Fat Free

Twenty-five years ago, liposuction (sometimes called lipoplasty) was a little known procedure in this country. Who could have guessed that by 2005 it would be the most frequently performed aesthetic surgery procedure, among both men and women? In 2005, more than 450,000 liposuctions were performed.

Dr. Peter Pacik, M.D., FACS, founder of The Plastic Surgery Center, Manchester, explains that liposuction removes localized collections of fatty tissue that do not respond to weight loss. The hips, buttocks and abdomen are often targeted, but other areas including the neck and face may be suitable for the procedure. Among men, around the waist and under the arm are typical sites. Liposuction may also be used to reduce enlarged male breasts. The result is a smoother, more evenly proportioned body contour.

There are variations in liposuction procedure. All make use of a cannula, which is a small, hollow tube with a vacuum at one end. Small incisions are made in the targeted area. The cannula is inserted in an incision to suck out the fat.

Tumescent (or suction-assisted) liposuction, which involves the injection of a saline and anesthetic solution into the area being treated, is considered by many surgeons to be the safest and most effective technique. The anesthetic reduces bleeding as well as pain. In ultrasonic-assisted liposuction (UAL), sound waves are used to liquefy the fat before it is removed. Dr. Pacik notes, however, that many surgeons have moved away from this technique. Power assisted liposuction (PAL) employs a motor-powered cannula, which allows the surgeon to use smaller movements. Talk with your doctor about which method is best for you.

The surgery should be performed in a well-equipped, modern surgical setting. The patient will be sedated, usually with a light general anesthesia. After the procedure, a snug, compression garment is worn, to promote skin shrinkage and to minimize swelling and bruising. Generally, you can return to work within one or two weeks and to more strenuous activities in three or four.

The best candidate for liposuction is a person in good health, physically and emotionally, and of moderate weight. The skin should have normal elasticity that can readily adjust to the change in the targeted area. Age is not a factor, except as age may have contributed to the loss of elasticity of the skin. The results of liposuction usually give the patient a positive feeling and greater self-confidence. But one should have realistic expectations. The full results will not be evident for at least six months.

Dr. Pacik also explains what liposuction does not accomplish. It is not a weight-loss technique. Though elimination of fat deposits will reduce size in the treated area, the maximum weight loss would be around six pounds, and likely less, depending on the area to be treated. It is not intended to replace the need for a healthy diet and regular exercise. Liposuction is not a solution to the stretched, excess skin that may result from extreme weight loss and other factors. A skin tightening procedure, such as a tummy tuck or thigh lift, would be the preferred option.

Liposuction is not a treatment for cellulite, says Dr. Pacik, though it may result in slight improvement in a few patients. Cellulite, areas of small, raised bumps under the skin, comes from the structure of the skin. The layer of fibrous tissue under the outer skin does not expand to accommodate the underlying fat. The fat is constricted and the skin is pulled into dimples.

Currently there is no cure for cellulite, though there are procedures aimed at creating a smoother surface in the affected area. A new option for treating cellulite was reported at a recent conference of the American Society of Plastic Surgery. An enzyme that breaks down collagen is injected in the affected area. Results showed a 77 percent reduction in cellulite. But the study involved just 10 women. More studies are needed, including long term follow-up studies, before the technique can be assessed.

What are the risks of liposuction? As with any plastic surgery, liposuction carries some risk. There could be bruising or scarring. More serious complications, such as infection, nerve damage or adverse reaction to anesthesia, are rare. A thorough physical prior to the procedure is essential.

But for a healthy patient with reasonably good skin tone, there is little risk, says Dr. Pacik, provided that the procedure is performed by a board certified plastic surgeon in a fully equipped surgery center.

“We were amazed,” he says, “that there were so few complications in the 1980s. Then, by the mid 1990s, there were many complications. We were puzzled, until we realized that by that time, the procedure was offered by physicians who had not been trained in plastic surgery.”

Before you choose a surgeon, learn as much as you can about the procedure. Ask prospective surgeons how many liposuction procedures they have performed and look at before-and-after photos of previous patients. NH