The fashion world has decreed that there is no room for flabby abs, bulgy thighs, or love handles. In response, droves of average citizens with a little extra flesh here and there are turning to liposuction.

How's It Done?

Liposuction is the surgical "vacuuming" of fat from beneath the surface of the skin. A special fat extractor (a thin hollow stainless steel tube) known as a cannula is inserted into the fatty areas between the skin and muscle through small incisions in the skin. The cannula creates tiny tunnels, breaks up the fat cells, and loosens them so they can be removed by a high pressure vacuum attached to the end of the cannula.

The tumescent technique, involves injection of large volumes of salt water containing lidocaine (a local anesthetic) and small amounts of adrenaline (a naturally occurring hormone that shrinks blood vessels) prior to the removal of fat. This numbs the tissues and shrinks the blood vessels, thereby eliminating pain and reducing bleeding, bruising, and swelling.

Other, newer liposuction techniques include Ultrasound-assisted, Power assisted liposuction and laser assisted liposuction. Just as it sounds, ultrasound-assisted liposuction uses ultrasound waves to bust up the fat, prior to vacuuming. Powered liposuction uses ultra-fast back-and-forth vibration of the cannula to break up the fat, while vaccuming it away. Laser assisted liposuction uses laser energy to liquefy fat prior to its removal.

Satisfied Customers

The upward trend of liposuction surgeries indicates that a great many patients are pleased with the results and experience minimal troubles.

"Liposuction is by far the most commonly performed surgical cosmetic procedure done in the country, and has the highest patient satisfaction index of any cosmetic surgery we do," says Leo McCafferty, M.D., a plastic surgeon and regional spokesperson for the American Society for Aesthetic Plastic Surgery. Liposuction is a good method of spot reduction, but is not an effective method of weight loss.

Kellie Gray, a 25-year-old salon owner from Fort Walton Beach, Florida, says, "I had 800 CCs (cubic centimeters) removed from my hips and outer thighs. My clothes fit better now and people keep asking, 'Are you losing weight?'"

Immediately following the surgery, Gray says she experienced a burning sensation in her legs, along with some swelling, soreness, bruising, and small scars that are hardly noticeable today. The worst part of liposuction, says Gray, was the pain, which, she adds, wasn't bad enough to dissuade her from doing it again. She also didn't like wearing the compression garment, which is a fancy girdle that's commonly worn for a few weeks afterwards to help reduce the swelling and to shrink the skin. Four weeks after the surgery, Gray's pants size had shrunk from a size 10 to a 6.

Kim McIntosh, 45, of Kinston, North Carolina, had a similarly successful outcome. At 35 years old, she had liposuction on her thighs, stomach, and waist.

"I had soft, fatty thighs and no shape in the waist," says McIntosh. She says the results were even better than she expected, although she did take medication to manage the pain. "The liposuction made a world of difference in how I looked, moved, wore my clothes—and in my self-esteem," McIntosh adds.

Poor Results

Leah Carlson, 42, of South Lake Tahoe, California, wasn't as fortunate. In 1995, after losing 120 pounds, Carlson still felt her hips and thighs were out of proportion, so she signed up for liposuction.

Contrary to her doctor's promises, Carlson's first liposuction surgery did not produce noticeable results.

"I was disappointed and the doctor was disappointed and completely confounded how he could've removed so much fat without any apparent change," says Carlson. "A few months later he offered to do another surgery at no charge. He thought that since I'd lost so much weight, this caused me to have very fibrous fat, and he wanted to try a new tool with which he had achieved excellent results."

The second liposuction procedure for Carlson proved a disaster.

"The surgeon used a cannula he wasn't trained to use. My lymphatic and vascular systems were destroyed, causing the tissue in both inner thighs to die," explains Carlson. Eventually gangrene set in and she was fighting for her life. Corrective procedures led to more than four years of medical troubles, such as leg circulation problems, which make it painful to stand, and leg swelling, which makes it difficult to sit.

Carlson is convinced the biggest factor to her botched liposuction experience was her doctor.

"I believed that if a doctor was a doctor and was able to perform a procedure, he must be well-trained. I assumed there were laws to make sure that was the case," says Carlson.

Not so.

"Anyone with an MD after his or her name can perform liposuction, with little or no training," says Carlson.

Armed With Knowledge

Dr. McCafferty is quick to agree that choosing a qualified doctor is critical. He says that liposuction is a "buyer beware" market. To reduce risk, McCafferty has the following tips:

  • Check the doctor's credentials. Liposuction should be performed by a plastic surgeon, preferably board certified in plastic surgery. To verify that a plastic surgeon is board certified, contact the American Board of Plastic Surgery.
  • Ask questions. Ask if your doctor has been trained in liposuction, and if so, when, where, and how long. Ask to see documentation that verifies training. Ask if your doctor has privileges to do the procedure in a hospital. Although most liposuction procedures are not done in a hospital, "admitting privileges" signify that the surgeon has been critically reviewed by other members of the medical staff, the hospital administration, and the credentialing boards.
  • Check out the facility. The procedure should be performed in an accredited office facility, outpatient center, or hospital.
  • Don't have too much removed. "Small liposuctions, where less than 2000 CCs of fat are removed, can be performed on an outpatient basis," says McCafferty. "But when you get to the moderate to large range—3000 to 5000 CCs—it's better to keep a patient overnight in a hospital or accredited extended care facility so as to monitor fluid, electrolytes, and urine output." 5000 ccs of fat is the recommended maximum amount of fat that should be removed in an outpatient setting.
  • Lose weight first. Liposuction becomes less safe as the amount of fat to be removed increases, so losing weight first makes your procedure safer.
  • Don't overdo it. The procedure is safer when done alone and not "piggybacked" with other cosmetic procedures, such as facelifts or breast augmentation. Combining a slew of procedures resulting in long operative times can lead to serious problems, says McCafferty.
  • Have a preoperative consultation . This screening is important. The ideal liposuction candidate needs to be in good overall health and have realistic expectations. He or she should also be a relatively normal weight but have collections of fat that don't respond to diet and exercise.

Why Take the Risk?

Before you decide to undertake the expense (most insurance doesn't pay) and the risk, you may want to rethink your motivation. Although liposuction may seem like a quick fix, says McCafferty, it is a surgical procedure with possible complications.