What is it?

Liposuction is a procedure designed to remove unwanted fat with minimal incisions.

Who is a candidate for this operation?

The most suitable patients are those who have reasonable expectations about the results that they will achieve with this type of surgery.   It is useful for patients that have fat accumulation in an area disproportionate to the remainder of the body. On occasion body contour irregularities can also be helped with liposuctioning

Who is not a good candidate for this operation?

What is generally not helped by suction lipectomy is widespread obesity or patients who have excessive loose skin.   For many patients who have excessive skin or who have lost the elasticity of their skin a traditional skin resection may be necessary.    If their body contouring irregularities are due to structures other than fat, such as bone, or weaknesses in the muscles, these problems cannot be corrected by liposuction.   On occasion it may be necessary to address these problems at a later date with other surgical procedures.

What does it accomplish?

With liposuction you can take away fat permanently. Each person is born with a specific number of fat cells. These fat cells get larger or smaller depending on the amount of calories consumed or the metabolism of the person. When you remove the fat cells from an area of the body for example the outer thigh, the fat never comes back. You will still have some cells remaining in that area but essentially, the procedure if done correctly will have long lasting affects.

Will liposuction treat Cellulite?

Not usually. Cellulite is located in a more superficial layer and is not usually remove with liposuction.   If the patient has cellulite, it is likely that the areas of cellulite will still be present after surgery and on occasion may become even more noticeable.

What happens during the first consultation?

In the first consultation you will get a chance to discuss your concerns with our patient care coordinators and Dr, Marefat. We will tell you what you need to know about your procedure and will help you determine what is best for you.   You will receive information booklets and pricing on the procedures.

How is it done?

Liposuction is done through a small puncture hole that is usually hidden in a natural fold of the body. The incision itself can be as small as an eighth of an inch. The area to be suctioned is then infiltrated with a solution containing medicines that cut back on bleeding and postoperative pain, This is why large amounts of fat can be removed with little blood loss and need for hospitalization.

What are the goals of surgery?

Our objective is to improve the body contour.   However, we cannot change the nature of the skin.   We want to establish more normal proportions between the areas of the body and therefore give the body a better overall harmony.   We also want to improve the appearance both in and out of clothing.

What kind of anesthesia will I have?  

It depends on how much liposuctioning you need. Local anesthesia, IV sedation, or general anesthesia can all be used for this surgery.   In all cases however the local injections of the tumescent solution is used whether or not you are asleep. With the tumescent technique requirements for giving IV sedation or general anesthetic are decreased and thus there is less risk or side effect as a result of these anesthetics.   Some patients are very uncomfortable about being awake during the procedure and in such situations it is best to be put to sleep.

What can I expect after surgery?

After surgery you will have a moderate amount of drainage from the liposuction incisions. You will need to rest for the first two or three days, but most people are up and about shortly after surgery. We generally recommend our patients to take off 5-7 days from work. Heavy lifting and exercising should be avoided in the first two weeks. You body will tell you when you are ready to get back into your regular exercise routine. You will need to wear support garments for approximately four to six weeks after surgery.   This helps in the attachment of the skin back to the underlying tissues after liposuctioning and reduces the chances of fluid collections under the skin.   During this interval you can remove the garment to shower and rest your skin for short periods of time. There will be some numbness associated with the surgery.   This numbness usually persists for about four to six weeks. Minor lumps and irregularities are common after liposuctioning.   These irregularities are related to accumulations of fluid in certain areas of the subcutaneous fatty layer of the skin as a result of either infiltration of the fluid or as a result of the trauma associated with liposuctioning.   Irregularities even out after the first two or three weeks after the surgery.   Minor asymmetry between the two sides of the body can be seen after the liposuctioning.   This too is related to accumulations of fluid or trauma related to the operation.   These asymmetries usually resolve within two to three weeks after the liposuctioning.  

Will there be waviness and irregularities?

Not usually. However this is still the most common aesthetic complication of liposuctioning. It seems to occur more in people with poor skin turgor and patients who have cellulite.   One way to avoid waviness and irregularities is to use very small gauge cannulas and to take your time removing the fat.   However even when everything is done right that there is still a chance that you may develop some irregularity and if this does occur we can usually fix this problem in a touch up procedure.   This touch up procedure is done approximately three months after the initial liposuctioning.

What are some of the complications of liposuction?

Before I tell you about the complications of liposuction let me tell a little bit about how to digest these bits and pieces of information. Reading about complications can be quite scary. Many people cannot comfortably sit through a consultation session without having some real doubts about surgery. But it is different when you have these complications explained to you by a Doctor. He or she can put it in perspective for you and tell you the likelihood of such complications occurring. Most complications are very rare. Some are less rare and need to be explained to you in more detail so that you know how we would tackle these problems if they occurred. The purpose of explaining risks and complications is for you to know what steps we take to treat you and put you back on the road to recovery. Remember that every surgeon has his or her own way of treating problems. You must go over these potential risks with your surgeon to gain better insight and understanding.

•  Bleeding . This is very uncommon with liposuction because we are generally not cutting tissues but using a blunt tipped cannula to remove the fat. However we have had some reports of bleeding in the literature about this complication. There are those who are at higher risk of bleeding. The use of some medications such as aspirin or coudamin (a blood thinner) could put you at higher risk of bleeding. If you are contemplating surgery you should refrain from using Aspirin containing products from two weeks before surgery until two weeks after surgery. Some people with history of uncontrolled hypertension can be at higher risk of bleeding after the surgery. There are some individuals who have some problem with their coagulation system that they were not aware of and consequently have had bleeding after surgery. If you have bleeding after surgery it may entail returning to the operating room to stop it.

•  Infection . It is very uncommon to get an infection with this procedure. We usually give all our patients antibiotics both before and after surgery. If infection however, occurs we will treat it very aggressively with sronger antibiotics.

•  Skin discoloration .   This can occur in any surgery. It is due to blood metabolites and is usually temporary and self-limiting. Sometimes these blood pigments stay in the subcutaneous tissues permanently. These are very rare and generally occur in patients with darker skin complexion.   If this occurs we may need to treat your skin with certain bleaching agents which could help ameliorate the problem

•  Discomfort and pain . This is easily controlled with oral pain medications.   With the use of the tumescent technique and the use of the local anesthetics in the tissues both the pain and the discomfort should be minimized.  

•  Temporary numbness associated with the surgery.   This numbness usually persists for several weeks and it depends on the extent of surgery performed.   Most of this numbness returns to normal after seven to ten days.   However, it is not unusual to see persistent numbness even after four to six weeks have passed.  

•  Minor lumps and irregularities .   These irregularities are related to accumulations of fluid in certain areas of the subcutaneous fatty layer of the skin as a result of either infiltration of the fluid or as a result of the trauma associated with surgery.   Irregularities even out after the first two or three weeks after the surgery.  

•  Minor asymmetry between the two sides of the body can be seen after the liposuctioning.   This too is related to accumulations of fluid or trauma related to the operation.   These asymmetries usually resolve within two to three weeks. Activities.

•  Permanent scars.   Scars are present whenever there is any incision. Almost all operations will involve some scarring. The extent of the scar will depend on the nature of the problem and the extent of surgery. Liposuction puncture wounds made during are minute and in two to three months they heal so well that they are barely visible. Other operations may have more extensive incisions and thus more scarring. The nature and extent of the scar also depends on the location of the incision as well as the genetic ability of the patient to heal scars. I rarely see cases in which the scar has become a major problem. However, if they do become prominent and visible I can usually improve them with scar revision procedures. It is more prudent to wait approximately one year before attempting scar revision.

•  Excessive skin. In certain individuals the skin has lost its ability to contract after having been stretched. The patient may be left with an excessive roll of skin in the area of surgery that does not go away. In such cases it is necessary to remove this excessive roll of skin directly. This will result in having a permanent scar in the area of excision.

•  Waviness and surface irregularities .   This is a problem that is perhaps one of the most undesirable side effects of liposuctioning.   It is unpredictable and we will not know which patient will have surface irregularities but it seems to occur more in people with poor skin turgor and patients who have cellulite.   One way which I have avoided waviness and irregularities is to use very small gauge cannulas and to take my time removing the fat. Never the less there is still a chance that you may develop some irregularity and if this does occur we can usually fix this problem in a touch up procedure.   This touch up procedure is done in a second stage approximately three months after the initial liposuctioning.

•  . Persistent edema . This problem is very rare but if it occurs it can be bothersome and may last for many weeks after surgery. Generally this is not a permanent problem.   Only in a few cases in the literature have people had problems with persistent edema.   It is because of problems such as this that we encourage the use of the garments after surgery and should there be continued edema we will encourage the use of this garment until the problem is resolved.  

•  Altered areas of sensation .   In rare occasions it is possible to have an area remain permanently numb or be associated with parasthesia. Usually these problems are seen in cases that a skin resection is being performed at the same time as the liposuctioning.   The liposuctioning can, however, injure nerves in the area and these injured nerves can later develop permanent scarring and problems related to nerve conduction.   Usually, the surrounding nerves are able to cover the area of impaired sensation and after four or five weeks the area is reenervated by these nerves.   However, if this does not happen the patient is left with an area that has permanent numbness or altered sensation.   This may or may not be a correctable problem.   Often the size of these impaired sensory areas are not much larger than half a dollar or a quarter sized area and most patients are not bothered by it.

•  Surgical Shock and Pulmonary complications . There are certain uncommon risks and complications that can also occur.   These include shock that might require transfusion. This is a very uncommon problem that I have certainly not seen in any of my patients but is occasionally reported in the literature.   The need for autologous blood was discussed and I mentioned to the patient that because of the tumescent technique the need for autologous blood transfusion in these cases has been virtually eliminated.

•    Seromas and hematomas .   These are collections of fluid or blood under the skin. If this occurs it will need to be drained.   This is usually done with the use of a syringe.   To the patient it will entail more frequent office visits after surgery until the problem is solved.   Usually these problems do not cause any permanent damage.  

•  Skin loss . This has been seen in a few cases with major skin undermining.    Usually these occur in people who are smokers or have some underlying problem with circulation.   If you smoke I strongly encourage you to quit smoking two weeks prior to surgery and to refrain from smoking until two weeks after surgery.  

•  Fat embolism . In a few cases in the literature we have seen cases of pulmonary fat embolism as a result of liposuctioning.   This problem is very uncommon and there is no clear answer as to why it occurs.   It may be related to the entrance of some of the fat into the blood vessels during the operation that travel to the lung and block the pulmonary vessels.   If this occurs as a result of our operation and the problem is severe there is no question that the patient will need to be admitted.

•  Life threatening conditions . It is very uncommon to see severe complications with cosmetic surgery. However should such a condition arise for any reason, you will be immediately admitted to the hospital.

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When and where are touchup procedures done?
Touchups are done after three months. These procedures are much simpler than the first procedure and are not as painful.   I can usually do them in the office with a small amount of local anesthetic solution.

When are the sutures removed?

There are very few sutures in liposuction procedures in general. These usually come out in the first week. Sometimes you may have absorbable sutures that do not need to come out.

How many visits do I have after surgery?

We like to see our patients frequently after surgery. You are seen by the Doctor or nurse within 2-3 days of surgery. Then the normal postoperative routine is: 1 week, 1month, 3 months.6months, and 12 months. Of course if there is a need you may be seen more. After a year we encourage our patients to come for routine follow-up visits every 3-5 years.

When can I wear make-up?

Yes. You should be able to wear makeup if you have had liposuction. We do not recommend your putting makeup on your incisions however, because this may result in tattooing of the skin by the pigments of the makeup.

Am I a good candidate?

You are a good candidate for liposuction if you have localized areas of fat collection, good skin tone, good general health, and realistic expectations. This does not mean that you cannot perform liposuction if you do not meet these criteria. However, the best results are seen in individuals who have one or two areas of their body and which they cannot seem to get rid of with dieting and exercising. Generally the younger you are the better a candidate you are for surgery. But the physiologic age of person is more important than the chronological age. That is to say you may be 60 years old, but your skin and general health could be better than most who are 50 years old.

Procedure: Liposuction continued

What does the surgery cost?

The cost of surgery varies but here are some guidelines that will help you determine roughly what you could expect. Remember that these are only rough estimates . These estimations include the cost of the operating room and the anesthesia. The fee may be subject to change without notice. The best way for you get an accurate cost analysis is to see a doctor.

Liposuction:     $3,150 - $6,000

How do I pay for surgery?   

You can pay for surgery by certified check, Credit card, or cash. Payments for cosmetic surgery are expected prior to the procedure. If you are scheduling several weeks in advance of surgery you can pay by personal check.

Are there scars?

Yes. However these scars are very small (about 1/8 th of an inch) and are usually hidden in areas of the body that you would not normally see them (belly button, pubic hair area). Each area of liposuction will generally have one or two small scars. After several months these scars fade and are hardly visible.

Does it hurt?

The pain involved in liposuction is very tolerable. We have heard our patients describe it as 'muscle aches and pain' or just 'soreness'. Many patients do not finish the pain medications prescribed to them for pain relief. But having said that remember that pain is very subjective, and it is not easy to predict what degree of pain you will have.

Will I be awake during surgery?

If you are having just a small area liposuctioned and this can be done in the office then you will be awake. However if you are having a large area liposuctioned, or having multiple areas suctioned you will most likely be done in an outpatient facility under general anesthesia,

Where is the surgery performed? (i.e. office suite or hospital)

The surgery can be done either in the office or the outpatient facility depending on the size and number of areas suctioned. For example if you have a small localized area of fat in your outer thigh, it is quite feasible to do this in the office under local anesthesia. On the other hand, if you want to have you entire mid body liposuctioned, then you are much more likely to be done in the outpatient facility. We rarely see the need to perform liposuction in the hospital setting anymore. Only in rare situations in which the patient may have risk factors does Dr.Marefat suggest the hospital environment for surgery.

Are medical photographs taken?  

Yes. In all cosmetic and reconstructive cases medical photos are taken. Photographs are mandatory because this is the only way for us to compare you before and after results. Photographs in plastic surgery serve much the same role that x-rays serve for orthopedic surgery.

Date Revised: 1/24/07

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