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Liposuction (also called lipoplasty, liposculpture or lipectomy) is a surgical technique in which specific areas of fat under the skin are permanently removed through a small incision in the skin using a cannula (hollow metal tube) and a suction pump. The fat is sucked out through the tube with the aim of re-shaping the body in that area. Areas that can benefit from this procedure are many and include stubborn fat around the back, chest, stomach, hips, buttocks, thighs, knees, upper arms, underneath the chin and the neck. Suitable candidates for liposuction are average weight people with firm, elastic skin who have pockets of fat in specific areas. It is not an alternative to sensible dieting, a cure for obesity or a treatment for cellulite. The anaesthetic used may be local, regional (i.e. via an epidural), or general, depending upon the area treated, the technique used, and your doctor's recommendations. Depending on the extent of the procedure, you may be able to return to work within a few days to a week. Private costs for liposuction can range from approximately £1,500 - £5,000, (depending upon the area(s) treated).
Radiofrequency Assisted Liposuction (RFAL™) using the BodyTite™ device from Invasix Ltd provides minimally invasive body tightening and skin contraction.
VASER Lipo is a liposuction procedure performed using the VASER (Vibration Amplification of Sound Energy at Resonance) device, which uses ultrasound energy for a treatment known as Liposelection.
Liposuction (also called lipoplasty, liposculpture or lipectomy) is a surgical technique for removing specific areas of stubborn fat that do not respond to a healthy diet and regular exercise.
Dr Giorgio Fisher, an Italian Gynaecologist, first used liposuction as a technique for removal of fat in 1974.
It was then widely used in Europe by Dr. Illouz, a French Plastic Surgeon and eventually it reached the United States in the early 1980s. However, some bad publicity caused by the need for blood transfusions in some patients, and several deaths in others after liposuction, meant that this type of fat removal did not become popular until a new technique was developed. Dr Jeffrey Klein, a Californian dermatologist (skin specialist), devised this new treatment, called tumescent anaesthesia, in 1985. It proved to be much safer than the older treatment.
Over the last decade or so there have been many improvements in the procedure making it much safer and easier to perform in trained hands. The result is that liposuction is now the second most popular surgical cosmetic treatment performed in the U.S. with 289,261 procedures in 2018, according to statistics from the American Society for Aesthetic Plastic Surgery (ASAPS); this is a decrease however of 5.1% on 2017 figures, which may be due to the expanding range of technologies and techniques now being employed in less-invasive fat removal procedures, aside from traditional liposuction, such as ultrasound (HIFU) and cryogenic (cryolipo) modalities. Overall there is an increase of 31.9% in liposuction procedures in the USA when comparing 2014 to 2018.
Similar data is not yet available for the United Kingdom, but liposuction becomes increasingly popular year after year.
If you are considering liposuction for the removal of areas of stubborn fat, the following information will give you a basic understanding of the procedure. It can't answer all your questions, since a lot depends on the individual patient and the surgeon. Please ask a surgeon about anything you don't understand.
How Does it Work
Liposuction, lipoplasty, liposculpture is a surgical technique in which specific areas of fat under the skin are removed through a small incision in the skin using a cannula (hollow metal tube) and a suction pump. The fat is sucked out through the tube with the aim of shaping the body in that area.
After puberty we do not create new fat cells in our bodies. When you gain weight, the fat cells that you have expand or grow bigger. Liposuction permanently removes fat cells to improve the body's shape. If you gain weight after liposuction, it goes to the old fat cells that remain in the body, so that the fatty deposits that existed before liposuction can no longer balloon out of proportion to the now thinner surrounding area.
However, long-term body weight is not affected by liposuction. Liposuction cannot prevent you gaining weight. It is not an alternative to sensible dieting; it is a method for removing fat that does not respond to a healthy diet and regular exercise. If you want to lose weight after liposuction, you will still have to diet.
It is also not a treatment for cellulite.
Areas that can benefit from this procedure are many and include stubborn fat around the back, chest, stomach, hips, buttocks, thighs, knees, upper arms, underneath the chin and the neck.
Suitable candidates for liposuction are average weight people with firm, elastic skin who have pockets of fat in specific areas. You should be physically healthy and psychologically stable to have a treatment of this kind. Your age is not a major consideration but older people with less elastic skin should not expect the same results as younger people with firmer bodies.
Your first discussion with a practitioner should clearly set out your expectations of the treatment and establish that they match those predicted by your practitioner. Be realistic!
A medical history should be taken, to make sure that there are no reasons why you shouldn’t undergo liposuction. You would also normally be asked to sign a consent form at this time which means that you have understood the potential benefits and risks associated with this type of procedure.
Photographs may also be taken by the practitioner for a "before and after" comparison at a later date.
Your surgeon or doctor will give you specific instructions before coming in for the liposuction treatment. This may include avoiding the use of aspirin or any similar drugs for a couple of weeks before treatment (as these can cause increased bleeding). They may advise you to stop smoking as this can delay the wound healing, and avoid alcohol for a few days before the procedure.
The anaesthetic may be local, regional (i.e. via an epidural injection), or general, depending upon the area treated, the technique used, and your surgeon’s or doctor’s recommendations for you.
The use of a general anaesthetic carries a small additional risk which your practitioner will discuss with you before any decisions are made.
Depending upon the type of anaesthetic used, you may also have to fast (eat or drink nothing) during the night before and morning of your surgery.
Small areas of liposuction may be performed in an outpatient clinic room with the appropriate facilities, but large areas would normally be done in a hospital.
Small incisions, around 5mm or so in length, are made around the area to be treated, and a hollow suction tube (cannula) is put in and then moved around under the skin to break up the unwanted fat. The fat is removed either manually with a large syringe, or with the use of a vacuum pump. The overlying skin remains attached to the connective tissue and underlying muscles of the skin during the operation. A thin blanket of fat is left under the skin to help prevent rippling or bumpy skin occurring after the liposuction is over.
The basic technique of liposuction, as described above, is used in all patients undergoing this procedure. However, as the procedure has been improved and developed, several variations have been introduced. These are described below.
A technique in which a solution of lignocaine (an anaesthetic) and adrenaline (a drug that contracts blood vessels to reduce bleeding) is injected into the fatty areas before liposuction. This helps the practitioner to remove fat more easily, reduces blood loss, bruising, and provides local anaesthesia before and after treatment. Hence, it reduces any pain or discomfort that the patient may feel.
Large volumes of fluid - sometimes as much as three times the amount of fat to be removed – are injected into the fatty area. This procedure is usually performed on patients who only need a local anaesthetic, but it usually takes much longer to do the treatment, sometimes up to 4 or 5 hours for large areas of fat removal.
The super-wet technique
Similar to the tumescent technique above, except that less fluid is used. This is usually performed under a sedative given through a syringe into the vein, or via a general anaesthetic, and typically takes around one or two hours.
Ultrasound – Assisted Lipoplasty (UAL)
For this procedure a special cannula (a hollow suction tube) that produces ultrasonic rays of energy is used. The energy breaks down the walls of the fat cells which makes the fat liquid and this liquid is then removed by standard liposuction. UAL improves the ease and success of liposuction in fibrous areas of the body, such as the upper back or the enlarged male breast where the fat is much tougher to break down. It can also be a more precise technique as a follow-up procedure once the main volume of fat has been removed by other methods. In general, UAL takes longer than basic liposuction.
The doctor or surgeon must have advanced surgical skills and be experienced in cosmetic surgery to perform procedures that involve the removal of a large amount of fat (i.e. more than 5 litres).
After the fat is removed, the wounds are stitched and sometimes a drainage tube is inserted for a few days to prevent any fluid build up.
If you are not staying overnight in hospital, it may be wise to have someone take you home and look after you for a day or so following the procedure.
Although good results achieved with this procedure can be permanent, with a sensible diet and exercise, some patients may require a repeat procedure in the future in order to achieve or maintain a desired result.
Depending on the extent of the procedure, you may be able to return to work within a few days to a week.
Side Effects and Risks
Some pressure, movement, and stinging can be felt whilst fat is removed, but it is rarely painful. Any pain following the procedure is usually controlled with pain-killing tablets.
Bruising, swelling, and some blood coloured fluid leaking from the wounds may be expected for a few days. Infection is a potential complication, along with numbness, or nerve damage at the site of the liposuction.
You may also be able to see some unevenness, persistent swelling, or lumpiness at the places where the liposuction took place, and a little skin discolouration, or scarring at the incision points. If you have liposuction which involves ultrasound, there may also be a risk of burns to the skin and to the deeper tissues under the skin.
Only very rarely, more serious risks or side effects can include blood clots, severe infections and death.
It is very important that you carefully follow the advice of your practitioner following any liposuction treatment. This will make sure that the treatment is successful and reduces the risk of complications.
Post-treatment recommendations may include:
As long as you are in good general health and have realistic expectations of the operation, then most people are suitable candidates for liposuction.
If you are prone to keloid (red, angry, raised) scars, or have a history of problems with wound healing your surgeon may not recommend this procedure or may caution you that scars could be raised and very visible.
Who Can Do It
Liposuction, lipoplasty or liposculpture surgery should only performed by suitably trained doctors and surgeons. Ideally you would want to find someone who specialises in liposuction as part of their cosmetic practice.
For more information about practitioner training, qualifications and relevant medical organisations please view the information contained within the Legislation section of the Consulting Room.
It is highly unlikely that anyone considering liposuction, lipoplasty or liposculpture would be able to access this free of charge on the National Health Service.
However certain regions do make special cases, and we would always recommend that you visit your General Practitioner before embarking upon a cosmetic procedure involving surgery.
As well as their advice and guidance they may also be able to refer you to a local NHS Hospital for a consultation.
The NHS has set out the following guidelines on how to get cosmetic surgery through the NHS:
"To qualify for surgery on the NHS you must meet specific criteria as set out by your local health authority. The NHS will not pay for surgery for cosmetic reasons alone. Reconstructive and cosmetic surgery to correct, or improve, congenital abnormalities and injuries will usually be carried out free of charge.
NHS reconstructive surgery is performed by plastic surgeons who have had extensive training and belong to the British Association of Plastic Reconstructive and Aesthetic Surgeons. Surgeons who carry out cosmetic surgery through the NHS also belong to the British Association of Aesthetic Plastic Surgeons.
To receive cosmetic surgery from the NHS, you will normally need a referral from your GP. You will have a consultation with a plastic surgeon and an assessment by a psychiatrist, or psychologist. It will then be decided whether there is enough social, psychological, or physical benefit to be gained to justify surgery."
Prices for a private liposuction operation can range from £1,500 - £5,000 depending upon the area(s) treated.
Liposuction has become a much safer procedure over the last 10 years with the development of newer techniques. This has caused it to become one of the most common cosmetic surgery procedures performed today.
Patients who are not clinically obese (very overweight) and who are realistic about this treatment can successfully achieve an improved body shape by reducing the amount of fat in specific areas of their bodies.
Overall longevity of results does, however, depend upon good control of your weight in the future.
Before and After Pictures
Please note that results of cosmetic surgery vary enormously, depending upon both the patient and the skill of the individual surgeon, so outcomes for procedures will always be more variable than those for less invasive non-surgical treatments.
(All before and after photographs featured are real patients treated by highly experienced surgeons, your results may differ).
Arm ("bingo wings") before and 6 weeks after liposuction.
Photographs courtesy of Consultant Plastic Surgeon, Mr Christopher Inglefield, BSc, MBBS, FRCS (Plast) at London Bridge Plastic Surgery.