Candidates for Surgery

Candidates for Liposuction surgery have excess subcutaneous fat, which is resistant to diet and exercise and wish to change the contours of their body.  The common areas for liposuction surgery are the upper part of the neck (under the chin), upper arms and armpits, male chest/breasts, trunk, abdomen, waist, hips, thighs, flank, back, inner knees, and ankles.

The majority of patients are close to an average and healthy weight and desire permanent contour changes; thus, patients with average weight, localized fat collections, and healthy elastic skin are the best candidates for liposuction.  Due to aging or familial predisposition, certain areas of the body become more prominent, often creating the “Pear” or “Cello” in female’s distribution or “spare tire” in males.   Although many ages and body weights may be candidates for liposuction, Suction Assisted Lipectomy (SAL) generates the best results in younger patients, non-smokers, darker skin types, and non sun- worshipers.   Patients experiencing obesity, cellulite, stretch marks, history of “yo-yo” weight gain and losses, or loose, sagging, inelastic skin, are several problems which would tend toward poor results.  In fact, these problems may be worsened by liposuction and may need other procedures such as a leg or body lift (e.g. tummy tuck) to improve their appearance.  Unfortunately, many individuals performing liposuction are not trained in other techniques of body contouring and may not have the experience to recognize that a different procedure (such as a tummy tuck) may provide a better result for the patient. Suction Assisted Lipectomy (SAL) may be used in conjunction with other body contouring procedures, such as breast reduction, tummy tuck, thigh lift, or face lift.

Improved techniques now allow larger amounts of fat removal. Up to 5000 ml (about 11 pounds) can be safely removed at one time on an outpatient basis for most patients without other medical problems.  Liposculpture can be useful to heavier persons as well.

Liposuction is also known as Suction Assisted Lipectomy (SAL) and was practiced widely in Europe during the mid 1970's, and later popularized in the United States during the early 1980's. Over the past few decades, liposuction has become the most requested cosmetic procedure, due in part to its relative simplicity.  The procedure only necessitates only a small incision, typically placed within a normal fold of skin. 

Frequently, patients seek liposuction to reduce their weight and general obesity. Unfortunately, liposuction is not intended to treat these problems mainly because the weight is regained because of lifestyle and poor eating habits. Standard methods of weight reduction are required for these patients.

Intended Result

The intended result of liposuction is a permanent improvement in the contour and proportion of the treated areas. The surgery creates a more flattering figure or physique, in or out of clothing, by removing inches from isolated areas, rather than pounds.   The procedure re-sculpts isolated areas by permanently removing the fat cells.

Probably the most important determinant of your result is the skill and experience of your surgeon. Dr. Nichter and Dr. Horowitz are board certified plastic surgeons and each has more than 25 years experience in Liposuction and Liposculpture.

Procedure Description

Liposuction can be performed in an outpatient setting, such as the surgeon's office or Surgicenter; less frequently, a short hospitalization will be administered if required by a medical condition. The procedure can last from 30 minutes to several hours, depending on how many body areas are being operated upon.

The type of anesthesia will also vary.  Local anesthetic with sedation can be used for small areas in our office; however, more extensive areas usually require general anesthesia.  A Tumescent Liposuction technique refers to the placement of a saline solution with dilute local anesthetic to minimize blood loss, require less anesthesia, and make the fat extraction process more efficient. Through a small incision, usually less than one-half inch, a blunt-tipped instrument called a cannula is passed back and forth, essentially vacuuming out the fat. The cannula is connected to tubing attached to a machine which generates a vacuum, negative pressure.  Power Assisted Liposuction is generally used and refers to fine vibrations applied to the cannula which allows the cannula to be passed more easily.  This results in diminished bruising and can be used for fibrous areas such as the back, upper abdomen or in repeat liposuction cases.  Ultrasonic liposuction can also be used in special cases, when required, but over the years has lost favor as heat is produced at the tip, which can lead to complications.

Variations on the technique such as Liposculpture or “Ab Etching” refer to advanced techniques of varying the amount of fat that remains and removed to mimic muscle development or to augment certain areas, for example, the “Brazilian Butt lift”.

During surgery, IV fluids are usually required to replace losses which occur with the procedure. In the 25 years that the Plastic Surgeons, Dr. Nichter and Dr. Horowitz, have been practicing a transfusion has never been required.  In rare cases when high volume liposuction is performed in a hospital setting, a patient, if appropriate, can donate and  receive his/her own blood (autologous donation) if needed.

Additional procedures that may enhance the result are Tummy Tuck (Abdominoplasty), Breast Reduction, Breast Lift, Breast Augmentation, Thigh Lift, or Buttock Lift.

Post-Operative Healing

As with all operations, pain and discomfort varies greatly from patient to patient. Generally, one should expect that pain medication will be required for the first few days. Continuing discomfort can last varying amounts of time.  Much of the swelling and bruising will be improved within two weeks; however, some will persist for six to eight weeks.  It is often difficult to see permanent changes in the body shape before this time.

Most patients are instructed to wear an elastic garment from four to six weeks to help with skin shrinkage. Dr. Nichter and Dr. Horowitz will tell you how long you should wear your elastic garment. For patients with poor skin elasticity Endermologie treatments may be recommended.

Normal activity may be resumed at 1 to 2 weeks post operation.  In general, patients may return to office work 3-5 days after the operation, and 14 days for more active employment.  After the operation, exercises are recommended, such as walking immediately and progressive activities beginning on the 14th day, in order to minimize the adhesions between the skin and the deeper tissues. Walking, swimming, or a stationary bicycle can usually begin in a few days after surgery. Specific time periods for resumption of daily activities, work, and exercise with be further discussed by your surgeon post operation.

Early results are seen 10-14 days after surgery, but improvement continues for 4-6 months.  Persistent swelling and irregularities may be present for several months.  If antibiotics are prescribed, they should be taken as directed.

Risks of Surgery

Liposuction is a generally safe procedure, yet, similar to any surgery, liposuction possesses the potential for complications such as; prolonged healing time, including swelling, bruising or bleeding, infection or changes in skin appearance.  

In general, liposuction results are permanent; however, if the patient gains a large amount of weight, the operated area will also increase but to a lesser degree than if the operation had not occurred. Rippling may also occur with large weight gain.

Depending on results, the operation may be repeated in certain cases. It is preferable to operate in stages on heavier patients. 

The risk of liposuction or Liposculpture surgery can be minimized by selecting a well trained board certified plastic surgeon with experience.  Unfortunately it is a “buyers beware” marketplace and it has been estimated that more liposuction procedures are performed by physicians that are not certified by the American Board of Plastic Surgery. General Surgeons, Dermatologists, ENT, Gynecologists, Emergency Medicine, Radiologists, Family Practice and others frequently advertise and perform this surgery without the same training, standards or qualifications found by a Plastic Surgeon.  For example, most of the surgeons who advertise that they “only use local anesthesia for all liposuction cases” generally do not have hospital privileges because of insufficient training and are not board certified Plastic Surgeons.  If you do not choose the Pacific Center for Plastic Surgery physicians, then we urge you to make sure that your doctor is qualified by making sure that they are a member of the American Society of Plastic Surgery or the American Society of Aesthetic Plastic Surgery (www.surgery.org)

Scarring: Following surgery, your surgical scars will go through a maturation process. For the first few months they will be red and possibly raised, firm or unsightly. As the scar matures, after 6-12 months, it becomes soft, pale, and flat, and much less noticeable. At this time, the scar can be shortened and the appearance minimized by using a Diolite or similar laser which we commonly use at the Pacific Center for Plastic Surgery. You may experience numbness, tingling, burning, "crawling", or other peculiar sensations around the surgical area.  This is a result of the healing of tiny nerves and it is a temporary sensation that will disappear progressively.  Rarely, people prone to keloids may develop an abnormal scar that becomes prominent and unsightly with time.  If you or a blood relative has a tendency to keloid formation, please inform your doctors.

Before and After Photos

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