Facts About Liposuction: How Liposuction Works

by Food and Drug Administration (FDA)

A self-described athlete, thirty-year-old Jeanne Smith of Washington, DC, is fit, active, and happy. But like many young women, she has felt dissatisfied with her looks. Because she works in the medical field, Smith knows about its latest trends and techniques. So when friends talked about their satisfaction with liposuction, Smith already knew about the procedure and readily considered its pros and cons. She decided it suited her.

She wanted some body sculpting and knew what she was getting into. "I had basically the lower half of my body done, and it was pretty targeted surgery," she says. "I experienced drainage afterwards and that's normal. I stayed out of work for about one week, though I was active during that time. I went to movies, out to dinner ... but was not up to my 100-percent best."

That was more than one year ago, and Smith says she is happy with her new trimmer look.

Or consider the case of Robert F. Jackson, M.D., board-certified cosmetic surgeon of Marion, Ind., and chairman of the liposuction committee of the American Academy of Cosmetic Surgery. Himself a liposuction patient, Jackson had excess tummy fat — a potbelly, he calls it — removed. "The day after the surgery, I felt sore," he says, "but the pain was minimal." His surgery took place on Friday morning, and by Monday, Jackson was back at work.

These cases represent two of the many individuals who have helped make liposuction the most popular form of cosmetic surgery today. An estimated 287,000 procedures were performed in 1999, according to the American Society for Aesthetic Plastic Surgery. Liposuction has become the technique of choice for people who want an improved body shape, a body sculpted to reflect their own — and society's — ideals of physical beauty. Moreover, liposuction may be used in conjunction with facelifts, for chin and tummy tucks, and to reduce the size of abdomens, hips, and thighs.

"Most liposuction procedures are done for purely cosmetic reasons," says Lori Brown, Ph.D., an epidemiologist in the Food and Drug Administration's Center for Devices and Radiological Health. But she adds that some medical conditions, such as large breasts in men; lipomas, or fatty lumps; or fatty deposits like the buffalo hump — caused by hormonal imbalances that grow masses of fat on and around the neck — may be treated with liposuction.

But the rise in its popularity and changes in the techniques doctors use to perform liposuction have raised concerns within FDA. There is growing evidence that the increased aggressiveness with which the procedure is performed — especially the amount of tissue sucked from the body, the venues in which the procedures are performed, and the amount of anesthesia used to sedate patients during increasingly lengthy procedures — may be increasing the risk of post-surgical complications and even death.

How Liposuction Works

Conceptually, liposuction (or lipoplasty) is a straightforward technique in which excess fatty tissue is suctioned from beneath the skin. Prior to surgery, doctors flush the targeted area or areas with a solution composed of lidocaine (a local anesthetic similar in its numbing effects to novocaine), saline, and epinephrine (a drug that constricts blood vessels and thus reduces bleeding during surgery).

Then doctors insert a hollow wand-like device called a cannula through incisions in the skin. They push and pull the cannula around through fatty deposits, breaking up the cells, which, along with other body fluids, are suctioned out by an attached vacuuming device.

It's a simple system, says Stephen Rhodes, chief of the plastic and reconstructive surgery devices branch in FDA's CDRH. "It's essentially just a cannula and a vacuum." However, these products have only been approved for body contouring, and are not intended for large-scale fat removal, an increasingly popular use of liposuction.

There are several liposuction techniques available today. The amount of injected fluid determines the technique used, explains Peter B. Fodor, M.D., chief of plastic surgery at Century City Hospital in Los Angeles and spokesman for the American Society for Aesthetic Plastic Surgery.

In the "dry" technique, which few doctors use anymore, no fluid is injected into the targeted area.

For "wet" liposuction, the surgeon injects only a small amount of fluid, about six to eight ounces and usually containing small amounts of ephinephrine, regardless of how much tissue is subsequently removed.

The "superwet" technique evolved, says Fodor, because doctors found that the more fluid they injected — up to a point — the less blood was lost. "We found that by injecting one cc of solution for each cc of aspirate [amount of tissue and fluid removed], the blood loss was negligible." Although lidocaine is sometimes added when performing wet or superwet liposuction, patients will also receive general or epidural anesthesia.

In the tumescent technique, doctors inject up to five times as much fluid as aspirate. Because the injected fluid also contains large amounts of lidocaine, tumescent liposuction is generally performed with only a local anesthetic.

Many doctors are offering a modified version of the procedure that calls for using ultrasound in addition to the injected solution and the suctioning. Rhodes and others at the FDA are especially concerned about this practice, which calls for using devices not approved for liposuction — that is, special cannulas that vibrate at high rates and emulsify fat tissue before its removal. The wand generates a great deal of heat, and if doctors don't move it constantly, it can cause severe burns. As Roxolana Horbowyj, M.D., senior medical officer in CDRH, points out, a temperature increase of 20 degrees Celsius (about 36 degrees Fahrenheit) may encourage cell death. And, as FDA epidemiologist Brown notes, "We don't really know the long-term effects of ultrasound on tissues."

About the Author

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FDA is A United States government body that oversees medical devices, including contact lenses, intraocular lenses, excimer lasers and eyedrops. In the US, these products must be approved by the FDA before they can be marketed.