{{Short description|Surgery to remove unwanted fat}} {{Copy edit|date=April 2026}} {{Infobox interventions | Name = Liposuction | Image = Fat removal using cannula during tumescent liposuction.jpg | Caption = A plastic surgeon performing liposuction surgery | synonyms = Lipoplasty, lipectomy, fat modeling, liposculpture, suction lipectomy, suction-assisted fat removal, lipo, lymph-sparing liposuction, tumescent liposuction, water-assisted liposuction, power-assisted liposuction, laser-assisted liposuction, ultra-sound assisted liposuction | ICD10 = 0JDL3ZZ: RT UPPER LEG; 0JDM3ZZ: LT UPPER LEG; OJDN3ZZ: RT LOWER LEG; 0JDP3ZZ: LT LOWER LEG | MeshID = DO65134 | MedlinePlus = 002985 | HCPCSlevel2 = }} {{Human body weight}}
<!-- Definition and medical effects --> '''Liposuction''', or simply '''lipo''', is a type of fat-removal procedure used in plastic surgery.<ref name=Dix2013>{{cite journal|last1=Dixit|first1=VV|last2=Wagh|first2=MS|title=Unfavourable outcomes of liposuction and their management.|journal=Indian Journal of Plastic Surgery|date=May 2013|volume=46|issue=2|pages=377–92|pmid=24501474|doi=10.4103/0970-0358.118617|pmc=3901919 |doi-access=free }}</ref> Evidence does not support an effect on weight beyond a couple of months and does not appear to affect obesity-related problems.<ref name=pmid26210190>{{cite journal |doi=10.1007/s11695-015-1797-1 |pmid=26210190 |title=Short- and Long-Term Effects of Abdominal Lipectomy on Weight and Fat Mass in Females: A Systematic Review |journal=Obesity Surgery |volume=25 |issue=10 |pages=1950–8 |year=2015 |last1=Seretis |first1=Konstantinos |last2=Goulis |first2=Dimitrios G |last3=Koliakos |first3=Georgios |last4=Demiri |first4=Efterpi |s2cid=37230028 }}</ref><ref name=Insulin2015>{{cite journal|last1=Seretis|first1=K|last2=Goulis|first2=DG|last3=Koliakos|first3=G|last4=Demiri|first4=E|title=The effects of abdominal lipectomy in metabolic syndrome components and insulin sensitivity in females: A systematic review and meta-analysis.|journal=Metabolism: Clinical and Experimental|date=December 2015|volume=64|issue=12|pages=1640–9|pmid=26475176|doi=10.1016/j.metabol.2015.09.015}}</ref>
<!-- Procedure --> The procedure may be performed under general, regional, or local anesthesia. It involves using a cannula and negative pressure to suck out fat.<ref name=Nor2014/> As a cosmetic procedure it is believed to work best on people with a normal weight and good skin elasticity.<ref name=Nor2014>{{cite book|last1=Norton|first1=Jeffrey A.|title=Surgery Basic Science and Clinical Evidence|date=2012|publisher=Springer Berlin Heidelberg|location=Berlin, Heidelberg|isbn=978-3-642-57282-1|page=2014|url=https://books.google.com/books?id=p9MGCAAAQBAJ&pg=PA2014}}</ref>
<!-- Long-term Outcome --> While the suctioned fat cells are permanently gone, after a few months overall body fat generally returns to the same level as before treatment.<ref name=pmid26210190/> This is despite maintaining the previous diet and exercise regimen. While the fat returns somewhat to the treated area, most of the increased fat occurs in the abdominal area. Visceral fat—the fat surrounding the internal organs—increases, and this condition has been linked to life-shortening diseases such as diabetes, stroke, and heart attack.<ref name=pmid26210190/>
== Uses == There are two different uses for liposuction:
=== Cosmetic === thumb|Doctor Performing Liposuction Surgery Cosmetic liposuction is used to change the body's contour or shape, to aesthetically improve the appearance of body parts and contour. It should not be used for weight loss.<ref name="Davis">{{Cite journal |last1=Davis |first1=William |last2=Lawrence |first2=Naomi |date=October 2020 |title=Weight Loss: How Does It Fit in With Liposuction? |url=https://journals.lww.com/10.1097/DSS.0000000000002225 |journal=Dermatologic Surgery |language=en |volume=46 |issue=1 |pages=S22–S28 |doi=10.1097/DSS.0000000000002225 |pmid=31652224 |s2cid=204908385 |issn=1076-0512|url-access=subscription }}</ref> Benefits from cosmetic liposuction appear to be of a short-term nature with little long-term effect.<ref name=pmid26210190/> After a few months fat typically returns and redistributes.<ref name=pmid26210190/> Liposuction does not help obesity-related metabolic disorders like insulin resistance.<ref name=Insulin2015/>
=== Reconstructive, medically necessary === Reconstructive, medically necessary liposuction is used to treat lipedema,<ref name="baumgartner">{{Cite journal |last1=Baumgartner |first1=A. |last2=Hueppe |first2=M. |last3=Schmeller |first3=W. |date=May 2016 |title=Long-term benefit of liposuction in patients with lipoedema: a follow-up study after an average of 4 and 8 years |url=https://academic.oup.com/bjd/article/174/5/1061/6616552 |journal=British Journal of Dermatology |language=en |volume=174 |issue=5 |pages=1061–1067 |doi=10.1111/bjd.14289|pmid=26574236 |s2cid=54522402 |url-access=subscription }}</ref> to remove excess fat in the chronic medical condition lymphedema,<ref name="NHS">{{cite web |url=https://www.nhs.uk/conditions/lymphoedema/treatment/#liposuction |title = Lymphoedema treatment |author=<!--Not stated--> |date=July 18, 2017 |website=NHS Choices |publisher=NHS GOV.UK |access-date= February 24, 2018}}</ref> and to remove lipomas from areas of the body.<ref>{{cite web |title=Cosmetic and Reconstructive Services and Procedures |url=https://www.uhcprovider.com/content/dam/provider/docs/public/policies/medadv-guidelines/c/cosmetic-reconstructive-services-procedures.pdf |publisher=UnitedHealthcare® Medicare Advantage |access-date=6 July 2024 |date=February 23, 2024}}</ref><ref>{{cite web | last1=Charifa | first1=Ahmad | last2=Azmat | first2=Chaudhary Ehtsham | last3=Badri | first3=Talel | title=Lipoma Pathology | publisher=StatPearls Publishing | date=2022-12-05 | pmid=29493968 | url=https://www.ncbi.nlm.nih.gov/books/NBK482343/ | access-date=2024-07-06}}</ref>
If the documentation supports the liposuction for a medical reason (lipedema, lymphedema, lipomas) as reconstructive, and not investigational, experimental, or unproven, the claim is medically necessary and should be reimbursed.<ref name="j033">{{cite web | title=Cosmetic and Reconstructive Services of the Trunk, Groin, and Extremities | website=Anthem | date=2024-04-29 |url=https://www.anthem.com/dam/medpolicies/abc/active/policies/mp_pw_a050277.html | access-date=2024-07-06}}</ref> While most insurance companies may initially deny the claim, many can be won upon appeal if the documentation and the patient's need supports the criteria for reconstructive surgery.<ref>{{Cite web|url=https://www.cms.gov/medicare-coverage-database/details/lcd-details.aspx?LCDId=34698&ContrId=268&ver=28&ContrVer=1&CntrctrSelected=268*1&Cntrctr=268&s=5&DocType=1&bc=AAAAAAIAAAAA&|title = LCD — Cosmetic and Reconstructive Surgery (L34698)}}</ref><ref>{{cite web |title=Billing and Coding Guidelines for Cosmetic and Reconstructive Surgery LCD |url=https://downloads.cms.gov/medicare-coverage-database/lcd_attachments/34698_20/L34698_GSURG032_BCG.pdf |access-date=6 July 2024}}</ref><ref>{{Cite web|url=https://www.novitas-solutions.com/webcenter/portal/MedicareJL/pagebyid?contentId=00099545|title = Reasonable & Necessary Guidlines}}</ref>
The techniques and terms listed below: tumescent, lymph-sparing, Tumescent Local Anesthesia (TLA), Water-Assisted Liposuction (WAL), Power-Assisted Liposuction (PAL), Laser-Assisted Liposuction (LAL) all apply to reconstructive, medically necessary liposuction.{{cn|date=July 2024}}
== Techniques == thumb|Liposuction aspirate
In general, fat is removed via a cannula (a hollow tube) and aspirator (a suction device). Liposuction techniques can be categorized by the amount of fluid injected, and by the mechanism by which the cannula works. If the removed fat is used as filler for the face, lips, or breasts, knowledge of the precise technique used to remove the fat is indicated.<ref>{{Cite web|url=https://www.plasticsurgery.org/cosmetic-procedures/fat-transfer-breast-augmentation|title=Fat Transfer Breast Augmentation|website=American Society of Plastic Surgeons}}</ref> There are numerous types of liposuction. Some can be described as techniques or modalities. These techniques of liposuction are categorized depending upon the type of energy used for the liquifaction of fat. Often surgeons will use two or more of the different techniques below in the same session.{{citation needed|date=January 2022}} Liposuction is frequently combined with other body contouring procedures to improve overall trunk proportions.
=== Abdominal etching === '''Abdominal etching''' is a cosmetic liposuction technique intended to accentuate the visible contours of the anterior abdominal wall, including the linea alba, linea semilunaris, and tendinous intersections of the rectus abdominis.<ref name="Agochukwu2019">{{cite journal |last1=Agochukwu-Nwubah |first1=Nneamaka |last2=Mentz |first2=Henry A. |title=Abdominal Etching: Past and Present |journal=Aesthetic Surgery Journal |year=2019 |volume=39 |issue=12 |pages=1368–1377 |doi=10.1093/asj/sjz153 |pmid=31111146}}</ref><ref name="Saad2020">{{cite journal |last1=Saad |first1=Ahmad |last2=Combina |first2=Luciano Nahas |last3=Altamirano-Arcos |first3=Carlos |title=Abdominal Etching |journal=Clinics in Plastic Surgery |year=2020 |volume=47 |issue=3 |pages=397–408 |pmid=32448476}}</ref>
The technique was first described in 1993 and is generally discussed in the literature as part of high-definition liposculpture rather than as a weight-loss procedure.<ref name="Mentz1993">{{cite journal |last1=Mentz |first1=H. A. |last2=Gilliland |first2=M. D. |last3=Patronella |first3=C. K. |title=Abdominal etching: differential liposuction to detail abdominal musculature |journal=Aesthetic Plastic Surgery |year=1993 |volume=17 |issue=4 |pages=287–290 |doi=10.1007/BF00437100 |pmid=8273529}}</ref><ref name="Escandon2022">{{cite journal |last1=Escandón |first1=Joseph M. |last2=Vyas |first2=Krishna S. |last3=Manrique |first3=Oscar J. |title=High-Definition Lipoplasty in Male Patients: A Systematic Review of Surgical Techniques and Outcomes |journal=Aesthetic Surgery Journal |year=2022 |volume=42 |issue=1 |pages=68–85 |doi=10.1093/asj/sjab300}}</ref>
The technique was first described in 1993 and is generally discussed in the literature as part of high-definition liposculpture rather than as a weight-loss procedure.<ref name="Mentz1993"></ref><ref name="Escandon2022"></ref> Recent case-series literature has also described rectus abdominis fat grafting as an adjunct to abdominal contouring procedures.<ref>{{cite journal |last1=Paez |first1=Zamir |last2=Ramírez |first2=Brian |last3=Paez |first3=Hassan |last4=Ovalle |first4=Maria |last5=Varela |first5=Agustina |title=Rectus Abdominis Fat Grafting: Outcomes and Safety |journal=Plastic and Reconstructive Surgery Global Open |year=2026 |volume=14 |issue=3 |article-number=e7546 |doi=10.1097/GOX.0000000000007546}}</ref>
=== Suction-assisted liposuction (SAL) === This is the most generic term for liposuction. In the CPT manual it is referred to as "suction-assisted lipectomy" and includes codes: 15876–15879.<ref>{{cite book | last=Association | first=American Medical | title=CPT Professional 2020 | publisher=American Medical Association Press | date=2019-09-23 | isbn=978-1-62202-898-6 | page=}}</ref>
=== Micro-cannula === This does not address a particular technique but the diameter of the cannula, a stainless steel tube which is inserted into subcutaneous fat through a small opening or incision in the skin. The outside diameter of micro-cannulas range from 1 mm to 3 mm.<ref name="Wollina, Uwe 2010">{{cite journal | last1=Wollina | first1=U. | last2=Goldman | first2=A. | last3=Heinig | first3=B. | title=Microcannular tumescent liposuction in advanced lipedema and Dercum's disease | journal=Giornale Italiano di Dermatologia e Venereologia | volume=145 | issue=2 | date=2010 | issn=0392-0488 | pmid=20467389 | pages=151–159}}</ref>
=== Lymph-sparing liposuction === This technique does not require a particular wand and is most often performed with either tumescent liposuction or WAL (below). It refers to the specific surgical technique, the skill of the surgeon, and the extensive training that is unique to removing lipedema fat.<ref name="doi.org">{{cite journal | last1=van de Pas | first1=Chantalle B | last2=Boonen | first2=Robert SM | last3=Stevens | first3=Shaula | last4=Willemsen | first4=Sten | last5=Valkema | first5=Roelf | last6=Neumann | first6=Martino | title=Does tumescent liposuction damage the lymph vessels in lipoedema patients? | journal=Phlebology: The Journal of Venous Disease | volume=35 | issue=4 | date=2020 | issn=0268-3555 | pmid=31674863 | pmc=7178148 | doi=10.1177/0268355519885217 | pages=231–236}}</ref> Because the scope is different for removal of lipedema fat versus cosmetic contouring, if lymph-sparing is not addressed in the surgical operative notes, a medical necessity review committee could determine that the procedure poses "a risk to the lymph system."<ref>{{cite journal | last1=Cobos | first1=Leopoldo | last2=Herbst | first2=Karen | last3=Ussery | first3=Christopher | title=MON-116 Liposuction for Lipedema (Persistent Fat) in the US Improves Quality of Life | journal=Journal of the Endocrine Society | publisher=The Endocrine Society | volume=3 | issue=Supplement_1 | year=2019 | pages=MON-116 | issn=2472-1972 | doi=10.1210/js.2019-mon-116 | pmc=6550731 }}</ref><ref>{{cite journal | last1=Sandhofer | first1=Matthias | last2=Hanke | first2=C. William | last3=Habbema | first3=Louis | last4=Podda | first4=Maurizio | last5=Rapprich | first5=Stefan | last6=Schmeller | first6=Wilfried | last7=Herbst | first7=Karen | last8=Anderhuber | first8=Friedrich | last9=Pilsl | first9=Ulrike | last10=Sattler | first10=Gerhard | last11=Sandhofer | first11=Martina | last12=Moosbauer | first12=Werner | last13=Sattler | first13=Sonja | last14=Schauer | first14=Patrick | last15=Faulhaber | first15=Jörg | last16=Maier | first16=Sabine | last17=Barsch | first17=Martin | last18=Mindt | first18=Sonani | last19=Halk | first19=Anne B. | title=Prevention of Progression of Lipedema With Liposuction Using Tumescent Local Anesthesia: Results of an International Consensus Conference | journal=Dermatologic Surgery | volume=46 | issue=2 | date=2020 | issn=1076-0512 | doi=10.1097/DSS.0000000000002019 | pages=220–228| pmid=31356433 }}</ref><ref name="Lliposuccion">{{Cite web|url=https://www.liposuction.com/|title=Liposuction.com — Brought to you by DR. Klein, Inventor of Tumescent Liposuction|website=www.liposuction.com}}</ref>
=== Tumescent local anesthesia (TLA)/tumescent liposuction === This may be referenced either way above, but the technique is the same.<ref>{{cite journal | last1=Schmeller | first1=Wilfried | last2=Meier-Vollrath | first2=Ilka | title=Tumescent Liposuction: A New and Successful Therapy for Lipedema | journal=Journal of Cutaneous Medicine and Surgery | volume=10 | issue=1 | date=2006 | issn=1203-4754 | doi=10.1007/7140.2006.00006 | pages=7–10| pmid=17241565 }}</ref> This is an anesthesia technique recommended for lymph-sparing liposuction surgery. Tumescent Liposuction refers to the use of anesthesia during liposuction. The word "tumescent" means swollen and firm. By injecting a large volume of very dilute lidocaine (local anesthetic) and epinephrine (capillary constrictor) into subcutaneous fat, the targeted tissue becomes swollen and firm, or tumescent. This technique does not require a special or specific type of wand.<ref name="Wollina, Uwe 2010"/><ref name="doi.org"/>
=== Power-assisted liposuction (PAL) === alt=Surgeon performing power-assisted liposuction with a motorized cannula in an operating room.|thumb|Intraoperative view of power-assisted liposuction (PAL) demonstrating use of a reciprocating cannula. Referred to as "a vibrating cannula" in research studies, PAL uses a specific type of wand that creates an up and down, vibrating-like motion of the cannula to acquire greater fat removal. When compared to simple suction-assisted liposuction, PAL requires less energy for the surgeon to operate while also resulting in greater fat removal. It is commonly used for difficult, secondary, scarred areas, and when harvesting large volumes of fat for transfers to other areas.<ref name="Tabbal e75">{{Cite journal|last1=Tabbal|first1=Geo N.|last2=Ahmad|first2=Jamil|last3=Lista|first3=Frank|last4=Rohrich|first4=Rod J.|date=November 2013|title=Advances in Liposuction|journal=Plastic and Reconstructive Surgery Global Open|language=en-US|volume=1|issue=8|pages=e75|doi=10.1097/GOX.0000000000000007|pmid=25289270|issn=2169-7574|pmc=4186292}}</ref><ref name="Venkataram J 2077">{{cite journal | last=Venkataram | first=Jayashree | title=Tumescent liposuction: A review | journal=Journal of Cutaneous and Aesthetic Surgery | volume=1 | issue=2 | date=2008 | pages=49–57 | issn=0974-2077 | pmid=20300344 | pmc=2840906 | doi=10.4103/0974-2077.44159 | doi-access=free }}</ref>
Note that techniques can be combined; for instance one could refer to the procedure as "lymph-sparing, tumescent liposuction using a vibrating (PAL) microcannula to treat lipedema."{{citation needed|date=January 2022}}
=== Water-jet assisted liposuction (WAL) === A specific technique and wand commonly used for patients who require lymph-sparing liposuction for lipedema. The lipedema fat is removed using a fan-shaped jet of water, which includes the anesthetic. In contrast to tumescent liposuction above, where the anesthetic solution is injected separately and beforehand, the WAL wand both injects the solution and suctions the fat. BodyJet is a Water-Assisted Liposuction system.<ref>{{cite journal | last1=Stutz | first1=J. J. | last2=Krahl | first2=D. | title=Water Jet-Assisted Liposuction for Patients with Lipoedema: Histologic and Immunohistologic Analysis of the Aspirates of 30 Lipoedema Patients | journal=Aesthetic Plastic Surgery | volume=33 | issue=2 | date=2009 | issn=0364-216X | doi=10.1007/s00266-008-9214-y | pages=153–162| pmid=18663515 }}</ref>
=== Fibro-lympho-lipo-aspiration (FLLA) === This rare and unique term for liposuction for lipedema is used in a specific paper by Campisi, ''Fibro-Lipo-Lymph-Aspiration With a Lymph Vessel Sparing Procedure to Treat Advanced Lymphedema After Multiple Lymphatic-Venous Anastomoses: The Complete Treatment Protocol''. This term emphasizes the uniqueness of the reconstructive procedure versus the cosmetic procedure. Everything about the surgical suction application via cannula is different from standard suction lipectomy. The goal of FLLA is to relieve symptoms such as pain, ameliorate disability, improve function and quality of life, and halt disease progression.<ref>{{Cite journal |last1=Campisi |first1=Corrado |last2=Francesco |first2=Boccardo |last3=Campisi |first3=Corradino |date=2016-07-11 |title=Fibro-Lipo-Lymph-Aspiration With a Lymph Vessel Sparing Procedure to Treat Advanced Lymphedema After Multiple Lymphatic-Venous Anastomoses: The Complete Treatment Protocol |url=https://www.researchgate.net/publication/305277713 |journal=Annals of Plastic Surgery |volume=78 |issue=2 |pages=184–190 |doi=10.1097/SAP.0000000000000853|pmid=27404468 |hdl=11567/846714 |s2cid=30771397 }}</ref>
Only small blunt cannulas are used, great care is used to not injure lymphatic which are already abnormal and increased risk of injury. Only the longitudinal orientation of cannulas is used at critical junctures. Preoperatively critical lymphatic structures are scanned and marked. FLLA surgery is significantly more time-consuming than cosmetic surgery often requiring 4–5 hours per body part; much larger aspirate volume is removed versus cosmetic suction lipectomy.
The benefit to lymphatics function comes not only from the removal of subcutaneous adipose tissue, but also the all components of the loose connective tissue including removing fibrosis in the interstitial space.<ref>{{cite journal | last1=Campisi | first1=Corrado Cesare | last2=Ryan | first2=Melissa | last3=Boccardo | first3=Francesco | last4=Campisi | first4=Corradino | title=Fibro-Lipo-Lymph-Aspiration With a Lymph Vessel Sparing Procedure to Treat Advanced Lymphedema After Multiple Lymphatic-Venous Anastomoses | journal=Annals of Plastic Surgery | publisher=Ovid Technologies (Wolters Kluwer Health) | volume=78 | issue=2 | year=2017 | issn=0148-7043 | doi=10.1097/sap.0000000000000853 | pages=184–190| pmid=27404468 }}</ref>
=== Ultrasound-assisted liposuction (UAL) === Ultrasound-assisted liposuction techniques used in the 1980s and 1990s were associated with cases of tissue damage, usually from excessive exposure to ultrasound energy.<ref>{{cite book |doi=10.1007/978-3-540-46326-9_55 |chapter=Innovation in Plastic and Aesthetic Surgery Lipoplasty |title=Innovations in Plastic and Aesthetic Surgery |pages=443–53 |year=2008 |last1=Jewell |first1=M |isbn=978-3-540-46321-4 }}</ref> Third-generation UAL devices address this problem by using pulsed energy delivery and a specialized probe that allows physicians to safely remove excess fat.<ref>{{cite journal |doi=10.1016/j.cps.2005.09.001 |pmid=16427979 |title=Liposuction and VASER |journal=Clinics in Plastic Surgery |volume=33 |issue=1 |pages=107–15, vii |year=2006 |last1=De Souza Pinto |first1=Ewaldo Bolivar |last2=Chiarello De Souza Pinto Abdala |first2=Priscila |last3=Montecinos Maciel |first3=Christovam |last4=De Paula Turchiari Dos Santos |first4=Fabiana |last5=Pessoa Martello De Souza |first5=Rodrigo }}</ref> UAL is beneficial in people with a particular skin tone, in liposuction of areas that are more difficult to remove fat, that include treatment of gynecomastia, or areas where secondary liposuction is being performed.<ref>{{Cite journal|last1=Tabbal|first1=Geo N.|last2=Ahmad|first2=Jamil|last3=Lista|first3=Frank|last4=Rohrich|first4=Rod J.|date=November 2013|title=Advances in Liposuction|journal=Plastic and Reconstructive Surgery Global Open|language=en-US|volume=1|issue=8|pages=e75|doi=10.1097/GOX.0000000000000007|pmid=25289270|pmc=4186292|issn=2169-7574}}</ref>
=== Laser-assisted liposuction/lipolysis (LAL) === Referred to as Smart Lipo, this technique uses laser technology to coagulate and tighten the skin and boost collagen performance.<ref>{{cite journal | last1=Leclère | first1=Franck Marie | last2=Moreno-Moraga | first2=Javier | last3=Mordon | first3=Serge | last4=Servell | first4=Pascal | last5=Unglaub | first5=Frank | last6=Kolb | first6=Frédéric | last7=Rimareix | first7=Françoise | last8=Trelles | first8=Mario A | title=Laser-assisted lipolysis for cankle remodelling: a prospective study in 30 patients | journal=Lasers in Medical Science | volume=29 | issue=1 | date=2014 | issn=0268-8921 | doi=10.1007/s10103-013-1279-4 | pages=131–136| pmid=23471498 }}</ref> Uses include "cankles", debulking surgery for elephantiasis nostras<ref>{{cite journal | last1=Wollina | first1=Uwe | last2=Heinig | first2=Birgit | last3=Nowak | first3=Andreas | title=Debulking Surgery for Elephantiasis Nostras With Large Ectatic Podoplanin-Negative Lymphatic Vessels in Patients With Lipo-Lymphedema | journal=ePlasty | publisher=HMP Global | volume=14 | date=2014 | pages=e11 | pmid=24741382 | pmc=3944717 }}</ref> and lipedema.<ref>{{cite journal | last1=Wollina | first1=Uwe | last2=Heinig | first2=Birgit | last3=Nowak | first3=Andreas | title=Treatment of elderly patients with advanced lipedema: a combination of laser-assisted liposuction, medial thigh lift, and lower partial abdominoplasty | journal=Clinical, Cosmetic and Investigational Dermatology | date=2014 | volume=7 | pages=35–42 | issn=1178-7015 | pmid=24489474 | pmc=3904776 | doi=10.2147/CCID.S56655 | doi-access=free }}</ref>
=== Radiofrequency-assisted liposuction ===
Radiofrequency-assisted Liposuction, also known as RFAL, is a new procedure that is being done by thermal energy to promote skin tightening and remove unwanted fat. In this technique, radio waves of specific frequency are used to melt fat.<ref>{{cite web |url=https://www.plasticsurgery.org/news/blog/what-is-radiofrequency-assisted-liposuction | title=What is radiofrequency-assisted liposuction? }}</ref>
=== After care—sutures === Doctors disagree on the issues of scarring with not suturing versus resolution of the swelling allowed by leaving the wounds open to drain fluid. Suturing is more common with a large cannula.<ref name="Venkataram J 2077"/> Since the incisions are small, and the amount of fluid that must drain out is large, some surgeons opt to leave the incisions open, while others suture them only partially, leaving space for the fluid to drain out.<ref>{{Cite web|url=https://medlineplus.gov/ency/article/002985.htm|title=Liposuction: MedlinePlus Medical Encyclopedia|website=medlineplus.gov}}</ref>
== Safety and risks == Liposuction is considered very safe, though not all liposuction surgery is equal. Small volume liposuction (<1,000 cc) done awake is different from large volume liposuction (>5,000 cc, in some cases 10,000 cc) done with anesthesia and a hospital stay.<ref>Haeck, Phillip C. M.D.; Swanson, Jennifer A. B.S., M.Ed.; Gutowski, Karol A. M.D.; Basu, C Bob M.D., M.P.H.; Wandel, Amy G. M.D.; Damitz, Lynn A. M.D.; Reisman, Neal R. M.D., J.D.; Baker, Stephen B. M.D., D.D.S. the ASPS Patient Safety CommitteeAuthor Information</ref>
Suction-assisted lipectomy (aka liposuction) were identified{{when|date=January 2024}} from the Tracking Operations and Outcomes for Plastic Surgeons database maintained by the American Society of Plastic Surgeons (ASPS).<ref name="plasticsurgery.org">{{Cite web|url=https://www.plasticsurgery.org/for-medical-professionals/advocacy/key-issues/liposuction|title = Liposuction}}</ref> The ASPS maintains a registry of plastic surgery cases called TOPS (Tracking Operations & Outcomes for Plastic Surgeons) which is the largest database of plastic surgery cases. The TOPS database is only voluntary, not available to the public, and does not follow cases long-term or get testimony and experience of patients, only from doctors who profit from doing liposuction.<ref>{{Cite web |title=How much liposuction is 'safe'? The answer varies by body weight |url=https://www.sciencedaily.com/releases/2015/09/150901140705.htm |access-date=2022-05-22 |website=ScienceDaily |language=en}}</ref> Based on this database, no deaths were found in about 4,500 cases done by plastic surgeons 2009–10. However, non-plastic surgeons are not included in this.<ref name="haeck">{{Cite journal |last1=Haeck |first1=Phillip C. |last2=Swanson |first2=Jennifer A. |last3=Gutowski |first3=Karol A. |last4=Basu |first4=C Bob |last5=Wandel |first5=Amy G. |last6=Damitz |first6=Lynn A. |last7=Reisman |first7=Neal R. |last8=Baker |first8=Stephen B. |date=October 2009 |title=Evidence-Based Patient Safety Advisory: Liposuction |url=http://journals.lww.com/00006534-200910001-00005 |journal=Plastic and Reconstructive Surgery |language=en |volume=124 |issue=4 Suppl |pages=28S–44S |doi=10.1097/PRS.0b013e3181b52fcd |pmid=20827238 |s2cid=9461544 |issn=0032-1052|url-access=subscription }}</ref>
In a 2015 study, 69 of 4,534 patients (1.5 percent) meeting inclusion criteria experienced a postoperative complication. Their conclusion was that: Liposuction by board-certified plastic surgeons is safe, with a low risk of life-threatening complications. Traditional liposuction volume thresholds do not accurately convey individualized risk. The authors' risk assessment model showed that volumes above 100 ml per unit of body mass index confer an increased risk of complications.<ref name="Chow">{{Cite journal |last1=Chow |first1=Ian |last2=Alghoul |first2=Mohammed S. |last3=Khavanin |first3=Nima |last4=Hanwright |first4=Philip J. |last5=Mayer |first5=Kristen E. |last6=Hume |first6=Keith M. |last7=Murphy |first7=Robert X. |last8=Gutowski |first8=Karol A. |last9=Kim |first9=John Y. S. |date=September 2015 |title=Is There a Safe Lipoaspirate Volume? A Risk Assessment Model of Liposuction Volume as a Function of Body Mass Index |url=http://journals.lww.com/00006534-201509000-00007 |journal=Plastic and Reconstructive Surgery |language=en |volume=136 |issue=3 |pages=474–483 |doi=10.1097/PRS.0000000000001498 |pmid=26313819 |s2cid=44910216 |issn=0032-1052|url-access=subscription }}</ref> An example is the case of Aarthi Agarwal, a Bollywood actress who died six weeks after liposuction surgery after going into cardiac arrest.<ref>{{Cite web |title=Bollywood Star Aarthi Agarwal Dies After Lipo |url=https://news.sky.com/story/bollywood-star-aarthi-agarwal-dies-after-lipo-10356667 |access-date=2024-08-15 |website=Sky News |language=en}}</ref>
A spectrum of complications may occur due to any liposuction. Risk is increased when treated areas cover a greater percentage of the body, incisions are numerous, a large amount of tissue is removed, and concurrent surgeries are done at the same time. To address safety issues, in 2009 the American Society of Plastic Surgeons (ASPS) published ''Evidence-Based Patient Safety Advisory: Liposuction''. This 17-page document addresses key safety issues and offers recommendations.<ref name="plasticsurgery.org"/> In addition, the increase in tumescent and lymph-sparing techniques have had a positive impact on diminishing complications.<ref name="campisi">{{Cite journal |last1=Campisi |first1=Corrado Cesare |last2=Ryan |first2=Melissa |last3=Boccardo |first3=Francesco |last4=Campisi |first4=Corradino |date=February 2017 |title=Fibro-Lipo-Lymph-Aspiration With a Lymph Vessel Sparing Procedure to Treat Advanced Lymphedema After Multiple Lymphatic-Venous Anastomoses: The Complete Treatment Protocol |url=https://journals.lww.com/00000637-201702000-00014 |journal=Annals of Plastic Surgery |language=en |volume=78 |issue=2 |pages=184–190 |doi=10.1097/SAP.0000000000000853 |pmid=27404468 |s2cid=30771397 |issn=0148-7043|url-access=subscription }}</ref> In a 2009 paper, the author found from a series of 3,240 procedures, no deaths occurred, and no complications requiring hospitalization were experienced. In nine cases, complications developed that needed further action. The conclusion was that liposuction using exclusively Tumescent Local Anesthesia (TLA) is a proven safe procedure provided that the existing guidelines are meticulously followed.<ref name="Habbema">{{Cite journal |last=Habbema |first=Louis |date=November 2009 |title=Safety of Liposuction Using Exclusively Tumescent Local Anesthesia in 3,240 Consecutive Cases |url=https://journals.lww.com/00042728-200911000-00003 |journal=Dermatologic Surgery |language=en |volume=35 |issue=11 |pages=1728–1735 |doi=10.1111/j.1524-4725.2009.01284.x |pmid=19660028 |s2cid=1267050 |issn=1076-0512|url-access=subscription }}</ref><ref name="doi.org"/>
Serious complications include deep vein thrombosis, organ perforation, bleeding, and infection.<ref name="Tier2011">{{cite journal |last1=Tierney |first1=Emily P. |last2=Kouba |first2=David J. |last3=Hanke |first3=C. William |title=Safety of tumescent and laser-assisted liposuction: review of the literature |journal=Journal of Drugs in Dermatology |date=December 2011 |volume=10 |issue=12 |pages=1363–9 |pmid=22134559 |url=http://jddonline.com/articles/dermatology/S1545961611P1363X/1 }}</ref> As of 2011, deaths were reported to occur in about one per ten thousand cases.<ref>{{cite book|last1=Draelos|first1=Zoe|title=Cosmetic Dermatology: Products and Procedures|date=2011|publisher=John Wiley & Sons|isbn=978-1-4443-5951-0|page=Chapter 56|url=https://books.google.com/books?id=RQxk3aS_ntgC&pg=RA9-PT394}}</ref>
=== Medical tourism === {{See also|Stella Obasanjo}} To obtain liposuction at lower cost or at a shorter wait may encourage medical tourism. The Dominican Republic has been a popular destination for US medical tourists, because it is fairly close. Since 2003, the CDC has reported adverse events after cosmetic surgery, particularly due to liposuction in combination with gluteal fat transfer, abdominoplasty, and breast augmentation. During 2009–2022, 93 U.S. citizens died after cosmetic surgery in the Dominican Republic, and 90% of autopsy-confirmed deaths were due to embolism; in 55% due to fat embolism and in 35% due to pulmonary venous thromboembolism.<ref name="cdc">{{Cite journal |last=Hudson |first=Matthew |date=2024 |title=Deaths of U.S. Citizens Undergoing Cosmetic Surgery — Dominican Republic, 2009–2022 |url=https://www.cdc.gov/mmwr/volumes/73/wr/mm7303a3.htm |access-date=2024-01-25 |journal=MMWR. Morbidity and Mortality Weekly Report |volume=73 |issue=3 |pages=62–65 |language=en-us |doi=10.15585/mmwr.mm7303a3|pmid=38271279 |pmc=10824547 }}</ref>
=== Side effects === * Pain, which may be temporary or chronic * Post-liposuction fat redistribution or post liposuction weight gain * Bruising * Infections * Embolisms may occur when loosened fat enters the blood through blood vessels ruptured during liposuction. Pieces of fat can wind up in the lungs, or even the brain. Fat emboli may cause permanent disability or, in some cases, be fatal. * Puncture wounds in the organs (visceral perforations) may require surgery for repair. They can also prove fatal. * Seroma is a pooling of serum, the straw-colored liquid from blood, in areas where tissue has been removed. "Seromas, which are pockets of clear fluid, may form under the skin after liposuction.<ref name=Stephan2010>{{cite journal|last1=Stephan|first1=PJ|last2=Kenkel|first2=JM|title=Updates and advances in liposuction.|journal=Aesthetic Surgery Journal|date=2010|volume=30|issue=1|pages=83–97|pmid=20442081|doi=10.1177/1090820X10362728|doi-access=free}}</ref> * Paresthesias (changes in sensation that may be caused by nerve compression) is an altered sensation at the site of the liposuction. This may either be in the form of an increased sensitivity (pain), or numbness in the area. In some cases, these changes in sensation may be permanent, although typical patients recover over the span of several weeks.<ref name=Stephan2010/> * Swelling, in some cases, may persist for weeks or months after liposuction. * Skin necrosis occurs when the skin above the liposuction site changes color and falls off. Large areas of skin necrosis may become infected with bacteria or microorganisms. * Burns can occur during ultrasound-assisted liposuction if the ultrasound probe becomes hot. * Fluid imbalance may impact the patient after returning home. The condition can result in serious ailments such as heart problems, excess fluid collecting in the lungs, or kidney problems. * Toxicity from anesthesia due to the use of lidocaine, a skin-numbing drug, can cause lightheadedness, restlessness, drowsiness, a ringing in the ears, slurred speech, a metallic taste in the mouth, numbness of the lips and tongue, shivering, muscle twitching and convulsions. Lidocaine usage has already been linked to deaths from liposuction.<ref name=Paik2014>{{cite journal|last1=Paik|first1=AM|last2=Daniali|first2=LN|last3=Lee|first3=ES|last4=Hsia|first4=HC|title=Local anesthetic use in tumescent liposuction: an American Society of Plastic Surgeons survey.|journal=Annals of Plastic Surgery|date=2014|volume=74|issue=2|pages=145–151|pmid=25590254|doi=10.1097/SAP.0000000000000420|s2cid=8511923}}</ref> * Scars at the site of the incision are usually small and fade with time, although some may be larger or more prominent. * Deformities in the shape of the body may occur at the liposuction site after the procedure for about 20% of patients.<ref name=Stephan2010/> * Death
== History == Relatively modern techniques for body contouring and removal of fat were first performed by a French surgeon, Charles Dujarier, but a 1926 case that resulted in the amputation of the leg of a French dancer due to excessive tissue removal and too-tight suturing set back interest in body contouring for decades.<ref name=Bellini2017>{{cite journal|last1=Bellini|first1=E|last2=Grieco|first2=MP|last3=Raposio|first3=E|title=A journey through liposuction and liposculture: Review.|journal=Annals of Medicine and Surgery (2012)|date=December 2017|volume=24|pages=53–60|doi=10.1016/j.amsu.2017.10.024|pmid=29158895|pmc=5681335}}</ref><ref>{{cite journal |pmid=2473691 |year=1989 |last1=Glicenstein |first1=J |title=L'affaire Dujarier |trans-title=Dujarier's case |language=French |journal=Annales de Chirurgie Plastique Esthétique |volume=34 |issue=3 |pages=290–2 }}</ref>
Liposuction evolved from work in the late 1960s from surgeons in Europe using techniques to cut away fat, which were limited to regions without many blood vessels due to the amount of bleeding the technique caused.<ref name=Bellini2017/>
In the mid-1970s in Rome, Arpad Fischer and his son Giorgio Fischer created the technique of using a blunt cannula linked to suction; they used it only to remove fat on the outer thighs.<ref name=Sterodimas2012>{{cite journal|last1=Sterodimas|first1=A|last2=Boriani|first2=F|last3=Magarakis|first3=E|last4=Nicaretta|first4=B|last5=Pereira|first5=LH|last6=Illouz|first6=YG|title=Thirtyfour years of liposuction: past, present and future.|journal=European Review for Medical and Pharmacological Sciences|date=March 2012|volume=16|issue=3|pages=393–406|pmid=22530358}}</ref> In 1977, Arpad Fischer and Giorgio Fischer reviewed 245 cases with the planotome{{clarify|date=January 2024}} instrument for treating cellulite in the lateral trochanteric (hip-thigh) areas. There was a 4.9 per cent incidence of seromas, despite incision-wound suction catheters and compression dressings; 2 per cent of the cases developed pseudocysts that required removal of the capsule (cyst) through a wider incision (>{{cvt|5|mm}}) and the use of the panotome.<ref>{{cite journal|author1=Fischer A. |author2=Fischer G. |title= Revised Technique for Cellulite fat reduction in Riding Breeches deformity|journal= Bulletin of the International Academy of Cosmetic Surgery |year=1977|volume= 2|issue=4|pages=40–43}}</ref><ref>Schiffman, p. 3.</ref> The Fischers called their procedure liposculpture.<ref>{{Cite journal |last=Fischer |first=Giorgio |date=December 1997 |title=Liposculpture: My Technique |url=http://journals.lww.com/00042728-199712000-00012 |journal=Dermatologic Surgery |language=en |volume=23 |issue=12 |pages=1183–1187 |doi=10.1111/j.1524-4725.1997.tb00469.x |pmid=9426663 |s2cid=27004290 |issn=1076-0512|url-access=subscription }}</ref>
Yves-Gérard Illouz and Fournier extended the Fischers' work to the whole body, which they were able to use by using different sized cannulae.<ref name=Bellini2017/> Illouz later developed the "wet" technique in which the fat tissue was injected with saline and hyaluronidase, which helped dissolve tissue holding the fat, prior to suctioning.<ref name=Bellini2017/> Lidocaine was also added as a local anesthetic.<ref name=Bellini2017/> Fournier also advocated using compression after the operation, and travelled and lectured to spread the technique.<ref name=Bellini2017/> The Europeans had performed the procedures under general anesthesia; in the 1980s, American dermatologists pioneered techniques allowing only local anesthetics to be used; Jeffrey A. Klein published a method that became known as "tumescent" in which a large volume of very dilute lidocaine, along with epinephrine to help control bleeding via vasoconstriction, and sodium bicarbonate as a buffering agent.<ref name=Bellini2017/>
In 2015, liposuction surpassed breast augmentation surgery as the most commonly performed cosmetic procedure in the US.<ref name=Chia2017>{{cite journal|last1=Chia|first1=CT|last2=Neinstein|first2=RM|last3=Theodorou|first3=SJ|title=Evidence-Based Medicine: Liposuction.|journal=Plastic and Reconstructive Surgery|date=January 2017|volume=139|issue=1|pages=267e–274e|doi=10.1097/PRS.0000000000002859|pmid=28027260|s2cid=9549294}}</ref>
== See also == * Bariatrics – branch of medicine that deals with the causes, prevention, and treatment of obesity * Gastric bypass surgery * Lipotomy * Spot reduction * Death of Catherine Cando –Ecuadorian case involving liposuction complications
== References == {{Reflist}}
== External links == {{Commons category|Liposuction}}
{{Skin and subcutaneous tissue procedures|state=collapsed}} {{Authority control}}
Category:Abdominal surgical procedures Category:Management of obesity Category:Medical ultrasonography Category:Plastic surgery Category:Surgical removal procedures