Plastic Surgery Briefing - Liposuction
Liposuction is a surgical technique used to contour the body by removing
unwanted areas of fat. During the procedure, a hollow suction tube, or
"cannula," is passed through small skin incisions and manipulated in such a
way that the unwanted fat is broken up and transferred through the tube by
the attached vacuum machine. Patients may be given general anesthesia or
merely sedated to undergo liposuction and generally do not need to remain
hospitalized overnight. Improvements in body contour are usually permanent
with this procedure.
From its introduction into the United States in 1982, liposuction has grown
to become the nation's most frequently performed cosmetic plastic surgery
procedure. In addition, its techniques have been adapted for such
non-cosmetic purposes as tumor surgery, breast reduction and flap contouring.
A recent modification of the technique, ultrasound-assisted liposuction
(UAL), substitutes high-frequency ultrasonic energy for mechanical energy, to
remove localized areas of fat.
The tumescent technique allows surgeons to inject large amounts of fluid into
the areas of fat before performing liposuction. The fluid, containing local
anesthetic(s) and blood vessel constricting drugs, can reduce blood loss,
alleviate pain and lessen the need for general anesthesia. The local
anesthesia is usually supplemented with intravenous sedation or general
anesthesia when liposuction is performed by plastic surgeons.
With the "super-wet" technique, lesser amounts of fluid and local anesthetic
are injected and blood loss is similarly reduced. The procedure is usually
done under general or spinal anesthetic.
The American Society of Plastic Surgeons (ASPS) believes that liposuction is
generally safe, provided that patients are carefully selected, the operating
facility is properly equipped, and the physician has basic (core) accredited
surgical training with special training in body contouring. Patients should
be aware that lipoplasty to remove more than five liters (5000cc's) of fat
and fluid requires a high level of surgical skill and a provision for
prolonged monitoring after the procedure.
ASPS believes that ultrasound-assisted liposuction (UAL) is an acceptable
alternative to traditional liposuction in some circumstances because it
offers the potential of easier removal of fat in more fibrous areas. However,
because the heat generated by ultrasonic energy creates a risk for burns to
treated areas, plastic surgeons should complete a CME category 1 approved
training program in UAL before using the technique clinically.
ASPS believes that pre-injection methods (including "tumescent" and
"super-wet" techniques) usually decrease blood loss and reduce the need for
transfusion. Surgeons who use these techniques to remove large volumes of fat
and fluid must have a background of surgical education in the principles of
ASPS does not recommend liposuction for individuals with complicated
diabetes, poor circulation, significant heart or lung disease, or those with
recent surgery in the region to be treated.
Because there are no federal or state laws governing the scope or quality of
specialty education a physician must attain to designate him/herself a
specialist, patients should exercise care in selecting a surgeon. In
particular, ASPS recommends that individuals seeking liposuction inquire
whether privileges to perform liposuction have been granted to a particular
surgeon at an accredited hospital because hospitals must examine credentials
carefully before granting specialty privileges to staff physicians.
The ideal candidate for liposuction is a healthy adult man or woman with
localized areas of unwanted fat beneath firm, elastic skin. Although patients
of all ages may benefit from liposuction, the loss of skin elasticity with
advancing age may limit the degree of improvement in older patients. Women
usually seek liposuction to improve contour in the hips, thighs, abdomen,
legs, buttocks, and face-neck area. Men most frequently seek improvement in
the waist and abdomen.
Limitations, Risks and Complications
Liposuction cannot compensate for deficiencies in diet and exercise. It is
generally not a suitable method for weight loss, nor will it tighten loose
skin or eliminate the shallow surface irregularities popularly termed
Imperfections in final appearance are not uncommon after liposuction. The
skin surface may be irregular, asymmetric, or even "baggy," especially in the
older patient. Numbness and pigmentation may occur. Sometimes additional
surgery may bring further improvement.
As noted, ultrasound-assisted liposuction carries the risk for burns to the
skin and deeper tissues. In addition, the long-term biological effects, if any, of ultrasound energy are not known.
Though serious medical complications from liposuction are rare, the risks
increase if a greater number and size of areas are treated at one time.
Removal of large volumes of fat and fluid may require sizable volumes of
pre-injection fluid and longer operating times than in smaller operations.
The combination of these factors can create greater hazards for infection,
delays in healing, improper fluid balance, injury (especially perforation) to
vital organs, shock, and unfavorable drug reactions. As with any surgical
procedure, blood clots may form in the veins with risk of migration to the lungs, which can be fatal.
All patients experience some degree of discomfort after liposuction, though
most begin to feel better during the first week. Pain, swelling,
discoloration, and numbness should be expected, and a drain tube may
occasionally be placed beneath the skin for a day or more. Ordinarily,
patients are instructed to wear a snug elastic garment over the treated area
for a few weeks. With the garment in place, many are able to return to work
within a few days and to resume strenuous activity within the first month.
Although most of the discoloration and swelling usually disappear by six
weeks, some may persist for six months or longer.
A nationwide survey of ASPS member plastic surgeons in 1996 has disclosed the
Liposuction is the most popular cosmetic plastic surgery procedure in the
United States. ASPS members performed 109,353 liposuction procedures in 1996.
97,169, or 89%, of these patients were women.
The greatest demand for liposuction is seen on the Pacific coast, including
the states of Alaska, California, Hawaii, Oregon, and Washington.
Despite some regional variation, the average surgeon's fee for liposuction to a single site is $1,710.
This briefing paper on liposuction for plastic surgery patients and consumers
was developed by ASPS which formed a task force to review the history and
physiology of liposuction. The task force includes representatives from ASPS,
the American Society for Aesthetic Plastic Surgery and the Lipoplasty
The American Society of Plastic Surgeons represents 97 percent of all
physicians certified by the American Board of Plastic Surgery (ABPS). By
choosing an ASPS member plastic surgeon who is certified by the ABPS, one can
be assured that the physician has graduated from an accredited medical school
and completed at least five years of additional residency training, usually
three years in general surgery and two years of plastic surgery. Additionally
a physician must also practice plastic surgery for two years and pass
comprehensive written and oral examinations.
This document is designed to provide accurate and authoritative information
in regard to the topic covered as of the date of publication and is subject
to change as scientific knowledge and technology advances and as practice
patterns evolve. The views expressed herein represent the collective, but not
necessarily the individual, views of members of the American Society of