Background Information:

What are the other Names for the Procedure?

• Fat Removal - Suctioning
• Suction Lipectomy
• Suction-Assisted Lipectomy

What is Liposuction surgical procedure?

Liposuction is a surgical technique that involves the permanent removal of excess body fat by suction, using specialized surgical equipment.

What part of the Body does the Procedure involve?

The Liposuction procedure may involve the thighs and hips, buttocks, fat cells within the abdominal wall, and chin (or other adjoining areas).

Why is the Liposuction surgical procedure Performed?

Liposuction is performed for the visual improvement of fatty deposits that an individual has found difficult to get rid of with a daily healthy diet or exercise.

What are some Alternative Choices for the Procedure?

If Liposuction is being considered for weight loss, then dietary modifications, exercising, or in certain circumstances, even bariatric surgery is an alternative choice.

What are the Recent Advances in the Procedure?

• A modification of the traditional cannula (hollow tube) used to suction fat, called liposhaver, is currently used. This helps to cut fat
• Fat deposits may be broken down using ultrasound waves

What is the Cost of performing the Liposuction surgical procedure?

The cost of Liposuction surgical procedure depends on a variety of factors, such as the type of your health insurance, annual deductibles, co-pay requirements, out-of-network and in-network of your healthcare providers and healthcare facilities.

In many cases, an estimate may be provided before the procedure. The final amount depends upon the findings during the surgery/procedure and post-operative care that is necessary. However, Liposuction is usually a cosmetic procedure that is generally not covered by health insurance.

When do you need a Second Opinion, prior to the Procedure?

• It is normal for a patient to feel uncomfortable and confused with a sudden inflow of information regarding Liposuction surgical procedure and what needs to be done
• If the patient needs further reassurance or a second opinion, a physician will almost always assist in recommending another physician
• Also, if the procedure involves multiple surgeries or has many alternatives, the patient may take a second opinion to understand and choose the best one. They can also choose to approach another physician independently

What are some Helpful Resources?

Complete Guide to Symptoms, Illness & Surgery; Written by H Winter Griffith, M.D.; Revised and updated by Stephen Moore, M.D. and Kenneth Yoder, M.D.; The Berkley Publishing Group, 5^th Edition, New York, 2006

http://www.surgery.com/procedure/liposuction (accessed on 07/30/2014)

Prior to Liposuction surgical procedure:

How is the Liposuction surgical procedure Performed?

• Liposuction is usually performed under local anesthesia
• A surgeon first numbs the skin overlying the fat pocket, by injecting a local anesthetic. He/she then makes multiple small incisions on the skin
• More local anesthetic is injected into the fat area to be suctioned out. The surgeon then uses a hollow tube (cannula) to suction out the fat
• Once the procedure is done, the surgeon may either suture the small incisions or apply dressing over the surgical wounds

Where is the Procedure Performed?

A Liposuction procedure is usually performed in an out-patient surgery center facility, a physician’s clinic/office, or a hospital. The individual can usually go home once the procedure is completed.

Who Performs the Procedure?

A plastic surgeon performs the Liposuction procedure.

How long will the Procedure take?

The duration of Liposuction varies depending on the area and the amount of fat to be removed. The procedure can last anywhere between 30 minutes to 2 hours.

What do you need to tell your Physician before the Procedure?

It is very important to provide the following information to your healthcare provider. This enables your healthcare provider in assessing the risks for the liposuction surgical procedure and helps avoid unnecessary complications.

• Provide a complete list of medications you are currently, taking to your physician. This information is useful for a variety of reasons. For example, it can help your healthcare provider prevent complications due to a drug interaction
• If you are allergic to any specific medication or food items
• If you are taking blood thinners, such as aspirin, warfarin, herbal supplements, or any other such medications
• If you or your family members, have a history of bleeding disorders, or if there is a tendency to bleed more than normal
• If you have diabetes, high blood pressure, chest pains, or have previously suffered from a heart attack
• If you have ever been diagnosed with blood clots in your leg (deep vein thrombosis) or lung (embolism of lung)
• If you have a history of frequent bone fractures (this may affect bone-healing, if bones are involved as part of your procedure)
• A list of all previous surgical procedures you have undergone, like for example: Removal of appendix, gallbladder, or any other part, of your body; surgical repair of any body part, such as hernia repair, perforation of bowel wall, etc.

What Preparations are needed, prior to the Procedure?

• The physician may evaluate the individual’s medical history to gain a comprehensive knowledge of the overall health status of the patient including information related to the medications that are being currently taken
• Some medications increase a person’s chances of bleeding and it may be recommended to discontinue them for a period of time, before the procedure is performed
• Blood tests may be performed to determine if there is a bleeding tendency or any other medical conditions that prevents the person from undergoing the procedure
• Inform the physician if you are allergic to any local anesthetics, lidocaine, etc
• Avoid application of any cosmetics, deodorant, or topical medicines on the area, prior to the procedure
• It is advisable to quit smoking and the use of any nicotine based products, for a while, before the surgery
• Consumption of alcoholic drinks must also be avoided for a period of time, as instructed
• The patient must avoid eating or drinking at least 8 hours prior to the surgical procedure, depending on when the procedure is arranged
• For persons suffering from diabetes, it is important that the blood sugar stays within the normal range; if not their diabetologist may have to control blood sugar by recommending insulin and/or a combination of oral medicines

What is the Consent Process before the Procedure?

A physician will request your consent for Liposuction procedure using an Informed Consent Form.

Consent for the Procedure: A “consent” is your approval to undergo a procedure. A consent form is signed after the risks and benefits of the procedure, and alternative treatment options, are discussed. This process is called informed consent.

You must sign the forms only after you are totally satisfied by the answers to your questions. In case of minors and individuals unable to personally give their consent, the individual’s legal guardian or next of kin, shall give their consent for the procedure.

What Tests are needed, before the Liposuction surgical procedure?

Before a Liposuction procedure, the patient has to undergo certain routine tests, such as:

• Blood tests
• Urine analysis

What are some Questions for your Physician?

Some of the basic questions that you might ask your physician are as follows:

• What is a Liposuction procedure?
• Why is this procedure necessary?  How will it help?
• How soon should I get it done? Is it an emergency?
• Who are the medical personnel involved in this procedure?
• Where is the procedure performed? 
• What are the risks while performing the procedure?
• What are the complications that might take place, during recovery?
• How long will it take to recover? When can I resume normal work?
• How many such procedures have you (the physician) performed?
• Are there any follow-up tests, periodic visits to the healthcare facility required, after the procedure?
• What are the costs involved?

During the Liposuction surgical procedure:

What kind of Anesthesia is given, during the Procedure?

Local anesthesia by injection for small areas of Liposuction or general anesthesia by injection and inhalation is administered, for larger areas of Liposuction procedure. The type of anesthesia shall be determined by your physician.

How much Blood will you lose, during the Procedure?

• Typically, fat tissues have a good blood supply. Hence, during Liposuction, some blood loss may be anticipated. In some cases, a blood transfusion may also be necessary
• However, in a majority of cases, the blood loss is minimal and no blood transfusions are required

What are the possible Risks and Complications during the Liposuction surgical procedure?

There are general factors that increase the risk of getting complications during surgery and they include:

• Obesity: Generally greater the degree of obesity, greater is the surgical risk
• Smoking: Longer the smoking history (in pack years smoked), greater the surgical risk
• Advancing age
• Poorly controlled diabetes, as evidenced by a high hemoglobin A1c and a high fasting glucose
• Poorly functioning kidney, as evidenced by increased BUN (blood urea nitrogen) and blood creatinine
• Poorly functioning liver, as evidenced by increased blood liver function tests
• Hypertension (increased blood pressure), especially if it is poorly controlled
• Poor nutritional status (malnutrition with mineral and vitamin deficiencies)
• Poor lung function, as evidenced by abnormal lung function tests
• History of bleeding disorders
• Longstanding illness, such as autoimmune disorders, chronic infections
• Poor immune system due to a variety of causes

The possible risks or complications that may arise during the Liposuction surgery are:

• Excessive bleeding
• Excessive fluid loss leading to severe fall in the blood pressure (shock)
• Anesthetic complications
• Accidental injury to the neighboring tissues, or perforation of the internal organs
• Rarely, fat particles or blood clots arising at the surgical site may travel through the blood vessels into the lungs, heart, or brain. This is called fat embolism

What Post-Operative Care is needed at the Healthcare Facility after the Liposuction surgical procedure?

At the healthcare facility, usually there is no requirement for any post-procedure care, unless any complications arise. 

After the Liposuction surgical procedure:

What are the possible Risks and Complications after the Liposuction surgical procedure?

Post Liposuction procedure, the possible complications that may arise are:

• Excessive bleeding leading to anemia; this is a very rare complication
• Infection in the surgical wound
• Excessive scarring, called keloid formation, may occur
• Chronic venous infections (phlebitis)
• Blood clot formation in deep veins; these may travel to the lungs (thromboembolism)

What is the Prognosis after the Surgery?

• Liposuction is generally a cosmetic procedure and not a permanent weight loss solution; when used for altering body contours, it produces the desired results
• However, it is possible that individuals may regain fat, if they follow unhealthy eating patterns and/or lead a sedentary lifestyle. It is important to consult a dietician after the procedure, to prevent weight gain

When do you need to call your Physician?

Do contact your physician if you notice any of the following symptoms:

• Worsening pain and swelling surrounding the surgical wound
• Bleeding or fluid drainage around the surgical wound
• The occurrence of any symptom that leads to constipation
• Pain and swelling in the legs
• Signs of an infection
• Dizziness
• Muscle aches
• Fever, feeling sick
• Complications associated with prescription medications used in treatment

What Post-Operative Care is needed at Home after the Liposuction surgical procedure?

At home, the following post-operative care is recommended, after a Liposuction procedure:

• Post-surgery, wear supportive garments for 2-3 weeks, to avoid tissue swelling in the surgical site. These garments may be removed at the time of showering
• Resume showering after 24 hours, but keep the wound clean and dry. However, avoid taking baths, until the surgical wound is completely healed. Gently wash the surgical wound with mild or unscented soap. Replace the dressings on the surgical wound after showering
• Use a heat pad or warm compress to relieve pain due to the incision
• Complete the course of prescribed medication, under advice of the physician
• Take antibiotic medication to help combat or prevent infection (under physician’s advice)
• Avoid taking nonprescription medications, such as aspirin. However, individuals may take acetaminophen to relieve pain, if necessary (under physician’s advice)
• Resume driving only after 2 weeks, after the procedure, or as advised by your physician
• Avoid sex till a complete healing has taken place (under advise by the physician)
• Individuals may be advised to add a healthy amount of vitamin or mineral supplements to their daily diet

How long does it normally take to fully recover, from the Procedure?

Post Liposuction, normal activity may usually be resumed after a week.

Additional Information:

What happens to tissue (if any), taken out during the Procedure?

The Liposuction procedure does involve the surgical removal of fat tissue; but, it is discarded.

When should you expect results from the pathologist regarding tissue taken out, during the Procedure?

The tissue removed during the procedure is discarded and hence, a pathologist does not get involved in the care of the patient.

Who will you receive a Bill from, after the Liposuction surgical procedure?

It is important to note that the number of bills that the patient may receive depends on the arrangement the healthcare facility has with the physician and other healthcare providers.

Sometimes, the patient may get a single bill that includes the healthcare facility and the consultant physician charges. Sometimes, the patient might get multiple bills depending on the healthcare provider involved. For instance, the patient may get a bill from:

• The outpatient facility, physician’s office or hospital
• An anesthesiologist (if anesthesia was administered)
• An plastic surgeon

The patient is advised to inquire and confirm the type of billing, before the Liposuction procedure is performed.

Thanks and Gratitude:

We sincerely acknowledge and thank Dr. Douglas J. Jones for reviewing the article. His valuable input and feedback has helped enrich the contents of this article.

Douglas J. Jones, MD FACS
Board Certified General Surgeon and Faculty Member
University of Illinois, College of Medicine at Urbana-Champaign
506 S. Mathews Ave., Urbana, IL 61801, USA