Liposuction is a surgical procedure that removes excess fat from areas of the body via small, hollow instruments called cannulas. These instruments are inserted into tiny cuts (incisions) generally no bigger than one-quarter inch in diameter, where the fat will be removed. A medical-grade vacuum suctions tiny, broken up globules of fat into a canister. In tumescent liposuction, local anesthetic and other medications are injected into the fatty layer before suctioning excess fat.
Additionally, laser-assisted liposuction is available. While there are many forms of lasers, most combine one or two types of lasers that melt the fat before the tumescent portion of the liposuction. "Smart Lipo" was the first laser-assisted liposuction, but there are many others now available. Invariably, these are used alongside other methods, such as tumescent liposuction.
Methods of laser-assisted liposuction are named by the laser used in conjunction with the liposuction, such as Smart Lipo, Vaser, Laser Lipolysis, and other newer forms. Laser-assisted liposuction is not the same as LipoDissolve, or mesotherapy, which are non-FDA approved procedures that consist of materials injected into the areas of the fat with the hope that these areas will dissolve. Any laser used in addition to liposuction should be FDA-approved for just that task.
There is an initial consultation before the procedure, at which time the surgeon will evaluate the areas to be suctioned. These may be the chin, abdomen, chest (both male and female), hips, thighs (both inner and outer), knees, calves, and arms. Initial photographs are taken, and results of the surgeon's prior work or illustrative examples of the procedure may be shown to the patient. Additionally, many offices can show prospective patients their own pictures on a computer and manipulating the picture (or drawing on the computerized picture) to illustrate the expected results.
During this consultation, information on the procedure is given, and the risks are explained. Questions the prospective patient has are answered. If the patient is deemed a good candidate for tumescent liposuction, they then will be scheduled for a pre-liposuction evaluation. Laser-assisted liposuction may be recommended to accompany the tumescent method as well.
The patient who undergoes this procedure is typically evaluated at least one to two weeks before the procedure and, at that time, blood tests, medical history and physical, measurements, and photographs are taken. Depending on results of the history and physical examination, the patient may need further evaluation, medical clearance from a primary physician, EKG, and/or other tests performed before the procedure.
At the time of the preoperative evaluation, an informed consent is given if it is close to the time of the procedure. This may include a written and, in some practices, a computer-generated, informed consent form with examples of potential complications and expectations of the surgery.
Before surgery, the patient is advised of which, if any, medications they will be taking before, during, and after the surgery. Additionally, if there are any medications that need to be stopped before surgery, this is communicated as well. Certain pain relievers, such as aspirin and non-steroidal anti-inflammatory agents (such as ibuprofen [Advil] or naproxen [Aleve]) are to be avoided for at least seven days before the surgery. Some surgeons may advise the patient to stop other medications, such as thyroid medications, antidepressants, and various antibiotics in preparation for the surgery.
During the Procedure
On the day of the procedure, the patient typically has an initial opportunity to ask questions to the nurse and surgeon, after which a final consent form is signed. At this time, the surgeon marks the areas to be suctioned and an intravenous line (IV) is placed to deliver fluids and medications as necessary. If tumescent liposuction is planned, the patient will be given an oral mild sedative pill and is taken to the operating room. In the operating room, a nurse will then inject approximately four to 20 tiny areas with numbing solution and start to inject the tumescent fluid with a small needle.
Depending on the area to be suctioned, the process of numbing an area can take from 30 minutes (chin or knees) to several hours (most other areas). To get good anesthesia to the area, it is important to perform the numbing slowly, as this can make the experience more pleasant. Most patients have very little, if any, discomfort during this part of the process. Additionally, they may fall asleep, watch TV, or listen to music at this time.
If the surgeon is performing the non-tumescent method (without injecting the solution into the area to be suctioned), anesthesia ranging from intramuscular-only to general anesthesia may be given. Both the tumescent liposuction procedure and the non-tumescent procedure yield excellent results; however, the former avoids the risks of injected anesthesia. Additional benefits of tumescent liposuction include the use of smaller cannulas, less bleeding, less need for post-procedure pain control, less bruising, and quicker recovery.
After the area is anesthetized (if performing tumescent liposuction) or the patient is sedated, the surgeon will suction the area(s). Before the tumescent method or suction, the laser-assisted liposuction portion may be used to help melt the fat and seems to result in larger amounts of fat being suctioned, with potentially more retraction of the areas as well.
In tumescent liposuction, generally less areas can be suctioned at one time as the fluid that tumesces, or anesthetizes, the area contains lidocaine and several other ingredients. The total amount that can be used is based on the weight of the patient. Typically, this means that no more than one large area or two smaller areas can be done at one time except in unusual cases.
On the other hand, in the traditional method, many areas are typically able to be suctioned at once. However, a large amount of fat suctioning at one time may increase risks to the patient.
The entire procedure may last an hour or less, depending on the areas to be suctioned. It may be necessary to give a little more numbing material during the procedure. Additionally, some surgeons may use an intravenous relaxant medication, such as Versed, during the procedure.
Medically Reviewed by a Doctor on 9/8/2014
Joel Schlessinger, MD
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