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. Liposuction is an excellent method of spot reduction, but is not an effective method of weight loss. Many patients are encouraged to start an exercise and health program.

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

The tumescent technique involves injection beneath the skin comprised of large volumes of saltwater containing lidocaine (a local anesthetic) and small amounts of adrenaline (a naturally occurring hormone which shrinks blood vessels). By injecting this solution into the fat prior to performing liposuction, it 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 terms 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; and if the amount of fluid injected is twice or more the amount of fat to be removed, then it is called tumescent liposuction.

No matter 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 a somewhat messy – yet normal – procedure, so we recommend to place towels in the car for the drive home after surgery, as well as place towels on the floor of your house, and on the bed. Also, be sure to 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.

Patients who are overweight, or who have loose skin, 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 most commonly treated.

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 jawline. If, however, the skin of the neck is loose or hanging, liposuction alone will not produce the desired result even if there is excess fat in this area. 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 four liters of fat. For these patients, liposuction is extremely safe, and can be done on an outpatient basis.

Many of the issues we have seen on television and in the newspapers is when "large volume liposuction" is performed. This is defined as removing more than five liters of fat. After about five liters of removal, the body undergoes certain physiologic changes that need to be monitored, which is why it preferably should be done in a hospital setting. It is not until after about six or seven liters that we really have to take certain things into consideration. Some surgeons will not perform large volume liposuction; at our practice, we have found that it can be done safely when abiding certain criteria. The precautions are as follows:

1. Your fluid status needs to be carefully monitored. If too much fluid is injected, then you may develop water in the lungs (pulmonary edema) or if too little fluid is given then you could go into 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, which is especially true after very large volume liposuction - greater than six or seven liters.

3. You may develop anemia requiring blood transfusion. Again, this is very unlikely, but there is a higher chance after seven to eight liter removal. If this amount is predicted to be removed, you can donate your own blood 10 to 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 possibly steroids. This can occur with any amount of liposuction, but perhaps is more common with larger than seven liter removals.

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

Click here to see your BMI.

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

Designed to extract fat, the tools used for these methods are at our disposal. Like many things in life, it will depend on your surgeon's comfort level with each of these tools and whether he/she believes in that particular technology or instrument. So when this question is asked, you may receive many different answers. In the long run, each 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, let me start by saying that everyone's skin is different; therefore, everyone will respond differently. However, some generalizations 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.The analogy is much like when you are 10 to 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, are older, or you already have loose skin, 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, so 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, the skin has lost much of its elastic properties and will not retract as well as we would like. These cases are usually patients who have had children or have been through extreme changes in body weight by either 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; you can have children without any problems.

Liposuction is a procedure that removes fat cells, those that lie only above the muscle layers. We can never remove all the fat cells that are in your body; therefore, the fatty layer that is being removed plays no part in childbearing. Liposuction patients are similar to body builders and very fit mothers, in that they are all still able to have healthy babies despite having a very low body fat percentage.

When can I return to work?

On average, you can return to work after about one week. Some patients, however, have recuperated so well that were able to return to work after three days. Dr. Mendieta recommends at least one week off. At first, your old clothes will not fit because you are swollen. The swelling will begin to decrease after two weeks; at this time, you may begin to see some changes to your body. However, your clothes may still not fit properly. After about one month you will see the greatest improvement, and you will continue to see refinements for up to three to six months. You can expect to feel normal again after one month.

What is the cost of liposuction?

This is the hardest question to answer because there are so many variables, among which include: the areas that you are interested in treating, 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 to visit the physician for accurate prices.

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. This sensation develops because the nerves are regenerating, which may take up to six months to go away. It rarely takes longer than six months; in some cases, it may take up to a year. (The number of patients who have had permanent sensory changes is extremely rare.) Certain exercises that may help with the hypersensitivity changes are what we call the "desensitization technique.” The theory is that we need to over-stimulate the body so that the body becomes accustomed to the normal touch. Therefore, you need to use a variety of materials (i.e. cotton balls, T-shirts, towels, napkins, the hand) to constantly touch the body. You will notice that after some time, the numbness will not bother you and the sensation improves.

Other medicines that may help are Vitamin B6, B12, and Niacin. Consult with your physician first.

My skin changed colors after liposuction what can I do?

Immediately after your liposuction surgery, you will have bruising that may last between four and five weeks. It can be improved with the use of Arnica creams and pills, which you need to take immediately after your surgery and continue to do so for three to four weeks. (Consult your physician before using). You may need to take Arnica creams and pills for up to six weeks if you have very pale skin. If, after two months, your skin shows persistent discoloration, “hyperpigmentation” may be present. This is the darkening of the skin, which occurs most often in Hispanics, Afro-Americans, and patients with olive-colored skin. However, it may also 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. Here are a few things that can be done to help recovery.

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

* Hydroquinone – a lightening cream used twice daily
* The use of low level glycolic peels in a repeated fashion
* Kojic acid with the above regimen (sometimes can be combined)

All of these are prescription medicines would need to be followed by an MD, such as Dr. Mendieta. 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, which will take about six to eight weeks for most of it to improve. However, it will take about six to eight months to fully make any final judgments. The skin has an amazing way of redistributing itself, especially in the beginning. Because of all the swelling, it will difficult to see your final result right away.

Some of the things that may help in speeding up your recovery are massage therapy, ultrasound therapy, and Endermologie. A special machine that massages the body, Endermologie is 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, because in actuality everyone has one side of the body that is very different than the other. We 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 previously did not see. 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 – we just need to give it time to heal. With all that said, you need to give your liposuction results at least six months to fully appear 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. Typically 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 three to six 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 in clothes than it did before. Again, though, it will take at least one month for the changes to manifest.

I have waviness and skin irregularities.

This can happen, but usually there are a few things that can be done to improve these conditions. The best thing, however, it is to give it time. Sometimes it can take longer than six months for all the swelling to go away (every case is different). In the meantime, Dr. Mendieta encourages massage therapy, especially Endermologie. This is a particular massage given with a specialized machine, designed to help with cellulite and irregularities. It will take several treatments for results to appear, usually more than six. Not all physicians believe in this, but it has been somewhat helpful in our practice.

If the problem persists, even after one year of waiting and massage therapy, 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, known as "fat transfer.” However, this will completely depend on your skin type and what the problem is.

If the inner legs are the problem, an option may be an inner leg lift. This will need to be evaluated before suggestions are 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 the fat is very localized, one can try steroid injection but most of us would use this with great caution because it may cause thinning of the skin. However, for the right patient, it may be a good alternative to consider.

I don't see a difference after my liposuction.

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