Complementary Information on Liposuction

Liposuction allows the radical and permanent removal of localised fat deposits.

These localised fat deposits generally do not disappear despite dieting or physical exercise.

However, liposuction is not a weight loss method and its purpose is therefore not to control the patient's weight: a correctly performed liposuction will not eliminate the need for improved lifestyle habits. Liposuction is not a treatment for obesity.

The principle of liposuction (developed from 1977 by Yves-Gerard ILLOUZ) is to introduce, through very small incisions, blunt-tipped, non-cutting cannulas with multiple openings at their tip. These cannulas are connected to a closed circuit in which negative pressure is created.

This is how the harmonious and non-traumatic aspiration of excess fat cells becomes possible.

Since these fat cells do not have the ability to multiply again, there will be no recurrence of this excess fat cell population.

In practice, liposuction can be applied to a large number of body areas: "saddlebags" of course, but also the hips, abdomen, thighs, knees, calves, ankles, arms and back. Technical improvements have also extended its application to the face and neck (double chin, facial contour).

Recent advances, particularly in superficial liposuction using very fine cannulas, mean that the skin overlying the treated area no longer suffers from liposuction: on the contrary, the skin's appearance can be improved by the skin retraction generated by correctly performed superficial liposuction.

However, it should be kept in mind that liposuction, despite its extreme popularisation in recent years, must always be considered as a genuine surgical procedure that can legally be performed in France only by a competent and qualified plastic surgeon, specifically trained in this type of technique and practising in a truly surgical setting.

The treatment of such localised fat deposits does not warrant coverage by health insurance.

A preoperative assessment is carried out in accordance with prescriptions.

The anaesthetist will be seen in consultation no later than 48 hours before the procedure.

Smoking is not an absolute contraindication, but cessation one month before the procedure is recommended given its adverse effect on healing.

Discontinuation of oral contraception may be required, particularly in cases of associated risk factors (obesity, poor venous condition, coagulation disorders).

No medication containing aspirin should be taken in the 10 days prior to the procedure.

Depending on the type of anaesthesia, you may be asked to fast (no food or drink) for 6 hours before the procedure.

Type of anaesthesia: liposuction can be performed, depending on the case and the extent of the areas to be treated, under local anaesthesia, under local anaesthesia deepened by tranquillisers administered intravenously ("twilight" anaesthesia), under general anaesthesia, or possibly under regional anaesthesia (epidural or spinal anaesthesia).

The choice between these different techniques will result from a discussion between you, the surgeon and the anaesthetist.

Hospitalisation: the duration of hospitalisation depends on the amount of fat extracted. It may be short, on the order of a few hours for small liposuctions (when local anaesthesia was used). It will be 1 or 2 days for more extensive liposuction (performed under general anaesthesia).

Each surgeon adopts a technique of their own, which they adapt to each case to achieve the best results. However, common basic principles can be identified:

The incisions are short (approximately 3 or 4 millimetres) and discreet, as they are most often hidden in a natural fold.

In some cases your surgeon may propose "assisted" liposuction (motorised cannulas, vibrating cannulas, radiofrequency-coupled devices, etc.) intended to improve results on very lax skin or skin heavily infiltrated with cellulite. Their actual effectiveness remains controversial, but they may provide an additional benefit in certain indications.

The amount of fat extracted must of course be adapted to the quality of the overlying skin, which is one of the determining factors for the quality of the result.

At the end of the procedure, a shaping compression garment to limit postoperative oedema is applied, most often using an adapted compression garment or elastic bandages.

The duration of the procedure depends on the amount of fat to be extracted and the number of areas to be treated. It can vary from 20 minutes to 3 hours (averaging 1 to 2 hours).

It should be noted that the time needed to recover from liposuction is proportional to the amount of fat extracted.

In the postoperative period, ecchymoses (bruising) and oedema (swelling) appear in the treated areas.

Pain is variable but generally mild, thanks to the use of very fine cannulas.

Fatigue may be felt during the first few days, especially after significant fat extraction.

Normal activities can be resumed 2 to 10 days after the procedure, depending on the extent of the liposuction and the type of professional activity.

Bruising resolves within 10 to 20 days after the procedure.

Wearing a compression garment is recommended for 2 to 4 weeks.

Sports activities can be expected to resume 3 weeks after the procedure.

The treated areas should not be exposed to sun or UV light for at least 3 weeks.

There is no noticeable change in appearance during the first 2 to 3 weeks, as initial postoperative swelling of the operated tissues (oedema) is present.

It is only after 3 weeks, once this oedema has resolved, that the result will begin to appear. The skin will take approximately 3 to 6 months to fully retract over the new contours and adapt to the new silhouette.

In some cases, it is possible to take advantage of the extraction of this natural tissue, fat, to re-contour certain areas considered insufficiently shaped (face, buttocks, hands, breasts — still much debated except in cases of reconstruction after cancer). If this option interests you, discuss it in advance with your surgeon as not all scenarios are necessarily feasible (see "autologous fat re-injection or lipostructure").

Assessed definitively within 6 months after the procedure, the result is most often satisfactory, whenever the indication and technique have been correct: the liposuction will have permanently eliminated localised fat deposits while producing appreciable skin retraction.

The goal of this surgery is to bring about an improvement, not to achieve perfection. If your expectations are realistic, the result obtained should give you great satisfaction.

We have seen that, in most cases, a correctly indicated and performed liposuction provides a real benefit to the patient, with a satisfactory result conforming to expectations.

In some cases, localised imperfections may be observed, without constituting real complications: under-correction, residual asymmetry, or surface irregularities. These are generally amenable to complementary treatment: a small liposuction "touch-up," often performed under simple local anaesthesia from the 6th postoperative month onward.

Liposuction, although performed for essentially aesthetic motivations, remains a genuine surgical procedure, which implies the risks associated with any medical act, however minor.

A distinction must be made between complications related to anaesthesia and those related to the surgical procedure.

Regarding anaesthesia, during the consultation, the anaesthetist will personally inform the patient of the anaesthetic risks. It should be understood that anaesthesia induces sometimes unpredictable reactions in the body that are more or less easy to control: having recourse to a fully competent Anaesthetist practising in a truly surgical setting (recovery room, resuscitation facilities) means that the risks incurred have become statistically very low.

Indeed, techniques, anaesthetic products and monitoring methods have made immense progress over the past thirty years, offering optimal safety, especially when the procedure is performed electively and on a healthy person.

Regarding the surgical procedure: by choosing a qualified and competent Plastic Surgeon, trained in this type of intervention, you minimise these risks as much as possible, without however eliminating them entirely.

True complications are exceptional after quality liposuction: great rigour in the choice of indication and surgical execution should provide effective and genuine prevention in practice.

For completeness, however, the following should be mentioned despite their usual rarity:
• Thromboembolic events (phlebitis, pulmonary embolism) are the most serious complication. The risk of occurrence is increased if such an event appears in the patient's medical history. Anti-thrombosis stockings, early mobilisation and possible anticoagulant treatment help reduce this risk.
• Bleeding is rarely serious, except in cases of associated coagulation disorders.
• Haematoma and lymphatic effusion occur exceptionally after correctly performed liposuction.
• Likewise, localised skin necrosis, which prolongs healing time and may leave scars, should no longer be observed.
• Infection, extremely rare in this type of "closed" surgery, can be prevented by prescribing prophylactic antibiotic treatment.
• Finally, metabolic disturbances or anaemia have been observed following excessive liposuction.
• Overall, risks should not be overestimated, but one should simply be aware that a surgical procedure, even an apparently simple one, always involves a small element of uncertainty.

Choosing a qualified Plastic Surgeon ensures that the practitioner has the training and competence required to prevent these complications, or to treat them effectively should they arise.