Surgical Procedure

Suction lipectomy is usually performed in an outpatient surgical facility under a deep sedative or a light general anesthetic, supplemented by local anesthesia, although an occasional small area may be suctioned strictly under a local anesthetic alone. Small incisions are made in convenient skin folds wherever available. Large amounts of saline solution containing local anesthetics are infiltrated into the surgical sites prior to suctioning. If you have a large amount of fat to be aspirated, or if your fat is in a generally more fibrous area, your surgeon might recommend first treating the area with an ultrasonic probe or in using the newer power assisted liposuction (PAL) or laser machines. These probes assist by breaking up the fat and, in such situations, allow more to be removed with less blood loss, and minimize surgeon fatigue. A narrow, metal cannula, which is connected by a clear hose to a powerful vacuum machine, is passed back and forth through the area of excess fat, selectively removing the excess fat. It must be understood that only the layer of fat between the skin and the underlying muscle (the amount you can pinch before surgery) can be suctioned. None of the liposuction procedures significantly tighten loose skin! Some surgeons just perform liposuction and others just traditional excisional procedures. It is highly recommended that each patient requesting body contouring be evaluated by a qualified surgeon who can offer both options to a patient, based on each patient’s needs and desires – thus, patient expectations are more likely to be met!

A large variety of liposuction machines are now on the market and are highly touted by the manufacturers of each. We have a variety of machines available at the Laguna Hills Surgery Center, but it is generally accepted in the scientific literature that results are based more on surgeon technique and the size of cannulas (the smaller the cannula, the less bruising and blood loss, allowing more fat to be removed) than on brand or type of machine. The Power Assist, Laser and Ultrasound machines all produce comparable results, the main advantage over the older generation of machines being the decrease in bruising and the decrease in surgeon fatigue!

The tunnels that are created throughout the area of previous fatty excess fill with blood and body fluids, thus creating the bruising and swelling that are seen after the operation. The bruising usually subsides within three to four weeks, but the final swelling will not dissipate before three to four months have passed by (longer for ankles and calves).

The patient’s age, general health and body size determine the amount of fat, which can be removed safely at any one operative sitting. An absolute maximum that can be removed in the ideal young and healthy candidate is limited to 5 liters of aspirate. Suctioning of larger amounts will increase health risks and could necessitate a transfusion. However, every effort is made to stay within the five-liter limit and to avoid the need for a transfusion or for hospitalization. If removing more than a total of five liters of excess fat is anticipated, performing a second operative procedure three to four months later will be recommended as a safer approach. On occasion, the surgeon will remove the entire five liters of fat from one area before another previously discussed area can be treated. Likewise, it will be necessary to return to surgery three to four months later to remove the remaining fat. The patient must understand that fees will be encountered each time another trip to the operating room becomes necessary.

It is estimated that 5% of patients treated will require touch-up procedures, which consist of removing remaining or new accumulations of fat. In instances where the skin droops or sags after removal of the fat, surgical excision of the excess skin may be desired and this could leave scars, which would be permanent. As mentioned, re-operating will result in additional fees, as well as require additional time for recovery. The patient will be responsible for all costs associated with secondary surgical procedures.