Liposuction: Everything You Need to Know
Liposuction hit the U.S. in the early 1980s, but some advances have been truly game changers. Here's what you need to know.
Beyond breast lifts and tummy tucks, eyelid and nose surgery, liposuction ranks as one of the most popular cosmetic surgery procedures. It’s second only to breast augmentation. Maybe that’s because the treatment has changed in recent years: It’s gentler, safer, and tailored to your body.
According to the American Society for Aesthetic Plastic Surgery (ASAPS), in 2019, 270,670 people had liposuction to removed unwanted fat from their arms, legs, necks, stomachs, thighs, and other areas. It’s so common that liposuction is performed by nearly 90 percent of all plastic surgeons in the United States. Here’s how the procedure has changed and everything you need to know if you’re considering liposuction.
Liposuction is safer and doesn’t always require general anesthesia
Some liposuction advances, namely tumescent liposuction, likely have saved many lives and dramatically cut back on blood loss and the need for fine-tuning. In the past, the technique led to bleeding and bruising; sometimes patients needed a transfusion due to blood loss. Enter tumescent liposuction. This technique delivers fluid containing the numbing agent lidocaine, saline (salt water), and epinephrine to the treatment area, where it hardens fat, making it easier to remove.
“The tumescent technique has made the biggest impact on liposuction,” says Lara Devgan, MD, a plastic surgeon in New York City and an attending plastic surgeon at Lenox Hill Hospital. The epinephrine in the cocktail basically eliminates bleeding as it narrows blood vessels. “This has been a great improvement in safety.” In many cases, this technique means no more general anesthesia and its accompanying risks.
“You can turn over and stand so we can see how the results look when gravity is working, and do any touching up before you leave the operating room,” adds Bruce Katz, MD, clinical professor of dermatology at the Icahn School of Medicine at Mt. Sinai, director of the Cosmetic Surgery & Laser Clinic at Mount Sinai Hospital, and director of the JUVA Skin & Laser Center in New York. All types of liposuction can be done via the tumescent technique. “This is now the gold standard,” Dr. Katz says.
Treatment is tailored to individual locations on your body
Cannulas are the thin, hollow tubes that, when attached to the vacuum pump, suck out fat. They now come in all different shapes and sizes including sharp, angled, and blunt-tipped. “We can now choose the right cannula for the right procedure,” Dr. Devgan says. “For example, I may choose an angled cannula for neck lipo, but for ab-etching, where a man wants a more defined six-pack, I would choose another type.”
It’s gentler on your body
In its early years, liposuction was very taxing on surgeons as each motion involved serious effort, but power-assisted lipo has made things easier on surgeons and patients and improved results. “With power-assisted liposuction, the tip of the cannula vibrates rapidly so the liposuction is gentler on the body,” says Dr. Devgan, comparing this liposuction advance to a power-assisted lawnmower or blender. “Instead of just relying on our hand, we get some added vibration and power for a smoother procedure.” (Liposuction is common. Check out these plastic surgery procedures you didn’t know existed.)
Your skin looks better post-procedure
In the past, a lot of liposuction could make the skin look rough and cause cellulite. Now, a procedure called SAFE—which stands for separation, aspirate, fat equalization—helps skin look better after liposuction.
“In the past, the more fat we suctioned out, the worse the skin looked,” says the procedure’s creator, Simeon Wall, Jr., MD, a board-certified plastic surgeon at The Wall Center for Plastic Surgery in Shreveport, Louisiana. “Now, with SAFE, you can take out as much fat as you want and it never increases the risk of contour deformity.”
Separation involves loosening the fat. Once the fat is loosened, it is easier to remove or aspirate. The third step—fat equalization—involves smoothing out the layer of fat that is left behind.
“The SAFE technique has revolutionized liposuction, and has been adopted by many plastic surgeons to help them achieve predictably aesthetic results,” says Gary D. Breslow, MD, medical director of The Breslow Center For Plastic Surgery in Paramus, New Jersey.
Your skin is tightened
“All assisted liposuction techniques break up the fat so it dislodges easier and there is less trauma and bleeding,” says Miles Graivier, MD, a plastic surgeon in Atlanta. For example, radio frequency-assisted liposuction uses radio-frequency energy to break up the fat before it is removed. “This elevates the temperature of the skin to stimulate the production of collagen and produce a better skin-tightening effect,” he explains. Collagen is the main structural protein found in skin, and it is responsible for our skin’s supple, elastic, and youthful qualities.
Ultrasound-assisted liposuction emulsifies the fat with sound waves, making it easier to remove, but it can burn the skin if it gets too hot. Ultrasound lipo techniques include VASER and UltraShape. “Fat cells are fragile so there is no reason to use higher amounts of ultrasound,” says past ASAPS President Peter Bela Fodor, MD, a plastic surgeon in Los Angeles who developed the VASER technique with a physicist. “VASER breaks up the tissue much better and there is no collateral damage to blood vessels, nerves. and connective tissue.”
Laser liposuction removes fat and tightens skin, says Dr. Katz. “With unassisted liposuction, you take out fat but it produces a deflated balloon-like effect on the skin,” he says. The heat from the laser, however, seals tiny blood vessels in the treatment area, so there’s less blood, bruising, swelling, and downtime. The heat also softens fat so it is easier to suck out. There’s more: Laser energy boosts the production of collagen, research indicates, eliminating that deflated balloon look.
You can use the fat to your benefit
Water-assisted liposuction removes unwanted fat with less trauma and bruising. This means that the fat can be salvaged and used to plump up areas of the body where volume is lacking—such as the breasts, rear, or face. “Water loosens fat cells from connective tissue, and the fat is removed,” explains Dr. Graivier. Tickle lipo offers the same perk. It breaks up fat with acoustic waves and leaves connective tissues untouched. (Its more scientific name is Notational Infrasonic Liposuction.) “I would use these two gentler methods if I needed a large volume of fat to use for fat grafting procedures such as for breast or rear enhancement,” he says.
You may not have to have surgery at all to remove fat
Liposuction works, but it is a surgery and all surgeries involve downtime and risk. In recent years, there has been an explosion of non-surgical fat reduction technologies. Some promise to chill and kill fat. Others melt it away gradually with laser ultrasound or radio-frequency energy, and some dissolve it via injections. Some are aimed at smaller pockets of fat (double chins) while others target larger areas like the stomach.
“With liposuction, the fat is sucked out through small cannulas. At the end of the procedure, you can see canisters of your fat, which has been physically removed. You can also see an immediate result,” says David Shafer, MD, a New York City-based plastic surgeon. “While the non-invasive methods have minimal to no recovery, the results and can not even be compared to true liposuction.” Still, he says, liposuction does involve recovery and time off from work, unlike these non-invasive procedures.
- American Society for Aesthetic Plastic Surgery (ASAPS): "AESTHETIC PLASTIC SURGERY NATIONAL DATABANK STATISTICS"
- Lara Devgan, MD, a plastic surgeon in New York City and an attending plastic surgeon at Lenox Hill Hospital
- Bruce Katz, MD, clinical professor of dermatology at the Icahn School of Medicine at Mt. Sinai, Director of the Cosmetic Surgery & Laser Clinic at Mount Sinai Hospital and Director of the JUVA Skin & Laser Center in New York
- Simeon Wall, Jr., MD, a board-certified plastic surgeon at The Wall Center for Plastic Surgery in Shreveport, Louisiana
- Gary D. Breslow, MD, FACS, medical director of The Breslow Center For Plastic Surgery in Paramus, New Jersey
- Aesthetic Surgery Journal: "Tissue Tightening Technologies: Fact or Fiction"
- Miles Graivier, MD, plastic surgeon in Atlanta
- Peter Bela Fodor, MD, a plastic surgeon in Los Angeles
- David Shafer, MD, a New York City plastic surgeon