How Is Liposuction Performed?

There are several different types of anesthesia and techniques that surgeons use to perform a liposuction.

Anesthesia

Procedure

Ultrasound-assisted liposuction

Anesthesia

The anesthesia your surgeon will choose depends on several factors, including:

• The amount of fat removed

• The liposuction technique selected

• Your pain tolerance

There are three primary types of anesthesia:

1. Local: This form of anesthesia numbs only the area to be treated. Usually, you will also receive a sedative, which will make you drowsy or may cause you to fall asleep. The local anesthetic is injected into the surgical area. The sedative is generally administered through an intravenous tube. You should feel no pain during the procedure but may experience a sensation of pulling or tugging.

2. Regional: An epidural block, the kind of regional anesthesia often used in childbirth, may be given in a liposuction surgery. It's administered in the form of an injection and is given in the back. This injection numbs the lower half of your body. These numbing effects wear off within a couple of hours after surgery. You will be awake during surgery but will feel no pain during the procedure.

3. General: You are unconscious with this type of anesthesia. This anesthesia is administered intravenously, often through a tube inserted into the back of your hand or elsewhere. As with the other types of anesthesia, you will not experience pain during the operation.

The Procedure

In most cases, the first thing the surgeon does is to inject a solution into the treatment area. The solution is comprised mostly of salt water, which works to make fat removal easier. This wetting solution also contains epinephrine, a medication that shrinks blood vessels, which acts to decrease bleeding and bruising. The solution also usually includes a local anesthetic to temporarily minimize pain.

The amount of wetting solution injected before the procedure varies depending on the technique employed.

• Wet liposuction: The amount of wetting solution is less than the volume of fat removed. This technique often requires intravenous (IV) sedation or general anesthesia.

• Super-wet liposuction: The wetting solution is equal to the volume of fat removed. This technique often requires intravenous (IV) sedation or general anesthesia.

• Tumescent liposuction: The wetting solution is two to three times the volume of fat removed. This solution causes fat deposits to swell (tumesce). Tumescent liposuction is the most commonly used liposuction technique and it usually requires only local anesthesia. This technique has the advantage of resulting in less bleeding, and therefore less bruising, than the wet techniques.

Doctors rarely perform dry liposuction anymore because fluid injection is safer.

After the fluid has been injected, the surgeon makes a small incision (cut) in your skin near the area that contains the fat that is targeted for removal. A narrow metal tube called a cannula is inserted through the cut into the area of excess fat.

The cannula is attached to a strong vacuum pump via a flexible pipe. By manipulating the cannula back and forth through the fat, the surgeon can suction out the fat cells. Usually, the incisions are closed with a few stitches.

Ultrasound-Assisted Liposuction

Ultrasound-assisted liposuction follows the same technique as with standard liposuction with the following steps:

• Fluid injection

• Small incision in the skin

• Insertion of a cannula (tube) into the incision

However, with ultrasound-assisted liposuction, the cannula is connected to an ultrasound machine, which uses energy from sound waves to break apart the cells in the unwanted fat. Then the surgeon suctions out the "melted" fat as well as the previously injected fluid. Usually, a few stitches are used to close the wounds.

The time for this type of surgery varies, but it generally is longer than for liposuction without ultrasound.