Liposuction is a common procedure for men and women. We recommend it for people stable at a normal weight who want to improve their body contour. The ideal patient is one with pockets of fat, such as “love handles” or “inner thighs,” resistant to diet and exercise.

There are many terms with liposuction: Tumescent, SAL, Ultrasonic, UAL, VASERlipo®, liposculpting, LipoSelection®, laser liposuction, Smartlipo™.

Almost all plastic surgeons use the tumescent technique to help with anesthesia and to reduce blood loss.

Liposuction Consultation

Before you consider liposuction, I recommend you get an evaluation by a Board Certified plastic surgeon who in addition to liposuction does procedures like fat transfer and abdominoplasty. Big questions you need answers for include:

  1. How much fat do you have? In what areas?
  2. What is your skin quality?
  3. Do you have areas where you would benefit from fat transfer?

Liposuction can be effective in many areas:

  • Face: chin, neck
  • Torso: upper arms, breast/chest (including the male breast or “gynecomastia”), abdomen, waist, hips, buttocks
  • Legs: thighs, knees, calves, and ankles

During your consultation, I will review all of these issues with you. If you receive liposuction, you will change your fat pattern. It is important to anticipate what those changes will be, as well as to address any areas which could be become a problem later on. I have seen many patients who had liposuction of the flank and thigh who present with fat arms and backs. This was predictable—those patients should have had liposuction to their back and arms at the time of their original liposuction. CoolSculpting® and KYBELLA® are good for individuals with small amounts of fat and good skin tone. If you have more fat or laxity of the skin, you will need another option.

Liposuction permanently removes fat cells through small incisions. As long as you maintain a stable weight with exercise and nutrition, the fat should not return.

What should I expect during liposuction?

Areas to be suctioned are filled with a fluid called “tumescent.” Tumescent fluid is made of anesthetic (to numb the local area and reduce the amount of general anesthetic), epinephrine (to reduce blood loss and bruising), and saline. For procedures of the trunk and thighs, I use two positions (from the front and back) to have a smooth natural transition in the sculpting from front to back. My bias is to use general anesthesia for patient safety, fluid regulation, and more fat removal. I perform the tumescent liposuction procedure in an outpatient surgery center in Palo Alto. Board certified anesthesia doctors give the anesthesia.

I treat my patients globally, usually addressing multiple areas, to help ensure a smooth, natural contour. This is important to make sure future weight fluctuations don’t create a “funny” body shape. I do all ranges of fat removal, from small touch ups to large volume removal (around 5 liters).

Liposuction may not work well as a stand-alone procedure. If your skin has many stretch marks, fine wrinkling, or drooping, you will likely need skin removal. This may involve abdominoplasty, mini-abdominoplasty, medial thigh lift, arm lift, or body lift.

"Dr. Greenberg completely resculpted my waistline and gave me curves that were better than when I was 25!" - K.S., Waltham
*Individual results may vary
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What are the different liposuction methods?

Ultrasonic liposuction, or UAL, uses ultrasonic energy waves to help break up the fat. I find my patients are very athletic–as most Bay Area people are–and they tend to have firm, fibrous fat. UAL is critical in fibrous areas such as the upper abdomen, back, and thighs, and in secondary liposuction cases. Men in general tend to be fibrous, and should use ultrasonic liposuction. I like to use UAL with most patients, as I feel it helps give a smoother result, larger fat volume removal, and better skin retraction.

SAL is traditional liposuction. This uses cannulas (thin tubes) hooked up to suction. I always follow use of the ultrasonic liposuction with traditional liposuction. As fat removal progresses, I use smaller and finer cannulas to help sculpt and contour.

Laser liposuction uses a laser as its energy source to break up fat as the ultrasonic does. Many use a small gauge cannula, so it needs to be combined with other fat removal techniques. Due to the small size of the cannula, the surgery takes more time. I prefer ultrasonic, as it preserves the stem cells in the fat.  Stem cells have huge effects on the quality of the skin (see my blogs on the subject).

All of these different kinds of liposuction are combined with the tumescent technique. All of them remove fat. Downtime following surgery is related to the amount of fat removed and areas treated.

It is difficult to redo a liposuction case. I urge you to choose your surgeon wisely, as your first shot is truly your best shot. Liposuction is one of the most common procedures I perform. I have co-authored a chapter on the subject published in a plastic surgical textbook. I redo many cases from other doctors due to irregularities, fat remaining, and poor shape. A disturbing trend is non-plastic surgeons doing liposuction. Many take a weekend course, and some of the laser liposuction companies are targeting non-plastic surgeons purposefully. There is a skill to doing good liposuction. It is not simply getting out as much fat as you can. I see patients who have loose skin, very irregular fat removal, and poor body shape. These patients were told “if the skin doesn’t look good, go to a plastic surgeon and get a tummy tuck.” When I meet these patients, I know their first surgeon was not a plastic surgeon. They did not have the right procedure for their body type. Please be evaluated by a plastic surgeon and get multiple consultations prior to doing the procedure. See my page on picking a plastic surgeon.

What are the noninvasive options?

Many noninvasive liposuction techniques have been developed by a number of manufacturers. I was on the advisory board of one company. CoolSculpting® is the most commonly used one. It works, and if you have a small amount of fat and good skin quality, it may be a good choice for you. I get why it is so enticing. No bruising, no recovery. Sign me up!

But there are a few things you must consider:

What is fat transfer?

Finally, fat transfer is the new frontier of plastic surgery. Instead of using synthetic fillers for the face or implants for the buttocks, changes can be done by using your own fat as an injection. Fat is liquid gold. Do not throw away your fat.

There are many techniques used. I have trained with fat transfer pioneer Dr. Roger Khouri, attended courses focused on fat transfer with other pioneers like Dr. Coleman, and performed fat transfer for a decade. I love it.  I harvest the fat using traditional liposuction techniques, centrifuge the fat to help concentrate it and make it more uniform, and then inject it by carefully placing the fat where needed.

  • MICROFAT. injecting under the skin using a fine cannula to add volume to an area.
  • NANOFAT. injecting with a small needle into the skin itself, to help correct lines (around the mouth, between the brow, on the forehead).

People who do not understand fat worry the fat could be lumpy or uneven.  Please know this is not seen in my practice, and is not supported by good technique and what we have seen during scientific study.  Also, the stem cells in the fat improve the quality of the overlying skin, making your “comforter” look prettier. Before you remove the fat, think! Is there an area which would benefit—the face, buttocks, hands, or breasts—from adding fat?

 

Skin Quality Matters

Skin quality is paramount to your result. Imagine the skin and fat on your abdomen is like a comforter. As you age, your bed under the comforter may become a little lumpy. A thick comforter of skin and fat smooths out the look of the underlying bed.

CoolSculpting® freezes the fat from the top down, in essence thinning your comforter to a summer blanket. If you have issues with skin quality, the CoolSculpting® treatment can make it worse. Sometimes liposuction is not an option because the removal of fat will cause the skin to wrinkle. Sometimes you can remove some of the deep fat and still do okay.

Please get an evaluation by a doctor who does abdominoplasty and skin tightening procedures. If your doctor only performs liposuction or CoolSculpting® therapy, they may recommend a procedure even though it is not the ideal procedure for you. Many of the skin issues caused by this are not fixable. With any noninvasive system, fat is absorbed in the bloodstream and a collection of fluid or liquefied fat under the skin could be an issue.