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Lipoplasty or liposuction -- the removal of fat using suction -- was first introduced in the United States in the early 1980s. Since then, many refinements have been added to make the procedure safer and to provide more precise results with quicker recovery times. More than 478,000 liposuctions were performed in 2004, an increase of 24 percent since 2003, keeping liposuction the number one surgical cosmetic procedure in the United States, according to the American Society for Aesthetic Plastic Surgery. The main purpose of liposuction is to reshape a body area or areas, not to reduce weight. It is most often used on areas that do not respond well to diet and exercise, such as outer thighs and hips on women ("saddlebags"), the waist and backs of men ("love handles"), as well as the face, neck, abdomen, buttocks, legs, and upper arms. Liposuction may used in combination with other procedures, including abdominoplasty (tummy tuck), facelift, and breast reduction (reduction mammoplasty).
In addition, the results of liposuction are considered permanent, but only if you're careful about your diet and health afterward. "If you want liposuction, but you don't incorporate diet, exercise, and lifestyle changes into your regimen, liposuction won't be successful long-term," says Rod Rohrich, MD, President of the American Society of Plastic Surgeons.
Liposuction is generally performed as an outpatient procedure in an accredited doctor's surgical suite or surgical center. Unless a large volume of fat is removed, a hospital stay is generally not required. Depending on the procedure, general or local anesthesia may be used. In the traditional procedure, a doctor inserts a small, thin tube called a cannula through tiny incisions in the skin. Fat is vacuumed through the cannula while the surgeon moves the instruments around under the skin to target various fat deposits. If many sites are being treated, the surgeon tries to make the incision sites as inconspicuous as possible.
Because of recent improvements to make liposuction safer, easier, and less painful, a variety of techniques are now available. Your doctor will assess which option is best for you.
Two of the more common methods of lipoplasty are:
Tumescent liposuction (Fluid injection): Considered the safest and most effective method with the quickest recovery time, a medicated saline solution of lidocaine (a local anesthetic) and epinephrine (a drug that constricts blood vessels) is injected into fatty tissue before liposuction. The solution makes the fat expand and become more firm, allowing the cannula to move more smoothly under the skin. The medicated solution also greatly reduces blood loss and provides anesthesia during and after the surgery, thereby cutting down on the risks associated with traditional liposuction. This form of liposuction also cuts down on bruising, swelling, and pain after the procedure.
Ultrasound-assisted (ultrasonic) liposuction (UAL): This technique uses a special cannula that produces ultrasonic energy. (This is called "internal" UAL.) The energy explodes the walls of fats cells, liquefying the fat before it is removed. Once fat has been liquefied, the cannula can move around more easily. This technique may be particularly useful for areas where fat is very firm or fibrous (for example, the sides, back, and the area around the navel; also, male breasts). "External" UAL, performed with a vibrating machine applied to the outside of the skin before liposuction, may also be used.
Pain Level/Recovery Time: Following surgery, the part of the body that was treated is tightly wrapped to help reduce bruising, swelling, and pain. Elastic bandages and tape or tight-fitting garments may also be used. Patients may have to wear these compression garments for a week or more. Following tumescent liposuction, fluid may drain from the incision sites for several days. Antibiotics may be used to fight infection. Some patients experience pain, burning, swelling, bleeding, and temporary numbness. Stitches are removed or will dissolve within a week to 10 days. Scars are usually small and hidden from view. Most people can return to their normal routines within one to two weeks. Larger procedures require longer recovery periods. Some results may be noticeable right away after surgery, but improvement will continue for weeks or months as swelling subsides.
Skin may be loose in treated areas after fat has been removed. It may take six months for the skin to tighten or retract. The skin of younger people tends to have more elasticity than older skin and "bounces back" more quickly. However, the skin surface may be irregular, asymmetric, or even "baggy," especially in older patients. Sometimes additional surgery is recommended.
Cost: $2,704 (national average for surgeon's fees)** Average surgeon's fee for liposuction may vary by region:
For New England (CT, ME, MA, NH, RI, VT) and Middle Atlantic (NJ, NY, PA): $2,974 For East North Central (IL, IN, MI, OH, WI) and West North Central (IA, KS, MN, MO, NE, ND, SD): $2,487 For South Atlantic (DE, DC, FL, GA, MD, NC, SC, VA, WV): $2,568 For East South Central (AL, KY, MS, TN) and West South Central: (AR, LA, OK, TX): $2,595 For Mountain (AZ, CO, ID, MT, NV, NM, UT, WY) and Pacific (AK, CA, HI, OR, WA): $2,866
**Note: These averages for surgeon's fees are provided by the American Association for Aesthetic Plastic Surgery, Inc. These figures do not include fees for the surgical facility, anesthesia, medical tests, prescriptions, or other miscellaneous costs related to surgery. In addition, most insurance companies do not cover the cost of liposuction for cosmetic purposes. Check with your insurance company.
The best candidates for liposuction are physically healthy individuals with normal weight and firm, elastic skin who have pockets of excess fat in certain areas. It is important to note that liposuction is not used to treat obesity and it will not remove cellulite or stretch marks. Age is not a major factor, but older individuals with less elastic skin may not achieve the same results as a younger patient with more elastic skin. Liposuction carries greater risks for individuals with health problems, including diabetes, significant heart or lung disease, poor blood circulation, or those who have already had surgery near the area where they desire liposuction.
Liposuction is considered safe and effective as long as the patient is carefully selected and the surgery is performed by a properly trained, board-certified plastic surgeon.
Keep in mind that there are no guarantees. Complications are rare, but they do occur. Ask your doctor for complete information about the risks. For the ultrasound-assisted technique, risks include injury or burns to skin or injury of deeper tissues. In addition, the long-term effects of ultrasound on the body are not yet known. For the tumescent method, the injected solution may cause a reaction to the anesthetic (if too much lidocaine is used). There is also risk of fluid collection in the lungs (if too much fluid is administered).
Lauren, 29, New York
Lauren, an art director and graphic designer in New York City, runs 25 miles a week and eats healthfully. But a year ago, she gained some weight -- she was up to 126 pounds from her usual 113. "Genetically, I gain in my stomach -- like my mother and sister," Lauren says. She worked hard trying to lose the weight through diet and exercise, but the gut wouldn't give. "If I had to go to a wedding, I would make sure to eat only cottage cheese and cranberries or grapes for 24 hours so I'd look slimmer," Lauren says.
She started to think about liposuction. "My friends said, "Don't do it. Why spend all that money? Get a personal trainer." But I'm my own person. If I'm running five miles a day, what's a personal trainer going to do? Put me on some weights? I'll still have a genetic problem [losing the weight]," she says.
After careful thought and consideration, Lauren opted for liposuction. The procedure was performed on a Wednesday in her doctor's office, under general anesthesia. She had four small incisions in her lower abdomen. "Afterward, I have to admit it was pretty painful," Lauren says. "When I got home, I lay in bed for two and a half days...I was back at work on Monday -- not loving myself." By Tuesday, she felt better. She wore compression garments, elasticized clothing that stabilizes tissue, around the clock for three weeks, then 75 percent of the time for three more weeks. She was able to run again three weeks after surgery. "I had to slow my time and distance for a week," Lauren says. Now she's up to speed, but she continues to wear the compression garment for daily runs.
Results? "I feel a hundred times better about myself," she says. "I can put on pants that I wore two years ago. I'm thrilled with the results. It's so much more than I could have gotten if I committed two hours a day in the gym." She feels that the fee of $4,500 was money well spent.
Karen, 43, Miami, Florida
Karen is 5-foot-7, 125 pounds, and muscular. She works out six or seven days a week. But after she turned 40, she says, no matter how much she worked out, she couldn't get rid of fat on her thighs and lower back. Her doctor said that liposuction would help remove some of the fullness and help contour her waistline.
The procedure took place in July 2003 in the doctor's office. Karen woke up from the anesthesia feeling groggy. The pain was mild. For the first night and day, she had to sleep on waterproof sheets because the incisions were oozing fluid. After about two weeks she was able to return to the gym, but she continued to wear compression garments for six or seven weeks.
Results? "I don't see much of a change," Karen says with regret. "I was doing this for spot reduction, not to lose weight. But when you hit a certain age, your skin doesn't shrink back. The elasticity is gone." So now, instead of fullness in her thighs, Karen has saggy skin and six puncture-wound scars. Bottom line: "For my body type, skin type, and age, I would not recommend liposuction," Karen says. Total cost of surgery: $2,500.
To Learn More: Visit the Public Site section of the American Society for Aesthetic Plastic Surgery's Web site. Or call their toll-free referral line at 1-888-ASAPS-11.
Check out the Learn section of BeautySurg.com, the "cosmetic surgery supersite."
For physician referrals, call the American Society of Plastic Surgeons referral service at 1-888-4PLASTIC or visit them online. Click on "Learn About Procedures" to find out more.