Liposuction

Overview

Some fat stays put however steady your weight and however regularly you exercise, often on the abdomen, flanks, thighs, upper arms, back, chin or neck. Liposuction changes the contour of these areas by removing fat from beneath the skin through a thin metal tube called a cannula, which is passed through small cuts a few millimetres long.

It is not a weight loss treatment. The amount of fat a surgeon can safely remove in one session is limited, and the change on the scale is usually small. The aim is shape, not weight. People who are hoping to lose a large amount of weight are usually advised to look at diet, exercise, medical treatment or bariatric surgery first.

Liposuction also does not tighten skin or treat cellulite. Your skin needs enough elasticity to shrink back over the new contour. If it does not, the result can look loose or uneven, and a skin tightening operation may be more suitable.

Who needs it

Nobody needs liposuction for their health, with a few exceptions such as some cases of lipoedema (a condition where fat builds up in the legs and sometimes arms in a painful, symmetric pattern), where surgeons use it as part of treatment.

For cosmetic liposuction, surgeons usually look for:

• A stable weight, close to the weight you plan to stay at.
• Specific areas of fat that have not changed with diet and exercise.
• Firm, elastic skin over those areas.
• Good general health, with no uncontrolled heart, lung, blood clotting or blood sugar problems.
• No smoking, or a willingness to stop well before and after surgery.

Many surgeons set an upper limit on body mass index (BMI, a measure of weight relative to height) for cosmetic liposuction, and they will check your past clots, bleeding problems and medicines. A good surgeon may advise against surgery if your weight is still changing, if the area you are worried about is mostly loose skin, or if your goals seem driven by pressure from others. That advice protects you.

How it is done

Most liposuction is done under general anaesthesia. Small areas can be treated under local anaesthetic with sedation. The operation takes one to four hours depending on how many areas are treated.

Tumescent fluid

Nearly all modern liposuction begins by filling the area with tumescent fluid, a large volume of salt solution mixed with a local anaesthetic (lidocaine) and adrenaline (which narrows blood vessels). The fluid makes the fat firmer, reduces bleeding and numbs the area for some hours after surgery. The surgeon calculates the dose of lidocaine carefully, since too much can be harmful.

Techniques

After the fluid has taken effect, the surgeon moves the cannula back and forth under the skin to loosen and suction out the fat. Several methods help with this:

• Suction assisted liposuction (SAL): the standard method, using suction and the surgeon's hand movement only.
• Power assisted liposuction (PAL): the cannula vibrates rapidly, which can make breaking up fibrous fat easier.
• Ultrasound assisted liposuction (UAL), including VASER: sound energy loosens the fat before it is removed. It can help in fibrous areas such as the back or male chest. Surgeons take care to avoid burns.
• Laser assisted liposuction: laser energy melts fat through a thin fibre. Claims about skin tightening vary, and your surgeon can explain what it adds in your case.

The surgeon's judgement and the amount removed matter more than the device name. The small cuts are closed with a stitch or left to drain, and you are put into a compression garment before you wake up.

Recovery and how long you stay

Small procedures are often day surgery. Larger volumes or several areas usually mean a night or two in hospital so the team can monitor fluids and pain. Expect fluid leaking from the cuts for a day or two, bruising, swelling and soreness that feels like a deep muscle ache.

The compression garment is a fitted elastic garment that presses the treated area. It helps control swelling and supports the skin as it settles. Surgeons commonly ask for it to be worn almost all the time for two to three weeks, then for several more weeks during the day. You will be encouraged to walk the evening of surgery and often after that, which lowers the risk of clots.

Most people return to desk work within one to two weeks and to exercise after four to six weeks, on their surgeon's advice. Swelling goes down over three to six months, so the final contour takes time to show.

Risks to discuss openly with your surgeon include:

• Uneven contours, dents or ripples, sometimes needing a touch up.
• Seroma (a pocket of fluid under the skin that may need draining).
• Numbness or altered feeling in the treated skin, usually temporary.
• Infection, bleeding and fluid imbalance.
• Blood clots in the legs or lungs, and rarely fat embolism (fat entering the bloodstream).
• Rarely, injury to internal organs from the cannula.

Plan on 10 to 14 days in the destination. The first garment change usually comes within a few days, and the surgeon wants to see the treated areas again before you fly, because a seroma or uneven swelling is easier to deal with while you are still close by. With several areas treated, that review tends to fall at the later end of the range. A long operation followed by a long flight adds to clot risk, so the surgeon sets your flying date. Liposuction is offered in all five of our destination countries, and when clinics quote, MediCurage asks each one to state whether garments, drain care and follow up visits are included, so the numbers you compare cover the same things.

Questions to ask your surgeon

1. Which areas do you think will respond to liposuction, and which will not?
2. Is my skin firm enough, or would a skin removal operation suit me better?
3. Which technique will you use, and why that one for my body?
4. How much fat do you plan to remove, and will I stay overnight?
5. How do you lower the risk of blood clots during and after surgery?
6. How long do I wear the garment, and how many do I need?
7. What would you do if the contour is uneven after the swelling settles?
8. When can I take a long flight home?

Point to the exact areas that bother you while the surgeon examines you standing up. "The abdomen" or "the thighs" can mean different things to different people, and a plan that names each area makes the quotes easier to compare.