Swelling due to lipo will not dissipate until 3-4 months.

Q: I have some unwanted fat over my hips and abdominal wall that I have not been able to lose. I saw a few doctors about liposuction but had a variety of recommendations based on various machines and techniques. Basically, I’m confused. Can you give me a synopsis of the procedure and various alternatives?

-Leslie R., San Juan Capistrano

A: Liposuction is currently one of the most commonly performed surgical procedures in the United States by plastic surgeons - second only to breast augmentation. You certainly are not alone if you have concerns with unwanted fatty deposits! The beauty of this purely elective procedure is that it allows the surgeon to remove bothersome, disproportionate, localized fat deposits through relatively inconspicuous incisions. The liposuction procedure has been designed to vacuum away localized, stable fatty deposits - ideally those which cannot be controlled by diet and exercise. Liposuction should not be considered as an alternative method of weight control or a treatment for generalized obesity; nor will suction lipectomy help loose skin (unless combined with a traditional resection). Only the fat within the layer between the skin and the first layer of muscles is accessible to liposuction - fat within your abdominal cavity, for example, can just be decreased by consuming less calories or by burning more calories!

Plastic Surgeons usually performed liposuction in an outpatient surgical facility under a deep sedative or a light general anesthetic, supplemented by local anesthesia, although an occasional, a small area may be suctioned strictly under a local anesthetic alone. It should be noted that liposuction these days is frequently performed by non surgeons like dermatologists, family practitioners and even dentists. Since such practitioners are not surgeons and cannot get surgical privileges in hospitals or surgery centers, they will generally attempt to do such procedures in an office with just a local anesthetic (it is illegal in California to administer a general anesthetic in an office setting) - something that is technically feasible but not as comfortable for the patient or as safe because offices do not have to live up to the same quality and sterility standards as surgical facilities do. If you are considering seeing a particular doctor, you can always check the American Board of Plastic Surgery website to see if the doctor you are interested in is a Board Certified in Plastic Surgery – go ahead and give it a try and you’ll be amazed at how many doctors who represent themselves as plastic surgeons are indeed not plastic surgeons (https://www.abplsurg.org/ModDefault.aspx?section=PubFind)!

The liposuction procedure is done via small incisions in convenient skin folds and should not leave visible scars. Through these incisions, a metal cannula which is connected via rubber tubing to a vacuum machine, is inserted and passed back and forth in the fatty layer, removing the excess. During the early days of liposuction, larger cannuals which could leave surface irregularities were employed and blood loss could be significant. Now cannulas are of a much smaller diameter and fat removal is more precise. In 1986, Dr. Bunkis and associates published the results of their research with liposuction associated blood loss (Quantitative analysis of blood and fat in suction lipectomy aspirates. Plastic and Reconstructive Surgery 78:765) and recommended instilling local anesthetics containing epinephrine into the surgical fields to reduce blood loss. As a result, most surgeons doing liposuction today infiltrate large amounts of saline solution containing local anesthetics into the surgical sites prior to suctioning. Infiltrating this wetting solution is generally know as the tumescent techique and has resulted in less blood loss and reduced bruising, thus expediting recovery after liposuction.

A large variety of liposuction machines are now on the market and each manufacturer will tout his as the best one available (just as Chevy, Ford or Chrysler will tell you that their cars are superior to the competition, but is one brand really that superior to another?). We have a variety of machines available at the Laguna Hills and Tracy Surgery Centers where I perform liposuction, but it is generally accepted in the scientific literature that results are based more on surgical technique and the size of cannulas (the smaller the cannula, the less bruising and blood loss) than on brand or type of machine. The various Laser, Vaser, Water Jet, Power Assist, Laser and Ultrasound machines all produce comparable results, the main advantage over the older generation of machines being the decrease in bruising and the decrease in surgeon fatigue!

The only layer of fat which we can access with liposuction cannulas is the one between the skin and the underlying muscle (the amount you can pinch above the muscle). Despite loud claims to the contrary, none of the liposuction procedures significantly tighten loose skin! This is one good reason to have a surgeon who also does traditional excisional procedures evaluate you before you consider going ahead with a body contouring procedure. Such a qualified surgeon can offer both a liposuction alone option versus a combination of liposuction and skin removal to a patient, based on each patient’s needs and desires – thus, patient expectations are more likely to be met!

The bruising that results from liposuction usually subsides within three to four weeks, but the final swelling will not dissipate before three to four months have passed by (longer for ankles and calves).

The absolute maximum amount of fat that can be removed safely in the ideal young and healthy candidate is limited to 5 liters of aspirate - and because of a few overzealous surgeons who have caused patient deaths in the past, this 5 liter limit is now encoded as law in the State of California. But not every patient is a candidate to have 5 liters of fat aspirated at any given procedures - the patient’s age, general health and body size may limit the amount of fat which can be removed safely at any one operative sitting to a number fat below the legislated 5 liter limit. Suctioning of larger amounts will increase health risks and could necessitate a transfusion. Performing a second operative procedure three to four months after the first procedure will be recommended as a safer approach if removing more than a total of five liters of excess fat is anticipated.

If you have any specific questions about liposuction or body contouring procedures, your best bet would be to see a qualified plastic surgeon to review your options. Pease feel free to contact our office at 949-888-9700 to set up an appointment with Bunkis; you may also check out our web site at www.orangecountyplasticsurgery.com to get further information about our office or procedures we offer. I’ll also share a few examples to give you an idea of the possibilities that liposuction offers.

 (Actual patient of Dr. Bunkis) 46 year old female, before and 3 years after aspiration of the excess fat from her abdominal wall and flanks. 

(Actual patient of Dr. Bunkis) 42 year old female before and after a neck liposuction and an upper eyelid blepaharoplasty 

(Actual patient of Dr. Bunkis) 34 year old male before and after abdominal wall, flank and chest liposuction (5,000 cc)


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