Liposuction In-Depth - Cosmetic Surgeon Search

What is Liposuction? Top
Liposuction is a surgical procedure intended to remove fat deposits and shape the body. Fat is removed from under the skin with the use of a vacuum-suction canula (a hollow pen-like instrument) or using an ultrasonic probe that emulfsies (breaks up into small pieces) the fat and then removes it with suction.

Persons with localized fat may decide to have liposuction to remove fat from that area. Liposuction is a procedure for shaping the body and is not recommended for weight loss.
Liposuction may be performed on the abdomen, hips, thighs, calves, arms, buttocks, back, neck, or face. A liposuction procedure may include more than one site, for instance, the abdomen, back, and thighs all on the same day.

Liposuction is also used to reduce breast size in men with large breasts (gynecomastia) or to remove fat tumors (lipomas) but it is most commonly used for cosmetic body shaping.

Who Performs Liposuction & Where is Liposuction Performed? Top
Many liposuction surgeries are performed by plastic surgeons or by dermatologists. Any licensed physician may perform liposuction. While some physicians' professional societies may recommend training before performing liposuction surgery, no standardized training is required. As a result, there will be differences in experience and training in physicians performing liposuction. You can ask your physician to tell you whether he or she has had specialized training to do liposuction and whether they have successfully done liposuction before. But remember, even the best screened patients under the care of the best trained and experienced physicians may experience complications as a result of liposuction.

Liposuction may be performed in a

Because liposuction is a surgical procedure, it is important that it be performed in a clean environment. Emergencies may arise during any surgery and access to emergency medical equipment and/or a nearby hospital emergency room is important. These are things that you should ask your physician before the liposuction.

How can I find the right doctor for me? Top
The FDA cannot recommend physicians to you. However, there are some things that you may consider:

What Does the FDA Regulate? Top
In the United States, the Food and Drug Administration (FDA) regulates the sale of medical devices, such as the equipment (canulas, pumps, collecting containers, ultrasound probes, etc) and drugs (anesthesia) used for liposuction.

Before a medical device can be legally sold in the U.S., the person or company that wants to sell the device must seek approval from the FDA. To gain approval, they must present evidence that the device is reasonably safe and effective for a particular use, the "indication." Once a device is approved, other similar devices may be cleared by the FDA for use. This requires less information since an equivalent device has already been shown to be safe and effective. In some cases, devices that were on the market before FDA started regulating medical devices may be cleared. Once the FDA has approved or cleared a medical device, a doctor may decide to use that device for other indications if the doctor feels it is in the best interest of a patient. The use of an approved or cleared device for other than its FDA-approved indication is called "off-label use."

The FDA does not have the authority to:

When is Liposuction not for me? Top
You are probably NOT a good candidate for liposuction surgery if:

What are the Alternatives to Liposuction?

Liposuction is usually cosmetic surgery so is not considered medically necessary (there are rare exceptions to this). Because of this, it is you who will decide whether or not you will undergo this procedure. You may decide that liposuction is not right for you. You may make this decision without consulting a physician or after consulting with a physician. A consultation with a physician does not obligate you to have liposuction if you decide that you do not want to.
Some of the alternatives to liposuction are:

What are the Risks or Complications Associated with Liposuction? Top

Risks
Most patients are pleased with the outcome of their liposuction surgery. However, like any other medical procedure, there are risks involved. That's why it is important for you to understand the limitations and possible complications of liposuction surgery. Before you have liposuction, you should be aware of these risks and should weigh the risks and benefits based on your own personal value system. Try to avoid being influenced by friends that have had the procedure or doctors encouraging you to do so. Decide for yourself whether you are willing to take the risks involved in liposuction.

Take your time deciding if you are willing to accept the risks inherent in liposuction. Because it is usually a cosmetic procedure, and not medically necessary, there is no reason to rush. Gather as much information as you can so that you make an informed decision about whether liposuction is right for you. Don't believe that complications "only happen to other people." It is important for you to understand what the risks are and decide if you are willing to accept the possibility that it might happen to you.

What can I Expect Before, During, and After Liposuction? Top

Before...
Before you undergo liposuction, you should undergo a complete physical exam so that your doctor can determine if you are an acceptable candidate for liposuction. It is important for you to discuss any medical conditions that you have and to tell your doctor about any medications that you are taking including any herbal or other non-prescription ones. If your doctor decides that you can have liposuction, discuss the procedure thoroughly with him or her before deciding if you want to go through with the procedure. Just because a physician says that you may have liposuction does not mean that you must decide to have liposuction. You may still change your mind even after discussing the procedure with a physician.
Your physician should be able to answer any questions that you have about liposuction including questions about what to expect during and after liposuction and the complications or problems that sometimes occur with liposuction. Some physicians will provide written information about liposuction. You may also take information from this website to your appointment to discuss with your physician.
You may want to have someone drive you to your appointment for liposuction. You may be tired or uncomfortable after liposuction and unable to drive yourself home. Discuss this with your physician before the day of your procedure.
Your physician may prescribe an antibiotic drug for you to take before and after the surgery. This is to prevent infections.

During…
On the day of the liposuction surgery, the physician will mark your body with a pen to indicate where the fat is to be removed. Then you will receive anesthesia, that is medicine that prevents you from feeling pain. Some physicians use only local anesthesia, that is, anesthesia that they inject with a syringe or pump into the area where they will do the liposuction. The anesthesia medicine is injected along with a lot of fluid, usually buffered salt water and epinephrine, a drug to reduce bleeding. Large volumes of liquid may be injected, until the skin is very firm. If your physician uses only this kind of local anesthesia, also sometimes called tumescent anesthesia, then you will be awake during the procedure. Other physicians use local anesthesia and a sedative that can be taken by mouth or injected from a syringe. Still others prefer to use general anesthesia, that is to use anesthesia that will put you to sleep during the procedure. This is usually done in a hospital.

Once the anesthesia is working, the physician will make an incision (cut) in the area where the liposuction will be performed. A canula, a hollow tube that is about the size and shape of a skinny pen, will be inserted into the incision. The physician moves this canula back and forth to suction out the fat. The fat, and liquid that has been injected, are collected in a flask. The physician will monitor the amount of fluid and fat that are removed. Because you will be losing liquid and fat from your body, it may be necessary to replace some of that fluid. This is done with an intravenous (i.v.) line for the replacement of fluid.

After…
Depending upon the amount of fat removed and the location of the surgery (doctor's office, surgical center, hospital), you may leave the doctor's office soon after the surgery or you may spend the night in the surgical center or hospital. Ask your doctor how long it will be before you should be able to return to your normal level of activity or if you will need to miss work after liposuction.

The cuts where the doctor inserted the canula may be leaky or drain fluids for several days. In some cases, the doctor may insert a drainage tube to drain fluid away from the wound.

You will wear special tight garments to keep your skin compressed after the liposuction procedure. Your doctor will tell you how long to wear these, usually for weeks. Some doctors provide these garments but others will tell you where to purchase them before your surgery.

Your doctor will also probably give you some after-surgery instructions. This will include information about wearing compression garments, taking an antibiotic if that has been prescribed, and the level of activity that is safe for you after your liposuction procedure. You should also have information about signs of problems that you should be aware of, for instance the signs of infections or other problems that you need to know about.

When the anesthesia wears off, you may have some pain. If the pain is extreme or of a long duration, you should contact your physician. You will also have some swelling after the surgery. In some cases, this swelling will remain for weeks or even months. If you have pain and swelling, this may be the sign of infection and you should contact your physician.

You will have scars, usually small, where the physician cuts your skin and inserts the canula to remove fat tissue.

Will I look the way I want after liposuction? Top
While medical complications are important, the reason that people have liposuction surgery is for cosmetic reasons. The cosmetic effect after liposuction may be very good and many patients report being satisfied. However, it is possible that the cosmetic effect will not be what you expected. In other words, your appearance after liposuction may not be what you expected or wanted. Some physicians counsel their patients that reasonable expectations are important. It may be difficult to have reasonable expectations after reading advertisements and looking at pictures of women and men who have had liposuction. Remember that advertising is made to make you want to purchase a product or service. Advertisements do not usually tell you about problems or shortcomings of the product or service. If you want to know more about advertising ethics, or want to report on false advertising, explore the following websites:
· http://www.ftc.gov/bcp/menu-ads.htm
· http://www.ftc.gov/bcp/menu-health.htm
Some cosmetic shortcomings after liposuction include:
· There may be scars at the site where the doctor made the cut to insert the liposuction canula. These scars are usually small and fade with time but in some people, scars may be larger or more prominent.
· The liposuction site may have a wavy or bumpy appearance after liposuction.
· Liposuction results may not be permanent. If you gain weight after liposuction surgery, the fat may return to sites where you had liposuction or to other sites.
· Results may be less dramatic than what you were expecting and this can be disappointing.

Liposuction Surgery Checklist Top
Know what makes you a poor candidate for liposuction

Report Problems with Liposuction to the FDA Top
· Health professionals or consumers should report serious adverse reactions or other problems related to equipment or medications used for liposuction through the FDA's MedWatch Program (http://www.fda.gov/medwatch/).
· The Safe Medical Devices Act of 1990 requires hospitals and other user facilities to report deaths, serious illness and injuries associated with the use of medical devices. Questions about mandatory reporting can be answered by the
Division of Surveillance Systems, Reporting Systems Branch, by phone on 301-827-0361, or write to
FDA, CDRH,
MDR User Reporting (HFZ-531),
PO Box 3002,
Rockville, MD 20847-3002

Glossary Of Liposuction Terms Top

Anesthetic - drugs that cause the loss of feeling or sensation.
Canula (or cannula) - a hollow pen-like instrument or tube used to draw off fluid.
Edema - swelling caused by large amount of fluid in cells or tissues.
Emboli - something that blocks a blood vessel. See embolism.
Embolism - the blocking of a blood vessel or organ by pieces of matter such as fat.
Emulsify - to break up into small pieces.
Epinephrine - a drug injected before liposuction to reduce bleeding during the procedure.
Infection - invasion by and multiplication of bacteria or microorganisms that can produce tissue injury.
Lidocaine - an anesthetic that may be injected in large amounts of liquid during liposuction.
Lipoplasty - another name for liposuction.
Liposuction - a usually cosmetic surgical procedure in which fat is removed from a specific area of the body, by means of suction.
Necrotizing Faciitis - a bacterial infection in which bacteria infect and kill the skin and underlying tissues.
Paresthesia - a change in feelings or sensation. May be an increase in feeling (pain) or a decrease in feeling (numbness).
Pulmonary embolism - pieces of fat may find their way into the blood stream and get stuck in the lungs during liposuction. This causes shortness of breath or trouble breathing.
Probe - see canula.
Sedative - a drug which helps a person to relax and may make them feel sleepy.
Seroma - a collection of fluid from the blood that has pooled at the liposuction site.
Skin necrosis - skin or underlying tissue dies and falls off.
Suction assisted liposuction - see liposuction.
Thrombophlebitis - inflammation of a vein caused by a blood clot.
Toxic Shock Syndrome - an infection caused by bacteria that release toxins into the body. This type of infection can occur after surgery if bacteria are accidentally introduced during the surgery.
Ultrasound assisted liposuction - a type of liposuction in which fat is first loosened by using an ultrasonic probe and then removed by means of suction.
Visceral perforations - organs may be punctured accidentally with the liposuction probe or canula during liposuction.

Lipoplasty: Ten Tips for Safety and Effectiveness Top

Source: American Society for Aesthetic Plastic Surgery

For most of its 18-year history in the U.S., lipoplasty (liposuction) has been an extremely safe cosmetic surgical procedure. However, as new techniques were introduced in the '90s -- and physicians found they could remove greater and greater amounts of fat -- the incidence of complications suddenly rose. Today, thanks to new physician guidelines and a major educational campaign by plastic surgery organizations including the American Society for Aesthetic Plastic Surgery (ASAPS), patients can again feel confident about the safety of lipoplasty performed by board-certified plastic surgeons. In fact, a leading malpractice insurer of plastic surgeons reports that there have been no significant claims associated with lipoplasty for its 1000 insured plastic surgeons since October 1998 - reflecting the success of recent research and educational efforts to identify and avoid risk factors.

ASAPS, the largest organization of board-certified plastic surgeons who specialize in cosmetic surgery, recommends the following Ten Tips for Safety and Effectiveness of lipoplasty procedures:
Understand the procedure’s limitations. Lipoplasty is not a cure for obesity. It can, however, effectively eliminate localized fat deposits that are resistant to diet and exercise. To be a good candidate for lipoplasty, you should be within 30% of your ideal body weight and have adequate skin elasticity.

Don’t try to do too much at once. Multiple procedures performed at the same time increase the risks of surgery. Your board-certified plastic surgeon will advise you about what can be safely accomplished in one surgical session.

Provide an accurate medical history. You should be in good general health. Be sure to discuss with your surgeon any past or present medical conditions, as well asmedications that you are taking including dietary or herbal supplements.

Discuss the procedure thoroughly. You and your surgeon will make choices about anesthesia (local or general) and technique. A qualified, board-certified plastic surgeon will discuss with you all aspects of the procedure so you’ll know what to expect.

Understand the risks. The current data on lipoplasty safety establishes that serious complications are extremely rare when the procedure is performed by board-certified plastic surgeons in accordance with accepted standards of practice. However, every type of surgery carries some risk. If your surgeon is reluctant to discuss possible complications with you, find another surgeon.

Plan adequate aftercare. Lipoplasty is often performed as an outpatient procedure, and you can return home the same day. However, it is important that you have someone to help you for the first day or two following surgery. If more than five liters (5000 cc’s) of fat and fluid are removed, your surgeon may recommend an overnight hospital stay.

Plan adequate recovery time. Don’t schedule lipoplasty right before an important event in your life or at a time when you might feel pressured to resume normal activities too soon.
Check your doctor’s credentials. Lipoplasty is a surgical procedure and should be performed by a doctor with surgical training and credentials. Remember, any doctor (even one from a nonsurgical specialty) can legally perform lipoplasty. Certification by the American Board of Plastic Surgery ensures at least five years of surgical training, including two years of training specifically in plastic surgery.

Check your doctor’s hospital privileges. Lipoplasty often is performed outside the hospital in an office-based surgical facility. Many board-certified plastic surgeons operate in office-based surgical suites, even though they have privileges to do the procedure in a hospital. However, sometimes doctors operate outside the hospital because they do not have the necessary credentials to obtain privileges to perform lipoplasty in an accredited hospital. Get verification of your doctor’s hospital privileges in writing.

Check for facility accreditation. Office-based plastic surgery has a safety record comparable to hospital-based ambulatory surgery -- when the physician is board-certified in a surgical specialty and the facility has met the stringent safety standards for accreditation. Ask for proof of the surgical facility’s accreditation status.

LIPOPLASTY VERSUS DIETING: WHICH SHOULD YOU CHOOSE? - 10 CONSUMER TIPS Top

Source: American Society for Aesthetic Plastic Surgery

If you’ve resolved to get in shape in 2001, the road ahead may seem daunting. Getting fit often requires major lifestyle changes including reducing food intake, selecting foods that are better for you, and sticking to an exercise routine. Could lipoplasty (liposuction) offer an easier way to achieve your ideal body? The American Society for Aesthetic Plastic Surgery (ASAPS) offers these consumer tip questions and answers to help you determine if lipoplasty is right for you:

LIPOPLASTY: WHICH TECHNIQUE IS BEST? Top

Source: American Society for Aesthetic Plastic Surgery

Lipoplasty (liposuction) continues to be the most popular cosmetic surgical procedure, according to American Society for Aesthetic Plastic Surgery (ASAPS) statistics that show 376,633 lipoplasty surgeries performed last year, up 113% since 1997. Although traditional suction-assisted lipoplasty (SAL) still is the most widely used technique, new technology has produced a number of other options. New Jersey plastic surgeon and ASAPS vice president Franklin DiSpaltro, MD, moderates a panel of experts who compare current lipoplasty techniques at the ASAPS Annual Meeting, May 3-9, in New York.

According to Dr. DiSpaltro, equivalent results can be achieved using any of the currently popular techniques. "The primary benefit of the newer lipoplasty devices is that they enable the surgeon to perform surgery using less physical force and to therefore focus on liposculpting," says Dr. DiSpaltro. "This may translate into reduced trauma to the tissues and faster patient recovery – but these potential advantages are still being studied and evaluated. The best advice for a person considering lipoplasty is not to focus on the technology but, rather, on the training and experience of the surgeon, who should be certified by the American Board of Plastic Surgery."

The growing number of lipoplasty techniques have come to be known by acronyms such as SAL, UAL, E-UAL, VAL and so on – a veritable alphabet soup of terminologies that can be confusing to the uninitiated. Here’s a brief glossary of traditional and new, evolving lipoplasty technologies being discussed this week at the ASAPS meeting:

Suction-Assisted Lipoplasty (SAL): Traditional method during which fat is removed by inserting a small, hollow tube (cannula) through one or more tiny incisions near the area to be suctioned. The cannula is connected by tubing to a vacuum pressure unit, and the surgeon guides the device to suction away undesired fat.

Ultrasound-Assisted Lipoplasty (UAL): Uses sound waves transmitted to the tip of the cannula to liquefy the fat before it is removed by suction. Particularly useful for removing fibrous fat and scarred fatty tissues.

External-Ultrasound Lipoplasty (E-UAL): Uses external ultrasound waves to alter fat cells. The area is injected with fluid containing local anesthetic to transmit ultrasonic energy. Liquefied fat is removed by suction.

Power-Assisted Lipoplasty (PAL): A reciprocating cannula (that is, with a back and forth motion of the tip) passes through tissue to suction out fat and fibrous or scarred tissue with reduced effort.

Vaser-Assisted Lipoplasty (VAL): Uses intermittent bursts of ultrasonic energy to break up fat molecules, which are then removed by suction.

LIPOPLASTY SAFETY Top

Source: American Society for Aesthetic Plastic Surgery

Historical Perspective: Lipoplasty (liposuction) is the single most requested aesthetic (cosmetic) surgical procedure in the United States, with more than 287,000 procedures performed in 1999 [statistics from the American Society for Aesthetic Plastic Surgery (ASAPS)]. From its introduction in the U.S. in 1982 until the early 1990s, lipoplasty had among the lowest complication rates of all aesthetic surgical procedures. However, as new techniques were introduced, and physicians found they could remove larger amounts of fat, the incidence of major complications, including fatal outcomes, rose alarmingly.

Pre-1998 Data: A 1998 survey conducted by the plastic surgeons' Lipoplasty Task Force found that 0.3% of patients (70 out of 24,295 cases) undergoing lipoplasty during the previous twelve months had experienced significant complications. These complications included contour irregularities, unplanned hospital admission and prolonged swelling. There was one fatal outcome per 5,000 procedures. Another survey, published in the January 2000 issue of Plastic and Reconstructive Surgery, also is based on procedures performed prior to 1998. Neither survey reflects the current state of lipoplasty safety.
Physician Guidelines Developed: In January of 1998, based on the available information concerning fatal outcomes associated with lipoplasty, the plastic surgeons' Lipoplasty Task Force established that the primary factors increasing risk include: 1) excessive amounts of fluid and local anesthesia, 2) excessive fat removal, 3) performance of multiple unrelated procedures in the same surgical session, 4) poor patient selection/patient health, and 5) inadequate postoperative monitoring of patients undergoing large-volume fat removal. All of these factors can be avoided. Safety guidelines were endorsed by the American Society for Aesthetic Plastic Surgery. An intense educational effort was undertaken by the plastic surgery organizations, including ASAPS, to communicate the task force's findings to their member surgeons through meetings, seminars and plastic surgery publications.

Current Data: Results of the educational efforts were dramatic: Mark Gorney, MD, Medical Director of The Doctors' Company, a leading malpractice carrier, reports that "Since October 1998, there have been no (zero) significant insurance claims and no (zero) fatal outcomes associated with lipoplasty performed by our 1000 insured board-certified plastic surgeons." Complications may follow any surgical procedure, even with highest level of care, but this data support the fact that lipoplasty is a safe and effective operation when performed in accordance with accepted standards of practice by a surgeon certified by the American Board of Plastic Surgery.

Bigger Breasts From Liposuction: Too Good To Be True? Top

Source: American Society for Aesthetic Plastic Surgery

Anecdotal reports in the lay press suggesting that lipoplasty (liposuction) - and specifically Power-Assisted Lipoplasty (PAL) - results in increased breast size and volume have not been verified by scientific research. It is the position of the American Society for Aesthetic Plastic Surgery (ASAPS) that lipoplasty is designed for body contouring, and - without objective scientific data - claims of other unrelated benefits from the procedure are misleading to patients. The reason why a patient may think breast size has increased following lipoplasty may have more to do with weight gain than with fat removal.

Over time, several techniques have evolved as modifications of standard lipoplasty, Suction-Assisted Lipoplasty (SAL), including Power-Assisted Lipoplasty (PAL), and Ultrasound-Assisted Lipoplasty (UAL), and using terms such as superwet or tumescent to refer to the ratios of injected fluid to aspirate removed during the procedure.

It is ASAPS' position that the choice of instrumentation and technique is subject to the determination of the operating surgeon and is of less consequence than the surgeon's training and experience. ASAPS suggests that anyone considering lipoplasty select a surgeon who is certified by the American Board of Plastic Surgery (ABPS), and is a member of the American Society for Aesthetic Plastic Surgery (ASAPS). A trained, board-certified plastic surgeon will be able to recommend a treatment plan that is appropriate for the particular patient.

Lipoplasty is a serious surgical procedure that has been demonstrated to be safe and effective when safety guidelines are in place. According to ASAPS statistics, lipoplasty is the most popular cosmetic surgical procedure, with over 385,000 procedures performed in 2001.