How does Liposuction Work?

The first thing that comes to mind when one hears the words Cosmetic Surgery is Liposuction. And rightly so it is the most commonly performed aesthetic surgery in the world. It is Simple, it is safe and it gives stunning results.

But have you ever wondered how it actually works?

Let’s begin with …

Understanding the structure of human skin.

The skin that we see, feel and touch and sometimes hold in our hands as a tyre (the dreaded abdominal tyre) is made up of three layers.

1. The Epidermis is the visible skin. 
2. Below it lies the Dermis which is a thick layer of connective tissue that gives the skin its elasticity and strength. 
3. And finally below the dermis is the subcutaneous fat. The Fat layer envelopes our body from the head to the toe. 

The subcutaneous fat layer is further divided into three parts. superficial, intermediate and deep. 

The superficial fat layer is intimately attached to the undersurface of the skin (Dermis). The deep layer lies directly over the muscle and bone. And as the name suggests Intermediate lies between them.

The thickness and the type of fat in each of the layers depend on the body region. For example, the back has a thinner fat layer which is condensed and fibrous as opposed to the fat in the inner thigh which is relatively loose.

As I have previously told you the knowledge of these variations in the type and distribution of fat across all regions of the body allows the surgeon to be precise and give awesome results.

There is one other thing I want you to keep in mind. I want you to think about the Role of fat. 

Why do we have a layer of fat below the skin in the first place?

well, subcutaneous fat is actually very important.

• Subcutaneous fat is important for body heat regulation. It serves as a blanket wrapped around our bodies.
• Fat also serves as a cushion over the muscles and bones. 
• And it is an important storehouse of energy. Being civilised has enabled us continuous access to food sources. But our ancestors did not enjoy this luxury. There were times when they had to go on without food for days. The stored energy in the fat layer helps to survive fasting. And this is how fasting or dieting works to reduce fat.
• The subcutaneous fat layer makes our skin soft and supple to the touch. It helps to give a  beautiful contour.

so, if fat is so important why do we want to get rid of it? and Where does all the extra fat come from?

Fat is good. Extra fat is not. we want to get rid of extra fat.

Think of it in this way over millions of years of evolution our bodies have become adept at storing whatever extra energy we may consume. It is always in survival mode trying to horde as much as possible for bad days. but the bad days of starvation don’t come (except if you are dieting) and so fat keeps accumulating.

Keeping in mind the important role of the fat layer for our survival it is imperative that we do not remove all the fat. 

Only the extra unwanted fat needs to be removed. Another way of saying this is that the superficial layer of fat is not removed in a Liposuction procedure as it is essential for aesthetics as well as survival. And so Liposuction targets only the intermediate and deep fat layers.

Coming to the question at hand,

How does Liposuction work?

So far, I have told you a little about the evolution of Liposuction and how it has made liposuction extremely safe. And a little about the skin and subcutaneous fat. 

But to know how liposuction actually works, we need to go a little deeper. Let us go at the cellular level.

Fat is stored inside the fat cells called adipocytes. The number of adipocytes is more or less fixed. Fat individuals don’t have more cells it’s just that their cells have accumulated more fat and grown bigger in size.

The process of extracting fat with the help of cannulas breaks these fat cells and sucks them out as well. The final aspirate after liposuction contains fat as well as fat cells.

Once taken out of the body these fat cells don’t grow back.

Interesting fact: The fat we just extracted a few sentences ago can be easily transferred to other body areas. This forms the basis of structural fat Grafting which is another awesome procedure usually done to improve scars, augment breasts (Fat Fill Breast Augmentation) and augment buttocks (Brazilian Butt Lift).

Let us now make sense of everything we have learned so far by knowing the steps of liposuction.

Steps of Liposuction.

1. Anaesthesia. The obvious first step is to numb the area or body region. This can be done in two ways
   • General Anesthesia: If the body area is large then general anaesthesia is advised. The benefit is that you will remain asleep throughout the procedure.
   • Local Anesthesia: If only a couple of regions need liposuction then Local Anesthesia is preferred. You remain awake throughout the surgery. The benefit is that you can return home immediately after the procedure. There is a small drawback, the process of anaesthetic infiltration is slightly painful for the first few seconds.

2. Incisions: multiple tiny 2 mm to 4 mm incisions are made around the region to be suctioned. These stab incisions are only skin deep and heal quickly. There is no need to suture them. They leave behind a dot-like scar.
3. Tumescent Fluid Infiltration (Klein’s solution): a multihole infiltration cannula is used to push and spread the infiltration solution below the skin. If the procedure is being done under local anaesthetic then numbing and infiltration is done at the same time. 
4. Vacuum-assisted suction: Once the infiltration fluid has maximum effect liposuction is performed. A liposuction cannula of an appropriate size is attached to the liposuction machine with help of tubing. With a gradual to and fro motion, the cannula is moved through the fat to suck out the extra fat. This extra fat gets collected outside the body in jars.
5. Dressing and Pressure Garment: The last step is to apply small dressings over the incision sites and place a tight pressure garment.