BALTIMORE — For some people, no matter how much they exercise or how thin they are, stubborn fatty deposits cause bulges. That might explain why the number of liposuction procedures increased by 23 percent between 1997 and 1998. Some 218,000 patients in the United States in 1998 chose liposuction as the best way to get the body contour that they wanted. And it's not just women opting for this — 14 percent of the procedures were done on men. For both men and women, the procedure is most commonly performed for people between the ages of 19 and 50. In this InteliHealth series on cosmetic surgery, Craig A. Vander Kolk, M.D., associate professor of plastic surgery at Johns Hopkins, explains what liposuction can do — and its limitations.
InteliHealth: Why is liposuction so popular?
Dr. Vander Kolk: Liposuction is a great operation, and it has revolutionized plastic surgery and body appearance. Before we had it, the only way was to go in and make a large incision and remove fat and tissue and skin and then sew things back up. There were serious problems with that, especially with healing. Liposuction started in France in the early 1970s, when surgeons there realized you could make a small incision, introduce a thin plastic tube called a cannula and make small tunnels within the tissue to draw the fat into the cannula and "suck" it away. Then the body would redrape the skin over the area, without surgeons having to remove the skin. It's been a boon to patients who want to be thinner and shapelier.
IH: Who benefits the most?
Dr. Vander Kolk: It's the perfect situation for people whose fat in one or two locations is out of proportion to the rest of their body. Rather than pinch an inch, they pinch two or three inches in one place. These tend to be localized fatty deposits, not a person who is generally overweight. Women, for example, tend to have more fat in the hips, thighs and buttocks, and men to have it in the abdomen or the "love handles." When they're out of proportion to the rest of the body, you can remove this fat and the skin will redrape over it. You're taking out the underlying structure and allowing the skin to look more natural. Liposuction has been extended to removing more fat in people who are overweight, not just people who have thinned down but retain localized fat deposits that diet and exercise don't affect.
IH: What are the two kinds of liposuction, and what is the difference?
Dr. Vander Kolk: The tumescent technique is what you think of as traditional liposuction. It is used because we can inject fluids that numb the area and constrict blood vessels, which allows more fat to be removed with less blood loss. You can contour areas nicely, and the patients tolerate it well. Ultrasonic liposuction was developed to allow surgeons to remove more fat faster, which would improve the overall result by allowing more control. As it turns out, it's not really faster nor is it safer, but you can remove fat that is more dense and difficult to remove with the tumescent technique. For example, it can be used if you've had a previous surgery, and it works well in removing male breast tissue, which tends to be very dense.
IH: Should I ask for the ultrasonic? I see it advertised a lot.
Dr. Vander Kolk: It's not a gimmick, but it's close. People come in insisting on it, and I just don't think it's right for everybody. Your surgeon is the best judge of which method to use. There are times in which it's advantageous, but there are times when the tumescent method is preferred.
IH: But if I'm just 15 or 20 pounds overweight, it doesn't sound like liposuction is the answer.
Dr. Vander Kolk: No, and that's the No. 1 question people come in with: Can I use this instead of losing weight? In general, liposuction removes 1500 to 3000 ccs of tissue. That translates to between two and six and a half pounds. If you remove more than that, you have the potential for serious side effects. It's not going to be a shortcut to weight loss. On the other hand, if you have liposuction done and then you do gain weight, you'll gain it proportionately, so you might gain 15 or 20 pounds, but you'll stay in proportion.
IH: When is this procedure most commonly done?
Dr. Vander Kolk: The biggest group of patients is in the 30 to 45-age range, probably because they can afford to have it done. In California, it's more commonly done between 21 and 30.
IH: What is the operation itself like?
Dr. Vander Kolk: The operation takes about two hours and is done with the patient under twilight sleep with additional local anesthetic. It's done on an outpatient basis, and I strongly recommend that you have it done in an accredited operating facility, not just a clinic or doctor's office. You come in and your body is prepped, which includes cleaning the skin, and then you are put into a twilight sleep. A small incision is made to inject tumescent fluid, then the cannula is attached to the suction device and the fat is removed. The negative pressure sucks fat into the opening and it is sheared off. With the ultrasonic liposuction, ultrasonic waves pulverize the fat cells and they break apart, allowing the fatty fluid to be removed. The incisions are bandaged and the patient is placed in an elastic garment because you want the skin to redrape correctly. It's kind of like Swiss cheese; you've honeycombed the fat to make these tunnels, and the elastic garment collapses the tunnels. It also decreases the fluid and helps the skin to redrape in the desired shape.
IH: What is recovery like?
Dr. Vander Kolk: When the patients go home, they feel like they've been hit by a truck. They're not interested in moving very much for the first couple of days, and strong pain medicine is used. After three to five days, they can be active around the house, and after seven to 10 days they can do light work. After three to four weeks, they can become active in light athletic activities, but the elastic garment must be worn night and day for three to six weeks.
IH: Are there side effects?
Dr. Vander Kolk: Generally speaking, it's a very safe operation. It has a good cost-benefit ratio; the costs are not extreme for the benefits, and the risks are small. There have been several high-profile cases of patients who died, but those surgeons were not well trained or they pushed to the extreme of trying to take off too much. Liposuction can cause skin irregularities, numbness and some discoloration of the skin, but those side effects are few and far between. It's as safe as any operation.
IH: Who shouldn't have it done?
Dr. Vander Kolk: We're counting on the skin to redrape, so when the skin is sagging or droopy already, that might not happen. That's why it's generally seen as a younger person's operation. After the age of 50 it's generally done in conjunction with a tummy tuck or some other type of skin excision and tightening procedure.
Copyright The Johns Hopkins University, 1999. All rights reserved. This interview is not intended to provide advice on personal medical matters, nor is it intended to be a substitute for consultation.
