Liposuction:

Cost from $ 1,950 (one area)

Cost with Financing $ 55 per month

Inherited traits often prevent people from achieving their desired body shape. Even years of exercise may not yield significant results in certain people. For many, the answer is liposuction, also known as liposculpture, a procedure that extracts fat deposits from specific areas of the body.

A small incision is made in the skin just large enough to accommodate a small hollow tube called a cannula.  The cannula suctions the fat from selected areas of the body to create the desired contour. This procedure is ideal for those who are within 30% of their ideal body weight and would like to contour specific areas.

Liposuction is usually performed under general anesthesia and takes from one to 3 or more hours depending on the area and amount of fat being removed.  Recovery also depends upon the extent of your surgery. Sutures are removed in one week. Normal athletic activities can be resumed in about three weeks.

Tumescent Technique:

The tumescent technique for liposuction is still the most commonly used method for achieving desired results in contouring areas such as the waist, hips, thighs and buttocks. This technique works by injecting controlled amounts of a special fluid under the skin. This fluid causes the fat to swell such that it is easier to remove.This fluid also numbs and constricts blood flow to the area to reduce blood loss. Because there is so little blood loss, there is minimal bruising.

Medication is also added to this fluid such that post-operative pain is reduced for 18 to 24 hours after surgery. After the fluid is injected, a special hollow tube called a cannula is connected to a suction machine and then inserted under the skin. The cannula is moved back and forth to create thousands of tiny tunnels where the fat has been removed.

After surgery, a compression garment, or girdle, is put on the patient. The tiny tunnels collapse under the pressure of the garment. The garment is worn most of the time for the next 6 weeks.

The tissue continues to contract within the tunnel, creating a slimmer appearance. A new method, called Ultrasonic Assisted Liposuction, or UAL, is now being used in conjunction with tumescent techniques.

Ultrasonic Technique:

A new method, called Ultrasonic Assisted Liposuction, or UAL , is now being used in conjunction with tumescent liposuction techniques. UAL works by converting ultrasonic energy into heat, literally melting the fat cells, allowing the remains to be suctioned away. This method reduces the amount of trauma to the tissue, since less force is needed by the surgeon, leaving fibrous tissue and vascular structures intact. There is minimal blood loss, less bruising, and better retraction of tissue.

FAQ: Liposuction  

	1. What is liposuction?
	2. Who is a good candidate for liposuction?
	3. Who is not a good candidate for liposuction?
	4. Is liposuction a reasonable treatment for obesity?
	5. What is a successful liposuction surgery?
	6. Does liposuction always remove cellulite?
	7. Does liposuction produce permanent results?
	8. Does the fat come back in other spots after liposuction?
	9. Does liposuction cause dimpling or indentations in the skin?
	10. What Alternatives Are There to Liposuction?

1.What is liposuction?(top)

The concept of liposuction is surprisingly simple. Liposuction is a surgical technique that improves the body's contour by removing excess fat deposits located between the skin and muscle. Liposuction involves the use of a small stainless steel tube, called a cannula (from the Latin word for reed, tube, cane). The liposuction cannula, typically connected to a powerful suction pump, is inserted into the fat through small incisions in the skin, and fat is removed by suction as the cannula creates tiny tunnels through the fat. During the healing process after liposuction, these tiny tunnels shrink and disappear, resulting in an improved body contour.

2. Who is a good candidate for liposuction?(top)

A good candidate for liposuction is defined as any patient who is likely to be happy with the results of liposuction. The best candidates for liposuction are in good health and have realistic expectations of what liposuction can accomplish. Liposuction can provide a good candidate with a significant improvement, but it is unlikely to achieve perfection. There is no definite age or weight limit for patients who are "good candidates" for liposuction. Many liposuction patients are of average size but are concerned about localized accumulations of fat. However, some of the happiest patients have been individuals who are somewhat obese. A good candidate usually has one or more localized accumulations of fat that can be removed by liposuction

3. Who is not a good candidate for liposuction?(top)

A person who expects absolute perfection is not a good candidate for liposuction. Excessively obese patients are usually not good candidates for liposuction. A person who has a serious medical problem is not a good candidate for liposuction.

4. Is liposuction a reasonable treatment for obesity?(top)

Liposuction is not a good treatment of obesity. Liposuction is not effective, even as a last resort, for people who are unable to lose weight by dieting and exercise. Obese patients almost always regain the weight that is removed by liposuction unless there is a dramatic reduction in calorie intake (by dieting) or a significant increase in calorie expenditure (by exercising). Whenever large-volume liposuction has been used in an attempt to treat obesity by surgery, there has been a significant increase in the incidence of serious surgical complications. It is not safe to remove huge amounts of fat by liposuction. It is dangerous to remove more than 8 to 10 pounds of fat by liposuction in a single day. Thus, liposuction will not be of any significant benefit for an obese patient who believes that liposuction will aid in the effort to lose weight.

On the other hand, an overweight person whose weight has been stable for many years and has certain problem-areas of fat may be a good candidate for liposuction. Liposuction in an obese patient is reasonable when the goal is to improve a troublesome body contour area. It is not reasonable to use liposuction as a surgical technique for weight loss.

5. What is a successful liposuction surgery?(top)

A liposuction surgery is a success when the patient is happy with the results. The surgeon's goal is to obtain an optimal aesthetic result rather than to maximize the amount of fat removed. One of the most common causes for disappointment in the results of liposuction surgery is the removal of too much fat, which produces an abnormal or unusual appearance. The cosmetic success of a liposuction surgery is often the result of removing an amount of fat equivalent to less than a pound or two of butter from a woman's saddlebag area or from a man's love handle area. While this amount of fat is relatively small compared to a person's total body weight, it does produce a dramatic change in the patient's silhouette.

6. Does liposuction always remove cellulite?(top)

Liposuction improves the silhouette of the body, but does not necessarily eliminate the pre-existing subtle "puckering" of the skin that is often referred to as "cellulite." Liposuction does reduce the degree of cellulite to a degree but it is unlikely to  completely eliminate cellulite.

7. Does liposuction produce permanent results?(top)

After liposuction the body's new shape is more or less permanent. If a patient does gain a moderate amount of weight after liposuction, then the figure will simply be a larger version of the new body shape. Fat cells that are removed by liposuction do not grow back. As long as the patient does not gain excessive amounts of weight, the new, more pleasing silhouette is permanent. Of course after liposuction the clock keeps ticking, and advancing age will produce the usual changes in the shape of the body associated with the aging process. If a person gains weight after liposuction, she/he will not accumulate as much fat in the treated areas as would have happened if liposuction had not been done.

8. Does the fat come back in other spots after liposuction?(top)

If a patient does not gain weight after liposuction, then fat does not accumulate in other areas of the body. However, if a patient gains a significant amount of weight, say more than 10 pounds (5 kg), after liposuction, then the fat must go somewhere. In fact, the fat accumulates in every area of the body in proportion to the amount of fat cells in each area. Areas where fat cells have been removed by liposuction will accumulate relatively little fat, while areas not treated by liposuction will collect relatively more fat. For example, if a woman gains weight after liposuction of her hips, outer thighs, and abdomen, then most of the fat will be deposited elsewhere such as the woman's breasts, face, back and legs.

9. Does liposuction cause dimpling or indentations in the skin?(top)

Dimpling and indentations in the skin is a known risk of liposuction. However skin irregularities are unusual in the hands of a skilled surgeon. The use of large diameter cannulas tends to increase the risk of irregularities, while the use of microcannulas (less than 2.8 mm in outside diameter) reduces this risk. The use of microcannulas and multiple adits (very tiny 1.5 mm round holes placed in the skin) allows the surgeon to make a criss-cross pattern of tiny tunnels throughout the fat which produces smoother liposuction results compared to using larger cannulas and only two or three entrance incisions. When large cannulas are used, any inadvertent passage of the cannula too close to the skin may leave a depression or furrow, whereas one pass too close to the skin with a microcannula will not leave a visible depression.

10. What Alternatives Are There to Liposuction?(top)

Liposuction is never absolutely necessary. If you decide that liposuction is not for you, then you may consider the following alternatives to liposuction. Weight loss without liposuction can produce excellent aesthetic results. Weight loss can be achieved by dieting (decreased calorie intake) or by increased exercise (expenditure of calories). An alternative to abdominal liposuction is a tummy tuck.

FAQ: Liposuction Techniques and Instruments

	1. How many incisions are made?
	2. How long will take for the incisions to heal?
	3. Is it necessary to have an IV during liposuction?
	4. How long does it take to complete a typical liposuction procedure?
	5. What is the safest form of liposuction?
	6. What is a liposuction cannula?
	7. What is a microcannula?
	8. Is the ultrasonic assisted liposuction (UAL) technique safe and effective?
	9. Is power-assisted liposuction (using oscillating or vibrating cannulas) safe and effective

1. How many incisions are made?(top)

The number of linear incisions or adits (tiny round holes) that are placed in the skin is determined by a number of factors including size and location of the area being treated, and the surgeon’s technique. In general, when just a few (2 to 6) incisions are used in an area, the incisions tend to be somewhat larger (greater than ¼ inch long), and are closed with stitches. In contrast, surgeons who use small diameter microcannulas typically make multiple (4 to 12 or more) tiny adits in an area, which are so small (less than 1/8 inch in diameter) that no stitches are required.

2. How long will take for the incisions to heal? (top)

Incisions or adits usually close up in a week or two, and become completely healed with no scabs within 2 to 4 weeks. The incision sites slowly become less and less visible over 3 to 12 months, except in patients who have darkly pigmented skin, in which case the incision sites may remain visible for more than a year or two.

3. Is it necessary to have an IV during liposuction?(top)

Intravenous fluids are not necessary, and in fact are contraindicated with tumescent liposuction because the large volume of dilute tumescent local anesthetic fluid that is injected under the skin is sufficient to replace any fluid that is lost by liposuction.

4. How long does it take to complete a typical liposuction procedure?(top)

The average patient will be in the surgical facility for 3 to 7 hours. However, the actual surgery may only require 2 to 3 hours. The length of time that it takes to complete a liposuction depends on the size of the patient, the number of areas being treated, and the type of anesthesia being used. Because it takes a certain amount of time to inject local anesthesia, it usually takes longer to do liposuction using local anesthesia than it does using general anesthesia.

5. What is the safest form of liposuction?(top)

Tumescent liposuction totally by local anesthesia is the safest form of liposuction. Liposuction using general anesthesia or heavy IV sedation is somewhat less safe than liposuction totally by local anesthesia. The greatest danger of using general anesthesia or heavy IV sedation is that these forms of systemic anesthesia permit a surgeon to do too much liposuction on the same day and permit multiple unrelated cosmetic procedures on the same day as liposuction. If a patient desires a large amount of liposuction, or multiple unrelated cosmetic surgical procedures, it is safest to do the liposuction on two or three separate occasions, each separated by three to four weeks, and to not do unrelated surgical procedures on the same day as liposuction.

6. What is a liposuction cannula?(top)

Microcannulas permit smoother results after liposuction. A liposuction cannula is a small stainless steel tube that is inserted through an incision in the skin and removes subcutaneous fat. The fat is suctioned through the cannula, then through a long flexible plastic tube that attaches the cannula to a vacuum pump.

7. What is a microcannula?(top)

Tumescent liposuction totally by local anesthesia requires the use of very small cannulas or microcannulas. Microcannulas have an outside diameter = 2.8 mm. Microcannulas permit a more delicate and gentle approach to liposuction than can be achieved using larger cannulas. Because microcannulas require a minimal amount of force to be pushed through fatty tissue, the surgeon can control the direction and position of the cannula with much more accuracy: The ultimate result is a greatly reduced risk of inadvertently approaching too close to the undersurface of the skin and unintentionally causing irregularities.

8. Is the ultrasonic assisted liposuction (UAL) technique safe and effective?(top)

UAL is neither as safe nor as effective as traditional liposuction. See Risks of Ultrasonic Liposuction.

9. Is power-assisted liposuction (using oscillating or vibrating cannulas) safe and effective?(top)

Power assisted liposuction (PAL) uses a machine-powered cannula that oscillates in and out or vibrates very fast. PAL is relatively new and somewhat controversial. Manufacturers of these devices and some surgeons are enthusiastic about PAL and believe it makes liposuction easier. Other surgeons remain skeptical and have not found there to be any advantage in using PAL.

FAQ: Post-Op Pain and Discomfort

	1.How long after liposuction will the soreness or tenderness persist?
	2. What is the quality of the pain after liposuction
	3. What is the intensity of the pain after liposuction?
	4. Do elastic compression garments reduce post-operative pain?
	5. What can be done to minimize the soreness and swelling after liposuction?
	6. Will I have to stay in bed during the recovery period?
	7. Is tumescent liposuction with local anesthesia less painful than under general anesthesia?
	8. Why is tumescent liposuction totally by local anesthesia typically less painful than liposuction under general anesthesia?

1. How long after liposuction will the soreness or tenderness persist?(top)

During the two days immediately after liposuction, the amount of pain experienced depends on the type of anesthesia used for liposuction. Local anesthesia usually persists for more than 24 hours after surgery. Liposuction under general anesthesia, without using local anesthesia at the same time, is much more painful and typically requires narcotic analgesia.

During the days and weeks following liposuction, the degree of soreness and swelling is a function of the type of aftercare procedures employed. Soreness is usually the most intense 2 to 4 days after liposuction and then decreases steadily. The tenderness and soreness typically is quite bothersome for up to 4 weeks, but gradually subsides over the following next 4 to 8 weeks.

2. What is the quality of the pain after liposuction?(top)

Immediately after tumescent liposuction, the local anesthesia persists for 12 to 24 hours, so that the only discomfort is described as soreness or tenderness. Beginning the day after tumescent liposuction totally by local anesthesia, the quality of pain is similar to that of a sunburn and to muscle soreness that one might experience after having worked-out too vigorously. This type of pain rarely requires any medication other than acetaminophen (Tylenol).

3. What is the intensity of the pain after liposuction?(top)

In the hands of surgeons who are skilled in liposuction totally by local aesthesia, patients usually have less discomfort after surgery than when liposuction is done by general anesthesia.

The intensity of pain immediately after liposuction is quite mild when local anesthesia is used because of the persistence of the local anesthetic effect. After liposuction totally by local anesthesia, patients rarely require any medication other than acetaminophen (Tylenol). When general anesthesia is used without sufficient lidocaine (local anesthetic) in the tumescent solution, the pain is more intense and often requires the use of narcotic analgesics. Your surgeon will help decide what is best for your case


4. Do elastic compression garments reduce post-operative pain?(top)

Elastic compression garments can decrease post-liposuction pain if employed with the open-drainage technique. "Open-drainage" refers to the technique of not closing the tiny liposuction incisions with stitches in order to maximize the drainage of inflammation-causing blood-tinged anesthetic solution. Immediately after surgery, elastic garments encourage maximum amount of drainage of blood tinged anesthetic solution, which in turn reduces pain. After all the drainage has ceased, some patients continue to wear a compression garment in order to restrict the movement or jiggling of the treated areas. This reduces discomfort and gives a feeling of security.

5. What can be done to minimize the soreness and swelling after liposuction?(top)

Much of the swelling and soreness after liposuction is the result of residual blood tinged anesthetic solution that remains trapped under the skin after liposuction. Red blood cells that have leaked out of blood vessels, and fragments of fatty tissue that escape suction and remain under the skin cause inflammation. Inflammation causes swelling and pain. By encouraging the complete drainage of this blood tinged solution one can minimize soreness and swelling after liposuction. Complete drainage is encouraged by leaving the incision sites open (not closed with stitches) and by wearing an elastic compression garment.

6. Will I have to stay in bed during the recovery period?(top)

No. Patients are encouraged to walk and to be active after surgery. Most patients who have had tumescent liposuction totally by local anesthesia can expect to drive a car within 24 to 48 hours, and return to a normal work schedule within 24 to 72 hours. Patients who have had liposuction under general anesthesia tend to need more time off from work and over-all have a longer recovery period.

7. Is tumescent liposuction with local anesthesia less painful than under general anesthesia?(top)

Some patients have first had liposuction using general anesthesia prior, and then had more liposuction using the tumescent technique. The vast majority of patients have said that liposuction by the tumescent technique is a dramatically less painful experience than was liposuction under general anesthesia. Infiltrating the local anesthesia by the tumescent technique is typically associated with minimal discomfort. Once the area has been completely numbed, surgery in the area is essentially painless. In addition, because the local anesthesia persists in the treated area for more than 12 hours, there is no pain immediately after the surgery.



8. Why is tumescent liposuction totally by local anesthesia typically less painful than liposuction under general anesthesia?(top)

Pain associated with liposuction can occur at three different stages: during the infiltration of the tumescent solution, during liposuction, and postoperatively.

If the surgeon or nurse who does the tumescent infiltration has had special training in the techniques, then the patient typically has very little pain during the process of injecting the local anesthetic. The technique for infiltrating the solution of tumescent anesthesia requires special skill and training. Without this special training, surgeons must rely on general anesthesia.

After the tumescent local anesthesia has been thoroughly infiltrated into the fat, the subsequent liposuction should be painless.

The postoperative pain after liposuction is  worse for liposuction under general anesthesia compared to liposuction totally by local anesthesia. After tumescent liposuction, the local anesthesia persists for many hours after surgery and patients need only take Tylenol for discomfort. In contrast, with general anesthesia, patients typically require narcotic analgesics to control post operative pain.

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