Liposuction

Liposuction is a procedure that removes localised collections of fat through small incisions in the skin, with the goal of refining the contour of a body area. It’s one of the most commonly performed operations in plastic surgery worldwide, and it’s also one of the most commonly misunderstood. Liposuction is a contouring tool, not a weight loss tool, and patients who go into liposuction expecting it to take the place of diet and exercise are often disappointed by the result.

The patients who do well with liposuction are typically those who are close to their target weight, who have specific localised areas of fat that haven’t responded to exercise, and who have reasonable skin elasticity. Patients with loose skin, significant weight to lose, or unrealistic expectations about what liposuction can achieve are generally better served by a different approach, including in some cases by not having surgery at all. We’ll be honest at consultation about whether liposuction is the right answer for your situation.

Liposuction can address localised collections of fat that have proved resistant to diet and exercise. The areas most commonly treated include the flanks, the abdomen, the outer thighs, the inner thighs, the upper arms, the chest (in male patients with localised fatty enlargement, see also the Gynaecomastia page), the chin and neck, and the back. The procedure produces a change in contour by removing fat from specific areas, allowing the body shape to be reshaped in ways that exercise alone can’t achieve.

Liposuction can’t address loose skin. The skin needs to retract over the new smaller contour after fat is removed, and patients with significant skin laxity (whether from ageing, weight loss or other causes) are unlikely to be well served by liposuction alone. Where skin laxity is the main issue, an operation that removes skin (such as abdominoplasty, brachioplasty or thigh lift) is more likely to produce the result the patient is hoping for. In some patients, liposuction is combined with a skin removal procedure to address both the fat and the skin in the same operation.

Liposuction also can’t substitute for weight loss. The amount of fat that can be safely removed at one time is limited, and removing larger volumes (more than a few litres) significantly increases the risks of the procedure. Patients with substantial weight to lose are better served by addressing the weight first and then considering body contouring (including liposuction if needed) once their weight has stabilised.

Several different liposuction techniques exist, and they differ mostly in the method used to break up the fat before it's removed.

Liposuction can be performed under general anaesthesia or, for small areas, under local anaesthesia with sedation. The choice depends on the volume of fat being removed, the number of areas being treated, and patient preference. Most patients having more than one area treated, or having larger volumes removed, are treated under general anaesthesia in an accredited hospital.

Operating time depends on the number of areas being treated and the volume of fat being removed. Small single-area liposuction can take an hour or less. Multi-area liposuction or larger-volume cases can take three to four hours. Most patients go home the same day or stay one night, depending on the size of the operation and the patient’s circumstances.

Small incisions, typically 3 to 5 millimetres long, are made in inconspicuous locations to allow the cannula to be passed into the fat. These small incisions typically heal with very fine scars but they’re permanent and can be visible on close inspection.

Most patients describe moderate discomfort for the first three to five days after liposuction, with the operated areas feeling bruised and tender. Pain medication is typically required in the early days. Bruising is significant and can persist for two to three weeks, sometimes longer in larger procedures. Swelling persists for several weeks, sometimes longer, and the final contour isn’t apparent until the swelling has settled.

Compression garments are worn continuously for several weeks, including overnight. The garment supports the operated tissue, reduces swelling and helps the skin to retract over the new contour. Patients are encouraged to walk from the day after surgery to reduce the risk of blood clots, but heavy lifting, vigorous exercise and any activity that puts strain on the operated areas are off the list for around three to six weeks, depending on the operation.

Most patients with desk-based work return after one to two weeks. Patients in physical roles need longer. The final contour develops over several months as swelling settles and the skin retracts over the new shape. Drainage from the small incision sites is common in the first few days and is managed with absorbent pads.

The recognised risks include:

Liposuction is generally classified as a cosmetic procedure and doesn’t attract a Medicare rebate. The exception is liposuction performed as part of a procedure that does attract a rebate (for example, liposuction performed during the same operation as a Medicare-eligible abdominoplasty), where the rebate applies to the relevant component of the operation. A written quote covering all surgical, anaesthetic and hospital fees is provided after consultation.

Dr Henry Shepherd, BMed MD MS (Plast.) FRACS (Plast.) | Specialist Plastic Surgeon | AHPRA registration: MED 0001860545