Liposuction: Everything You Ever Wanted To Know

Allow me to give you an overview of how liposuction started, where it is currently at, and everything in the middle. Along the way you will have learned everything you ever wanted to know about liposuction and perhaps….some things that you maybe wished you didn’t know.

First, what is liposuction? The formal term is actually suction lipectomy or suction lipoplasty. Basically, if there is a cannula involved that has suction connected to it and you are using it to remove fat from under the skin that is liposuction. Let’s dive in to see how it started, how it’s currently performed, and all of the other important details.

Fifty years ago, in 1972, liposuction was born. If you were there to witness it you would have barely recognized it as liposuction and probably would have been deeply disturbed. The cannula was huge, it was sharp at the end like a giant needle as opposed to rounded to prevent tissue damage, there was no fluid injected to numb the area up and reduce bleeding, and no compression or drain was used afterwards. Let’s just say it was about as dangerous as you can possible make it. As with all things that humans come up with, small refinements over time took place to reduce risk and improve comfort and results. In 2022, voila! Just about anyone can have liposuction, without having to be admitted to the hospital, with minimal risk, and with great results, all while returning to work a few days later.

The progress seen over the last fifty years in terms of safety and efficacy of liposuction is key to its current success and to understand the important parts of liposuction. So what are these important parts of liposuction:

1. The surgeon

2. The patient

3. The fluid

4. The cannula

5. The aftercare

Let’s dive deeper.

The surgeon is an important part of liposuction just like they are an important part of any procedure. Patient selection, patient education, the technique used, the equipment selected, are all dependent on the surgeon. Even with all of this set, the surgeon still has to make sure he/she actually does the liposuction safely and effectively. After all, that cannula is just a pipe of sorts and it can do great things or great damage depending on how it’s used. More about this in the advanced technique section below.

The patient is important since there are key components of each patient that can impact the result of liposuction. Significant scar tissue from prior liposuction or other forms of surgery/injury can impact the current liposuction results. A second patient component is loose skin. Liposuction removes and reduces fat but it does not tighten skin. Patients with a lot of loose skin should be counseled about the limitations of liposuction for the area of concern. I have seen many patients who have had multiple rounds of liposuction resulting in a lot of irregularity when they really needed a skin tightening procedure like a tummy tuck.

The safety of liposuction is very closely related to the fluid that is placed in the tissues prior to liposuction. This fluid, called tumescent, usually contains lidocaine for numbing and epinephrine for vasoconstriction/bleeding. The proper mix of these medications, the amount of fluid placed, and the location of this fluid when placed all impact the safety and efficacy of the liposuction process. In 1972, the early liposuction beginnings did not include any tumescent fluid which resulted in a lot of bleeding and I would imagine future scar tissue formation. Later on, in the 1980’s, the opposite was seen, where the benefits of tumescent was appreciated so surgeons started using more and more fluid and medications which resulted in complications from lidocaine toxicity.

The cannula, ironically, the actual tool used in liposuction, is not the most important part of the safety and efficacy of liposuction. Initially, in 1972, the liposuction cannulas were very larger in diameter and sharp at the end. They we essentially giant needles. Soon afterwards, cannulas that are blunt/rounded at the end were introduced that increased safety. These new cannulas, which carry over to today, have various hole patterns on the side of the cannula to suction and remove the fat while keeping the end blunt to minimize puncture injuries. Once this change occurred the actual importance of the cannulas in terms of design was less. In the ideal world, the smallest cannulas should be used, but safe and effective results can be achieved with a variety of cannulas sizes which can vary based on surgeon preference, patient needs, and other liposuction treatments. These other liposuction treatments include different type of liposuction modalities. Lets spend a little time on the various types of liposuction modalities.

Liposuction modalities include suction assisted lipectomy (SAL) which is the traditional method, ultrasound assisted lipectomy (UAL), and laser assisted lipectomy (LAL). They can all provide great results safely. The more fibrous the tissue is including the presence of scar tissue the more helpful it is to have UAL and LAL. UAL and LAL can also decrease some of the bleeding and bruising in addition to the the effects of the tumescent fluid as discussed above.

Finally we have aftercare. Liposuction results in removal of fat which temporarily leaves little tunnels of “open space” where the cannula passed through and removed the fat. These spaces naturally want to fill up with healing fluid which can result in scar tissue formation. To reduce and eliminate this process and minimize or prevent scar tissue formation one of two things should occur in the aftercare portion of the liposuction process. These two things are: drainage and compression. Compression occurs via a compression garment or a wrap. This compresses the tissue where liposuction occurred and collapses the small “open spaces” so that they heal together and prevent fluid collection. Drainage can occur by leaving openings in the skin for the fluid to drain out or by placing drains to actively remove the fluid. Also important in the aftercare is hydration and elevation. These are more important for the safety and well being of the patient since liposuction results in fluid shift or third spacing and requires that the patient stay properly hydrated and in terms of liposuction of the legs, have the legs elevated as much as possible to reduce unnecessary swelling.

Advanced technique. Everything we can covered above deals with what I call acceptable safety and efficacy of liposuction. Beyond these items there are many additional items that can be introduced to further help achieve excellent results and expedite patient recovery. Pre-cannulation of the fat or vibrating the fat prior to actually suctioning the fat out is important. So is the process of how the cannula is passed back and forth in terms of direction(s) as well as depth. Much of this depends on the experience of the surgeon which allows the surgeon to assess the type of fat that is present, it’s quantity, ligaments, and skin draping. This is particularly important when performing a plus size tummy tuck®. Patient undergoing a plus size tummy tuck® tend to have more loose skin, more fat both in the superficial and deep layers, and stronger ligaments. Properly assessing all of this and using all of the components of liposuction that we have discussed above is important to maximizing safety and optimum contour.

It’s amazing to think that liposuction was invented fifty years ago and how it has changed not only how liposuction itself is now done but also how we approach body contouring surgery. Without liposuction much of body contouring surgery such as tummy tuck surgery, arm lifts, thigh lifts, BBL, and all fat transfer surgery would either be significantly limited or impossible. Fat transfer, which requires liposuction, is now also used by other surgical specialties to help with various medical issues including certain types of joint pain resulting from having bone on bone contact.

Who knew that removing fat with a cannula and some suction fifty years ago would have such a powerful impact on plastic surgery, society, and medicine in general. I wonder where liposuction will be fifty years from now in 2072? Maybe we will be walking into a machine, pushing a few buttons of what we would want removed, and walk out done in just a few seconds like an old photo booth!