According to statistics released by the American Society of Plastic Surgeons in 2017, liposuction is one of the most popular cosmetic surgery procedures in the United States, second only to breast augmentation in the number performed. For those who have pockets of stubborn fat, a body sculpting and fat removal procedure can help improve areas that are resistant to diet and exercise.
With liposuction, the skill and artistry of the surgeon can determine the success of the outcome—more so than the specific technology. The amount of fat to extract, the evenness with which it is removed, and the blending of one area into another are all artistic judgment calls on the surgeon’s part. Dr. Miguel Delgado, a board-certified plastic surgeon and specialist in body sculpting techniques performs liposuction at his San Francisco Bay Area practice.
The tumescent liposuction technique initially involved combining normal saline (sterile water containing the normal concentrations of the various salts found in the body) with epinephrine, a powerful vasoconstrictor (causes blood vessels to contract and thereby reduces or stops blood flow to an area). This innovation effectively controlled blood loss and allowed safe extraction of a much larger amount of fat. This enabled the fat extraction procedure to go from the removal of two to three liters (a liter being slightly larger than a quart) to many times that amount. Today, many physicians consider the tumescent technique to be the gold standard of fat removal methods.
In time, lidocaine (a local anesthetic) was added to the normal saline and epinephrine solution. An adequate level of local anesthesia could be accomplished with this combination, so that general anesthesia is no longer always required. This also opened the door to liposuction being performed by non-surgeon physicians of many different specialties.
| Procedure | What it does | Surgery | Recovery | Results |
| Liposuction | Removes fat via mechanical suction | Yes | 7-10 days, no vigorous exercise for 6 weeks | Long-lasting |
| CoolSculpting | Reduces fat using a cooling technology that destroys fat cells | No | None | Long-lasting |
As technology has advanced, new liposuction machines have been introduced. Here are some of the methods currently on the market.
The Power-Assisted Liposuction (PAL) technique placed the cannula into a hand-held power device that moved the cannula back and forth with the push of a button. The design made the process less laborious, facilitated faster extraction of fat, and achieved an overall smoother contour. The PAL System has the rotation of the powered cannula going back and forth and another system rotating side to side. The rotation is over 4000 cycles per minute. MicroAire’s PAL® LipoSculptor™ is a popular device that can be used for more aggressive fat removal. Dr. Delgado has used this system since 2012, which has reduced procedure time and, in most cases, led to smoother results.
Ultrasonic Assisted Liposuction (UAL) is another advanced fat removal technique. Ultrasonic Liposuction employs soundwaves that have the power to emulsify, or melt, fat. This process also creates heat, which in turn enhances skin contraction. This technique can be especially useful in secondary or revision cases. Approximately 25% of patients seeking liposuction in Dr. Delgado’s practice fall into this category. These are patients who were disappointed with their outcome and wish to undergo a corrective procedure. The VASERlipo™ System is one of the more popular ultrasonic systems, but others are on the market.
Laser Liposuction is the newest splash on the scene, and Smartlipo TriPlex® by Cynosure is widely used. This technology uses minimally invasive laser technology, which produces heat to melt fat and create skin contraction. The other stated advantage is that it can be performed under local anesthesia. This laser technology has a history of being extremely expensive with inadequate or questionable documentation of actual better results. To date, there is only anecdotal evidence to support superior results using laser methods. No large, valid studies exist that substantiate these claims. If Laser Liposuction does prove it can deliver higher patient satisfaction and better quality outcomes—and not fall by the wayside as another overrated marketing gimmick—it will earn a place at Marin Cosmetic Surgery Center. Dr. Delgado has seen many of his colleagues abandon this technology and sell their Smart Liposuction machines. For the time being, however, Dr. Delgado opts to offer only those procedures he knows to be of sound value for his patients.
Liposuction can be effective on people of varying weights and sizes. Results can be impressive, but actual outcomes will vary from patient to patient. Skin with good elasticity is more likely to adjust to the body’s new contours. Although age is not always a consideration, older patients tend to have less elasticity in their skin and, for this reason, will not achieve quite the same results as younger patients.
The most commonly treated areas in women are the inner and outer thighs, knees, hips (post iliac crests and flanks), abdomen, and arms, while men most often opt for treatment of their chin, waist, and stomach. Most of Dr. Delgado’s patients are looking for the treatment of multiple areas and, generally, these can be done in a single procedure.
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Liposuction is performed at Marin Cosmetic Surgery Center, located at Sutter Marin County Community Hospital. The operating room’s proximity to the hospital enables Dr. Delgado to offer exceptional surgical care while optimizing patient safety and privacy.
Before your procedure, Dr. Delgado will first utilize a special felt-tip pen to precisely map out the targeted treatment areas while you are in an upright position. These markings allow him to make accurate adjustments during surgery to accommodate any gravity-related changes in fat displacement when the body is moved to a horizontal position. Once the surgical map is complete, anesthesia can be administered, and the actual treatment can begin.
Liposuction is typically performed under general anesthesia, ensuring that you will be comfortable throughout the procedure and that Dr. Delgado can give you the best results possible. At Marin Cosmetic Surgery Center, anesthesia is administered by an experienced anesthesiologist.
During the liposuction procedure, Dr. Delgado will inject the tumescent fluid consisting of saline (sterile water with body-identical salt content), lidocaine (local anesthetic), and epinephrine (a vasoconstricting agent that controls bleeding)—a process that distends the fat layer.
Next, Dr. Delgado proceeds to make tiny incisions in inconspicuous areas, such as the navel and the buttock crease, depending on the location of the excess fat. A thin cannula is then inserted into the tiny incisions. Dr. Delgado may use Power-Assisted Liposuction (PAL) or Ultrasonic Assisted Liposuction (UAL), depending on the customized plan for the patient. The device is attached to tubing extending to a machine that provides a vacuum.
The cannula is pushed back and forth through the fat layer. This breaks up the fat cells so they can be vacuumed out through the tubing to a canister on the machine. Once the desired contour is achieved, incisions are then closed with sutures, and a compression garment is placed over the treated area(s).
The first step towards body sculpting surgery is a consultation with Dr. Delgado. This can be scheduled at either his San Francisco office or his Marin County office. At this appointment, you and Dr. Delgado will discuss your areas of concern and the look you wish to achieve in those areas.
Dr. Delgado often uses digital photography and computer imaging to illustrate results that can realistically be attained with fat removal via liposuction. The impact of variables such as asymmetries and the degree of skin elasticity, and adverse events like cellulitis, bleeding, and blood clots are also discussed.
Dr. Delgado will also provide a detailed preoperative instruction booklet intended to guide you through various preparations that should be made before surgery.
Are there potential risks and complications?
What areas can be treated?
Will there be scars?
How old should I be?
Can other procedures be peformed at the same time?
How much does liposuction cost?
Like all surgeries, liposuction procedures carry the risks of bleeding, infection, blood clots, and adverse events related to anesthesia. However, these risks are minimized by the combination of Dr. Delgado’s team of licensed and credentialed professionals and his accredited, state-of-the-art facility located contiguous to Novato Community Hospital, a Sutter Health Facility.
Liposuction can treat any part of the body that contains fat. Men usually opt to treat the abdomen, flanks, and underneath the neck. Women generally choose areas like the neck, arms, abdomen, flanks, back, inner and outer thighs, and knees.
Scars are very minimal. Dr. Delgado will place the small incisions in the most inconspicuous locations possible, including areas that would normally be covered by clothing. He will discuss the placement of these incisions with you prior to your procedure.
Though there is some controversy regarding this, Dr. Delgado believes that a person should be at least 18 years old and have the maturity and motivation to lose weight by exercise and diet.
Yes, this is quite commonly performed. For example, liposuction is often combined with a tummy tuck or other body contouring procedures as part of a Mommy Makeover.
The cost can vary greatly depending on the number of areas treated and how much fat is removed. At the time of your consultation, you will be given a detailed estimate of all your surgery fees.
