Article medically reviewed by Dr. Gavin Chan (MBBS, cosmetic physician, liposuctionist)
Templestowe Lower and Berwick Clinics
Dr. Gavin Chan has a background in intensive care, anaesthesia, and emergency medicine. Since 2004, Dr. Chan has provided cosmetic procedures, including anti-wrinkle injections, dermal fillers, liposuction, fat transfer, skin needling, and laser treatments. He is a doctor trainer for various dermal fillers and anti-wrinkle injections.
Last updated 1 July 2020
- Liposuction is used to permanently correct disproportionate fat deposits that are genetically acquired
- Liposuction is not for weight loss. Weight loss may be required prior to performing liposuction.
- Liposuction is best performed under general anaesthesia for patient comfort
- Liposuction of over 200mL needs to be performed in an accredited day surgery facility or hospital
- Local anaesthetic solution is infiltrated into the treatment area prior to liposuction. Liposuction is then performed with a cannula to remove the fat.
- A compression garment needs to be worn post-procedure for several weeks
- As with all surgical procedures, there are risks and complications associated with liposuction, however, overall it is a very safe and effective procedure.
Liposuction and body contouring - an introduction.
Liposuction is the world’s most popular cosmetic surgery procedure. It is an effective method of body contouring. Through targeted fat removal the body can be permanently reshaped. Liposuction is also commonly known as liposculpture or ‘lipo’.
Liposuction is performed with a long hollow metal tube called a cannula. Negative pressure or suction is applied through the cannula. The cannula is systematically passed through the treatment areas. Fat is suctioned and removed with the cannula to contour the body. It is possible also to transfer the removed fat to areas such as the face or buttocks to volumise those areas.
Genetically, we are predisposed to fat accumulation in certain areas. These accumulations may cause disproportionate body shapes or irregular body contours. Spot reduction of fat cannot be achieved with weight loss alone.
Men and women accumulate fat in different areas. Men tend to be more similar in shape and accumulate fat in the neck (double chin), chest, abdomen, and hips or ‘love handles’. Women tend to have more variation in their fat distribution. Fat accumulation can occur in the abdomen, hips, waist, thighs, calves, neck, arms or back. Women tend to have three main body shapes;
- Gynoid – colloquially known as the ‘pear shape’. Fat accumulation occurs mainly in the buttocks and thighs. The upper body, including the abdomen, breasts and arms tend to remain thinner.
- Android – colloquially known as the ‘apple shape’. Fat accumulation occurs mainly in the upper body. Abdomen, hips, waist, back, arms, and breasts tend to be bigger. The neck tends to accumulate fat leading to a double chin. Legs often remain very slim in comparison to the upper body.
- Hourglass – this is the most uncommon body shape for females, but the most desirable. Fat distribution is towards the buttocks and breasts, and the waist remains thin.
Liposuction is generally performed with the aim of creating an hourglass figure. Liposuction can be performed on almost any area of the body from the neck to the ankles. The body shape change is permanent. If weight gain occurs, the treated areas will not increase in size as quickly as it normally would prior to liposuction, as fewer fat cells remain in that area.
Case study 1
This patient had concerns about her mid-section. She tended to accumulate weight in this area and her legs and buttocks remained relatively thinner. She had liposuction to her abdomen, hips, waist, back, and arms. The fat that was removed from these areas was transferred to her buttocks to help further balance her proportions.
Choosing a liposuction surgeon
Liposuction is performed by a variety of doctors, including cosmetic surgeons and plastic surgeons. However, the most important factors when choosing a liposuction surgeon should include;
- Experience – how many cases of liposuction have they done and how often do they perform the procedure? Have they had experience with others with similar concerns?
- Understanding the ideal body shape – do they understand what areas need to be contoured with liposuction to transform your body shape into the ideal body shape?
- Surgical skills and ability to perform surgery – it is difficult to determine one’s surgical skills without a proper assessment, but are their previous results smooth and even? Are they fit enough to perform the physically challenging surgery of liposuction?
- Judgement – is what they are proposing to you a safe plan? Can they explain the rationale behind the plan they are proposing?
- Reputation – what is the satisfaction rate of their patients?
- Communication skills – are they able to effectively communicate with you? Are you comfortable expressing your concerns to them? Do they effectively communicate their plan to you?
Where should liposuction be performed?
In Australia, liposuction of greater than 200mLs must be performed in an accredited day surgery facility or hospital.
Accreditation helps to ensure certain criteria have been satisfied, and that the facility will be of a certain standard.
At the Victorian Cosmetic Institute, we perform liposuction in our accredited day surgery centre (pictured here).
Case study 2
This patient has previously had breast augmentation and wanted liposuction to help to balance her proportions. She had liposuction to her abdomen, hips, waist, back, arms, inner and outer thighs, and fat transferred to her buttocks. The result was an improvement in her body proportions and smoother lines to her shape.
When should I have liposuction?
Fat distribution patterns are genetic and tend to worsen with age and weight gain. Skin elasticity is better the younger you are. Given these facts, it may be argued that liposuction should be done at an earlier age whilst the skin elasticity and general health is optimal.
Often patients ask if they should have liposuction before or after weight loss. For those who are significantly overweight, it may be prudent to lose weight first. This will reduce the risk of surgery and allow a greater percentage of fat to be removed safely. Achieving a healthy and sustainable weight is preferred prior to any liposuction.
The other question that is often asked by women is, ‘should have liposuction before or after pregnancy?’. As with most cosmetic procedures, liposuction is contraindicated during pregnancy or breastfeeding periods. However, it is reasonable to suggest that females contemplating liposuction should have the procedure prior to pregnancy rather than delaying it until after. The integrity and elasticity of the skin are better prior to pregnancy in most cases, and this will allow for better results. Also, by removing the fat stores prior to pregnancy, these fat stores are less likely to expand during pregnancy and cause undue stress and stretch on the skin.
Who cannot have liposuction?
Those who are pregnant, breast-feeding, have blood clotting disorders or bleeding disorders, and those who have significant medical problems such as cardiac or respiratory problems, that may increase the risk of the procedure or recovery period.
Those with significant skin laxity due to ageing, weight loss or pregnancy, should be cautioned prior to having liposuction. Liposuction in the setting of skin laxity may cause further laxity and irregularity of the skin and an unacceptable appearance. Often skin tightening or skin reduction surgery is required prior to liposuction. An abdominoplasty is an example of a surgical procedure performed to remove excess skin as well as tighten abdominal musculature.
The consultation process
The first step is to have a consultation with one of our surgeons. Your medical history, medications, past surgical history, weight and body shape will be considered and your suitability for liposuction assessed.
The surgeon will assess your body shape and fat distribution. Skin-fold thicknesses and body circumferences will be taken. An overall assessment of the body fat distribution will be performed to determine the areas most suited to liposuction.
Skin elasticity is assessed. The degree of fat removal needs to be balanced with the skin’s ability to retract afterwards.
Before the procedure, depending on your health and the areas to be treated, you may also be required to have some test including;
- Blood tests – to examine your haemoglobin levels, platelet counts, kidney function, liver function, thyroid function, cholesterol, blood sugar level, and your blood’s clotting function. A pregnancy test may be performed if you are a female of childbearing age.
- ECG or stress ECG – for those with a history of cardiac problems or for those over 60
- Imaging studies – an ultrasound may be performed in those undergoing liposuction for gynaecomastia or ‘man boobs’ to determine the amount of fat and glandular tissue present
You will be measured and fitted for a compression garment that needs to be worn after the procedure. You will also be given a prescription for analgesics to be taken post-operatively.
Choice of anaesthetic: Local, twilight or general
Liposuction can be performed under local anaesthetic alone (fully awake), ‘twilight’ sedation, or with a general anaesthetic. The type of anaesthetic used will depend on the patient’s and surgeon’s choice, and the extent of the liposuction required;
- Local anaesthetic only (awake) – Liposuction under local anaesthetic only was first devised and performed by Dr Jeffrey Klein over 20 years ago. There may be discomfort or pain experienced as the local anaesthetic is infiltrated into the treatment area. It is best suited to smaller liposuction procedures.
- ‘Twilight’ sedation – Liposuction can be performed with intravenous medication and local anaesthetic. The patient is sedated, but often able to talk or respond to commands. Memory of the procedure may be hazy or intact depending on the drugs and amount of drugs given. The patient may be prone to moving during the procedure. There is a limitation to the degree of sedation that can be given as there is no airway used. Over-sedation may lead to obstruction of the airway. Balance between over and under-sedation is difficult.
- General anaesthestic – in most cases liposuction is best performed under general anaesthetic. Local anaesthetic is still used in smaller amounts and can reduce post-operative pain. A general anaesthetic involves the use of an airway, and is a deeper form of anaesthesia than twilight sedation. Patients do not tend to move, allowing the surgeon to perform the procedure more easily.
The liposuction procedure
On your arrival, you will have a final pre-operative consultation with your doctor before the procedure. Your doctor will mark and photograph the areas to be treated.
As liposuction is a sterile procedure, your skin is cleaned with an antiseptic solution. Small incisions are made in the skin to allow access to the fat to be removed. These incisions are very small. In most cases, they are made in inconspicuous areas such as a skin crease, so they cannot be seen once healed. The number of incisions made will usually depend on the area treated, and the access required. Most areas need 2 access points to ensure even fat removal.
From these incisions, the local anaesthetic solution is infiltrated into the fat of the treatment area. The local anaesthetic solution is a mix of;
- Local anaesthetic – xylocaine is the most commonly used local anaesthetic
- Sodium bicarbonate (optional) – this reduces the discomfort from the administration of the local anaesthetic. Not required if under a general anaesthetic.
- Adrenaline – this helps to constrict the surrounding blood vessels. By doing so, this reduces bleeding, bruising and keeps the local anaesthetic from being absorbed into the systemic circulation.
Once the local anaesthetic solution has been infiltrated into the fat, the area becomes swollen, and the fat layer becomes expanded, allowing for easier passage of the cannula and fat removal. The skin overlying the area becomes blanched from the adrenaline in the local anaesthetic solution. A cannula (a thin metal tube with a blunt tip and small holes at the end) is used to pass through the area to systematically to remove some of the fat. Light suction is provided by a machine or syringe (with its plunger pulled back) at the end of the cannula. The removal of fat relies mostly on the rasping action of the cannula’s holes rather than the suction.
Your doctor will constantly be assessing the areas treated for fat thickness and evenness by visual examination and pinching the area. The end-point for liposuction is not when all the fat is removed, but when enough fat is removed to provide a smooth contour and shape.
The entry points are then sutured or left open for drainage of the infiltrated local anaesthetic, dependent on their position and surgeon preference.
A compression garment is worn immediately after the procedure. The compression garment is recommended for 6 weeks and helps reduce swelling, bruising, and importantly help the skin retract after the removal of the fat.
Power-assisted liposuction and VASER liposuction
Power-assisted liposuction and VASER both help with the removal of fat with liposuction.
Power-assisted liposuction* – this technique involves the use of an oscillating cannula that is powered by an electric motor or compressed air. The tip of the cannula moves back and forward by a few millimetres in addition to the larger back and forth movements created by the surgeon. The advantages of this technique include; less operator fatigue, easier and smoother fat removal, and less trauma to the tissues treated as the oscillating tip passes through fibrous tissues easier.
Ultrasound (internal) assisted liposuction – Include machines such as the VASER. An ultrasound probe is firstly inserted into the area to be treated. Ultrasound energy helps to break down the fat and help to reduce blood loss during the procedure. The advantage of VASER is that liquefication of fat prior to suctioning can help make the procedure less traumatic. VASER is also used to perform Hi-Def liposuction. This is liposuction where there is an additional final step to accentuate the body shape and muscles. For example, extra liposuction can be performed over the tendinous insertions of the abdominal muscles to create a six-pack appearance.
After the procedure, you will be discharged home when appropriate, and you will need to arrange transport home as you will not be able to drive. You will require a friend or family member to take care of you when you arrive home.
After liposuction, there may be some drainage from the wounds. Usually, this fluid is absorbed by pads that are placed inside the compression garment. They may need to be changed, depending on the degree of drainage.
You will be prescribed pain killers or analgesia post-liposuction. Usually, the local anaesthetic given during the procedure takes a few hours to wear off, so you may not require any pain relief for some time after the procedure. The pain from liposuction is often likened to muscle soreness after a heavy workout, and in most cases still permits you to do light activities. Your normal exercise routine can be resumed usually after a week or more, once the discomfort has settled down. You will be able to return to work in most cases after a few days, but this depends on the number of areas treated, your recovery speed, and your line of work. Most people who have office jobs can return to work after 2 days, but this will depend on the number of areas treated.
The compression garment needs to be worn for several weeks post-procedure. Showering and garment removal should be minimised especially during the first week.
Your post-operative check-ups will occur on day 1,3 and 7. Sutures are removed on day 7.
Possible risks and complications arising from liposuction
As with any surgical or cosmetic procedure, there are risks as well as benefits to the procedure. Overall, done properly, liposuction is a safe and effective procedure that leads to aesthetically pleasing results.
Any surgical or invasive procedure carries risks. You should discuss these with your surgeon.
Complications from liposuction can be broadly categorised into cosmetic complications and medical or surgical complications. These include;
- Cosmetic complications are usually from over or under liposuctioning or a particular area and result in outcomes that may not be satisfactory to the surgeon or patient.
- Proper patient selection is an important part of reducing cosmetic complications, for example, a patient with poor skin elasticity may not achieve the results they desire due to poor skin retraction post procedure. Also, it is important for the surgeon to properly manage the patient’s expectations prior to the liposuction, and give them realistic expectations of what can and cannot be achieved.
- Skin irregularities – this is usually caused by over-liposuctioning, uneven liposuction, or too superficial liposuctioning or an area or areas.
- Skin laxity – Over-liposuctioning of an area can lead to a reduction of fat that the skin cannot retract enough over. The looser the skin to begin with, the more likely this will happen. If a larger fat deposit needs to be removed, sometimes it is done over two sessions to give the skin a better chance to retract.
- Missed areas – which are larger than surrounding areas and require further liposuction to correct.
- Cosmetic complications are usually managed by a ‘touch-up’ procedure. This may involve a small amount of liposuction to an area that is irregular or protruding after the initial liposuction, or transfer of fat from another part of the body to fill in a defect that has occurred from over-liposuctioning of a particular area. It is important to note that the final shape from liposuction is not usually achieved for 6 months, and that tissue remodelling occurs for about 1 year. Therefore, touch ups are usually best left for at least 6 months after the initial procedure.
- Medical or surgical complications make up a much smaller percentage of the complications that occur from liposuction, as liposuction done properly is a very safe procedure.
- Liposuction performed under general anaesthetic or sedation carry the usual, albeit small risks, associated with the use of anaesthetic agents.
- Excessive blood loss with today’s modern liposuction techniques is extremely uncommon.
- Infection after liposuction is again extremely uncommon, due to the fact that a sterile field is always maintained during the procedure, prophylactic antibiotics are given immediately before the procedure and are taken by the patient for a week after the procedure, as well as the fact that the anaesthetic solution given to numb the fat is antibacterial.
- Lignocaine toxicity – lignocaine is the local anaesthetic agent that is used in most liposuctions and this is safe up to a certain level that is based on the patient’s weight. Some drugs taken by the patient, including conventional medications and herbal medications, may interfere with the metabolism of lignocaine, and therefore it is important to disclose any medications you are taking to your doctor.
- Haematoma – also known as a collection of blood under the skin. Usually modern compression garments and the foam applied post-surgically prevent these, but they may require drainage
- Seroma – A collection of fluid under the skin that requires drainage, usually on a daily basis. Again compression garments help to significantly reduce seroma formation. They are more common with ultrasonic liposuction than other liposuction technques.
- Deep vein thrombosis / pulmonary emboli – this complication can result from any surgery due to the fact that surgery in association with the relative reduction in movement after surgery can promote blood clots e.g in the legs. These clots can then embolise to the lung (pulmoary emboli). You need to let your treating doctor know if you have a history of deep vein thrombosis so that appropriate measures can be taken. Liposuction done under local anaesthetic has a lesser chance of causing deep vein thrombosis than liposuction done under general anaesthetic as your still can use your muscles during liposuction under local anaesthetic, and this helps to promote circulation and prevent stasis of blood.
Overall, although complications cannot be avoid completely, with proper patient counselling, patient selection, and surgical technique, most complications can be reduced or avoided.
Liposuction: how much does it cost?
The price of liposuction will depend on the areas treated, the number of areas treated, the type of anaesthetic used.
It is important to realise that certain areas may be to be done in conjunction with others in order to achieve the best result. For example, it may be prudent to treat the hips if the outer thighs are being treated, otherwise, they will tend to look out of proportion. Therefore, we advise that a consultation is undertaken to ascertain what areas might best be treated to obtain the best results.
All post-liposuction review appointments are included in the price of the liposuction.
Theatre fees will depend on the length of the operation.
If performed under intravenous sedation or general anaesthetic, an anaesthetists fee will apply. This will depend on the anaesthetist and will depend on the time taken.
Due to the fact that liposuction in most cases is a cosmetic procedure, it does not attract rebates from private health insurance.
The cost of the liposuction surgical fees will depend on the extent and time required to perform your liposuction, and can only be assessed at the time of consultation.
Why choose Victorian Cosmetic Institute for liposuction?
Dr Gavin Chan and Dr Bruce Heideman are highly experienced, specialist liposuction surgeons.
Our techniques have been developed and refined over many years. We utilise Microaire power-assisted liposuction cannulas, VASER and Renuvion to help achieve the ideal liposuction outcomes. Our liposuction is performed at our accredited day surgery facilities.
We provide the highest level of patient care through our doctors and nurses, as well as by maintaining our facilities to the highest of standards.
As each person is differently shaped, we tailor each treatment to specifically suit the needs of each patient, and we are very thorough in our assessments prior to the procedure.
Overall, our goal is to provide the best experience possible for you when you come to see us.