The Liposuction Paradox


June 2, 2017

Liposuction is simultaneously one of the most frequently performed cosmetic procedures in the world and also one of the most commonly misunderstood. Liposuction is performed so frequently because it can deliver wonderful results with minimal downtime. Ironically, these areas (results and downtime) seem to generate a great deal of the concern many have about the procedure. Misunderstandings about who is a good candidate for liposuction also cause a good deal of confusion.  I’ll address each of these points here.

Let’s begin with the question about who is a good candidate for liposuction. The most basic criterion is the same as for any elective surgical procedure: you should be in overall good health. This isn’t to say you need to a professional athlete by any stretch, but any medical problems you might have should be well managed by your primary care doctor. Next are questions about how you are put together. In other words, “where is your fat and how does it look?” Generally, fat that is soft and that can be (gently) pinched by the examiner will respond well to liposuction. A bulging belly that is very firm probably won’t respond well to liposuction. This presentation implies that the fat is under the abdominal wall (behind the six-pack muscles), so we cannot safely address it surgically with liposuction nor with any other modality. This fat is exclusively at the mercy of diet and exercise. The next consideration is what is going on over the fat: how is your skin tone? People with very loose skin (this group most likely includes woman after childbirth and anyone after massive weight loss) may not be well served by having liposuction.  Removing the fat in this context can actually make loose skin look worse (think about what happens when you deflate a balloon). It’s not a flattering analogy, but it works: if there isn’t anything filling the balloon (or the skin envelope), it can look wavy or have rippling. Other options might be more appropriate. Finally, the best liposuction candidates are the ones that have realistic expectations. The key here is knowing what liposuction can do and what it cannot do. Liposuction is really a body contouring procedure. Patients can achieve a better shape for their body by removing bulges and enhancing flattering curves.  Liposuction is not weight loss surgery.  You’ll see amazing changes in the mirror, not so much on the scale.

In terms of the results you can expect, our liposuction Manhattan is designed to deliver a more fit version of your existing frame. It is unusual to perform a complete body transformation with liposuction alone. However, the individual that comes in with a bulging lower abdomen, protruding love handles, or a “boxy” torso, for example, is going to be very happy with the results. Thigh gap? Lipo can do that too. Arms a bit too full? Liposuction can slim them down. Someone who is generally overweight and is hoping liposuction will take the place of diet and exercise, however, will be disappointed. People read horror stories (ahem, internet) about lumps, bumps and other irregularities after liposuction.  This can indeed happen, and this why it is critical to select a surgeon who is a true liposuction expert. With the right surgeon, you can expect smooth, natural results.

In terms of downtime, this also has a lot to do with selecting the right surgeon and understanding the technique they use (the intensity of the procedure dictates the length and discomfort of the recovery). In our practice, the vast majority of patients having liposuction on a Friday will be back at work by Monday, only wearing a compression garment over weekend. Really? Really. We achieve this by using carefully controlled amounts of a specially designed anesthetic fluid and working with an excellent anesthesiologist. This allows us to do virtually all of our liposuction cases under sedation (like you’d have for a colonoscopy) rather than general anesthesia. You are awake and breathing on your own for the entire procedure, blissfully unaware of the goings-on in the room although you likely won’t remember any of it anyway.  In terms of discomfort during the (brief) recovery process, patients describe the feeling as being akin to a hard workout.

So, why is such a frequently performed procedure the subject of such misunderstanding? For one thing, many that undergo the procedure and have first-hand knowledge choose to keep it quiet. With tiny scars hidden in places like the belly button, it is easy enough to keep knowledge of your liposuction on a need to know basis. This could lead to many people that haven’t had it done assuming something with results this dramatic must have a major downside. Liposuction has also evolved dramatically over the past several years, and stories from “the old days” aren’t an accurate representation of how things go now. A great way to select a surgeon is to ask them to speak to patients who have had the procedure. Then, you can judge on your own from a first-hand account.