1. Is liposuction a reasonable treatment for obesity?

Unfortunately liposuction is not a treatment for obesity. The only treatment for obesity is weight loss. Weight loss can be achieved by diet and exercise, or various forms of gastric bypass or stapling. Liposuction of too much fat at any single time can be dangerous.


2. What is a successful liposuction surgery?

During liposuction fat is sucked out of the body by passing a small metal tube though the fat several times. Suction is applied to the tube and there are holes near, but usually not at, the tip of the tube known as a cannula. It is normal to inject saline, (which is normal intravenous fluid and therefore very safe), containing epinephrine into the fat first to wet the fat and to disperse the epinephrine. Epinephrine is a naturally occurring chemical that causes blood vessels to temporarily constrict or narrow. This reduces bleeding during the procedure. Many times lidocaine is also added to the fluid so that there is very little pain during and after the procedure. Because of this some surgeons will do this procedure while the patient is awake, but most patients prefer to be asleep. There are many variations on this basic procedure. Lidocaine dosage must be monitored carefully because toxic overdose is possible. Some cannulae emit ultrasound and some cannulae move quickly back and forth using external power. Ultrasound may be applied to the skin surface to help drive the fluid through, and wet and soften the fat for suctioning. The variations are marketed under difference names making them seem more enticing to the potential patient.


3. Does liposuction cause dimpling or indentations in the skin?

Liposuction needs to be done with care and artistry to try to get a smooth result. Too much liposuction at any one point can deplete the tissues of so much fat that the skin sticks directly to the muscle and this will cause unsatisfactory dimpling. The surgeon needs to be experienced and have an artistic eye. Poor skin tone will get worse after the fat is removed. Think of the skin as a bag and the fat as the contents of that bag. The bag will wrinkle up as it is emptied, unless the bag is tightened, by cutting some of the bag out and stitching it together to make it smaller, as in an abdominoplasty. Stretch marks are not corrected by liposuction.


4. What Alternatives Are There to Liposuction?

Mesotherapy is an alternative to liposuction, but is not recommended. This consists of injecting a cocktail of drugs, vitamins or other chemicals into the fat with the intention of dissolving it. There is no standard cocktail, and you may not be aware of what is actually being injected. The American Society of Plastic Surgeons has not approved it and I would not recommend it at this time. This may also be known as LipoDissolve. Some wraps and some forms of massage therapy are at best very short lived in their effect.


5. What type of liposuction is the best?

There is no best type of liposuction. The fact that there are so many small variations on the main theme of fluid with epinephrine infiltration following by suctioning means that there is no best method. The best method is usually the method that your surgeon is most comfortable using.


6. How much liposuction is excessive (Staged liposuction, Megaliposuction)?

Suctioning of fat causes some trauma within the fat layer under the skin. The body reacts by swelling and losing fluid at the point of trauma. If too much fat is suctioned at any one time then the fluid in the blood vessels may become critically depleted and must be replaced very quickly by giving intravenous fluid. If too much fat is suctioned and the patient is at home when this happens then the outcome could be fatal. Large volume liposuction patients should therefore be monitored in a hospital setting. There is disagreement as to how much is too much, and it probably varies a lot from person to person. Small people will be at greater risk than large people. Most plastic surgeons will agree that aspirating more than 5 liters at any one time is very risky. I like to be safer than that and use 3.5 liters as my personal maximum. Liposuction can be repeated after healing has taken place.


7. How is Tumescent Liposuction performed?

Tumescent liposuction refers to infiltration of very large volumes of saline into the tissues before liposuction is done. The amount is enough to stretch out the skin and make it very tight. I prefer to inject about the same volume as I expect to suck outratio of 1 to 1.