Who among us hasn’t stood naked in front of the mirror wondering how and when the “junk” took up residence in the “trunk” and dreaming of a way to unload it? Sure we diet and exercise, but some fat deposits—like the little jelly roll above the waistband of our low-rise jeans—just won’t budge. Tush and tummy troubles like these are examples of when liposuction is just what the doctor ordered—literally. Cosmetic surgeons stress that liposuction is not a replacement for diet and exercise, but that it is an effective way to eliminate stubborn fat pockets that defy calorie control and cardio.

Now that we’re clear on what liposuction isn’t (a magic wand/weight loss miracle) let’s move on to what it is. Liposuction is a surgical procedure that can be used to remove defiant fat deposits from a single body part or—in the hands of the right surgeon—it can be used to sculpt an entire (healthy weight) body into a tighter, more chiseled version of itself.

Hype vs. Skill

The marketing of liposuction is as ubiquitous as umbrellas on a rainy day, so unless you live under a rock, odds are you’ve seen the TV, Internet and even billboard pitches suggesting that you, too, could be rockin’ a string bikini ASAP, if you just phone 1-800-2GOOD-2B-TRU.

While liposuction has a 30-year history of delivering excellent results, experts say it’s important for consumers to have a discerning eye when choosing a surgeon and making the decision to go ahead
with liposuction.

“This is surgery and should be taken as seriously as any surgery,” says cosmetic surgeon Andre Berger, MD. That means looking beyond the bling of a surgeon’s sexy ads and focusing on his or her reputation and results. Dr. Berger, who practices in Beverly Hills, arguably the glitziest zip code around, says don’t worry so much about whether the surgeon has the newest piece of equipment or computer imaging software to show “virtual” before and after photos. “The most important tool that can be used in liposuction is the brain and the hands of the surgeon,” says Dr. Berger. “Patients are faced with all of these different companies and manufacturers advocating that their liposuction system is the best, but in the end, it’s really in the hands of the surgeon and the way they use the technology that will determine the results.”

Dr. Jane Petro, MD, who performed liposuction for several decades as a New York-based cosmetic surgeon, is now retired from private practice, and is teaching a new generation of cosmetic surgeons in her role as professor of surgery at New York Medical College. “I have seen liposuction evolve from the days when the surgeons—who now promote it as the salvation of mankind—were making fun of it,” says Dr. Petro. Her advice to people who are in the information-gathering stage: “If it sounds too good to be true, then it is. The more extreme the claims, the more likely they are to be exaggerated.”

Dear Fat: Bon Voyage

Not all liposuction is created equal, so prospective patients should arm themselves with the basics before booking a consultation. You don’t have to know how to rewire a carburetor when buying a car, but it helps to know the difference between an automatic and manual transmission. It’s the same with shopping for liposuction: Understanding some of the terminology associated with the procedure can help you make the best choices as far where, when and how much lipo to have.

All liposuction techniques have one thing in common: Skinny metal cylinders, called cannula, are attached via tubing to a suction machine and are used to extract fat through tiny incisions. In the early days of the procedure, the cannula were often as large as a garden hose, today the tubes are closer to the size of a drinking straw. Smaller tubes enable surgeons to employ greater finesse and achieve a more refined result, so in addition to minimizing saddle bags and love handles, surgeons can use liposuction to etch six-pack abs, or define a slender ankle or regal chin.

“Liposuction is sculpting,” says Seattle-based cosmetic surgeon Antonio Mangubat, MD. “In many respects it’s really not a lot different from what Michelangelo did with marble, except that we work on human tissue. Just like him, our aim is to create that perfect body proportion.”

Tumescent liposuction is the most common lipo procedure with the longest track record for safe and effective results. Tumescent refers to the process of first pumping in a solution of saline, adrenalin and lidocaine to prep the area from which fat will be extracted. This process enables the procedure to be done under local anesthesia, with minimal sedation. “When it’s used properly, it can reduce bruising, bleeding and pain,” says Dr. Petro. Tumescent local anesthesia is used for all current methods of liposuction, including traditional liposuction with suction cannula, laser-assisted liposuction, ultrasonic-assisted liposuction and water-assisted liposuction. “The

Lipo or Low-Level Laser?
One of the newest devices to enter the cosmetic surgeon’s practice is the Zerona Laser, which is a low-level laser being promoted and used for body contouring. The technology is said to work by penetrating the fat cell and releasing its contents (ie, fat), which is then disposed of by the body naturally. Experts say not to confuse the Zerona with liposuction or laser liposuction. While some surgeons and patients report treatment success, the jury is still out. So if you’re looking for tried-and-true results or for sculpting and spot reduction, you might be more satisfied with liposuction.

Tumescent technique is likely the only thing that’s been added to liposuction over the years that is universally accepted and absolutely benefits patients in terms of the ultimate outcome, says Dr. Petro.

Laser-assisted liposuction (including technologies such as SmartLipo, SlimLipo, and others) is a minimally invasive procedure that makes use of high-energy laser wavelengths to melt the fat cells and cause the skin to retract and tighten. (The older the skin, the less elasticity is has and the less elasticity it has the less likely it is to tightly hug the new curve that is defined via fat removal.) Laser-assisted liposuction was, in part, developed to help target specific body parts that were difficult to access with the more traditional methods. Considered a “gentler” procedure than standard lipo, your doctor is able to use smaller incisions, which means less chances of scarring.

Ultrasonic lipo, uses sound waves to help break up fat to make it easier to remove. Early ultrasonic lipo systems were associated with a high risk of skin burns. Today’s low energy systems, for example, VASER Lipo, offer the benefit of fat disruption—which theoretically equates to improvements in fat removal/body contouring—without the risks associated with the earlier devices.

Water-assisted liposuction is the newest alternative liposuction method. Under the trade name Body-Jet, it uses a gentle spray of tumescent anesthetic fluid to gently dislodge fat cells from the surrounding connective tissues (doctors say it’s like plucking grapes off a vine) while simultaneously aspirating out the fat cells. Dr. Petro says there’s very little evidence that any of the newer liposuction technology is any better than the oldest technology.

“Preliminary research and clinical data indicate that there may be some benefits from the new laser liposuction devices, but these advantages have not been confirmed by appropriate clinical trials comparing several techniques in a scientific manner. The only substantial, completely confirmed, universally accepted innovation to liposuction is the tumescent technique,” says Dr. Petro.

With liposuction, as with any surgery, it’s important to be clear about risks, recovery and realistic results. Any reputable surgeon will share these details in the form of an informed consent, which the patient must sign before undergoing surgery. Liposuction has the risks associated with any surgical procedure, such as infection or blood clot, as well as, contour irregularities and creation of loose skin, which are strictly related to lipo.

CONTOUR CAVEATS

Contour irregularities refer to little lumps, bumps and divots that can result after surgery. Sometimes these irregularities result from the surgeon’s technique, and other times they result from the patient’s healing process.

“Surgeons can cause irregularities by over-aggressive removal of fat, and this is really a function of the experience of the surgeon. Beginning surgeons generally don’t have the sensitivity that a more experienced surgeon has,” Dr. Berger points out.

In terms of contour irregularities that result from the healing process, Dr. Mangubat explains that those typically become visible after several weeks and then usually—but not always—eventually disappear. The creation of loose skin is something that patients need to be aware of, as well, because this may influence them to opt for surgery instead of lipo.

In addition to minimizing saddle bags and love handles, surgeons can use liposuction to etch six-pack abs, or define a slender ankle or regal chin.

“There are some people whose skin looks fine when they have a belly, but when the surgeon suctions out the belly fat, well, they could end up with [sagging] skin. Perhaps this patient would have done better with a tummy tuck,” he says.

Liposuction recovery occurs in stages. The first phase, which includes reduction of swelling, takes anywhere from a few days to a month. The next phase is the retraction, the tightening, the pulling in of the tissue, and this takes several months.

“As a matter of fact, says Dr. Berger, “that doesn’t even start for three weeks.” The smaller the surgery, the faster the recovery. A patient who has minimal lipo for a little tummy roll could recover almost overnight, but a larger patient who has had four or five liters of fat removed from around the abdomen, waist and hips will have a very different recovery experience. “Bigger surgery means more trauma, more pain and more recovery,” says Dr. Mangubat. All patients are instructed to move about right after surgery—to avoid the risk of blood clot, and are provided with compression garments to wear on the treated areas to help with the healing process.

The surgeons interviewed for this article say expect some initial drainage along with swelling, bruising and discomfort. The compression garments will minimize the swelling, bruising, discomfort and assist in the retraction of loose skin.

It takes quite a while for the final results to completely materialize, which is why Dr. Petro says if you are considering liposuction to be at your best, for instance, in your wedding photos then it’s crucial to have the surgery done at least six months prior to the big day.

“I almost never agreed to do anything for a patient who had an imminent social event. First of all, there could be a complication that interferes with the event and second of all, things never look as good on short notice as they will later on down the line.”

Risk and recovery parameters are pretty straight forward, results are a different story. A surgeon can show before and after photos of other patients who have had similar procedures, but every person heals differently and there’s no way to know in advance exactly what the result will be. “We really have to make sure that the patient’s expectations are in sync with what the procedure can realistically deliver,” says Dr. Berger. One certainty is that the permanence of fat removal is 100 percent.

“When I reduce an abdomen, it’s smaller for the rest of the patient’s life, even if they gain weight, because with liposuction you’re basically amputating the fat.”

The longevity of the overall result, on the other hand, is a matter of how the patient ages. “Patients who age well will have a long-lasting effect, whereas those patients who don’t have adequate skin elasticity will tend to droop. The aging process will take over.”