Liposuction: Insights and Key Considerations for 2024
Liposuction has long held a prominent position among plastic surgery procedures, but it's also frequently misunderstood. Despite significant advancements in fat removal techniques over time, making the procedure safer and more refined, it is still often wrongly perceived as simple or even crude. "In reality, the opposite is true," remarks Dr. Adam Kolker, a board-certified plastic surgeon in New York City. "It's actually one of the more challenging operations in plastic surgery." Not only is it highly artistic, demanding both an aesthetic sense and in-depth anatomical knowledge, but it also requires careful thought, as surgeons must predict which bodies will respond well to what Dr. Kolker terms "a change in the relationship" between skin and fat.
To provide context, the traditional liposuction process is a minimally invasive cosmetic operation that involves extracting body fat through a small incision in the targeted areas of the body. A cannula is inserted along with a tumescent solution (a combination of saline, local anesthetic such as lidocaine, and epinephrine) into the tissue, and then the required amount of fat is suctioned out to achieve the desired outcome. There are updated variations of this method, such as ultrasound-assisted liposuction (UAL), which utilizes ultrasonic energy to break up fat.
It's not a weight-loss method and doesn't address obesity or cellulite; rather, it's most suitable for those already at a healthy weight. The final results may take a few months to become noticeable as swelling subsides. Similar to any surgical procedure, there's a potential for side effects like hematoma, fluid pockets, and, rarely, blood clots.
It's also important to remember that while the results of liposuction are technically permanent, any weight gain can cause the remaining fat cells to expand or result in the formation of new ones. Thus, a healthy lifestyle (including a balanced diet and regular exercise) is crucial to sustain the results.
When seeking the ideal lipo surgeon, be discerning, especially when browsing through before and after photo galleries. Because, as our experts often point out, it's several distinct details – those described below – that combine to produce the most outstanding results.
Unnoticeable Cannula Scars
On the journey to achieving natural-looking results, top plastic surgeons aim to minimize visible evidence. While liposuction doesn't involve long incisions with a scalpel, accessing fat deposits requires inserting a stainless steel cannula beneath the skin in multiple locations, leaving small marks. "Frequently, the cannula sites are the sole visible sign of liposuction surgery. Similar to all other cosmetic surgeries, the aim is to place incisions in natural skin tension lines, shadows, or areas hidden by clothing," explains Dr. Umbareen Mahmood, a board-certified plastic surgeon in New York City. Certain body parts offer convenient hiding places – the belly button when treating the abdomen or a buttock crease when slimming the outer thigh – but others, like the middle back, lack the creases and folds that can camouflage cannula access points. In such areas, surgeons typically target a section of skin that is usually covered by undergarments, such as within the bra line or bikini line.
Smooth Contours
Here, we're referring to two aspects: avoiding contour irregularities, such as lumps and bumps, and ensuring a seamless transition between treatment zones.
Contour irregularities are among the common complications of liposuction. These texture issues can occur if surgeons remove too much fat (particularly from areas prone to depressions, like the outer thighs) or if they target the incorrect layer. As Dr. Kolker explains, "There's a system of fascia, or connective tissue, throughout the body, with fat above and below it, but the proportions vary in different areas." These ratios can also differ from person to person. Extracting superficial fat – the padding just beneath the skin – instead of deeper reserves in certain areas can lead to visible lumps, so targeting the correct layer is essential for a flawless outcome. That said, certain individuals are more prone to lumps, notes Dr. Mahmood, such as those with "soft, easily moldable or 'doughy' tissue."
To minimize indentations during body contouring with liposuction, surgeons employ a technique called fat equalization. "It involves passing a specific cannula, known as an exploded tip or basket cannula, over the liposuction sites without suction to essentially help disperse any loose fat particles, allowing them to act like small fat grafts in the treated areas," Dr. Mahmood explains, filling in the gaps for a smooth effect.
Preventing bulges also means approaching the body in three dimensions. While 360 lipo has gained popularity, it's actually more of a standard practice than a trendy technique, as every body part has not only a front but also two sides and a back to consider. Take the abdomen, for example: "There are some individuals with highly localized fat and may be candidates for only anterior [frontal] abdominal contouring, but in most cases, you need to address these areas in a 360-degree manner," says Dr. Kolker.
Reducing one area in isolation tends to accentuate neighboring problem areas, even if they weren't initially very bothersome. "Having liposuction on the abdomen but neglecting the flanks can result in a flat, boxy abdominal appearance," explains Dr. Mahmood. Similarly, suctioning only the lower back to smooth a posterior muffin top can make bra rolls more prominent. For this reason, she adds, "I typically suggest performing liposuction on the abdomen and flanks together, followed by the upper and lower back together."
Natural Muscle Definition
"Exaggerated high-definition lipo results almost always make me cringe," says Dr. Kolker. The best way to delicately define the musculature is to follow the inherent peaks and valleys of the area being contoured. On the female abdomen, Dr. Mahmood states, "The key elements to emphasize are the linea alba – the vertical line extending from the top of the abdomen to the belly button – and the linea semilunaris, or the vertical lines on each side of the abdomen."
When striving for authenticity, it's also important to respect areas that should never be completely flat, like the space between the belly button and the pubic region, notes Dr. Kolker, "where there should always be a slight convexity."
While the sculpted look is highly desired, it's not suitable for everyone. "Many patients see the results of others and want the same, without realizing that their body characteristics are very different initially," says Dr. Mahmood. "Ideal candidates have a BMI below 28, are healthy, fit, non-smokers, have good underlying muscle tone, and have no excessive skin laxity."
Tight Skin
When asked about the secret to a liposuction result that appears non-surgical, both experts responded: the right candidate. And one of the main shared characteristics among successful candidates is firm, elastic skin. This is why liposuction results in people in their twenties almost always look better than those in their thirties, as Dr. Kolker notes, and why those in their thirties tend to look better than those in their forties, and so on.
During consultations, plastic surgeons conduct a series of pinch tests to assess the amount and quality of excess fat as well as skin elasticity – how quickly the skin bounces back after being pinched. In most cases, "There will be some degree of skin retraction with liposuction, especially if patients adhere to wearing postoperative compression garments," says Dr. Mahmood. Surgeons may also be able to promote a little more tightening by incorporating radiofrequency or plasma energy during the surgery. But these devices have their limits when it comes to loose skin. According to Dr. Mahmood, "Existing hanging folds of lower abdominal tissue or significant stretch marks are clear indicators that the skin will not retract adequately" after fat removal – and a tummy tuck might be necessary.
