Body contouring surgery has made it possible to eliminate excess skin of the abdomen, buttocks, hips, and thighs and reduce fatty deposits via liposuction or lipoplasty. Lower body lifts have become a commonly used method of removing excess skin and fatty tissue from the lateral hips and inner thighs to address the sagging skin that results from aging, pregnancy, extreme weight fluctuations, and an inactive lifestyle. In recent years, the advent of laser lipolysis devices that combine liposuction with laser energy has transformed body contouring by offering less invasive techniques. Another category of procedures that is gaining ground are the nonsurgical fat reduction devices that combine ultrasound, radio frequency, and other forms of laser- or light-based energy to dissolve fat.
Adult fat cells are thought to be incapable of multiplying. There are a fixed number distributed in a genetically predetermined fashion throughout the body. As you gain weight, these cells expand. As you lose weight, they contract but the number and distribution remain essentially unchanged, which accounts for why thin people may still complain about localized fatty deposits that don’t go away, even at their ideal weight. Dieting reduces your weight and overall size. Liposuction reduces the overall number of fat cells and affects shape and contour so that future weight gain or loss won’t be noticed as much in the areas that were treated as in nontreated areas. It is a safe and effective way to remove unsightly bulges from almost any area to produce an improved shape and contour.
New advances and technological innovations have liposuction procedures safer and simpler for both surgeons and patients. Most areas of your body can be suctioned for better contour and reduced volume, from the face down to the ankles. The most popular areas for women are the abdomen, inner thighs, outer thighs, hips, flanks, and knees. Liposuction can even be used to reduce heavy breasts in some women. Surgeons treat areas of the body circumferentially, instead of just removing fat deposits from selected spots. Sections like the abdomen, hips, waist, all around the thighs and knees, and upper arms can be combined to maximize the potential for the skin to shrink after the fat is removed. You should evaluate your body in distinct units, like the upper abdomen, lower abdomen, and knees, and prioritize the areas that would benefit most from recontouring. If you are very overweight, you may have to undergo these procedures in stages.
• Chin, neck, jowls, cheeks
• Upper arms
• Posterior and anterior axillary folds
• Upper and lower abdomen
• Upper back and back rolls
• Upper hips and flanks
• Banana rolls
• Outer thigh
• Inner thighs
• Anterior and posterior thighs
• Inner knees
Tiny incisions of approximately one quarter inch long or less are made at the sites where fat is to be removed, and a wetting solution is infused to provide anesthesia, reduce bleeding, and improve fat extraction. This requires careful monitoring to avoid toxicity. The surgeon uses various sizes of hollow, tubular instruments that have holes at one end to trap the fat, and that are attached to suction tubing through which the excess fat is evacuated. These cannulae are inserted under the skin and moved in a back and forth and crisscross fashion within the fat, essentially pushing it aside while protecting the vessels and nerves. Fat is suctioned out through holes at the tip. Warmed tumescent liquid, a diluted solution containing lidocaine, epinephrine, and intravenous fluid is injected into the area to be treated. The saline solution softens the fat, the adrenaline decreases the blood loss and bruising, and the lidocaine provides pain relief. For small amounts of fat, the tumescent solution may be used alone, or it can be supplemented with sedatives to put you in a sleepy state. General anesthesia may be used for longer procedures involving multiple areas.
It is better to lose some weight before surgery and more afterward. If you put on a few pounds after liposuction, you will lose some of the benefit of your result. If you lose some weight after, your shape will look that much better. It is not uncommon to undergo a small touch-up procedure six months later. If you have several areas to be suctioned, you may need to have it done in multiple stages. In some cases, a staged procedure may be a good solution. Liposuction may be done first, and skin excision and internal tightening can be done at a later stage. Fat from other areas can be suctioned and injected back to smooth and fill out dents and add curves. Liposuction can be used to delicately recontour legs from the ankles, calves, and knees up to the inner and outer thighs, taking inches off the circumference of the leg. Calves and anterior thighs are tricky because they are often largely muscle, but suctioning even small amounts can make a big difference in the overall shape.
The more elastic your skin, the better result you will see from liposuction. If you have flabby skin, liposuction can potentially make it look worse. Some areas of fat deposits are less forgiving than others and more often lead to sagging skin, for example, upper arms, inner thighs, knees, abdomen, and the neck. If your ultimate goal is to be taut, a tummy tuck, thigh lift, or lower body lift, which involves tightening underlying muscles and removing and redraping excess skin, may be better options.
Methods and technologies for fat removal continue to evolve. These are the most commonly used today:
- Liposelection™ by VASER® (Val)
- Laser Lipolysis (Lal)
Laser lipolysis systems combine energy, such as a diode laser or radio frequency, with fat removal techniques to maximum the potential for skin tightening. These energy-based devices are commonly marketed under trade names including Smart Lipo, Cool Lipo, Slim Lipo, Smooth Lipo, and others.
- Ultrasonic-Assisted Lipoplasty
Ultrasonic sound waves, like shock waves, are transmitted into the fatty tissues from the tip of the cannula probe. The fat cells are melted or liquefied and then removed by low-pressure vacuum through a suction tube. Ultrasonic liposuction is usually combined with traditional liposuction when both the deeper fat and more superficial fat are being removed.
- Power-Assisted Lipoplasty
With the addition of power, the cannulae used are motor-driven so they vibrate, which makes removing fat easier and faster for the surgeon. The primary advantage is that there is less physical exertion required for the surgeon to remove the fat with this method.
- Water-Assisted Lipoplasty (Wal)
This technology uses a fan-shaped water jet to infiltrate the fat into a gel-like form so that it can be suctioned out. Large volumes of fat can therefore be safely removed in one session.
- Custom-Assisted Liposuction (Cal)
This is one of more recent technologies to be introduced, also called Nutational Infrasonic Liposculpture system and Tickle Lipo. This system uses a very low frequency form of vibration, such as a sound wave, to remove fat in a precise manner from all over the body.
VASER utilizes advanced ultrasound to create a more precise way of separating fatty tissue. Fat pockets are quickly but gently dissolved and then safely removed from the abdomen, upper arms, hips, saddlebags, neck, or other areas. Due to its tissue selectivity process, this technology minimizes the possibility of uneven contouring, ripples, lumps, and bumps. Recovery is fast, minimizing pain and bruising and maximizing smooth skin retraction.
- Time: 1-4 hours
- Cost: $2,500 to $10,000 or more for several areas done at one time
- Back to work: 3-7 days
- Recovery: Most liposuctions are performed on an outpatient basis, and you can go home the same day. For large volume procedures or multiple sites, it may be recommended that you stay overnight in the hospital or clinic. During the two days following the procedure, you can expect significant swelling, but this rapidly subsides. Your face, feet, and hands may swell up from all the fluids pumped into you. Swelling travels down, so don’t be surprised if you’re puffy and bruised in places you didn’t have treated. There also will be numbness in some areas. Showering is usually permitted after one or two days. Most surgeons will request that you continue to wear a compression garment for several weeks after surgery. You can resume an exercise program in a matter of days or weeks, depending on the extent of the procedure. You can start to see your new shape best after three weeks, when most of the swelling has subsided. Residual swelling settles gradually over the next three months.
- Risks and side effects: A major benefit of liposuction surgery is that the scars needed are tiny. Small slit-like scars can be placed in hidden areas like in the belly button, in the crease under the buttocks, and inside the knee, so that they are well concealed. These scars generally heal well. After surgery, a compression garment will be placed. Wearing the girdle for a few weeks will hold everything in and keep swelling to a minimum. The risks from liposuction are most often related to the expertise of the surgeon as well as the anesthesiologist. Specific risks from the tumescent technique include rare complications like pulmonary edema, which is a collection of fluid in the lungs that may occur if too much fluid is administered. Lidocaine toxicity, which can occur if there is too much Lidocaine in the solution, is another potentially deadly complication. If your surgeon injects too much of the solution, overworking the heart or drowning in fluids are possible consequences. Anti-embolism boots are often used during surgery to prevent a blood clot from forming in the deep veins of the pelvis or legs. A fat embolus can also occur where a bit of fat travels into the bloodstream. The risk of a seroma is possible and is more common in areas like the abdomen and chest. In these cases, the surgeon may drain the excess fluid to relieve pressure. Generally, the greater the volume of fat removed, the greater the risks.
In some cases, a touch-up may be done six months after the initial procedure to refine an area that has previously been treated. If you have had liposuction and the skin is loose, additional liposuction will only make the skin look worse. A skin excision procedure may be recommended instead. The results of liposuction are permanent, as long as you keep your weight stable. If you gain weight after liposuction, you will tend to gain it back in the areas not suctioned, since the normal number of fat cells are still there and will continue to expand. There are still fat cells in the areas that were suctioned. If you do gain fat in other areas of the body that were not your primary trouble spots, it may be responsive to diet and exercise.
Wendy Lewis is a nationally recognized aesthetics consultant and the author of the Vibrant Nation Health and Beauty Guide, Cosmetic Procedures and Plastic Surgery After 50: Expert Advice for Choosing the Best Option for You.