Liposuction

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.

Liposuction techniques have continued to evolve, and the equipment has become more sophisticated since the introduction of the procedure in the early 1980s. Results were limited by the amount of blood loss incurred, and blood transfusions were sometimes needed. By the mid-1980s, the development of the Tumescent Technique revolutionized the procedure both in terms of safety and results.

Liposuction Before-and-After Photos

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.

Dr. Miguel Delgado, a board-certified plastic surgeon and specialist in body sculpting techniques, performs liposuction at his San Francisco Bay Area practice.

How Does Liposuction Work?

Liposuction is performed with cannulas, which are cylindrical steel tubes of varying lengths, diameters, and tip shapes. In the early days of fat extraction, large bore cannulas were used—5, 6, 7, and 8 millimeters in diameter. The procedure has evolved to use much smaller cannulas—2, 3, and 4 millimeters in diameter. Not only are the smaller-diameter cannulas less traumatic to the tissues, they also allow for a smoother, more even extraction of fat.

The cannulas are designed to attach to plastic tubing that is attached to a liposuction machine. This machine provides varying amounts of negative pressure to create a vacuum. This is the primary function of the machine, although it also has a portion that provides positive pressure to inject the tumescent fluid. Additionally, mounted on the machine are the canisters that receive the fat and residual tumescent fluid.

First, the machine is used to inject the tumescent fluid into the designated area of fat using a small cannula. A few minutes are allowed for the tumescent to anesthetize, establish bleeding control, and emulsify the fat for easier extraction. Then, a small bore cannula—attached to the length of tubing providing suction—is inserted into the same small incision, and the surgeon proceeds with the careful process of extracting the fat. Guided by the map drawn on the skin earlier in the preoperative area (with the patient in a standing position), the surgeon uses a back and forth motion with the suction cannula. The fat collects in the suction canister for later disposal, as the surgeon smooths and sculpts with the cannula. Slowly, the improved contours emerge until the procedure is completed to the surgeon’s practiced eye and aesthetic satisfaction. Dr. Delgado also uses a specialized roller to further smooth out the area.

As technology has advanced, new liposuction machines have been introduced. 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 was to make the process less laborious, facilitate faster extraction of fat, and achieve an overall smoother contour. The PAL System has the rotation of the powered cannula going back and forth, in addition to 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 re-do, 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 there are others 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.

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 judgement calls on the part of the surgeon. Likewise, sound medical decisions based on years of study and practice are made by the surgeon, the anesthesiologist, and other surgical team members. These are central to your safety while undergoing a procedure such as liposuction.

Who Is a Candidate for Liposuction?

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 a younger patient.

There is rarely any improvement in skin irregularities, as the procedure impacts the underlying fat—not the skin itself. The skin acts merely as a drape over the newly shaped contours underneath. Sometimes, the devices can add a certain degree of heat, which can possibly lead to some contraction to the skin. But this tightening effect would be minimal, if it occurs at all. Patients who expect the procedure to address the condition of the skin may be very disappointed.

Although cellulite is not a contraindication for the procedure, fat extraction will not improve this condition, if it exists.

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 abdomen. Most of Dr. Delgado’s patients are looking for treatment of multiple areas and, generally, these can be done in a single procedure.

How Do I Prepare for Liposuction Surgery?

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 the existence of asymmetries and the degree of skin elasticity—as well as adverse events like cellulitis, bleeding, and blood clots—are also discussed.

Once you are satisfied with the proposed plan and wish to move forward with treatment, Dr. Delgado will provide a detailed preoperative instruction booklet intended to guide you through various preparations that should be made prior to surgery. Included in this booklet are directions for discontinuing or avoiding medications like aspirin, ibuprofen, Aleve, Advil, and Motrin, as these blood-thinning medicines can increase the risk of bleeding during and after liposuction if consumed too near the date of surgery. In addition, the booklet will provide a list of various vitamins, supplements, and homeopathic products that can be taken before or after treatment to help minimize bruising and facilitate healing.

You will also need to arrange for reliable and competent help the first 24 hours (or possibly longer) after surgery, including a ride home from the treatment facility. During this early postoperative period, a family member or friend can lend invaluable assistance with daily tasks such as household chores, walking around, changing clothes, taking medications, caring for children, and more.

If at any time you have preparation questions leading up to your liposuction procedure, Dr. Delgado or a member of our staff will be happy to speak with you and help in any way possible.

How Is the Liposuction Procedure Performed?

Liposuction is performed at Marin Cosmetic Surgery Center, located on the campus of Sutter Marin County Community Hospital. The operating room’s close proximity to the hospital enables Dr. Delgado to offer exceptional surgical care while optimizing both patient safety and privacy. 

Prior to 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 for any gravity-related changes in fat displacement that occur 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.

During the liposuction procedure, Dr. Delgado will inject the tumescent fluid consisting of normal saline (sterile water with body-identical salt content), lidocaine (local anesthetic), and epinephrine (vasoconstricting agent that controls bleeding)—a process that distends the fat layer. Next, Dr. Delgado proceeds to make very small 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 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).

Anesthesia

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. Laryngeal mask airway (LMA) anesthesia, a state-of-the-art method uniquely suited for aesthetic surgery patients, is used. The level of anesthesia employed with LMA is less than that utilized in most hospitals, which allows you to breathe comfortably on your own while reducing the likelihood you will experience the nausea often associated with traditional anesthesia techniques. In addition, the medication typically wears off quickly, so you can feel like your normal self soon after the completion of surgery (depending on the amount of fat removed during treatment).

In order to optimize the safety and efficacy of anesthesia, our anesthesiologist will call you the evening before your procedure to go over your medical history, reiterate final preparation instructions, and answer any questions you might have about what to expect in regard to anesthesia.

Dr. Delgado is a fantastic plastic surgeon, and his staff are wonderful! He is a true artist, master at his craft, and a really nice person.

What Is Recovery from Liposuction Like?

Immediately following liposuction, you will be taken to a recovery room to spend a few hours under the care and supervision of our team. When fully alert and oriented, you can go home or to a local hotel. A responsible adult is required to drive and assist you for the first 24 hours following surgery. If you do not have such a person available, the Marin Cosmetic Surgery Center patient coordinator can arrange for a specially trained medical assistant to drive you to your destination and stay with you during this time period.

Some patients will spend the night in the recovery room at Marin Cosmetic Surgery Center, especially if a large volume of liposuction is performed. Overnight care is provided by a registered nurse who is trained in post-operative care, including ACLS (Advanced Cardiac Life Support) certification. An additional person, experienced in post-surgical care, is also on hand to assist the nurse as needed throughout the night. In the morning, Dr. Delgado personally checks these patients before they are discharged from the surgery center.

A compression garment is worn over the treated areas for four to six weeks. The purpose of this garment is to control swelling and promote skin contraction.

For the majority of patients, discomfort after surgery is generally limited to soreness, rather than pain. Pain medications are prescribed to lessen any discomfort felt during the first few days. Most patients often find that the discomfort is too minimal to merit the use of narcotics.

Bruising is normally quite evident and may not resolve completely for a week or two. Most of the swelling disappears after four to six weeks, but there may be a small amount of residual swelling for up to two to four months. For six to nine months, you may experience a fluctuating return of 10-15 percent swelling with exercise or excessive activity.

Sutures are removed seven to ten days after surgery. Patients usually return to work within a few days following the procedure, depending on their type of work.

It is important to resume light walking as soon as possible in order to discourage swelling and prevent blood clots in the legs. However, strenuous exercise should be avoided for four to six weeks because it can trigger unnecessary fluid retention in the treated areas.

What Are Potential Risks and Complications of Liposuction?

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 Marin Cosmetic Surgery Center—an accredited, state-of-the-art facility located contiguous to Novato Community Hospital, a Sutter Health Facility. These factors create a very safe environment for the patient.

The most common problems with liposuction are irregularities in skin contours due to poor skin quality (i.e., low elasticity, loose skin tone, etc.) or pre-existing cellulite. Sometimes under-correction occurs; often, this can be easily remedied in the office setting with a touch-up procedure using local anesthesia. If over-correction has occurred, fat injections can be done to fill any concavity. 

Swelling and bruising are normal and not considered complications. Both of these should resolve in time. In a few cases, some bruising will persist beyond the usual one to two weeks. Very rarely, areas of light discoloration can remain indefinitely after surgery.

If weight is gained in the future, the fat may distribute differently than it did prior to fat extraction. Generally, less fat will deposit in those areas that were treated.

What Type of Results Can I Expect from Liposuction?

Patients can usually see significant changes in their bodies after liposuction. In most cases, an improved aesthetic balance in the relationship between the areas treated and the rest of the body is apparent, as well as a reduction in overall size. Depending upon the extent and volume of the liposuction performed, a patient may go down in clothing size. Some individuals also may discover they can wear a greater variety of clothing styles than prior to the procedure. 

The results are long-lasting barring the impact of significant weight gain in the future. Scarring is minimal and continues to fade with time. The attractive results can evoke a higher sense of self-esteem. With these satisfying outcomes for patients, it is not surprising that the latest statistics available show that liposuction is one of the most commonly performed cosmetic surgery procedure in the United States.

Other Common Liposuction Questions

How is liposuction performed?

Liposuction is performed through small, 3-millimeter incisions that are strategically placed in the treatment area. Through these incisions, tumescent fluid (consisting of salt water, local anesthetic, and an agent that controls bleeding) is injected within the region to enhance fat extraction and control blood loss. Then, one or more techniques may be used to extract the fat. The tumescent liposuction technique consists of cannulas being moved back and forth extracting fat with moderate pressure vacuum. Prior to this, ultrasound may be used to break down the fat with ultrasonic waves, laser may be used to break down the fat using heat, or power-assisted liposuction may be used to extract the fat. The skill of the procedure lies in making sure that the remaining fat layer is smooth. At the conclusion of the procedure, a compression garment is placed to further assure a smooth skin surface.

What can I expect during my consultation?

In your initial consultation, you and Dr. Delgado will discuss your concerns and your goals for the appearance of your body. You will be asked whether your weight tends to fluctuate and, if so, to what degree. Dr. Delgado will evaluate the areas about which you are concerned in regard to the amount of fat, the degree of skin laxity, and the quality of the skin in terms of stretch marks or overly loose tissue—all of which affect the outcome of liposuction. He will indicate where incisions would be placed. You will have the opportunity to view before and after photographs of patients on whom Dr. Delgado has performed liposuction. Dr. Delgado may use computer imaging to demonstrate the results you can expect from your liposuction procedure. Lastly, you will receive a price quote for your procedure.

How long does the liposuction procedure take?

The amount of time your procedure will take depends on the size and number of areas being treated. Most procedures are completed in two to four hours. Dr. Delgado will be able to give you a more accurate time estimate during your consultation.

Will I be able to return home on the same day as my surgery?

In most cases, patients are able to return home on the same day as their procedure. However, due to the use of general anesthesia, you will not be able to drive yourself home. If you plan to have an extensive amount of fat extraction done, Dr. Delgado will advise you to stay overnight at the surgery center for observation and pain management.

Following my procedure, how long must I wait to return to work?

Most patients are able to return to work within one week. However, there will be some discomfort, much like the soreness from strenuous exercise. You may generally resume exercise programs and sports activities in four to six weeks.

What areas of the body can be treated?

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.

Will there be scars following my surgery?

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.

How old should I be?

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. Especially with a younger patient, Dr. Delgado will want to be sure that he/she understands the serious risks of the surgery. You will be evaluated on an individual basis regarding your suitability.

Can other surgical procedures be done at the same time?

Yes, this is quite commonly performed.  For example, liposuction is often combined with a tummy tuck and/or other body contouring procedures as part of a mommy makeover.

How much does liposuction surgery cost?

The cost of liposuction surgery can vary greatly depending on how many areas are treated and how much fat is to be removed. At the time of your consultation, you will be given a detailed estimate of all your surgery fees.