A garment is worn to help reduce swelling for a period of one month. Patients wake up wearing it. This garment is removed for short periods to bathe and shower and may be worn under regular clothing. Bruising usually disappears within one month. Most of the swelling (about 80%) is gone in one month and patients may then wear shorts or a bathing suit. It takes about 3 months for the swelling to completely disappear.

The volume removed from each area is measured, in ccs. Often there is more fatty tissue on one side than the other so that it is common for volumes to be different from one side to the other. During surgery, I assess how much to remove visually, by looking at the treated area, using my hand to judge the level and pinch-test to assess thickness, feeling the tissue resistance, and by taking into account the volume removed, which the nurse records in real time as the fat is removed.

The volume of fat removed is determined not so much by the surgeon as by the patient's body characteristics and how much extra fat is present to start with. At first, the fat comes out readily, a stream of fat globules coming out the suction tubing that is gratifying to watch and listen to, as the fat globules reverberate down the suction tubing and spill into the canister. Gradually, the fat stream slows to a trickle. Also, the tissue resistance decreases. I keep a hand on the treated area and reassess the change in contour as the fat comes off. An experienced surgeon knows how far to "push the envelope." This is the art of doing liposuction. It is important to take off as much excess fat as possible, to produce the best result for the patient, but it is even more important not to overdo the treatment. If the surgeon persists to try to take off another 10 percent or so, after the fat stream has been reduced to a trickle, this could cause unnecessary tissue trauma, more bruising, and increase the risk of skin irregularities or poor skin contraction. It is far better to be avoid such problems, and return for a touchup if necessary later on.

Most patients, right before surgery, tell me to take as much fat off as possible ("Don't hold back, doc!). Nothing personal, but they'd rather not come back for more surgery. Yes, they want it to be safe and all that, but they want as dramatic a result as possible!

I assure my patients that I will take off as much fat as I can without overdoing it and increasing the risk of complications. Patients understand that my job is to push the envelope as much as I can without pushing too far. I tell my patients I will treat them as if they are never coming back. The possibility of doing a touchup later does not mean I'm going to leave to another time something I could do today.

Postoperative discomfort depends on the extent of liposuction needed and the number of areas treated. There is usually a generalized soreness and some stiffness due to swelling. Pain is usually well controlled with medication which is taken during the first several days after surgery. The stitches dissolve on their own.

I have heard stories from patients who have been treated under local anesthetic, telling me how painful the procedure was. Some patients have friends who reported a lot of pain after liposuction. No doubt, liposuction can be a painful procedure. However, there are ways of reducing the pain. One way is by doing the surgery with the patient asleep, which is preferred for all but small touchup liposuction procedures. Local anesthetic is injected into the tissues as part of the tumescent (super wet) technique. This local anesthetic works for several hours after surgery, so you are not in pain waking up after surgery. Also, tissue trauma is minimized by using ultrasonic technique, less traumatic blunt cannulae, and avoiding overaggressive treatment. This allows for superior results with tolerable pain levels. Most patients report that the pain level was what they thought it would be. It does not surprise them. It is tolerable and controlled by prescribed painkillers.

There is a wide range of patient experiences. Some patients take liposuction in stride, even returning to work the next day. Others give me a somewhat accusatory look (maybe I'm paranoid) and tell me, "I feel like I've been run over by a truck." The number of areas treated is relevant. Most men have the abdomen and flanks treated, which is relatively easy to recover from. Some say it is like a tough workout in the gym. Most women also have the thighs treated. This causes more discomfort, particularly when sitting down.

Numbness in the treated areas is to be expected. The small sensory nerve endings have been traumatized by surgery. There may also be unusually sensitive areas, called "hypersensitivity." It typically takes about two months for the feeling to return to normal.

Most patients notice a difference immediately after surgery. However, swelling develops during the first few days, which can make the areas temporarily look fuller than they were before surgery, particularly in lean patients. That is why we recommend that patients wear loose-fitting clothing right after surgery. The garment helps limit the swelling and help it to go down faster. Although swelling is variable from patient to patient, we estimate that about 80 percent of swelling is gone in a month. Full resolution of swelling takes about three months. This is important for patients to know, because they may otherwise be disappointed at their one-month follow-up appointment, thinking that this is their final result, when in fact they still have a significant amount of swelling.

At the end of the operation, while you are still asleep, a "compression garment" is applied. This is either a simple Velcro^® binder that goes around the abdomen and flanks (commonly used in men), or a girdle that goes from the level of the upper abdomen down to the thighs, either above or, more commonly, just below, the knees. This helps to limit swelling. It is important to know that the purpose of the garment is not really to even out the fat layer. The remaining fat cells do not move around, which is why technical expertise in removing the fat cells evenly is important. So, the garment is not used to smooth contours. Rather, it is used to limit swelling, and help the swelling to go down sooner. Most patients also find it more comfortable to wear the garment. They feel that they need the support. It is removed for bathing, and may be washed, although should be dried in a no-heat cycle to avoid shrinking.

I usually recommend wearing the garment for one month. It is concealed under clothing, except during the summer when Capri pants may be necessary to conceal the knee-length girdle (when the knees are treated). However, two weeks after surgery you may wear spandex instead, such as cycling shorts or an aerobics outfit. You can alternate wearing the garment and wearing spandex. The principle is gentle compression. Some patients are never comfortable with the garment and make the switch to Spandex earlier. It is important to realize that too loose is better than too tight. If you don't wear the garment at all, your result will be the same, but your swelling will take longer to go down. I recommend wearing slightly compressive athletic garments when exercising, even after a month. This helps reduce swelling.

Time off work depends on the areas treated, physical requirements of the job, and your own pain tolerance. Men having the abdomen and flanks treated can usually be back at an office job in three or four days. Some return to work the day after surgery. For more physical jobs, such as a plumber or construction worker, one week off is recommended. If the job is very physical, such as going up and down ladders, two weeks off is better. For women, who usually have the lower body treated (thighs included), one week off is recommended for office jobs. However, plenty of my patients return to work sooner. If you have a job that involves standing for long periods (pharmacist for example), a week off is recommended. Otherwise, you will swell more and be uncomfortable at the end of the day. Sitting is uncomfortable after having the thighs treated and you will want to get up frequently and move around.

Many patients call the office several days or a week after surgery to report that their feet and ankles are swelling. They have a hard time putting on shoes. They wonder if this is normal. It is. The legs below the knees often swell more a week after surgery because of the effects of gravity, even when the calves are not treated with liposuction. Bruising may extend all the way down to the feet. This may be alleviated by elevating your legs on an ottoman when you are sitting. If one leg is swelling conspicuously more than the other, this should be assessed by your surgeon because this could signal a blood clot in a leg vein ("Deep venous thrombosis"), which is a serious complication requiring investigation and treatment.

Treatment of the abdomen and flanks takes about an hour. Lower body liposuction takes about 1 ½ hours. When the arms and underarms are included, it may take two hours. It is not unusual for me to treat the ("submental") fat pad under the chin at the same time, adding another 20 minutes or so. By prepping the patient circumferentially at the beginning, and then infusing all areas before starting liposuction, efficiency is maximized. This allows me to safely treat multiple areas in a comprehensive fashion without unduly long operating times. It also allows other cosmetic procedures (such as an abdominoplasty or breast augmentation) to be safely done simultaneously.

Most patients want to know when they can get back to exercising. Many work out on a regular basis, some every day. The most difficult aspect of the surgery may be interruption of their exercise routine. I tell them, no exercising for two weeks, and they give me the look that says, maybe for other patients, doctor, but not me. I then explain that they will be sore after surgery and if they do work out, they will have more swelling and will hurt more afterward (not while they are working out, but later). It is possible to get some non-vigorous exercise, by walking for example, but any vigorous exercising that raises the blood pressure will exacerbate swelling. Such exercising as using an elliptical machine or exercise bike should wait about three weeks after surgery. All exercises may be resumed three to four weeks after surgery. When resuming exercise, it is important to let your body tell you when you are ready. First do a light workout, maybe 50 percent of what you would ordinarily do, and then see how you feel the evening after exercising. If there is no problem, increase your exercise routine gradually. If you do it all at once, you will swell and hurt more, and will need to take more time off before resuming exercising, but fortunately, this will not jeopardize your result.

Liposuction of Arms

There is no garment that is applied to the arms. However, some patients will wear a snug athletic shirt that has sleeves to provide some gentle compression. Swelling and bruising are to be expected. The bruising may extend down the forearm due to gravity. There are areas of numbness that can take a few months to return to normal. The arms are sore, but the pain is tolerable. Often a caretaker may grab the arm to help, not realizing that it is sore. Because the arm is at a higher level than the heart, arm swelling tends to go down more quickly after liposuction than the legs. Because liposuction of the arms does not seem to add much to the amount of postoperative discomfort, and treats an area that is visible and responds favorably, it is common for women to have these areas treated.