Liposuction surgery uses a few incisions where a cannula or suction probe is inserted to break down and remove the excess fatty cell. Instead of removing as much fats as possible, a more important goal is to preserve the natural valleys and contours of the body, which is typically achieved by retaining some fat.
Today’s Los Angeles plastic surgeons prefer the use of microcannula, which has an outside diameter of less than 2 mm, due to their benefits such as:
1. Less risk of over-correction, i.e., removal of too much fat that leads to skin irregularities and less-than-optimal results. According to studies, microcannulas can prevent these complications because they remove fat in “small pieces” rather than in “big chunks.”
The side effects of over-correction are typically difficult and expensive to address because they require multiple procedures such as judicious liposuction to remove the bumps, and fat grafting to smooth out the dents.
2. Reduced risk of scarring. The small incisions can fade into a scar that is difficult to detect that one needs to get closer and stretch the skin just to be able to see it.
For most patients, liposuction scars are barely noticeable in six months, although dark-skinned individuals may experience post-inflammatory hyperpigmentation longer. If this condition persists for more than six months, they may consider hydroquinone and other medical-grade chemical peels and laser treatments.
3. Reduced postop symptoms. With this hollowed probe that reduces surgical trauma and bleeding, patients will experience less postop symptoms such as bruising, swelling, pain, and soreness.
Further minimizing the amount of surgical trauma is the use of local anesthesia-only approach, which also leads to safer liposuction.
4. Quicker recovery. And with reduced symptoms lead to shorter downtime. According to studies, most patients who had liposuction via microcannula were able to return to their normal life within three days of their surgery.
Nevertheless, it remains important to avoid strenuous activities and heavy lifting for at least three weeks of surgery to avoid persistent swelling, bleeding, and delayed healing.
5. Smoother results. In the past, large cannulas lead to increased risk of skin irregularities since they removed large chunks of fat. But with the advent of microcannulas noted for their precision, plastic surgeons are now able to preserve the natural contour lines with much ease.
And with improved accuracy, surgeons are also able to treat sensitive areas such as the neck, face, and ankle, which has not been possible in the past.
Despite being of normal weight, some people have double chin due to “stubborn” fat. And now, they have an option to eliminate it without having to undergo facial liposuction surgery, which involves downtime and certain risks.
The US Food and Drug Administration has recently approved an injectable drug called Kybella designed to dissolve the excess fat. The new product was developed by Kythera Biopharmaceuticals Inc., which has offered trainings for dermatologists and plastic surgeons in its Weslake Village, California office.
Kybella is made of deoxycholic acid, a naturally occurring chemical in the body that absorbs fat. When injected into the fat below the chin, referred to as submental fat, it can destroy the fat cells permanently, according to company statement. Meanwhile, it conducted clinical survey showing that 79 percent of respondents treated with the product reported high satisfaction due to cosmetic improvements in their chin and overall face.
Most patients will need two to three sessions, ideally spaced a month apart, to see visible improvements in their chin area. Despite having FDA approval, health authorities warn that it should not be used outside the submental area due to potential risks or unpredictable results.
Experts further warn that Kybella is only ideal for patients with a moderate amount of submental fat, while individuals with very little or too much fat in the chin area may not achieve predictably good results. Also, the injectable drug has some possible side effects such as swelling, pain, bruising, redness, numbness, difficulty swallowing, facial muscle weakness, nerve damage, and skin injury.
To avoid or minimize risk of complication, health authorities urge the consumers to only go to board certified dermatologists and plastic surgeons specifically trained to use Kybella.
While liposuction for double chin typically costs $1,500-$2,000, Kybella is estimated to cost $500-$600 per treatment.
Despite the appeal of Kybella, such as no or very little downtime, celebrity Beverly Hills plastic surgeon Dr. Tarick Smaili says chin liposuction surgery remains the “best option” for patients with a significant amount of excess fat. In this procedure, a 1-2 mm incision typically placed under the chin is used to access and remove the fat through a hollowed steel tube.
Infection after liposuction surgery, or removal of excess fat from under the skin by suction, is extremely rare with the advent of modern techniques. Other factors that can minimize the risk include proper patient selection, surgical planning, “right” venue (hospital or accredited outpatient surgical center), wound care, and use of antibiotics.
Beverly Hills plastic surgery expert Dr. Tarick Smaili says proper patient selection is the first and most crucial step to minimize infection risk and make the procedure significantly safer.
He warns that obesity is a contraindication to liposuction or any form of elective surgery because of the increased risk of infection, poor wound healing, and botched results, citing a 2011 study conducted by John Hopkins scientists showing that obese patients are 12 times more likely to have complication than their normal-weight counterparts following cosmetic procedure.
Obesity could also increase the infection risk 12 times, which experts have attributed to the overabundance of fatty tissue that is not well vascuralized (blood supply). Signs of this complication include fever, vomiting, persistent tenderness, “unusual” skin discoloration, and poor healing.
With the advent of tumescent liposuction, which is today’s gold standard, the infection risk following liposuction has been reduced drastically. In this technique, Dr. Smaili says a solution that combines lidocaine (a type of local anesthesia), saline (salt water), and epinephrine (drug that constricts the blood vessels to reduce bleeding) is injected into the fatty area.
Aside from making fat extraction gentler and more accurate, Dr. Smaili says the technique also minimizes the risk of infection because of lidocaine’s anti-bacterial effects.
Tumescent liposuction has also made it possible to perform liposuction completely under local anesthesia, which is tied to quicker recovery and less postop pain and discomfort, explains the celebrity Beverly Hills plastic surgery doctor.
To further reduce the infection risk, he only performs liposuction in an accredited outpatient surgical facility and hospital, “venues” staffed only by qualified professionals who use adequately sterilized instruments at the time of surgery.
Postop factors linked to infection must be avoided as well to prevent subsequent complications and poor results. Dr. Smaili says using public pools and bathtubs, or submerging the “open” wound under water, must be avoided for at least two weeks—or sometimes even longer.
A good rule of thumb, according to Dr. Smaili, is to wait for all the “access points” to seal themselves before a patient could immerse herself in swimming pools, bathtubs, and sea.
While not a conventional practice, Dr. Smaili says that some liposuction surgeons recommend oral antibiotics to all their patients in an attempt to prevent infection before it starts.
The primary aim of liposuction surgery is not to remove all the fat in the treated area, which could even lead to gaunt appearance and skin asymmetry. Instead, the procedure almost always leaves some layer of fat to preserve the natural contours and “valleys” of the body, which is particularly important when treating female patients.
The success of liposuction surgery, as with any body sculpting procedure, is only possible with proper patient selection.
The list below, shared by leading body sculpting expert Dr. Tarick Smaili, explains the proper way to select patients.
* Normal weight. For the sake of accuracy, plastic surgeons use body mass index, or BMI, to figure out if a patient is at a healthy weight for his or her height. Generally, the higher the number, the more body fat a person has.
Liposuction only works on localized subcutaneous fat, which is underneath the skin and is responsible for the appearance of fat rolls and unsightly bulges. Meanwhile it is surgically difficult, if not impossible, to remove the deeper, obesity-related visceral fat that only responds to real weight loss.
Obese patients are poor candidates for any type of elective surgery—not just body contouring but also facial procedures such as facelift—because of the increased risk of skin necrosis (death of tissue), infection, and wound dehiscence.
* Healthy individuals. Medical conditions that could prevent a person to heal properly, or could expose him or her to undue risk, is a poor candidate for liposuction or any type of elective plastic surgery. For example, blood-related disorder, diabetes, cancer, heart disease, and autoimmune deficiency can increase the risk of complications.
Also, patients who are taking drugs known to increase bleeding (e.g., anticoagulants, aspirin, and non-steroidal anti-inflamammatory drugs) are at higher risk of complication unless they will discontinue these medications at least two to three weeks prior to the operation.
* Motives and expectations. The ideal candidates for liposuction should have realistic expectations. First and foremost, it only removes just a small amount of localized fat, thus the preoperative weight and dress size will likely remain the same after surgery.
Liposuction is also not a substitute for “real” weight loss, making regular exercise and healthy diet more important than ever after surgery.
* Good skin tone. While old age is not an absolute contraindication to liposuction, it is known to decrease the capability to redrape to the new contour. Nevertheless, surveys have suggested that many patients past their prime have reported high satisfaction rate with their more streamlined appearance.
As long as the patient has realistic goals and expectations, liposuction could deliver a satisfying result.
Liposuction surgery removes excess subcutaneous fat (underneath the skin) by means of suction. A slender hollowed probe called cannula is introduced through small skin incisions to eliminate the excess fat, leading to a more streamlined figure.
Nevertheless, the surgery is not about how much fat is removed, but how natural the postop result will look like. For this reason, it is always necessary to leave some fat layers in the treated area to preserve the smoothness of the skin surface and natural curves of the body.
Contrary to popular belief, no one is too skinny for liposuction surgery. Leading Los Angeles plastic surgery expert Dr. Tarick Smaili says as long as the patient is healthy—i.e., no healing problem and weight issues—she can expect to achieve a good amount of improvement with the procedure.
In some cases, patients who are on the thin side are at an advantage because oftentimes they have a small localized fatty area that can be treated quicker compared with “large-framed” individuals. Also, they generally have good skin quality that allows it to shrink-wrap well to the new contour.
Women on the “heavier” side, meanwhile, may need more extensive liposuction to achieve the desired appearance. However, Dr. Smaili says it is highly ideal to limit the amount of removed fat/fluids by 4-5 liters because megaliposuction has been associated with higher risk of complications such as increased bleeding, more surgical trauma, longer recovery, and skin asymmetry.
If there is an indication to remove more than 4-5 liters fat/fluids, Dr. Smaili often recommends a second treatment performed any time after two weeks, or sometimes longer, to minimize risk of complications.
But for some naturally thin patients, the maximum amount of fat that can be removed safely by liposuction under one session could be lower than the 4-5 liters “guideline,” he adds.
Being “conservative” during fat removal is also deemed cost-effective because it is much easier to repeat liposuction to remove additional fat than correct gaunt appearance or skin asymmetry caused by over-aggressive liposuction, he further explains.
With all patients, particularly those who are on the thin side, smaller liposuction cannulae are particularly helpful in preventing or at least minimizing the risk of skin asymmetry as they provide doctors a good amount of control. Having a narrow diameter also allows them to stay in the “deeper” layer of the subcutaneous fat and minimize injury in the superficial layer very close to the skin, thus preventing unnatural contour and irregularities.