What is liposuction?

Liposuction involves removing fat by sucking it out through a tube. It is most effective for people whose weight is normal and who have have firm, elastic skin. It is not a substitute for losing weight.

Why have liposuction?

Liposuction can help to correct and improve the contours of parts of the body it is difficult to shift weight from. The areas that are most commonly treated by liposuction are the tummy, hips, buttocks, thighs, knees, neck and upper arms. Liposuction can also be used to remove lipomas (non-cancerous tumours of fatty tissue) and fatty swellings that can develop under men’s nipples to look like breasts (gynaecomastia).

What will happen before the procedure?

You will meet your surgeon to talk about why you want surgery and what you want. The surgeon will make a note of any illnesses you have or have had in the past. They will also make a record of any medication you are on, including herbal remedies and medicines that are not prescribed by your doctor.
Your surgeon will examine you, and may take some photographs for your medical records. They will ask you if you want to have someone with you during the examination, and ask you to sign a consent form for taking, storing and using the photographs.
The surgeon will measure your height and weight to make sure that it is safe to do an operation. If you are overweight, or planning to become pregnant, your surgeon may suggest delaying your operation.

How is the procedure performed?

Liposuction is carried out using a thin tube called a cannula that is inserted through tiny cuts in the skin. The cannula is used to loosen the fat and make the body part being treated a nicer shape. Next, a special suction device is attached to the cannula, and the fat is sucked from the body. Finally, the cuts in the skin are sewn up.
There are some slightly different techniques. Some surgeons inject the area being treated with solutions (known as a wet or tumescent technique), and others do not. Suction is usually performed with a powerful vacuum machine, but it is sometimes possible to use a simple syringe for small areas. Ultrasound assisted lipectomy, where ultrasound waves are used to help disrupt the fat cells and make them easier to remove, is another technique.

Choosing a surgeon

If you decide to have liposuction, only go to a surgeon who is properly trained and on the specialist register held by the General Medical Council (GMC). They will talk to you about what is possible for you or might give the best results. Members of several different organisations do cosmetic surgery, so your general practitioner (GP) is the best person to advise you on who to see.
You should talk to your surgeon before the procedure about whether you might need further surgery, and about how and when to pay. Nobody needs urgent liposuction. If you are not given time to think about it, you should look elsewhere.

How can I help the procedure be a success?

Be as healthy as possible. It is important to keep your weight steady with a good diet and regular exercise. Your GP can give you advice on this.If you smoke, stopping at least six weeks before the operation will help to reduce the risk of complications. Do not worry about removing hair near where cuts will be made, but do have a bath or shower during the 24 hours before your operation to make sure that the area is as clean as possible. You should avoid using aspirin or anti-inflammatory drugs for two weeks before the operation. If you are anaemic, you should take iron tablets. Your surgeon may advise you to stop taking the contraceptive pill if the liposuction is going to be extensive, perhaps involving cutting skin away.

What is the alternative treatment?

The main alternative to liposuction is diet and exercise to control your weight. However, some people find that there are areas of fat that diet cannot change, and this is where liposuction can help. For liposuction to work, your skin needs to be elastic. If it is very stretched, you may be offered operations to remove extra skin, such as a tummy tuck, instead.

What are the main risks and complications of liposuction?

As with all operations, there are risks involved in having liposuction. Although the risks are unlikely, it is important to weigh them up against the potential benefits of the surgery. Discuss each of them with your plastic surgeon to make sure you understand the potential complications and consequences.

• Scars There will be small scars from the surgery, usually in places that are not usually visible. These will usually be red at first, then purple, and then fade to become paler over 12 to 18 months. Occasionally, scars may become wider, thicker, red or painful, and you may need to have surgery to correct them.
• Friction burns The cannula rubbing against the skin can cause friction burns. They are usually mild and will settle with time.
• Bruising and bleeding Bruising is very common after liposuction, but heavy bleeding is rare. Any bleeding usually happens immediately after, or soon after, surgery. Before the surgery your surgeon will discuss any medicines that increase your risk of bleeding, and it is important to control high blood pressure.
• Seroma This is where fluid collects in the areas where the liposuction has been performed. It may need to be drained by having a needle through the skin, or by having another operation. This can affect the final result.
• Infection and swelling It is rare for the wounds to get infected, but if they do you may need antibiotics. Inflammation of the veins (thrombophlebitis) can happen around the inside of the knee and inner part of the upper thigh if these areas have been treated. It gradually settles within a few of weeks. Fine thread veins may appear in treated areas.
• Swelling, bruising and pain After the operation there will be a lot of swelling and bruising of the areas where liposuction was performed. This can take weeks to settle. The larger the area treated, the more swelling and bruising there will be, and it can take weeks to settle. There may be long-term pain, but this is rare. If you are having treatment to your legs, you may find that your ankles are swollen for a few weeks. If your ankles have been treated, they may stay swollen for a few months.
• Asymmetry This is where the areas where the liposuction was performed are not symmetrical. The contours of the treated areas can sometimes be irregular, particularly if a lot of fat has been removed, but these irregularities are usually minor. If the contours of where you have had liposuction are irregular, you may need more liposuction, or fat grafting (where fat from another area is injected), to smooth out the irregularities. Occasionally, the skin appears to be connected to the deep tissues. This is part of the bruising and will settle in time.
• Increased or reduced sensation After liposuction it is common to have areas that are numb or more sensitive than usual. This usually settles within a few months. Loss of sensation, though rare, may be permanent.
• Change of colour of the skin Bleeding, or the compression garments you have to wear after the liposuction, can change the colour of your skin in the areas treated. This change may be permanent.
• Damage to deeper structures Although rare, the surgery can damage deeper structures, including nerves, blood vessels, muscles, the bowel (the part of the intestine below the stomach) and other organs. This damage may be temporary or permanent. There is a higher risk of this if you have scars in the area being treated.
• Unsatisfactory result Sometimes, patients are not satisfied with the result of their liposuction, if the new contours or the amount of fat removed does not meet their expectations. It is important for you to understand that liposuction is not a treatment for obesity. The amount of fat that can be removed from an area is limited by what is safe (no more than three litres). So it may not be possible to slim down an area as much as you might like. Further liposuction may be carried out in the same area after six months. Sometimes the skin in the area treated has lost its elasticity and is loose. Liposuction in these areas will leave the skin loose. The surgeon may recommend that they remove the loose skin to correct this, either at the same time as the liposuction or as a second procedure. This is most likely in the abdomen, the buttocks, the neck, after pregnancy and after losing weight. Liposuction will not improve cellulite (dimples and wrinkles of the skin). It is very important that you talk to your surgeon, before you have the surgery, about the size and shape you want, and whether this can be safely achieved with a good outcome.
• Change over time The appearance of the areas where you had liposuction will change as a result of ageing, pregnancy or other circumstances not related to your surgery, such as putting on or losing weight. You may need further surgery or other treatments to maintain the results of the liposuction.
• Allergic reaction Rarely, allergic reactions to tape, stitches or solutions have been reported. If you have an allergic reaction you may need extra treatment.

Risks of anaesthetic

• Allergic reactions You could have an allergic reaction to drugs used during the surgery.
• Chest infection There is a small risk of chest infection. The risk is higher if you smoke.
• Blood clots Blood clots can form in the leg (called a deep vein thrombosis or ‘DVT’). These cause pain and swelling and need to be treated with blood-thinning medication. In rare cases, part of the clot breaks off and goes to the lungs (called a pulmonary embolus or ‘PE’). The risk of this is higher if you smoke, are overweight or are taking the contraceptive pill. There is also a risk of fat entering your bloodstream and having the same effect as a blood clot.
• Heart attack or stroke A heart attack or stroke could be caused by the strain surgery places on your heart. You will be assessed for the risk of this before your surgery.
• Death As with all surgery, it is possible to die as a result of this surgery.

What to expect after the operation

Liposuction is usually carried out under a general anaesthetic (so you would be asleep) or a local anaesthetic (where an area is numbed with injections). You could have an epidural (an injection in the back that numbs the nerves in the whole area) if the treatment is in the lower part of the body, but a local anaesthetic alone is only suitable for small areas. The operation usually takes between one and three hours, depending on the size of the area being treated. You might be given antibiotics to keep the wound clean. You might go home the same day as the liposuction, or stay in hospital overnight. If you do go home on the same day, a responsible adult should stay with you for the night. Simple painkillers should be enough to keep you comfortable. You may also be given compression stockings to wear, to reduce the risk of a blood clot in the leg or the lung.

Dressings

You will have some small dressings on the cuts that were made. Tight bandages or compression garments will reduce swelling and help the body adapt to its new shape. Compression garments should be worn both day and night, except when showering, for at least two weeks, and then during the day for another four to six weeks.

After liposuction, you must wear a snug compression garment around your lower body to reduce swelling

Recovery

You will be out of bed on the same day as your surgery. Rest for a few days to allow the fluid in the area you had treated to be absorbed.
If you only had a small amount of fat removed, you should be able to return to work within a few days. However, you may need extra time off if the liposuction was more extensive.You should be back to normal exercise in three to four weeks. Avoid strenuous activity for 10 to 12 weeks. With all activities, start gently.
Do not drive until you feel safe and are comfortable wearing a seatbelt. Check your insurance documents if you are not sure.
You can expect considerable bruising which will be uncomfortable and painful at times. The larger the area treated, the greater the pain will be. The bruising will usually be visible for about a month, but the lumpiness and swelling of deep bruising can take up to six months to disappear, particularly if your tummy or ankles have been treated. As swelling can take a long time to go down, you may not see the full benefit of the liposuction for up to six months. Rarely, a greyish stripe can discolour the skin for several months. This is more common when the ankles have been treated. If you have a tendency to be anaemic, or if you have had a large area treated, you may need to take iron tablets for a month.

Seeing the results

At first you will feel swollen and look bruised. This should settle down within one to six months and reveal your final shape. The effects of the liposuction should be long lasting if you keep your weight stable.

Your aftercare

• To protect your body, and get the best result, look after yourself.
• Avoid vigorous activities after your operation.
• Protect your wounds as you are told to.
• Putting on weight or being pregnant will affect the results.
• Maintain a healthy weight and level of exercise.

What to look out for

Bleeding after surgery can cause swelling, a change in colour, and pain, usually just on one side. The signs of an infection are pain, redness, swelling and pus in the wound, and you may also have a temperature. A blood clot on the leg can cause swelling and pain in the calf. If the clot goes to the lung, you might be breathless or have pain in your chest. If the wound is not healing well, it may be sore and weep.If you have any worries after your operation, speak to a doctor or go to A&E.

Disclaimer
This document is designed to give you useful information. It is not advice on your specific needs and circumstances. It does not replace the need for you to have a thorough consultation, so you should get advice from a suitably qualified medical practitioner. We – The BAAPS and BAPRAS – have no liability for any decision you make about the surgery you decide to have.