Overview
Liposuction is a very common cosmetic procedure designed to remove excessive fat from the desired parts of the body; it’s a safe, simple and effective way of body contouring.1 This technique involves drawing out small areas of fat that are hard to lose with exercise and diet. The procedure is carried out in areas where fat tends to collect, such as the bottom, hips, thigh and tummy.2
The first attempt to remodel the body silhouette dates back to 1921 when Dr.Charles Dujarrier performed surgery to remodel the ankles and knees of the dancer patient. The results from this surgery were tragic and led to necrosis and amputation due to excessive fat and tissue removal.1
After that, many attempts were made to make the technique less traumatic and reduce hemorrhagic risk. Lawrence Field, a Californian dermatological surgeon, visited France in 1977 to study the evolving techniques. In the early 80s, many surgeons travelled to France to study the procedure, and the blunt cannula technique was accepted in France and around the world.
Liposuction techniques then became available in dermatology and plastic surgery residency programs. Throughout this period, liposuction surgery was performed under general anaesthesia.
In today’s world, laser-assisted liposuction represents a relatively recent advancement in treating lipodystrophies and irregularities of adipose tissues.1
Liposuction is the most preferred cosmetic surgery around the world. It has become an essential complementary technique to enhance the aesthetic results of many other cosmetic procedures, such as augmentation, mammoplasty, body contouring and many others.1
Techniques
Tumescent technique
This technique is used to remove excessive fat accumulation under a special form of local anaesthesia called Tumescent liposuction, which is the most popular type of liposuction. This procedure may take longer than any other approach. This procedure involves the following steps:
- The surgeon injects a large amount of diluted local anaesthetic solution into the fatty tissue layer.
- The surgeon can make a small incision into the skin and insert a small tube called a cannula into the fatty tissue layer.
- Cannula is connected to the vacuum pump, which sucks fluid and fat from the desired area.3
Laser-assisted liposuction (LAL)
LAL uses a laser-equipped cannula to help break down targeted adipose tissues, which can drain out and show higher efficiency in fat reduction.4 The tubes are smaller than the ones used in other liposuction techniques, which makes them ideal for smaller areas of the body, such as the face, neck and chin. The laser energy also helps stimulate collagen production, which could help reduce post-procedure sagging.
Ultrasound-assisted liposuction (UAL)
UAL technique utilises an ultrasound cannula, which leads to the breakdown of adipose cells, which can then be suctioned out using a normal cannula to elevate surgeon fatigue and increase the procedure’s efficiency. This method helps remove fat from the fibrous areas, such as the lower back. This method can also be used in combination with other procedures, such as tumescent.4
Power-assisted liposuction (PAL)
PAL technique uses thin tubes that can move forth and back. The vibration allows the surgeon to duck out the tough fat more easily. This method also causes less pain and swelling and allows surgeons to work more efficiently.4
Regardless of the technology used, the endpoint of liposuction is based on the surgeon's clinical judgement of the surgeon and the lack of palpable adipose tissue in the targeted area.
Limitations, risks and complications
Although liposuction is a daycare procedure, it has been associated with major complications, including fatal outcomes. The incidents and severity of complications depend on the setup where it is performed and more often when large-volume liposuction is performed under general anaesthesia or combined with other major procedures like abdominoplasty.5
The risks of incidents are higher in settings like physicians’ offices, followed by ambulatory centres, and least in the hospital operating room.
Patients must be counselled before the procedure that some complications are expected, such as post-operation bruising and swelling.
Some of the most common complications that patients and teams should be mindful of are:
- The most common complications associated with liposuction are bruising and deformities. Postoperative bruising usually takes 1-2 weeks to clear. However, post-procedural oedema may take several weeks to resolve; thus, the final shape and contour may be evident until the swelling has resolved entirely.4
- Seroma. Only aggressive complications can lead to seroma. The collection of serous fluid in the treated area may lead to excessive bleeding of the fibrous tissues, forming a single cavity.1
- Temporary weight gain
- Paresthesia
- Infection is extremely uncommon; this may be because of extreme sterile techniques, small incisions, and the antibacterial effects of lidocaine.
The most common postoperative complications are contour irregularities. Using small cannulas, not performing superficial liposuction, turning the suction off when carrying out incision, constantly analysing the area, and proper positioning can all help reduce the chances of contour irregularities.41
Major risk factors for the development of severe complications are multiple procedures and poor standards of hygiene, excessive infiltration and intoxication from lidocaine. Excessive removal of adipose tissue and the selection of unfit patients can all contribute to the major failure of the procedure.1
Preparation for liposuction
Liposuction is a widely used cosmetic surgery procedure around the world. Understanding the basic core principles of the procedure is important for the patients and the entire healthcare team. Discussing the process, complications and recovery with the patients before operating is an important part of the procedure.4
Prior to liposuction, you may be asked to:
- Obtain laboratory tests or medical evaluations
- Take certain medications or adjust your current ones if you are taking any others. Stop smoking or vaping
- Avoid taking aspirin, herbal medicines and any anti-inflammatory drugs, as they increase the risk of bleeding.6
Post-operative care
- You should rest and elevate your body-treated area in the first few days after the surgery.
- Avoid heavy lifting, straining your body and bending. You can resume most of your normal activities within ten days or less.
- Avoid smoking completely, as it will increase the risk of coughing and bleeding.
- You may experience bruising or swelling after the procedure, which is normal. It will go down within a few days after the surgery.
- You may feel discomfort after the procedure, and it is limited to soreness rather than pain. Your surgeon may prescribe a painkiller to lessen any discomfort during the first few days,
- Walking soon after the surgery is important as it will lessen the swelling and prevent blood clots.
- You can return to your work within a few days after the surgery, depending on the nature of your work.7
FAQs
What to do if you have problems after the surgery?
Cosmetic surgery can often go wrong, and you might not get the results you expected. If you experience any pain or other symptoms, you should contact the clinic where the operation was carried out as soon as possible.
If you are unhappy with the results and are concerned about the procedure, you should take the matter up to the surgeon through the hospital or clinic where you were treated. If you have concerns, you should contact the Care Quality Commission CQC.
If necessary, you can raise a concern about the doctor to the General Medical Council GMC.
The Royal College of Surgeons has more information and advice about what to do if things go wrong with your surgery.2
What are the side effects of liposuction?
After the liposuction, it is expected to have the following:
- Developing swelling and bruising is common and can last up to 6 months
- Inflammation of the treated area
- Numbness, which should go away in 6-8 weeks
- Scars
- Fluid is coming from the cuts.2
How much does lipo surgery cost?
In the UK, liposuction prices start from £3,000 - £8,500, depending on where you go and what body’s areas need to be treated.2
Who should avoid having liposuction surgery?
Liposuction is not an obesity treatment, and it does not remove stretch marks or cellulite. It's only suitable for people who try different lifestyles, but nothing has helped.2
Summary
Liposuction is one of the most popular aesthetic interventions around the world. This intervention has showns hows rapid development since the 1970s. It is widely used in clinical practices and has many applications in aesthetic, reconstructive and functional fields. It is an excellent tool for redefining the body’s profile in patients who undergo significant weight loss. However, to receive satisfactory aesthetic results after the surgery, it is always necessary to associate the excision surgery to remove the skin access. The suction of adipose tissues allows empty areas, making surgery accessible and shorter and reducing possible complications.
References
- Bellini E, Grieco MP, Raposio E. A journey through liposuction and liposculpture: Review. Annals of Medicine and Surgery [Internet]. 2017 Dec [cited 2023 Dec 4];24:53–60. Available from: https://www.sciencedirect.com/science/article/pii/S2049080117303916
- nhs.uk [Internet]. 2023 [cited 2023 Dec 4]. Liposuction. Available from: https://www.nhs.uk/conditions/cosmetic-procedures/cosmetic-surgery/liposuction/
- The condition, current treatments and procedure | Liposuction for chronic lipoedema | Guidance | NICE [Internet]. 2022 [cited 2023 Dec 4]. Available from: https://www.nice.org.uk/guidance/ipg721/chapter/2-The-condition-current-treatments-and-procedure
- Bartow MJ, Raggio BS. Liposuction. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 [cited 2023 Dec 4]. Available from: http://www.ncbi.nlm.nih.gov/books/NBK563135/
- Sood J, Jayaraman L, Sethi N. Liposuction: Anaesthesia challenges. Indian J Anaesth [Internet]. 2011 [cited 2023 Dec 4];55(3):220–7. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3141144/
- Frank Campanile M| D, Wednesday M 27. American Society of Plastic Surgeons. [cited 2023 Dec 5]. What you do before liposuction really matters. Available from: https://www.plasticsurgery.org/news/blog/what-you-do-before-liposuction-really-matters
- Liposuction recovery & aftercare | the aesthetic society [Internet]. 2021 [cited 2023 Dec 5]. Available from: https://www.theaestheticsociety.org/procedures/body/liposuction/aftercare-recovery 07-01-16 37208616