Liposuction (fat removal) has achieved the distinction of being the most popular cosmetic surgical procedure. By removing unwanted deposits of excess fat, liposuction improves body appearance and smoothes irregular or distorted body shapes. The procedure is sometimes referred to as body contouring.

Liposuction may be useful for contouring under the chin, neck, cheeks, upper arms, breasts, abdomen, buttocks, hips, thighs, knees, calves, and ankle areas.

However, liposuction is a serious surgical procedure and possibly may involve a painful recovery. It has the potential for rare but serious or occasionally fatal complications, so the decision to have liposuction should be well thought out.

Before undergoing liposuction certain criteria must be met:

• An initial patient consultation. This will include a history, a thorough physical examination, and a psychological health examination.
• Your spouse's presence may be required during the visit and a second consultation is necessary to give you time to think over the surgery.
• You should feel free to express the reasons for the consult, be free to ask as many questions as desired, and feel satisfied with the answers to those questions. A properly informed person makes a better patient.
• You must understand fully the pre-operative preparations, the liposuction procedure, and the precise post-operative care.
• You must have realistic expectations. Liposuction may help to enhance your appearance and also your self-confidence, but it will probably not give you your ideal body.

There are several different liposuction procedures.

• Tumescent liposuction (fluid injection) is the most common type of liposuction. It involves injecting a large amount of medicated solution into the areas before the fat is removed (sometimes, up to three times the volume of fat to be removed). The fluid is a mixture of local anesthetic (lidocaine), a drug that contracts the blood vessels (epinephrine), and an intravenous (IV) salt solution.
  
  The lidocaine in the mixture helps to numb the area during and after surgery, and may be the only anesthesia needed for the procedure. The epinephrine in the solution helps to reduce the loss of blood, reduce the amount of bruising, and reduce the amount of swelling that accompanies the surgery. The IV solution helps to remove the fat more easily and is suctioned out along with the fat. This type of liposuction generally takes longer than other types.

• The super-wet technique is similar to the tumescent liposuction stated above. The difference is that not as much fluid is used during the surgery--the amount of fluid injected is equal to the amount of fat to be removed. This technique takes less time; however it often requires sedation via an IV, or general anesthesia.

• Ultrasound-assisted liposuction (UAL) is a fairly new technique, used in the US since 1996. During this technique ultrasonic vibrations are used to liquefy fat cells. After the cells are liquefied, they can be vacuumed out. UAL can be done in two ways, external (above the surface of the skin with a special emitter) or internal (below the surface of the skin with a small, heated cannula).
  
  This technique may help to remove fat from dense, fibrous areas of the body such as the upper back or enlarged male breast tissue. UAL is often used in combination with the tumescent technique, in secondary (follow-up) procedures, or when precision must be enhanced. In general this procedure takes longer than the super-wet technique.

Prior to the day of surgery you may have blood drawn and be asked to provide a urine sample. This allows the health care provider to rule out potential complications. If you are not hospitalized, you will need a ride home.

A liposuction machine and specialized instruments are required for this surgery. The surgical team first preps the patient's operative site and administers either local or general anesthesia. Through a small skin incision, a suction tube with a sharp end is inserted into the fat pockets and swept through the area where fat is to be removed. The dislodged fat is literally "vacuumed" away through the suction tube. A vacuum pump or a large syringe provides the suction action. Several skin punctures may be necessary to treat large areas.

After the appropriate amount of fat is removed, small drainage tubes may be inserted into the defatted areas to remove blood and fluid that accumulate during the first few days. If significant fluid or blood is lost during the surgery, the patient may require fluid replacement (intravenously) or even a blood transfusion.

After the surgery, pressure bandages are applied to keep pressure and stop any bleeding, as well as help maintain shape. Bandages are kept in place usually for at least 2 weeks. Your doctor may call you from time to time to check on your health status and monitor your healing. A visit back to the surgeon after 5-7 days is often recommended. Occasionally liposuction is associated with weight gain. This is due to the increased fluid from surgery.

Liposuction may or may not require hospitalization, depending on the location and extent of surgery. Liposuction can be done in an office-based facility, in a surgery center on an outpatient basis, or in a hospital. For reasons of cost and convenience, liposuction of smaller volumes is usually done as an outpatient. A stay in a hospital may be required if a larger volume of fat is being removed, or if you are having other procedures done at the same time.

The cost of any surgery varies significantly between surgeons, medical facilities, and regions of the country. Surgery charges can be separated into five parts: 1) the surgeon's fee, 2) the anesthesiologist's fee, 3) the hospital charges, which includes nursing care and the operating room, 4) the medications, and 5) additional charges (assisting surgeon; treatment of complications; diagnostic procedures, such as blood or X-ray exams; medical supplies; or equipment use).

Insurance coverage for surgery expenses depends on many factors and should be explored for each individual instance.

The following are some of the uses for liposuction:

• Cosmetic reasons are the most common, including "love handles", unsightly fat bulges, or an abnormal chin line.
• To improve sexual function by reducing abnormally placed fat deposits on the inner thighs, thus allowing easier access to the vagina.
• Body shaping for people who are bothered by fatty bulges or irregularities that cannot be eliminated by diet and/or exercise.

However, liposuction is generally NOT appropriate for these uses:

• Liposuction is not a substitute for exercise and diet, and it is not a cure for generalized obesity. However, it may be used in sequenced removal of fat from isolated areas at different points in time.
• It is not an effective treatment for the uneven, dimpled appearance of skin in the condition of cellulite.
• Certain areas should not have liposuction performed on them, such as the fat on the sides of the breasts. This is due to the fact that the breast is a common site for cancer.

Many alternatives to liposuction may be considered, including abdominoplasty (tummy tuck), excision of lipomas (fatty tumor), reduction mammaplasty (breast size reduction), or a combination of plastic surgery approaches.

• History of cardiac problems (heart attack)
• Hypertension
• Diabetes
• Reactions to medications (allergies)
• Pulmonary problems (shortness of breath, air pockets in blood stream)
• Allergies (antibiotics, asthma, surgical prep)
• Smoking, alcohol, or drug use

There are also inherent risks associated with receiving liposuction and these include:

• Shock (usually from inadequate fluid replacement during the surgery)
• Fluid overload -- usually from the procedure
• Infections (strep, staph)
• Bleeding, blood clot (thrombus)
• Fat embolism (tiny globules of fat in the blood stream that block blood flow to tissue)
• Nerve, skin, tissue, or organ damage or burns from the heat or instruments associated with liposuction
• Asymmetry (uneven fat removal)
• Drug reactions or overdose from the lidocaine used in the procedure
• Scarring (skin surface may be irregular, asymmetric, or even "baggy," especially in the older patient)

Finally, make sure to review and sign any informed consent (legal) and permission for photographs.