How Does Liposuction Work?

How Does Liposuction Work?

Have you ever wondered how does liposuction work? The word liposuction is comprised of two derivatives which include lipo and suction. Lipo refers to fatty tissues. Fat tissues are located between the skin and muscle. The fat is literally sandwiched between the outer skin layer and the deeper muscle layer. Within this sandwich, the fat is divided into a more superficial layer and a deeper layer. These two layers are separated by a thin connective tissue lining called the Scarpas fascia. These two layers have distinct differences that are important in the discussion of how liposuction works. The second derivative is suction which refers to the use of negative pressure that is administered through hollow cannulas in order to literally suck out the fat.

Significance of superficial versus deep fat layers

There are distinct anatomic and physiological differences between the superficial and deep fat layers that must be discussed when considering how liposuction works. The superficial fat layer lies directly below the skin. It is thinner than the deeper layer and is traversed by dense connective tissue cables, called retinacular ligaments. Because of the dense cables, this layer is difficult to traverse thus making liposuction more difficult than the deeper fat layer. Traditional liposuction avoids this layer and in fact, this layer serves as a smooth protective layer to hide any inconsistencies following routine liposuction. As a final point of interest, these layers remain constant through weight gain and loss. In contrast, the deeper fat layer is loose and void of dense cables making it the ideal layer to liposuction with hollow bore cannulas. This layer is also thicker than the superficial layer and more dynamic and increases and decreases in girth with weight gain or loss respectively.  

Differences in suction cannulas and suction pressures

Suction refers to the process of administering negative pressure through hollow bore cannulas that are literally used to rip the fat out of the deeper fat layer. At least, this is the case when we talk about traditional liposuction. Negative pressures can range from 10mm to 30 mm mercury pressure and is required to literally suction out the fat cells. In general, pressures higher than 15mm mercury pressure will cause fat cells to pop making them not usable for fat transfer. As such, patients who wish to have a Brazilian Buttock Lift, that is fat transfer to the buttock and hips, should only have their liposuction performed with pressures less than 15 mm mercury pressure. Now, let’s look at liposuction cannulas. Hollow bore cannulas with small holes at the tip are used to collect fat cells. Cannulas can range from 2mm to 6mm in girth. The larger the cannula caliber, the more aggressively the fat can be removed. In addition, the architecture and density of the cannula holes will affect the efficiency of fat removal. The more holes and the larger size of the holes, the quicker will the fat be removed.

Surgical steps involved in liposuction

The surgical steps involved to perform liposuction start with a customized surgical plan. Patients must complete a comprehensive physical examination in order to tally all of the areas that maintain undesirable, excess fat. It is critical to address all areas of excess fat when performing liposuction. This will ensure removal of all problem areas. It will also help determine whether you can accomplish your goals in a single surgery or whether you will require two surgeries. Staging of liposuction may be required if you require more than 5 Liters of fat removal. This is the limit of safe liposuction volume permitted by the state medical board that can be performed in an out patient surgical center.  When you complete your initial consultation your doctor will be able to recommend whether a single or two staged liposuction procedure is best for you. You might be wondering why is it so important to remove all of the excess fat? We will discuss this later.

What is tumescent solution?

Tumescent solution is injected throughout all of the tissue layers immediately prior to liposuction. The tumescent solution provides multiple roles for liposuction. First, tumescent solution provides pain control by having a numbing solution, called lidocaine. The numbing action of lidocaine can be observed within 10 seconds and will last up to 8 hours. This effect of tumescent solution is critical in patients undergoing liposuction without general anesthesia. It also provides all patients comfort in the early postoperative period. Second, tumescent solution minimizes blood loss by having a vascular constricting element, called epinephrine. Epinephrine is found in our bodies naturally and acts to constrict your blood vessels. For example, god forbid if you get into an accident, your body will automatically go into a sympathetic response and dump epinephrine into your system in an attempt to stop any unnecessary bleeding. This same epinephrine is added into your tumescent solution in order to constrict blood vessels that could be disrupted by the action of the hollow bore cannula moving back and forth during liposuction. Finally, bicarbonate is added to the solution to make the tumescent solution slightly basic. A slight basic solution eases the ability of the lidocaine to get into your cells thus providing numbing as quick as one minute following injection. A second utility of a slightly more basic solution is that it is more physiologic and thus provides a kinder environment to fat cells. This is especially important when you are planning to return the fat cells back into the body such as in a Brazilian Butt Lift.

Traditional Liposuction

Following surgical design and preoperative markings of the patient, the patient is taken back to the operating theater. The patient is provided anesthesia to make them comfortable. Next, they are prepped to make their skin sterile and draped with drapes. Then strategic port sites measuring less than 5mm are created with a small blade to allow for access to the body. Next, the tumescent solution is infiltrated and a brief delay is required to allow the tumescent solution to do its job. Finally, the liposuction cannulas are used to remove the fat.

Traditional liposuction technique

Traditional liposuction technique requires the surgeon to remove the deep fat evenly from only the deep fat layer. The more uniformly the fat is removed, the smoother will be your result. In order to remove the fat evenly, multiple port holes should be used so that tunnels of fat removed can be crosshatched together. If only a single port hole is used, it is feasible to consider that the area near the single port will have more passes than the area farthest from the port hole. Crosshatching provides the opportunity to provide more even fat removal in an area of fat excess. It is also critical to avoid fat removal from the superficial fat layer unless you are undergoing high definition liposuction, as this will result in contour irregularities such as divots. It is also important to provide for smooth transitions from areas that have been liposuctioned to areas not liposuctioned by a process called feathering. Using your eyes and by feel, appropriate liposuction is performed to achieve the desired effect. Liposuction is best performed in a 360 manner in order to remove all of the excess fat. Only following circumferential body contouring will a masterpiece figure be achieved.

The importance of removing all of the excess fat

The importance of removing all of the excess fat is two fold. First, removing all of your problem spots will result in the best aesthetic outcome. The human body can be compared to a glorified statue. If you are going to sculpt the body with liposuction, you might as well create a masterpiece. Properly sculpted human bodies should look great when naked or in a two piece bikini and when viewed from all angles. The second more important consideration is that when you remove all of the excess fat, you are protecting the patient from future contour irregularities. When you loose or gain fat, it will be removed or added to areas where you have the highest density of fat cells. As such, by reducing problem areas with liposuction, you are in essence eliminating any high density fat areas.  As a result if you do gain weight following liposuction, it will be added uniformly throughout your body. Uniform addition of fat volume rather than localized increase in growth will result in unnoticeable weight gain!

How does liposuction work following surgery?

Following your liposuction surgery, you will be temporarily placed in customized compression garments. These garments have several functions. First, the compression prevents your from unnecessary swelling. Excess swelling in the postoperative period can result not only in increased pain but potential compromise of your skin. Second, customized compression will allow your fat cells to settle evenly. Despite attempts to remove all of the fat, naturally a small amount of fat cells will remain behind. As these residual fat cells begin to settle, it is critical to make sure they settle evenly or you will risk a contour irregularity. More importantly, customized garments prevent you from creating a band deformity for example from wearing of pants that has a tight waist band. A tight waist band can literally push fat cells out of an area that results in a band like deformity. Patients are universally counselled to wear loose fitting clothes for the first two weeks following surgery. Finally, compression garments prevent any unnecessary bruising. Minimizing bruising means showing off your body sooner than later!

How does liposuction work regarding recovery?

Liposuction recovery is universally tolerable. Most patients describe the pain as soreness like when you have worked out really hard. You will be sore for several days with most of the pain having resolved following one week. Once off of your pain pills, you will be allowed to drive and complete your daily chores. Most patients will be back to normal after about one week. Since you do not have any lengthy incision lines, patients can even start physical activities at two weeks. This means going to the gym as early as two weeks to make your workout partners jealous. Generalized swelling is usually only minimal by the one month mark. So if you have any important activities or trips planned, make sure that you get your surgery done at a minimum one month prior.

How does liposuction work with regard to maintenance?

Now that you have your new figure, it is important to maintain it. What you need to realize is that your body is now like a canvas that your surgeon has altered. What you want to do is to minimize any changes of your sculpture. This means leading a healthy lifestyle with good nutrition and regular physical activity. You want to keep your weight stable. Dr. Mowlavi has coined this as your comfort weight which he makes you get to prior to surgery and to maintain after surgery.

How does liposuction work Conclusion

In summary, this blog was written to help you appreciate how does liposuction work. When you embark upon this journey to improve your appearance, liposuction can be a tremendous help. This journey also requires you to lead a healthy lifestyle. The final component to improving your appearance is choosing the right surgeon who maintains an artistic eye and possesses the surgical skills to get you to your goals.