Liposuction is a technique that removes fat from unwanted areas. The key to liposuction is to abstract the correct amount of fat, to cause the least disturbance of neighbouring tissue, to leave the person’s fluid balance undisturbed and to cause the least discomfort to the patient. Mechanical energy has been the mainstay of liposuction for many years but modern refinements utilising ultrasound, laser and water assisted techniques have helped to improve outcomes. By using additional energy sources one is able to disturb the neighbouring tissues less and reduce the discomfort. Patients tend to experience less bruising and swelling than traditional liposuction.
Further refinements have seen the increasing use of tumescent fluid to enable removal of large volumes of fat. Again this is to aid patient recovery and comfort however the use of often large volumes of fluid to improve results need to be carefully monitored in a facility with dedicated postoperative monitoring and care. Although liposuction can be performed under either local anaesthesia or general anaesthesia, postoperatively patients should be monitored closely to limit the complications resulting from fluid imbalance. Liposuction can be performed on any area of the body although for women it is most commonly performed on the abdomen and thighs and for men abdomen and flanks. Liposuction can also be performed in addition to facial surgery e.g. facelifts and neck lifts, breast surgery e.g. breast reduction / mastopexy and body rejuvenation surgery e.g. abdominoplasty and arm/thigh lift.
Liposuction remains one of the most commonly performed operations in cosmetic surgery, however it is important for patients to consult with a plastic surgeon with experience in liposuction and other body rejuvenation procedures. The pros and cons of local / general anaesthesia, types of liposuction, alternative procedures and additional non surgical / surgical treatments need to be discussed. Patients should be weight stable and at their ideal weight before considering liposuction and it should not be seen as quick fix to reduce fat. Judging the correct amount of fat to remove remains one of the most important decisions in order to limit complications.
One of the commonest errors is removal of too much fat or to perform the technique on patients with excess skin. With the right patient selection liposuction is an excellent tool to reduce unwanted fat and is best performed on isolated areas of fat and in patients with good quality skin. Choosing the right patient will help reduce the skin irregularities that occur following liposuction which remains the biggest concern long term. If liposuction is performed alone the incisions used are determined by the liposuction technique and the size of the cannula although they are usually no more than 0.5 – 1cm in length. The incisions can be well hidden and can be either sutured or left open. It is rare for patients to notice these incisions in the long term. Although non-invasive methods of liposuction exist and may be useful in certain patients the pros and cons of these techniques need to be discussed alongside the pros and cons of traditional invasive techniques. For the right patient liposuction provides excellent results and these results are often improved by the use of compression garments that help in the postoperative phases to reduce swelling and discomfort.
Further improvements in liposuction mean that patients can have the fat that has been removed injected into other areas of the body such as the breast, buttocks and face. Liposuction can thus now be seen as liposculpture and an important adjunctive tool in body rejuvenation