Questions about Liposuction:

What is Liposuction?

Liposuction is the surgical vacuuming of fat from beneath the surface of the skin. It is used to reduce fullness in any area of the body. It is an excellent method of spot reduction but is not an effective method of weight loss. However it has encouraged many patients to start an exercise and health program.

What is the tumescent technique? What is the difference between super wet and wet?

The tumescent technique involves injection beneath the skin of large volumes of salt water containing lidocaine, a local anesthetic and small amounts of adrenaline, a naturally occurring hormone which shrinks blood vessels. By injecting this solution to the fat prior to performing liposuction, the plastic surgeon numbs the tissues and shrinks the blood vessels thereby eliminating pain and reducing and minimizing bleeding, bruising, and swelling. The tumescent technique permits some patients who were previously treated under general anesthesia to be treated under local anesthesia with sedation.

The words tumescent, wet and super-wet refer to the amount of fluid used during the liposuction. If the amount of fluid injected is less than the amount of fat to be removed then it is called the wet technique. If the amount of fluid injected equals the amount of fat to be removed it is called super-wet if the amount of fluid injected is twice or more the amount of fat to be removed, then it is called tumescent liposuction.

Whatever the amount of fluid used, some of it will be suctioned out during surgery, however some of it will ooze out from the incision sites over the next 24 hours. This is somewhat messy, but it is normal, so we recommend to place towels in the car for however is taking you home, place towels on the floor of the house and on the bed. Also wear something you don't mind getting dirty after surgery.

Who is a candidate for liposuction?

Generally people who have localized areas of protruding fat achieve the most dramatic results. Patients who are slightly overweight can benefit from liposuction. It is best to be at or near your normal weight. Good skin elasticity permits the skin to shrink easily to the reduced contour. There are no absolute age limits for liposuction.

In patients that are overweight, or who have loose skin, they may require a tummy tuck in combination with liposuction to give the best results.

What areas are most frequently treated?

In women, the single most frequently treated areas are the outer thighs, followed by the stomach. In men, the flank area or "love handles" are treated most frequently.

Can liposuction tighten up a loose neck?

If there is excess fat in the area under the chin and the skin is taut, liposuction alone can produce a more sculpted, angular, and youthful jaw line. If, however, the skin of the neck is loose, hanging, or creepy, even if there is excess fat, liposuction alone will not produce the desired result. Patients with loose skin usually require a face and neck lift in addition to or instead of liposuction. In general, most patients who benefit from liposuction of the neck are under 40. Most patients over 40 will require some surgical skin tightening.

Liposuction seems very simple and safe. Are there any dangers?

Much has been written and talked about in the news regarding liposuction. However, liposuction can be performed very safely as long as certain parameters are adhered to. The majority of patient seeking liposuction are young and in good health requiring only the removal of localized fat deposits. The amount of fat to be removed is usually less than 4 liters of fat. In these patient liposuction is extremely safe, and can be done in an outpatient basis.

Many of the issues we have seen on TV and the newspapers is when "large volume liposuction" is performed. This is defined as removing more than 5 liters of fat. After about 5 liters of removal, the body undergoes certain physiologic changes that need to be monitored and this is why it preferably should be done in a hospital setting. But it is not until after about 6 or 7 liters that we really have to take certain things into consideration. Some surgeons will not perform large volume liposuction, but in our practice we have found that it can be done safely but we have certain criteria to further ensure safety. The precautions are the following:

1. Your fluid status needs to be carefully monitored. The reason is because if too much fluid is given then you can develop water in the lungs (Pulmonary edema) or if too little fluid is given then you can have hypovolemic shock. These complications are very rare but one needs to be attuned to this and monitor fluids carefully. This is why a hospital overnight stay may be required. A foley catheter is usually placed and maintained overnight this is perhaps one of the best ways to monitor your fluid status.

2. Your body temperature fluctuates and may require rewarming. This is best monitored with constant temperature sticker probes. This is especially true after very large volume liposuction - greater than 6 or 7 liters.

3. You may develop anemia requiring blood transfusion. Again this is very unlikely, but there is a higher chance after 7-8 liter removal. If this amount is predicted to be removed you can donate your own blood 10 -14 days before the procedure. If not it can be arranged to have your blood type available in the hospital.

4. Fat embolism is possible but it is extremely rare and not a well understood phenomenon. It is believed by some that this does not actually happen. The theory is that fat cells enter the blood stream and go to the lungs limiting the amount of oxygen in your system. The treatment is supportive care (oxygen) and maybe steroids. This can occur with any amount of liposuction but perhaps is more common with larger than 7 liter removals.

5. Pulmonary embolism is very rare but it is a very concerning issue. This is a blood clot in the lower legs that travels to the lungs and does not allow your blood to receive oxygen. In order to help prevent this, we place pneumatic stocking compressions to allow continuous circulation through your lower legs to help prevent blood from stagnating and forming a blood clot. This is why we encourage our patients to walk after surgery, since this stimulates blood to continuously flow.

Although liposuction is very safe and effective, it is a surgical procedure and can cause complications such as infection, bleeding, and nerve damage. In addition, aesthetic complications such as skin irregularity or waviness can occur if too much fat has been removed. Fortunately, complications are uncommon and most patients are satisfied with their results.

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What is better - UAL, power assisted liposuction or tumescent liposuction?

These are all tools that we have at our disposal to extract the fat. Like many things in life it will depend on your surgeon's comfort level with each of these tools and whether they believe in that particular technology or tool. So when this question is asked, you may receive many different answers. In the long run any of these methods can give you a very nice result.

Will my skin hang after liposuction?

This is an excellent million-dollar question. In order to best answer this question let me start by saying that everyone's skin is different and therefore everyone will respond differently. However some generalization can be made.

In most cases of young healthy patients with excellent skin tone and very localized areas of fat deposits, skin redraping is almost always excellent. The skin has an amazing property of being able to retract and shrink down to its new position without creating any overhang in your skin. The analogy is much like when you are 10-20 pounds overweight and you embark on a weight loss program. When you reach your final goal you are usually not left with loose skin that overhangs but rather a slimmer, trimmer you with perhaps more body definition.

However, if you are overweight by 60 or 70 pounds and you are older or you already have loose skin, then, when you loose the weight you may see some changes to the skin that indeed would leave some overhang and skin irregularities. This would also be true with liposuction.

These of course are generalities and like everything in life there are exceptions. Much of your particular case will depend on your skin type, if you have fluffy, loose skin to begin with and perhaps you have some stretch marks then this is the type of skin that has lost much of its elastic properties and will not retract as well as we would like. These cases are usually patients that have had children or have been through extreme changes in body weight either by weight loss or weight gain. In these cases it is best to combine liposuction with some sort of skin reducing procedure. See tummy tuck.

Your surgeon will be able to ascertain your particular case.

I want to get pregnant later in life, can I still have children?

This is a very common question. Liposuction will not affect you in any way, and you can have children, without any problems.

Liposuction is removing fat cells that are above the muscle layers only and we can never remove all the fat cells that are in your body. The fatty layer that is being removed plays no part in childbearing. An analogy would be that body builders, and very fit mothers that have a very low body fat percentage on them, are still able to have healthy babies.

When can I return to work?

On the average after about one week you can return to work, however some patients have recuperated so well that they have been able to return after three days. I would take at least one week off, and expect to feel normal after one month. At first, your old clothes will not fit because you are swollen, the swelling will begin to decrease after two weeks and at this time you may begin to see some changes in your body. However your clothes may still not fit properly, after about one month you will see the greatest improvement. You will continue to see refinements and continue to see improvement for up to 3-6 months.

What is the cost of liposuction?

This is the hardest question to answer since there are so many variables. Among which are the areas that you are interested, the amount to be removed, and the biggest of all whether it will be done in a hospital or in a surgical center. For this reason it is impossible to give an exact figure. It is best to either send photos for review or visit the physician for accurate prices. Contact us.

Do you have standards or safety guidelines for liposuction and tummy tucks?

Absolutely, safety is our foremost concern, to see our guidelines please click here. Also, see our BMI calculator.

I have numbness on my skin will it go away?

Numbness is normal, these sensation changes are because the nerves are regenerating and it may take up to six months to go away. Very rarely will it take longer than six months, but if it does it can take up to one year. The number of patients that have had permanent sensory changes is extremely rare. Certain exercises that may help with the hypersensitivity changes are what we call "desensitization technique". The theory is that we need to over stimulate the body so that the body gets accustomed to the normal touch. Therefore you need to use a variety of materials, i.e. cotton balls, t-shirts, towels, napkins, the hand and constantly touch the body with these materials. You will notice that after some time these things will not bother you and the sensation improves.

Other medicines that may help are Vitamin B6, B12, Niacin, but consult with your physician.

My skin changed colors after liposuction what can I do?

Immediately after your liposuction you will have bruising and this will last for 4-5 weeks. The bruising can be improved with the use of Arnica creams and pills. You need to take this immediately after your surgery and continued for 3-4 weeks. (Consult your physician before using). If you have very pale skin this can last for up to 6 weeks. However after two months if your skin has persistent discoloration then this could be what we call hyperpigmentation. This is the darkening of the skin and this occurs most often in Hispanics, Afro-Americans and patients with olive colored skin. However it may occur in very pale patients. This is essentially a result from the skin retracting and taking on a darker color. This discoloration may improve but it will take up to one year. There are a few things that can be done to help the recovery.

1. The use of Retin-A cream applied once daily coupled with

2. A hydroquinone which is a lightening cream used twice daily.

3. Also the use of low level glycolic peels in a repeated fashion.

4. Sometimes you can combine Kojic acid with the above regimen.

All these are prescription medicines and would need to be followed by a MD. Not all physicians may agree with the above but these have been helpful in our practice.

I feel lumpiness and see waviness in my skin.

This is very normal after liposuction, this will take up 6-8 weeks for most of it to improve. You really need to give this up to 6-8 months before making any final judgments. The skin has an amazing way of redistributing itself, and especially in the beginning because of all the swelling it will difficult to see your final result.

Things that may help in speeding up your recovery are Massage therapy, Ultrasound therapy, and Endermology. Endermology which is a special machine that gives massages, we have found to be a tremendous help in reducing the swelling and speeding up recovery. Not all physicians believe in this, but it has helped in our practice.

One side of my body looks different from the other.

This is a very common complaint, in actuality everyone has one side of the body that is very different than the other. We just don't notice it anymore because we have been looking at our bodies for so long that we no longer see the difference. If you ask to see your before pictures you will start to see the differences that you did not see before. Also in the beginning because both sides of the body heal at different rates, there is almost always more swelling on one side than the other and we just need to give it time to heal. With all that said you need to give you liposuction results at least 6 months before making any decisions.

It has been 3 weeks and my clothes don't fit. Also I don't see any changes in my weight on the scale.

At first even though your body has changed in shape, you are still swollen. Traditionally what happens is that for the first two weeks you may not see a change in your shape and your clothes will be too tight. Then after two weeks the swelling begins to decrease and the body takes on a new shape but it will take one month before you see a definitive change in the way your clothes fit. The swelling will continue to improve over the next 3-6 months.

As far as the scale is concerned, you usually do not see the change in weight but rather a change in shape. Your body will look much better and in clothes than it did before, but again it will take at least one month.

I have waviness and skin irregularities.

This can happen, usually there are a few things that can be done to improve this, but the best thing is to give it time. Sometimes it can take longer than six months for all the swelling to go away so I would give it another 4-6 months (every case is different). In the meantime, I would encourage massage therapy, and especially endermology. Endermology is a special massage given with a specialized machine which may help with cellulite and irregularities. It will take several treatments usually more than six. Not all physicians believe in this but it has been somewhat helpful in our practice.

If after one year of waiting and massage therapy, the problem persists then several options are available. The solutions would depend on the body part involved. If it is in the abdomen, then perhaps your skin quality may not have been good enough to retract properly and a tummy tuck may be the solution. Sometimes the areas of irregularity can be filled in with fat from another part of your body, the so called "fat transfer". However this will completely depend on your skin type and what the problem is.

If the inner legs are the problem, here the option would be an inner leg lift. This would need to be evaluated and suggestions made.

Many times one can redo the liposuction but this is sometimes extremely hard to do and may not be the best solution. Another option which is very controversial is the use of ultrasound therapy. This has been met with mixed experiences. Finally, if it is very localized, one can try steroid injection but most of us would use this with great caution since it may cause thinning of the skin. However in the right patient it may be a good alternative.

I don't see a difference after my liposuction.

After about 6 months what you see is what you get. Sometimes it may require further liposuction.