Since 1983, the most commonly performed cosmetic procedure in the United States has been liposuction. Breast augmentations are a little more popular some years, but over the long haul, fat removal leads the way.
Sucking fat keeps operating rooms across the country busy every day. And that’s because it is safe and effective. Two words worth repeating…safe and effective, but with a big asterisk*. More on that later.
Liposuction burst onto the scene three decades ago after first being described in France. Through incisions smaller than a quarter inch, a hollow tube called a cannula is pushed under the skin and agitated back and forth to break up the fat. Using a very powerful vacuum cleaner (creatively called a “liposuction machine”), that fat is removed from your belly or thighs and delivered to a canister, where it is treated as medical waste.
Sounds simple, doesn’t it? Deceptively simple, it turns out, inviting all sorts of doctors to put down their stethoscopes and pick up those cannulae. But more on that later, too.
When the procedure was new, no more than four pounds of fat could safely be suctioned. That’s because you would lose about a half pint of blood for every pound suctioned. Then plastic surgeons started injecting dilute lidocaine anesthetic containing epinephrine into the fat just before it is suctioned. That drug numbs the tissue and scrunches down blood vessels so much that the skin turns ghostly white.
Suctioning through that blood-starved fat cuts way down on blood loss. So much that 10 pounds or even more could now be safely suctioned. With this technique, by the end of the 1980s there seemed to be a race to see how much fat could be suctioned. Publications appeared with 10, 15, 20, even 30 pounds of fat being removed in a single session. But then the problems started, from terrible cosmetic results to deaths. Not just occasional, but dozens, even hundreds of people died during and shortly after liposuction.
The culprit in many cases was lidocaine, the ubiquitous anesthetic. You’ve had it many times in the dentist’s office, but for your teeth, less than a teaspoon is used. With liposuction, pints of the stuff are needed. And those large amounts can be toxic.
So plastic surgeons began to critically analyze the limitations of the procedure. Now, deaths are thankfully rare in patients of board certified plastic surgeons. Most of us have our patients “cleared” by a board certified internist prior to the procedure—you should only have cosmetic surgery if you are healthy. And most of us stick to the 10-pound limit. If more fat must be suctioned, it is safer to have the procedure in the hospital and stay overnight with an intravenous and a urinary catheter. But honestly, if you have more than 10 pounds that need to be suctioned, you really should spend your money on gym equipment and a good diet book, not on liposuction. Ethical plastic surgeons will steer you that way. When you close in on your ideal weight, then those last few pounds can be suctioned.
The operation I just mentioned uses the “tumescent” technique: inflating fat with the dilute epinephrine solution (“tumescing”). You might read about other techniques—ones that use ultrasound, laser, or other high tech machines. But the truth is that these methods have not proven to be better than the more traditional tumescent technique. Honest plastic surgeons concede that their main benefit is in marketing. Many people think that surgeons who use lasers are “high tech” and better than those who use “old fashioned” techniques. Sadly, many people choose doctors that way. I change my technique if a new technique is either better or has lower risks. So far, the “techsuction” techniques don’t fit that bill. I’ll stick to the methods that give uniformly good results and have a proven safety record.
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