Body Contouring (Liposuction) in NYC

Liposuction, also known as suction lipectomy or liposculpting, is a popular option for individuals with excess fat and either no skin excess or mild skin excess. There are many areas that have stubborn fat even after otherwise successful weight loss. The flanks and love handles are two areas that are notorious for being stubborn. Even thin/active patients still tend to have some unwanted excess in these areas. Other areas of stubborn fat include the inner thighs, lateral chest, and upper pubic area. Liposuction can be performed under general anesthesia or awake, under local anesthesia.

Tumescent fluid is the type of fluid that is placed before the fat is surgically removed with suction device. Tumescent fluid varies but tends to be made from intravenous fluid, a numbing medication like lidocaine, and epinephrine to constrict small blood vessels and limit blood loss. The terms tumescent liposuction, local liposuction, and awake liposuction are all terms to describe liposuction without general anesthesia. Patients are awake and talking through this procedure. If performed correctly, there is minimal discomfort because the tumescent fluid numbs the treatment area. In general, awake liposuction under local anesthesia is best for small volumes or limited body areas. Patients need to understand that they will feel some sensation during the procedure but this is usually more of a pressure sensation than a pain sensation.

Power-assisted liposuction (PAL) is liposuction with a vibrating surgical handpiece. The vibrating handpiece allows the surgeon to expend less energy during the operation. This technology is especially helpful for large-volume fat removal, the removal of dense/fibrous fat, and in revision liposuction cases with more scar tissue. While I like to use this technology for both primary and revision liposuction, I cannot argue that this technology improves or changes my patients’ results.

VASER stands for Vibration Amplification of Sound Energy at Resonance. This technology uses ultrasound waves to break up fibrous networks and allows the surgeon to expend less energy during the operation. Like power-assisted liposuction (PAL), this technology is especially helpful for large-volume fat removal, the removal of dense/fibrous fat, and in revision liposuction cases. While I sometimes use this technology, I cannot argue that this technology improves or changes my patients’ results.

Usually not. This is a decision that is discussed in your preoperative visit with your surgeon. Drains are small soft tubes that help avoid excess fluid from accumulating in your body. While drains are a small inconvenience for a few days, drains help the recovery process. Some surgeons do not use drains and leave small openings for fluid to drain. I tend to use drains more frequently in individuals who may be more prone to accumulating fluid (men, large volume, revision cases).

High definition liposuction, or high def lipo, is a style of liposuction that is relatively aggressive liposuction in terms of fat removal. High def lipo attempts to highlight muscles or anatomic subunits, and create contours to show off, or give the illusion, of a strong, muscular, and tone body. Both men and women are candidates for high definition liposuction. Women typically ask for their love handles to be smaller, their waist to be brought in, and their semilunar lines (vertical abdominal lines) to be highlighted. Men generally ask for their flanks to be brought in, their semilunar lines highlighted, and their chests to have a more sculpted/muscular look.

You can think of liposuction and high definition liposuction to be on a spectrum from moderately aggressive fat removal to very aggressive fat removal. Some of the other words to describe these surgeries are more designed for marketing the operation. It is important to discuss your goals and your expectations with your surgeon in terms of fat reduction prior to surgery. It is good to remember that it is not always about what is removed but also what is left behind.

A tummy tuck is a procedure where not only fat is removed but also skin is removed. In individuals with moderate to severe skin excess, liposuction can further deflate the skin and make the problem worse. There are some new liposuction technologies that advertise skin tightening properties. Without listing specific device names, I will say that all of these technologies have mild skin retraction results at best. That is not discounting their use or place in plastic surgery. That being said, there is no technology that will convert a tummy tuck patient into a liposuction patient at the moment. A consultation with a plastic surgeon will help you better understand where on the spectrum you are in terms of skin excess, fat excess, and skin elasticity.

Individuals who are interested in liposuction should be in good health and be fit for elective surgery. Patients should avoid smoking and nicotine-containing products that can affect blood flow and, ultimately, healing. Good candidates are weight stable and have excess fat under the skin (subcutaneous fat). Fat under the abdominal muscles (visceral fat) cannot be addressed with liposuction.

Absolutely. Liposuction is great for areas of stubborn fat and can be performed in almost any decade of your adult life. After children, you may wish to have additional liposuction or a formal tummy tuck to remove excess skin.

Liposuction, depending on the number of areas and the volume of fat being removed, takes anywhere from 1 to 3 hours. Additional operative time may be needed if another procedure is performed at the same visit. The total operative time may be longer when accounting for anesthesia time at the beginning and the end of the procedure.

In an outpatient surgery setting, the maximum amount of fat that can be removed is 5 liters. This number is recognized as a safe limit in a healthy adult. That being said, every patient is different and you should discuss the anticipated volume removal in a conversation with your surgeon at the preoperative visit. It is important to note that very good liposuction results can be obtained with smaller volumes depending on an individual’s anatomy. If you need or wish to have more than 5 liters removed, you will likely need two or more liposuction surgeries.

Liposuction is major surgery. You may have some discomfort in the early postoperative period. That being said, it is not a particularly painful operation. The level of discomfort also depends on the volume of fat removed, the number of areas treated, and the concentration of local anesthesia in the tumescent fluid. After the procedure, you will likely be put into a compression garment to give you support, limit the swelling, and help the recovery process. The garment should be snug but not tight as garments that are too tight can hurt the skin. It is not uncommon to feel more swollen on the second or third day after surgery. By the fourth day, the swelling will slowly start to improve.

After the first week, expect to be bruised and swollen. In the second week, the swelling will start to subside and your new shape will begin to show. The end result takes 3 months and there can sometimes be changes up to 1 year after surgery.

All surgeons have slightly different protocols so each patient should follow their surgeon’s protocol. In general, liposuction patients should be treated similar to other major surgeries with the avoidance of strenuous activity until your surgeon clears you. Patients should walk frequently to attempt to avoid blood clots. I tell my patients that they can return to desk jobs in 5-7 days and that they can return to light exercise at 2-3 weeks after surgery.

Every surgeon has a different protocol. I ask my patients to wear their garments 23 hours a day for the first 2 weeks and then another 2-3 weeks only at night. If a patient is uncomfortable in their garment or they enjoy wearing it then I may alter this timeframe slightly. I ask my patients to check their skin frequently, especially in the early postoperative period, to avoid pressure injuries to the skin.