Liposuction - surgery complications and the before and after

Liposuction

This factsheet is for people who are considering having cosmetic liposuction.

Liposuction, also known as liposculpture, is a cosmetic surgery operation to improve your body shape by removing unwanted fat from areas of the body. The hips are the most commonly treated site, but liposuction can also be performed on the tummy, thighs, inside of the knees, ankles, upper arms, neck and back.¹

Why have liposuction?

Liposuction can remove fat that you have not been able to shift with diet and exercise.

The fat cells will not be replaced by your body, so there should be a long-lasting change in your body shape, especially if you exercise, eat a healthy diet, and maintain a healthy weight after the operation. For more information about maintaining your weight and a healthy diet, please see the separate BUPA factsheets, Healthy weight for adults and Healthy eating.

Liposuction is not a treatment for weight control or obesity and it cannot remove cellulite or stretch marks.^1,2

There is a limit to the amount of fat that can be safely removed from an area, which is usually a maximum of three litres and a natural limitation when no further fat can be removed. Therefore it may not be possible to slim down an area as much as you might like.¹

What are the alternatives?

If you want to lose weight from your tummy, an alternative may be a tummy tuck, where excess fat and skin is removed from the abdomen. For more information, please see the separate BUPA factsheet, Tummy tuck (abdominoplasty).

Many creams, diet supplements and beauty treatments claim to reduce stubborn areas of fat and even cellulite. However, there is no scientific proof that they permanently reduce or remove fat.

What happens before a liposuction?

Your surgeon will discuss how to prepare for your operation. For example, you may be asked to:

• stop taking the contraceptive pill six weeks before surgery and use an alternative method of contraception as this reduces the risk of blood clotting (thrombosis) after the operation¹
• give up smoking as smoking increases the risk of chest infection and slows the healing of wounds as well as increasing the risk of blood clots in the legs^3,4
• stop taking medicines such as aspirin and anti-inflammatory medicines two weeks before surgery as they increase the risk of excessive bleeding¹

What should I expect in hospital?

Before surgery you will talk to your surgeon about the operation and you will be asked to sign a consent form. This confirms that you understand the risks, benefits and possible alternatives to the procedure and have given your permission for it to go ahead.

Your surgeon may draw on your body to mark the areas for liposuction. You will usually have a photograph taken before the operation, so that the results after surgery can be compared with your original appearance.

If you are having a general anaesthetic, you will be asked to follow fasting instructions. Typically, you must not eat or drink for about six hours before a general anaesthetic. However, some anaesthetists allow occasional sips of water until two hours beforehand.

The operation

Liposuction is usually done under a general anaesthetic, which means that you will be asleep throughout the procedure and will feel no pain. Alternatively, the surgery can be carried out under a local anaesthetic that numbs the area but you will be awake.¹ You may be given a sedative however.

Liposuction may be carried out as a day case, which means that you can have the operation and go home the same day. However, for more extensive treatment, an overnight stay may be necessary.

Your surgeon can use several different methods and will discuss what the most appropriate technique is for you.

Wet liposuction

This is the most common technique. Once the anaesthetic has taken effect, your surgeon will inject a fluid mixture containing a salty solution, local anaesthetic and adrenaline into the fatty area being treated.⁵ This helps reduce bleeding, bruising and swelling and makes it easier to remove the fat cells.

A cut will be made in your skin and a thin metal tube called a cannula will be inserted. This will be attached to a vacuum pump or a syringe and will be moved about vigorously within the fatty tissue to suck out the fat and the fluid. For larger areas, more than one cut may be made to reach all the fatty deposits that are being treated.

Once your surgeon has removed the required amount of fat, the cannula will be taken out and your cut(s) will be closed with stitches.

A variation of the wet technique is 'tumescent' liposuction where a larger volume of fluid is injected.

Dry liposuction

This method does not use an injection of fluid into the fatty area but the suction and cannula are used in a similar way. It can result in more bleeding and bruising and is now used less commonly.

Ultrasound liposuction

If the fat is very firm (on the back, for example), or there is a large amount, ultrasound (sound waves) treatment can break up the fat before it is removed.

After liposuction, the treated area will be firmly strapped with bandages or elasticated tape. You may be fitted with an elasticated support garment. This will help to reduce swelling and help your skin mould to your new shape.

After the operation

You will be given painkillers to help relieve any discomfort as the anaesthetic wears off.¹

It is important to do deep breathing exercises to help reduce the risk of developing a chest infection. Your doctor or nurse can show you how to do these.⁶

If your operation has been planned as a day case, you will usually be able to go home once you have made a full recovery from the anaesthetic. If you have had a general anaesthetic you will need to arrange for a friend or relative to drive you home and stay with you for the next 24 hours.

Before discharge, your nurse will give you advice about caring for your stitches, hygiene and bathing. You will also be given an appointment to have your stitches removed.

Recovering from liposuction

Once home, you may take more painkillers if needed, as advised by your surgeon or nurse.

You will usually need to wear the elasticated garment or bandages for two to three weeks, depending on your surgeon's advice. They can usually be temporarily removed to be washed and for bathing.¹

Your surgeon will give you advice about resuming your normal activities. You may need to avoid strenuous exercise for up to a month, but walking and gentle exercises are encouraged. If you only had small areas treated, you may only need a few days off work. For larger operations, you may need to take 7-10 days off.¹

It may be several months before you can see the full results of your operation as the swelling can take a long time to completely settle down.¹ It helps if you have skin with good elasticity, which is more likely to 'shrink' down to the smaller volume of fat beneath.²

Deciding on treatment

It is important not to rush into the decision to have any cosmetic operation. And it is sensible to discuss the options with your GP, who may be able to recommend reputable surgeons or give advice about how to choose which hospital to be treated in.

Liposuction is a commonly performed and generally safe surgical procedure. For people in good health who are not severely overweight⁵ the benefits in terms of improved appearance are usually greater than the disadvantages. However, in order to make a well-informed decision and give your consent, you need to be aware of the possible side-effects and the risk of complications.

Side-effects are the unwanted but mostly temporary effects of a successful procedure. For example, feeling sick as a result of the general anaesthetic. Anyone having liposuction can also expect:

• considerable bruising, which can be painful and usually takes about a month to disappear^1,5
• lumpiness or swelling, which may not completely settle for up to six months¹
• scars, typically 1-2 cm long, pink and noticeable at first, which should become finer after a few weeks¹
• thrombophlebitis (inflammation of the veins - not the same as thrombosis) around the inside of your knee and inner part of your upper thigh if these areas are treated, which should settle after a few weeks¹
• swollen ankles¹

If you have large areas treated or are prone to anaemia, you may need to take iron tablets for about a month after the operation.¹

Complications are unexpected problems that can occur during or after the procedure. Most people are not affected. The main complications of any operation are bleeding during or soon after the procedure, infection and an abnormal reaction to the anaesthetic. It's also possible for a blood clot to develop in a vein in the legs - a deep vein thrombosis or DVT.

Specific complications of liposuction are rare but can include:

• the development of fluid-filled areas under the skin, which may need to be drained with a needle⁵
• fat getting into one of the blood vessels, which could travel in the veins and cause a blockage in the lungs7
• numbness in the treated area that can last for several months, but can be permanent^1,5
• damage to internal organs, which may require surgery to repair and can occasionally be fatal⁵
• serious disruption of the fluid balance of the body due to fluid being injected and sucked out, which in very rare cases can cause breathing problems and be fatal^5,8
• unusually red or raised scars (called keloid scars) which some people have an inherited tendency to form¹
• an unexpected allergic reaction to the fluid used for wet liposuction

The chance of complications depends on the type of procedure that is being performed. Generally speaking, if you are having large volumes of fat and fluid removed during the operation, the risk of complications is higher.^2,8 Your surgeon will explain how the risks apply to you.

References

1. British Association of Aesthetic Plastic Surgeons (BAAPS), Liposuction, http://www.baaps.org.uk, viewed 01/03/2005.
2. Matarasso A, Hutchinson Z. Liposuction. JAMA 1998;285:266.
3. Smoking and wound healing. Am J Med. 1992 Jul 15;93(1A):22S-24S.
4. BHF factsheet on DVT, www.bhf.org.uk, viewed 21/02/2005.
5. Mayoclinic, Liposuction: considerations about body sculpting, www.mayoclinic.com, viewed 01/03/2005.
6. Clinical Evidence, Post-operative pulmonary infections, www.clinicalevidence.com, March 2004.
7. Fat embolism after liposuction, Chest, Vol 93, 1294-1295.
8. Chalekson C, Liposuction techniques, www.EMedicine.com, viewed 28/02/2005.

Published by BUPA's health information team, healthinfo@bupa.com, April 2005.