You know it as a solution to a problem involving body contours -- the physician can sculpt the body, ridding it of precise amounts of fat that refuse to go away with dieting and exercise. It has become a prime weapon in the battle against saddlebags, love handles, and other problem areas such as the abdomen, upper arms, buttocks and neck.
Although a small number of serious complications have been reported in recent months, liposuction is a very safe procedure when performed prudently and conservatively by experienced physicians. As with any surgery or medical procedure, it has its limitations. If informed about these limitations and understand how the procedure is done, you will almost invariably be satisfied with the results.
Liposuction involves removal of excess fat by suction through a straw-like wand. In the 1980s dermatologic surgeons introduced a major advance in the procedure that limits pain, reduces bleeding and allows more efficient removal of unwanted fat. It is called the tumescent (too-MES-ent) technique -- tumescent meaning swollen -- because of the swelling caused by the injection of a large volume of solution into the area. Typically the solution contains one or both of two medicines: lidocaine (a local anesthetic) and epinephrine (a drug to shrink small blood vessels called arterioles).
This tumescent technique is largely responsible for allowing the procedure to be done under local anesthesia in a doctor’s office. If liposuction is performed in a surgery center or hospital under general anesthesia, no lidocaine needs to be included in the tumescent solution.
- The amount of fat to be removed. Your surgeon should be able to estimate how much fat will be removed from your liposuction site. The prudent limit of fat removal in the doctor’s office is two liters (about four pounds), primarily due to the concentration of lidocaine necessary. In a surgery center or hospital the limit is four liters (eight pounds). Removal of more than four liters of fat causes an increase in the risk of complications. That’s when body fluids begin to shift dangerously, raising the possibility that you will need blood transfusions. Exceeding the limit may also cause fatty particles to enter the blood stream and cause a stroke.
- The amount of tumescence solution. Studies have shown that the safe dose is about 50 milliliters/kilogram of body weight. Some doctors make a point of not injecting more than three liters of solution for an office procedure.
- Two-for-one procedures. Another caution when asking your doctor about liposuction is that the procedure should not be combined with another major cosmetic procedure in the same body area. In particular, it would be risky to have abdominal liposuction immediately followed by abominoplasty, or surgical removal of excess skin from the belly. The body may not be able to handle the stress of the dual operations.
- Dedicated procedure rooms. Office procedures should be performed only in rooms dedicated to operative procedures, not in a room where routine office visits and examinations take place.
- General anesthesia. General anesthesia should be reserved for hospital or outpatient surgery centers, not for doctors’ offices.
- Physician selection. Who can you trust to perform your liposuction? There are no national standards, so you have to make your decision on other factors. Doctors elected to fellowship status in two professional societies are required to have competency in cosmetic surgery (although not necessarily in liposuction itself). They are the American Academy of Cosmetic Surgery and the American Society of Plastic Surgeons.
Dermatologists and plastic surgeons perform about 90 percent of all liposuctions. You should ask if they are board certified in their specialty. A doctor who has performed more than 100 liposuctions should be considered experienced. You could ask them where they learned how to do liposuction, in formal residency programs they would have performed cases under supervision, and in training courses they would be able to produce certificates of completion.
If your doctor satisfactorily answers all your questions and you elect to have liposuction, you can look forward to a safe and effective procedure.
