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Skin Excess


Liposuction is primarily a procedure to remove excess fat. It does not remove extra skin. Patients who have extra skin causing rolls in the abdomen are usually better served with a tummy tuck (“abdominoplasty”) simultaneously with liposuction. However, there are areas where the scars from a skin excisional procedure are more obvious, such as the arms and inner thighs. Here, we often do liposuction even in the presence of loose skin, hoping that a modest degree of skin contraction will help. It is possible to come back later and remove extra skin if necessary. However, it may be best to accept some skin looseness and avoid a scar.




Although liposuction is a good technique to remove extra fat cells and improve proportions, it is not consistently helpful for treating cellulite. In fact, there is no treatment available today that is good for treating cellulite, despite claims to the contrary and machines that are marketed and “FDA approved” for this purpose. Patients are disappointed to hear this news. Cellulite is a big, unsolved problem. In some patients, it may be possible to achieve modest improvement (See A.S., K.M., B.D. in Before and After Patient Photographs) in certain areas treated with ultrasonic liposuction, but patients should not count on this.


Fortunately, liposuction does not usually make cellulite worse, except for situations of poor skin laxity, where an excisional procedure such as a tummy tuck or thigh lift may be appropriate. The type of cellulite that is improved by pulling up on the skin (“secondary” cellulite) can be improved with a lifting technique such as a thigh/buttock lift, but this is a major procedure and does involve a long scar along the hip line. A thigh/buttock lift (when combined with a tummy tuck, this is called a “lower body lift”) is typically recommended for patients after major weight loss, or in patients whose cellulite is so severe that it prevents them from wearing shorts in the summer.


Skin Loss


Skin loss can happen if the blood supply to the skin is jeopardized. For example, if a patient has old scars, these scars can reduce the blood supply to an adjacent area of skin by acting as barriers to blood vessels. Liposuction may cause just enough trauma so that the overlying skin loses its viability. Skin loss due to burns is rare, particularly if the operator protects the entrance site and continually moves the cannula so as to avoid causing too much heat buildup in one area (like ironing clothes). Also, the duration of ultrasonic liposuction is limited to 2 to 5 minutes in one area.




During surgery, measurements of the amount of fluid injected, ultrasound time, and the volume removed (“aspirate volume”) are recorded. This helps to ensure symmetrical treatment. Of course, asymmetrical fat distribution is common, so it is not unusual to take more volume out from one side than the other. It is also important to recognize any existing skeletal asymmetry (See Patient K.M. in Before and After—With Breast Lift/Augmentation).


Seroma (Fluid Collection)


If ultrasound duration times are kept short and excessive tissue trauma avoided, seromas are rare. They tend to occur more frequently in areas that are simultaneously undermined, creating a pocket in which fluid may accumulate, such as under the chin after a submental lipectomy, or abdomen after an abdominoplasty.




Overtreatment is much more difficult to treat than under-treatment. It is not difficult to return to do more liposuction. However, if too much fat is removed, restoring normal contours is a challenge. Fortunately, fat injection is available and can be used to fill in defects.


Bowel Perforation


Patients occasionally ask about the risk of puncturing an organ during liposuction. The most important safety consideration is the surgeon’s experience. The cannula is passed horizontally in the subcutaneous plane, where there is minimal resistance. It is usually not difficult to stay in this plane. The use of the “superwet” technique, ultrasonic assistance, and blunt cannulae all help. Previous surgery which may cause scarring of this plane or hernias may increase the risk.