastic Surgery, patients can be assured that the surgeon has graduated from an accredited medical school, has completed at least five years of additional residency training (often three years in general surgery and two in plastic surgery), has been in plastic surgery practice two years or more, and has passed comprehensive written and oral examinations.

Statistics and Cost

Over 370,000 lipoplasty procedures were performed in 2000 by ASAPS (American Society of Aesthetic Plastic Surgery) members and candidates. Of these, 317,880 or 84.4 percent were performed for women. This represents a 31 percent increase as compared to 1999 statistics.

The average cost in 2000 for liposuction was $2,466 for suction-assisted and $2,651 for ultrasonic-assisted liposuction. These costs may vary depending on the number of areas treated.