LIPOSUCTION

If no amount of diet or exercise removes those stubborn saddlebags on your hips or that paunchy spot on your stomach, you may be able to get rid of that localized area of fat through surgery. Liposuction, also called lipoplasty, suction lipectomy or liposculpture, is a cosmetic surgical procedure that vacuums out fat from beneath the skin's surface to reduce fullness in areas such as the abdomen, hips, thighs, knees, buttocks, upper arms, chin, cheeks and neck.

Liposuction is the most popular form of cosmetic surgery among both men and women in the United States, with 301,882 procedures performed in 2007, according to the American Society for Aesthetic Plastic Surgery. First introduced in the United States in 1982, liposuction's popularity increased as refinements to the technique improved results and reduced recovery times. However, rates of the surgery have decreased slightly in the past seven years—down 15 percent from 2000 to 2007.

Although liposuction can produce permanent changes in body contour, it is not a substitute for a healthy low-fat diet and exercise. It will not tighten loose skin or eliminate the shallow surface fat irregularities called cellulite. It is a sculpting technique that can improve body proportions and help make clothing fit better.

Liposuction recontours the body by removing some of the body's finite number of fat cells. It's a myth that when you gain weight, you're adding new fat cells to your body. In fact, each person has a fixed number of fat cells. When you gain weight, those fat cells grow larger, but don't increase in number. When you lose weight, the fat cells shrink. Your genes determine how many and where fat cells are distributed, and some people tend to have more fat cells in some body areas than others. For example, some women have more fat cells in their thighs and hips, instead of a uniform fat distribution. Liposuction can permanently remove some fat cells from such areas. But, the fat cells that remain in the area treated still can grow larger if you gain weight. Many liposuction patients find, however, that newly added weight will not accumulate in the specific areas as it did before and instead distributes more evenly or in different areas. This is why weight gain is inadvisable after liposuction. Liposuction results are best when patients achieve a five- to 15-pound weight loss after the procedure.

There are several variations on the liposuction technique, but those most commonly used involve first infusing the area to be treated with a solution of saline, a local anesthesia and a drug that constricts blood vessels. Then, a hollow tube attached to a vacuum is inserted into the fat layer beneath the skin. The tube, called a cannula, is moved through the fat layer in a push-and-pull motion to break up the fat. Then, the dislodged fat is sucked out of the body either via a syringe attached to the cannula or a surgical vacuum. In the tumescent technique, the solution used is two to three times the amount of fat to be removed. In the super-wet technique, the amount of fluid infused is the same as the amount of fat slated for removal. In ultrasound-assisted liposuction, ultrasonic energy that liquefies the fat is applied through the cannula, which also suctions out the fat. Similarly, a new technique—laser-assisted liposuction—uses a laser beam to liquefy the fat. And another new method called power or power-assisted liposuction uses a motorized cannula that pushes and pulls itself while suctioning out the fat. The choice of technique depends on the patient and the surgeon's skill and preference. According to the American Academy of Cosmetic Surgery, not only does the tumescent technique offer improved safety, it offers the fastest recovery time and fewest complications of all the liposuction methods.

Liposuction of small areas can be performed in an outpatient office surgical setting under the local anesthetic that is included in the infusion solution. It is often combined with sedation to keep the patient more relaxed during the procedure. If large amounts of fat are to be removed, the procedure is likely to be performed on an outpatient basis in a hospital, using a general or regional anesthesia, such as an epidural block commonly used in childbirth, which may be combined with intravenous sedation. General anesthesia is used when the patient must be put to sleep. In cases involving general anesthesia and large areas of fat removal, patients may be hospitalized overnight.

Most liposuction patients are able to return to work in a few days. Normal activities can usually be resumed within 10 days or less after liposuction, depending on the extent of the procedure. Patients must wear compression garments for one to six weeks after surgery to help the skin smoothly adhere to the underlying tissue and remaining fat and to help control swelling in the treated area. Compression garments appear to me most effective in the first seven days following surgery. Temporary bruising, numbness of the skin and swelling are common postoperative side effects.

As with any surgery, liposuction carries risks, including death. A controversial study published in the journal Plastic Reconstructive Surgery in January 2000 found a death rate of about 20 in every 100,000 patients who underwent liposuction from 1994 to 1998. According to the American Society for Aesthetic Plastic Surgery (ASAPS), a task force of plastic surgeons in 1998 determined that the factors that increase the risk of death from liposuction include:

*poor patient health
*excessive fat removal
*too much fluid and local anesthesia used during the procedure
*performing multiple procedures along with liposuction in a single surgical session, especially under general anesthesia

In contrast, a large study conducted in 1998 by the Arthur Andersen firm for the American Academy of Cosmetic Surgery revealed a very favorable safety outcome profile for liposuction. In skilled surgical hands, life-threatening complications from anesthetics, blood clots and even perforation of the organs near the area being treated are extremely rare. Bleeding, excessive bruising and infection are possible but uncommon, occurring in less than one percent of patients. Seromas, or pockets of fluid that have collected under the skin, also can occur when large amounts of fat are removed, but can be treated in an office setting by draining with a needle and syringe.

More common complications that usually require additional liposuction surgery include irregularities in contour, such as lumps or divots where the surgeon has removed too little or too much fat, and asymmetry, where the contour differs on each side of the body. These kinds of complications can be the result of poor surgical technique, lack of experience in the procedure or performing a liposuction technique on a patient who is not appropriate for the procedure. That's why it's important to carefully select your surgeon and ask questions about the surgeon's experience with liposuction. Various studies in the medical literature have reported revision rates ranging from five to 20 percent, depending on the type of patient, the number of areas treated at one time and how much fat was removed. A small amount of fat is considered less than 1.5 liters, while a large amount is four to five liters. Removing more than five liters of fat in a single liposuction treatment is considered too risky by most surgeons unless performed in a hospital with an overnight stay.

The American Academy of Dermatology (AAD) offers these guidelines of care for liposuction procedures.

*Liposuction should not be performed under general anesthesia.
*Liposuction should only be performed on healthy individuals.
*Liposuction is not a treatment for obesity and shouldn't be used to extract large amounts of fat.
*Liposuction should not be performed along with other procedures.

In addition to carefully choosing your surgeon, it's important that you have realistic expectations of your liposuction surgery. Liposuction can improve your body contour, but it will not make you fit or thin. The only way to get in shape is to eat a healthy diet and exercise. The best candidates for liposuction are healthy, normal-weight people with firm, elastic skin who have localized pockets of fat that do not respond to diet and exercise. Although there are no absolute age limits for liposuction, older women who have lost skin elasticity may not achieve as good results from the procedure as younger women with elastic skin. Skin imperfections can occur after any liposuction. The skin surface may be irregular, asymmetric or baggy, and these problems tend to occur more often in women whose skin is no longer elastic enough to smooth out after the underlying fat is removed.