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Liposuction

Dear Dr. Horton, Thank you very much for my results from surgery. I feel like I look fantastic and balanced. All my clothes have a whole new meaning and I love getting dressed everyday now.

What is Liposuction?


Liposuction is a surgical technique that removes excess “adipose tissue” (fat) from specific stubborn fat deposits on the body. The purpose of liposuction is to improve body contour and reduce overall body size. Liposuction enables individuals who feel out of proportion due to their body shape or persistent fatty deposits despite achieving an optimal weight to become more proportional and look as fit, athletic and toned as they usually are!

During liposuction, localized deposits of fat cells that are resistant to diet and exercise are removed using a thin wand (known as a surgical “cannula”) and a vacuum to improve body contour. Common areas amenable to liposuction have amusing nicknames in popular culture: the hips, thighs (“saddle bags”), abdomen (“pooch”), flanks (“muffin-top” or “love handles”), buttocks (“banana roll”), arms (“bat wings”), and neck (“turkey waddle”). Accumulation of stubborn fat in these areas is called “Lipodystrophy” in the medical literature.

Liposuction is a simple and effective procedure to contour the body with less downtime than other more invasive surgeries. Liposuction can be performed on multiple areas of the body at one time, and can also be added as a complimentary procedure to surgery of the breasts, tummy, body or face.

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Who is a Good Candidate for Liposuction?

Good candidates for liposuction include healthy individuals of normal weight with good skin tone and elasticity, both men and women who have concentrated pockets of fat resistant to weight loss, and people who have achieved the maximum possible results with regular exercise and healthy, balanced diet.

Liposuction is not an alternative to weight loss and should be postponed if additional weight loss or pregnancy is planned in the near future for the best possible results. Please see our Preparing for Surgery section to learn more about optimizing your results from liposuction by becoming the best possible candidate for surgery.

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Is a Liposuction Part of a Mommy Makeover?

Liposuction is very often part of a Mommy Makeover! Common areas addressed by liposuction in Moms include the abdomen, flanks, pubic region, hips, inner and outer thighs, buttocks, arms and neck or chin. Please see our Mommy Makeover section to learn about changes that commonly occur in the body after pregnancy and about liposuction as a component of a Mommy Makeover!

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What Really Happens During Liposuction?

Please see our Preparing for Surgery section to learn about what happens in the operating room on the day of surgery.

During liposuction, tiny incisions are hidden in natural body creases such as the groin, belly button, armpit or buttock crease. Through these incisions, a special fluid mixture called “Tumescent Solution” is infiltrated into the fat. Tumescent solution contains normal saline (sterile salt water) which helps to “plump up” the fat cells for removal, adrenaline (epinephrine) which acts as a “vasoconstrictor” to decrease bruising and prevent bleeding, and a local anesthetic (lidocaine) which makes the area numb for many hours up to a few days after surgery and promotes postoperative comfort.

Next, a blunt-ended, thin-diameter wand known as a “Cannula” is introduced through the tiny incisions to gently suction out excess fat using a Vacuum. Fat cells are removed permanently! The treated areas are “feathered out” at their edges to blend naturally with the surrounding areas. At the end of the procedure, dissolving sutures are placed and a Compression Garment is applied. Surgery can take an hour and a half up to several hours if multiple areas are treated.

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What Are the Different Types of Liposuction?

Standard Liposuction (SAL)

Most liposuction cases are done using standard liposuction, also known as “suction-assisted lipectomy” (SAL). During this traditional liposuction technique, concentrated areas of fat to be removed are marked on the skin preoperatively while standing up. Injection of tumescent solution as described above is done for all cases of liposuction. This is known as the “Tumescent Technique” and is most safe way to remove fat while decreasing bruising and promoting postoperative comfort.

Liposuction can be performed in the office, but for optimal safety and patient comfort we usually recommend having surgery under general anesthesia in the main operating room as an outpatient (same-day) procedure. Most routine cases of liposuction remove up to a few liters of fat (3-5 pounds, up to 10 pounds of fat). “Large volume liposuction” refers to surgery where more than 5 liters of fat are removed (over 10 pounds). For safety, an overnight stay is usually recommended if many areas at once are being treated or if a large volume of fat removal is planned.

Ultrasonic Liposuction (UAL)

Ultrasonic liposuction is a two-stage procedure that first treats the fat with a wand that delivers ultrasound energy inside the body to help “melt” the fat before its removal. Regular liposuction is then used to remove the fat in the same operation. Other names for this technique are “ultrasound-assisted lipectomy” (UAL) or “Vaser” (a brand name of one type of machine). Ultrasonic liposuction is usually recommended for very stubborn fat deposits such as redo liposuction and other difficult-to-treat areas such male breast tissue (“gynecomastia“) or lipodystrophy associated with medications used to treat HIV.

Power-Assisted Liposuction (PAL)

Another machine that is infrequently used has a vibrating wand that purports to decrease surgeon fatigue. Known as “power-assisted liposuction” (PAL), this technique is not commonly performed by most Plastic Surgeons.

Other Brand Name Procedures

New machines and technologies emerge on the market every year. Many of these have brand names that are heavily promoted in the media and on large billboards to the general public. While these procedures often have familiar brand name recognition, there is no guarantee that they are appropriate for every patient in every situation.

In our practice, we only offer procedures and treatments that are FDA-approved, clinically proven and recommended by our professional societies, which are limited to Board-Certified Plastic Surgeons. For safety and to find the very best fit of procedure to match your specific body contouring goals, a formal in-person consultation including a complete history and full physical examination is essential.

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What is the Recovery After Liposuction?

After liposuction, mild discomfort requiring oral pain medication and swelling is expected for a few days. You will be given oral prescription pain medication and can switch to regular Tylenol when you feel ready. Medications such as aspirin, ibuprofen and other NSAIDs (Excedrin, Motrin, and Aleve) must be discontinued two weeks before and after surgery to limit bruising.

Bruising is expected after liposuction for 2-3 weeks. You will awake wearing a compression garment. It is recommended you wear your garment continuously for the first 3-5 days after surgery before removing it to shower, as your swelling will peak during this early postoperative period.

You can return to work within a few days, and resume exercise in a few weeks, or when you feel ready. You should continue to wear your compression garment for up to six weeks after liposuction to promote the flattest and firmest body contour possible. Numbness and overall tiredness is common for a few weeks after surgery.

It can take 3 months up to a year for all surgical swelling to subside and for the final results of liposuction to be apparent. Please see our Postoperative Instructions section for additional information pertaining to recovering from liposuction.

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Will Liposuction Remove Cellulite?

There are two Distinct Layers of Fat in the body: the Deep Layer (where excess fat is stored) and the Superficial Layer of fat (for instance in the face, at the ankles or over the sternum). Pinch your own sternum for an example of your superficial layer of fat. There is a structural anatomic boundary between these fatty layers known as “connective tissue” which is made up of collagen and elastin. The makeup of connective tissue is primarily genetic and differs between men and women.

Cellulite is a specific structural condition that occurs primarily in women but can also exist in men. As fat is stored and accumulates in the deep layer of fat, it bulges upward and is visible through the skin surface as dimpling, creating the “cottage cheese” contour of cellulite. Cellulite is a natural anatomic phenomenon that cannot be prevented or removed.

In most men, the connective tissue boundary between the deep and superficial fat layers is naturally strong and cross-linked, which prevents excess fat to be seen even if very thick (think of a big, smooth beer belly!) Unfortunately for most women, their connective tissue layer is naturally less cross-linked and weaker, becoming prone to further weakening with age. It is for this reason that women develop cellulite in dependent areas where fat is stored after a certain age (buttocks, back of the thighs), and why cellulite often persists despite being physically fit or obtaining a normal weight.

Liposuction specifically treats localized fat deposits (“lipodystrophy”) that persist despite a healthy diet, optimal weight and regular physical activity. Liposuction therefore only removes fat from the deep layer and stays out of the superficial layer. This ensures that only true surpluses of fat are removed and that the skin maintains its smooth and natural contour without creating ugly “ripples” or “waves” (irregularities) in its surface.

While liposuction does not specifically remove cellulite (nothing can), it can potentially improve the appearance of cellulite by debulking the deep layer of fat and lessening the tension on the skin from below. Wearing a postoperative compression garment facilitates a smooth skin contour and contraction of skin evenly after liposuction.

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What Are Potential Risks and Complications of Liposuction Surgery?

When you are considering any type of surgery, you should be fully educated about potential risks and complications. Please see our Preparing for Surgery section to learn about risks and potential complications related to surgery and Postoperative Instructions for additional information pertaining specifically to liposuction.

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Please click here to see before and after liposuction results!

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As women Plastic Surgeons, we intimately understand how a woman’s feelings about her body can influence her body image and self-esteem, and we aim to give you the results you are looking for! At your liposuction consultation, your surgeon will spend a great deal of time with you to get to know you personally and take a complete medical history. We will explore your reasons for seeking body contouring, examine you, and if you are an appropriate candidate for surgery, your options will be described in detail.

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Dr. Karen M. Horton, M.D. - Plastic Surgery, Physicians & Surgeons - Medical-M.D., San Francisco, CA