by Janice Wells
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) or
cannula is inserted into the fatty areas between the skin and muscle, through
small incisions in the skin. The extractor 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.
Another technique, known as 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). This numbs the tissues and shrinks the blood vessels, thereby
eliminating pain and reducing bleeding, bruising, and swelling.
Trying to look good
According the American Academy of Cosmetic Surgery, there was a 62% increase
in the number of liposuction procedures performed between 1998 and 1999—from
373,000 to 599,000.
"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.
Satisfied customers
The upward trend of liposuction surgeries indicates that a great many
patients are pleased with the results and experience minimal troubles. Kellie
Gray, for example, 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."
Disastrous 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 M.D. 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 recommends the following:
Check the doctor's credentials
- Liposuction should be performed by a 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, 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."
Lose weight first
- Liposuction becomes less safe as the amount of fat to be removed
increases, so losing weight first makes your procedure more safe.
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 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 serious surgical procedure. Why subject yourself to a surgical procedure just because gravity has redefined the way you look? Could an exercise program firm up those problem spots? Do you really need to wear a size 8? Or could you live with a great new haircut, a daily exercise program, healthful eating, and supportive family and friends?