Liposuction is suctioning out fat from underneath the skin using a device that looks like a metal straw. The straw is connected to a vacuum device. It is done through small incisions near the areas that concern you. Today all liposuction is done using the tumescent technique.
Before we use the metal rod, called a cannula to perform liposuction, we fill the area with fluid. This is called tumescent fluid. The fluid contains local anesthesia for pain control, and epinephrine which constricts small blood vessels. There is always some bruising but epinephrine makes it less. By making the area bigger with fluid we have a larger target. The larger target tends to give more even results as the fat is removed. If we did not add fluid to the area before we start, the body would add its own fluid as a reaction to the liposuction. By adding fluid ahead the body keeps its own natural fluids and patients are more comfortable.
The key to liposuction is how tight your skin is. If fat is removed from underneath good elastic skin the skin will shrink up nicely and the result will be better. If skin is loose and fat is removed the skin will become looser and the result more irregular. The paradox of liposuction is that is works best on the younger people because they have the best skin tone.
In consultation I pinch on my patients and evaluate their skin elasticity. Patients with good elasticity can have liposuction, patients with loose skin will do better with a skin tightening surgery. The hardest patients are patients in the middle. In this group of patients I tailor my liposuction. the goal is to take enough fat to make a difference but not so much that they become much looser. It is important to give realistic expectations.
Yes, There are different tools, but the idea is the same. All Use the tumescent technique.
1) Standard liposuction— is a cannula that is manually run in and out of the body. I use this on rare occasions now.
2) Power assisted liposuction— similar cannula to standard liposuction, but the handle causes the cannula to vibrate rapidly. I prefer this type of liposuction and use it frequently.
3) Ultrasonic liposuction– The cannula is different. It sends out hi frequency energy that disrupts the fat and surrounding tissue. I favor this in secondary liposuction where there is more scarring and more difficult to get through. It will often require the use of standard or power assisted liposuction to remove the disrupted tissue. Some claim that Ultrasonic can cause skin shrinkage. I think not. In fact going close to the skin can lead to significant problems.
4) Laser liposuction— sounds cool doesn’t it. Unfortunately the hype surrounding anything with the word laser attached often exceeds the reality. Like ultrasonic laser is a good tool, but essentially does the same thing using light rather than ultrasound. Cannulas are smaller and it can take longer to remove the fat. Once again I find the claims of skin tightening overly optimistic.
5) other tools have come and gone– liposhaving , waterjet for example. The four categories above are the mainstay of liposuction tools.
The tools are all good, I always recommend you let your surgeon guide you and allow your surgeon to use the tool he or she is most comfortable with.
I would call body contouring liposuction with an artistic goal, and its really what I do. Liposuction can’t make a heavy person a thin person, its really not designed to and it’s not safe. I use liposuction to try and make my patients more streamlined and sexy. I may use it to make the curves of the hip more shapely, soften a bulge, take down a trouble spot.
Commonly treated areas include the tummy, hips, legs, male breast tissue, arms, neck and chin. Other areas can be treated on a case by case basis. Remember the key to each of these areas being successfully treated is the quality of the skin.
The American society for plastics surgeons recommends no more than five liters of liposuction in the out patient setting. I adhere to this rule for the safety of my patients.
In liposuction the goal is not to remove all the fat. It wouldn’t look normal. we want to leave behind a normal and healthy superficial layer of fat. In fact the body has a deep and superficial layer of fat. We liposuction the deeper layer. It is a safer place to be with less chance of irregularity. After liposuction, a patient will always be able to pinch some fat, just not as much.
This question comes up a lot. The fat that is removed and the fat cells that are destroyed will not return. But even with liposuction some fat is left behind. This fat will get bigger if you gain weight and smaller if you lose it. So, the goal is to maintain your weight after surgery.
Mainly we throw it out, some patients will choose to use the fat to augment or enhance the buttocks. This is known as the Brazillian Butt Lift, discussed here.
Some surgeons are using the fat to augment breasts but this is highly controversial. Fat grafting to the breast can cause findings on mammogram that look like breast cancer.
Like anything it depends on how much is done. The average patient with a one or two site liposuction will take off less than a week. Patients can be sore, but usually not miserable. Skin operations such as liposuction tend to be more comfortable than surgeries that involve muscle tightening such as tummy tuck. Liposuction can cause swelling for a few days after the procedure. I ask my patients to wear a compression garment over the thigh, or upper arm, or buttocks, or whatever area of your body was treated with liposuction. In some cases changes can be seen right away, but the final result is usually seen at about six months when all swelling and inflammation resolves. Some patients can see shrinkage for up to a year.
It can be done either way. For smaller areas local may be all that is necessary. For larger areas I believe that being asleep is easier for my patients.
Can you combine liposuction with other surgeries ?
Yes, liposuction is frequently combined with other surgeries such a tummy tuck or facial rejuvenation. The key to any combination is to be sure the extent is reasonable and safe.
I go over the risks of liposuction extensively in consultation. The greatest risks are dimpling of the skin, waviness, asymmetry or irregularity. The better your skin tone the lower the risk.
Injectable fluids that dissolve fat have recently come and gone due to dissatisfaction and complications. New options are in the works. There are external radiofrequency machines that have some success as long as expectations are modified. They take much longer to see much less of a result. Coolsculpt which selectively freezes pockets of fat is what we offer to our patients who do not wish to have surgery.
There is always something new around the corner, but buyer beware ! Unfortunately, we live in a day where marketing and advertising often exceed science. If you see something new out there (that may sound too good to be true) feel free to ask me about it. I will always give you my candid opinion.
How do I schedule a consultation?
If you would like to meet with me to be evaluated please call my assistant Pei (pronounced “pay”) at the numbers on the home page or fill out the contact form on the right. She would be happy to schedule a complimentary consultation.
Dr. Adam Tattelbaum is known for his exceptional work in liposuction. Baltimore Maryland Washington DC patients choose Dr. Tattelbaum because of his outstanding reputation and because of the impressive results he consistently achieves. Schedule an appointment to learn more about Baltimore Maryland & Maryland plastic surgery procedures such as liposuction surgery.