Liposuction

Liposuctions

Liposuction is invasive surgery in which deposits of fat are removed to reshape or reduce volume in one or more areas of the body. It can be done for reconstructive or cosmetic reasons. Common areas targeted include the thighs, buttocks, abdomen, arms, neck and under the chin. This operation is also known as suction-assisted lipectomy, liposculpture or lipoplasty.

Liposuction is not a substitute for weight loss or a cure for obesity. Having liposuction will not help prevent cardiovascular disease or improve your general health. It is also not an effective treatment for cellulite (dimpled skin that typically appears on the thighs, hips and buttocks) or for loose, saggy skin.

Body image concerns are the main reason people consider liposuction. Some people who are in their healthy weight range have localised pockets of fat that don’t respond well to diet or exercise. These areas of fat deposits may be due to family traits rather than a lack of weight control or fitness. Liposuction slims and reshapes these specific areas of the body by removing excess fat deposits and improving body contours and proportion.

Some people with diabetes may seek suction-assisted lipectomy to treat contour problems from repeated insulin injections. Other people have liposuction performed on them to remove breast tissue (gynaecomastia) or treat post-traumatic pseudolipoma (swelling that resembles a lipoma – a slow-growing fatty lump under the skin).

For more information visit the Guideline for providers of liposuction – consumer summary.

Changes to laws that affect cosmetic procedures

In 2018, amendments were made to the Health Services Act 1988 to regulate all surgery, including cosmetic surgery. The changes specified that:

• all surgery must be carried out in a registered private hospital or day procedure centre
• liposuction and anaesthesia, including intravenous sedation and anything more than a low dose of local anaesthetic, must be carried out in a registered private hospital or day procedure centre.

This means that it is now illegal for:

• liposuction to be performed in an unregistered facility – this includes all procedures during which more than 200 ml of lipoaspirate (fat) is removed from a person in total
• any surgery (including cosmetic surgery) to be performed in facilities that are not registered with the Victorian Department of Health
• anaesthetic (other than low doses of local anaesthetic) to be administered in an unregistered facility.

How do I know if a facility or health service establishment is registered?

To find out if a facility is registered, you can:

• visit the Department of Health Private hospitals page and expand the ‘contact details for private hospitals’ link
• email the Department’s Private Hospitals Unit privatehospitals@health.vic.gov.au
• ask to see the facility’s certificate of registration (this is usually on display in an obvious place where consumers can see it easily).

You can also contact the unit to report suspected illegal activity or for further queries regarding liposuction, cosmetic surgery or anaesthesia in Victoria.

Suitability for liposuction

Liposuction is best suited to people with a healthy weight and firm, elastic skin, who have pockets of fat in certain areas.

To be suitable for liposuction you must:

• be physically healthy
• be aware of the limitations of this operation
• have realistic expectations.

Although age is not a significant concern, older people may have less skin elasticity and may not achieve the same results as a younger person with tighter skin.

Things to consider before liposuction

Before you choose to have liposuction, there are some important issues to keep in mind, including:

• Liposuction is suitable if you have bulges that persist despite a healthy diet and exercise. It is not a substitute for weight loss.
• If your skin is dimpled before the liposuction, it will probably still be dimpled afterwards.
• If the ‘extra’ skin doesn’t contract (tighten) after liposuction, you may need a further procedure to remove excess skin.
• The final results may take a few months to emerge, so it is important to wait before making any decisions about the necessity for further surgery.
• Think about the financial cost. Cosmetic surgery does not usually qualify for rebates from Medicare or private health insurance companies. For more information:
  • Ask your medical practitioner about any out-of-pocket costs you can expect, and if you will be eligible for a rebate.
  • Visit PrivateHealth.gov.au for more information on private health insurance.
• Smokers are at increased risk of complications. To decrease the risk of complications, and for your general health and wellbeing, try to quit smoking before having surgery.
• Consider asking another medical practitioner for a second opinion. It is important to have as much information as possible, before deciding to have liposuction.

Finding a qualified medical practitioner

Ask your GP for advice on a suitable and reputable medical practitioner or hospital where liposuction is performed. At your first consultation, ask the medical practitioner about their training and experience.

Liposuction is not a medical specialty, and no specialised training is currently required. In fact, it can be performed by any registered medical practitioner, such as a GP or a dermatologist. However, it is preferable to have this procedure done by a medical practitioner who is specially trained to perform liposuction and has a lot of experience in carrying out this operation.

Your current medical status and liposuction

If you are considering having liposuction, you need to discuss your current medical status with your medical practitioner. This includes discussing:

• your physical health – including your past medical history, such as diseases, illnesses, surgeries, immunisations and current physical status, which will include your diet and exercise regime. This would be a good time for the medical practitioner to check your blood pressure, temperature, heart rate/rhythm, oxygen saturation and respiratory rate
• your mental health – any mental illnesses or issues and their treatments
• medications you are currently on, including vitamins and supplements
• past reactions to medications
• any allergies you have.

As a result of this discussion, your medical practitioner will be able to assess the risks and possible complications of the surgery for you. They will also be able to tell you what preparations you will need to make to ensure your recovery from surgery is as smooth as possible.

Liposuction – what happens during surgery

All surgery, including liposuction, must be performed within licensed and accredited facilities. A registered anaesthetist must be present to treat you for any adverse reaction you may have to the anaesthetic. You can check if your anaesthetist is registered by searching on the AHPRA website.

Liposuction can take place under either a local or general anaesthetic. The length of the treatment will depend on the technique chosen and the amount of fat to be removed.

If only a small amount of fat and a limited number of body sites are involved, liposuction can be performed under local anaesthesia, which numbs only the affected areas. Some people prefer general anaesthesia, particularly if a large volume of fat is being removed.

The exact operation will depend on the specific liposuction technique used but, in general, the steps include:

• A tiny incision (cut) is made and a sterile liquid solution is given (infused) directly into the vein to reduce bleeding and trauma.
• A cannula (thin, hollow tube) is inserted.
• The cannula is pushed and pulled through the fat layer using a controlled back and forth motion to break up the fat cells.
• The dislodged fat is then suctioned out of the body using a surgical vacuum pump or large syringe attached to the cannula.
• The patient is given intravenous fluids during and immediately after surgery to replace any fluid lost when the fat is removed.
• Depending on the number of areas receiving treatment, the procedure can take up to two hours.

In some cases, liposuction is performed alone. In other cases, it is used with other surgeries such as a facelift, breast reduction or abdominoplasty (‘tummy tuck’).

Follow-up surgery may sometimes be recommended to reduce excess skin. This may occur when large amounts of fat – usually more than five litres – are suctioned.

Liposuction techniques

Specific liposuction techniques include:

• ultrasound-assisted – an ultrasound device is used to melt the pockets of fat to make them easier to remove
• tumescent – fluids containing a local anaesthetic, epinephrine and saline are injected into the fat pocket. Epinephrine helps to constrict blood vessels and limit blood loss and bruising
• super-wet – the medical practitioner injects approximately the same quantity of fluid as the amount of fat to be removed.

Immediately after liposuction

After the operation, you may expect:

• bruising and swelling
• possible numbness and minor pain
• to be given antibiotics to prevent infection
• a small drain to remain in situ for a few days to prevent fluid build-up
• to be asked to start walking around as soon as possible – your medical practitioner may advise this to reduce swelling and help prevent blood clots from forming in your legs
• to wear a pressure garment – this may need to be worn over the treated area for about a week after surgery to control swelling and help the skin adjust to the new underlying shape.

Potential complications of liposuction

All surgery carries some degree of risk. The risks of liposuction increase if a large number of body areas are treated at the same time, or if the areas operated on are large in size.

Some of the possible complications of liposuction may include:

• thermal burn or other heat injury to the skin or deeper tissues from the ultrasound device that is used to liquefy fat cells. This can occur with ultrasound-assisted liposuction
• lignocaine toxicity (if the solution’s lignocaine content is too high). This can occur with tumescent and super-wet liposuction
• collection of fluid in the lungs (if too much fluid is given). This can occur with tumescent and super-wet liposuction
• excessive fluid loss, which can lead to shock
• fluid accumulation
• infection – this is a serious complication, as infections that develop in fatty tissues are difficult to treat
• delayed healing
• friction burns or other damage to the skin or nerves
• irregular skin surface, uneven contours or rippling
• asymmetric or ‘baggy’ skin surface
• change in skin sensation or numbness
• skin pigmentation changes, skin discolouration or swelling
• significant scarring
• damage to deeper structures such as nerves, blood vessels, muscles, lungs and abdominal organs
• pain, which may be ongoing
• allergic reactions to medications
• formation of blood clots or fat clots, which may migrate to the lungs and cause death
• persistent swelling in the legs
• deep vein thrombosis, cardiac and lung complications.

Further surgery may be necessary to address complications.

This is not a complete list. For example, your medical history or lifestyle may put you at increased risk of certain complications. Speak to your medical practitioner for more information.

Self-care after liposuction

Be guided by your medical practitioner, but general self-care suggestions include:

• You may need to take a few days off work to rest.
• Avoid strenuous activity for about one month as the body continues to heal.
• See your medical practitioner 7–10 days after surgery to have your stitches removed.
• You may need to continue wearing your pressure garment for several weeks.
• Report any bleeding, unusual symptoms or severe pain to your medical practitioner.

Long-term outlook after liposuction

Your improved body contour will appear when the swelling and fluid retention subside. It may take several months for the swelling to fully disappear. Usually, the ‘extra’ skin will contract (tighten) after liposuction. In some cases, however, a procedure to remove excess skin may also be needed.

Liposuction is considered to be permanent, yet substantial weight gain after surgery can lead to further build-up of fatty tissue, which may affect the result. To continue to enjoy the results of liposuction in the longer term, it is important to control your weight and maintain a healthy lifestyle (such as eating a low-fat diet and getting enough exercise).

Alternatives to liposuction

Alternatives to liposuction can include:

• eating a healthier, low-fat diet
• exercise
• massage
• talking to a counsellor or psychologist – this may help you overcome your concerns about your appearance, and you may decide that you like yourself the way you are

Where to get help

• Your GP (doctor)
• A medical practitioner specially trained and experienced in performing cosmetic surgery
• A second opinion from another medical practitioner specially trained and experienced in performing cosmetic surgery
• Your psychologist, councillor or psychiatrist
• Cosmetic surgery hub and hotline, Australian Health Practitioner Regulation Agency (AHPRA) Tel. 1300 361 041
• Cosmetic surgery, Department of Health and Aged Care, Australian Government
• Private Hospitals Unit, Department of Health Email privatehospitals@health.vic.gov.au
• Australian Society of Plastic Surgeons Information Hotline Tel. 1300 367 446
• Royal Australasian College of SurgeonsTel. (03) 9249 1200
• Australian Health Practitioner Regulation Agency (AHPRA) Tel. 1300 419 495