Common Misperceptions About Liposuction
Liposuction today is significantly different from the liposuction of the past. Over the course of the last decade, the field of liposuction and body contouring has dramatically evolved. Unfortunately, the public perception of this procedure has lagged considerably behind. It is time to address six common misperceptions about liposuction that we often hear in our practice:
 1: If I get liposuction to one part of my body, the fat will return, either in the same place or in other parts of the body.
This is probably the biggest misperception we hear about liposuction. To fully understand why this not true, it is important to understand the biology of fat cells. When someone gains weight, the existing fat cells expand, which is referred to as hypertrophy. It seems counterintuitive, but new fat cells are not created when a person gains weight. Like muscles and nerves, the fat cells you have now are permanent. They can grow larger, but they do not divide and create new cells. Thus, by removing fat cells, you are permanently subtracting them and preventing any future growth from those cells. Some natural fat is always left behind to prevent fibrosis and scarring, but the fat which is removed is gone forever. Good riddance!
2: Liposuction will lead to loose skin in the area where the fat was removed.
We can all imagine a balloon deflating as the air escapes. This leads to a saggy balloon. It seems intuitive that the same thing would happen to the skin as fat is removed. Fortunately, there are two factors which help prevent this. First, the skin, unlike a balloon, has a network of proteins composed of collagen and elastin which allow contraction and tightening of the skin. This is sufficient to tighten the skin of many patients, especially younger people.
That’s the good news, but what happens as we age? Studies have shown that we lose about 6% of our collagen every decade, so our skin’s natural ability to snap back decreases with age. Fortunately, the past several years have seen the emergence of multiple technological devices to assist with skin tightening. These devices work by applying energy to the skin’s underlying collagen and elastin network, thereby causing contraction of the skin. In our practice, we use the Renuvion (J-Plasma) device which gently passes beneath the skin and directly heats the collagen proteins with plasma energy. This device is not only safe, but it has the added benefit of also being non time-consuming, and may be applied without the need for general anesthesia.
3: Liposuction only involves the removal of fat.
Wrong. Today, the field of liposuction has evolved from the early days of simple fat removal. With the advent of ultrasound-assisted devices, fine liposuction cannulas, and advances in surgical technique, we are now able to provide what is better termed ‘liposculpture.’ This process involves not just the removal of fat, but also the unveiling of the underlying musculature. An increasing focus is now placed on the patient’s underlying muscular anatomy, and techniques are used to strategically remove the fat and enhance this muscular appearance. Different levels of muscular definition can be provided, depending on a patient’s desired aesthetic. For some patients, a soft, low-definition appearance is desired, whereas more athletic patients may desire a high-definition procedure with further enhancement of the muscular anatomy. Today, we can safely perform either procedure, giving patients their desired result.
4: Liposuction is a weight-loss surgery.
It is commonly assumed that since a surgeon is removing fat, that liposuction is a weight-loss surgery. That’s not really true.  Bariatric surgeries such as a gastric sleeve, gastric bypass surgery, and lap-band placement are weight-loss surgeries. They work by restricting the size of the stomach or diverting portions of the gastrointestinal tract. This leads to weight loss over time.
Liposuction is, instead, an aesthetic procedure in which we are removing targeted areas of fat to improve the patient’s overall appearance. While many patients will obtain a boost in self-confidence and subsequently elect to pursue a more healthy, athletic lifestyle following liposuction, the procedure itself is not performed for weight loss.
5: Liposuction is only used for patients who refuse to lose fat the good old-fashioned way (i.e. strenuous exercise, extreme dieting).
This misperception is spread by many in the fitness and diet industry—all you have to do is exercise and watch that carb intake, and you will have the body of your dreams. For those of us with stubborn, resistant areas of fat, we know that regardless of our activity, we just cannot lose those love handles, banana rolls, upper arm fat, fatty knees or unwanted tissue around our navels.
Each person carries fatty tissue in different areas and in different amounts. Even at a low body fat percentage, a person who carries the majority of fat in the anterior abdomen may never achieve the desired 6-pack appearance. This can lead to disillusionment and a return to an unhealthy lifestyle.
To remove this stubborn fat, we can now use ultrasound-assisted devices to gently soften the fat, whether it be in be in the back, abdomen, neck, legs, or arms, and then sculpt the areas with small liposuction cannulas. An increasing number of healthy, fit patients are now seeking this procedure to tighten up areas that are exercise and diet resistant.
6: Liposuction requires general anesthesia.
General anesthesia, when provided by a well-trained anesthetist, is incredibly safe. However, some patients are concerned about being under general anesthesia for a variety of reasons. Today, many of our liposuction procedures can be done awake with minimal discomfort in the outpatient setting. By slowly infiltrating the tissues with a solution containing a numbing agent such as lidocaine, the procedure can be done with the patient awake. A lot of our patients are able to chat with us as we perform the procedure. Of course, for patients desiring to sleep through the surgery or for those who wish for a higher-definition appearance, general anesthesia remains a safe and excellent option.
As you can see, liposuction has dramatically evolved in the past few years. If this is something you are considering, be sure to contact a trusted plastic surgeon with experience with these procedures and devices.