Review

Liposuction: Concepts, safety, and techniques in body-contouring surgery

Shannon Wu, BA, Demetrius M. Coombs, MD and Raffi Gurunian, MD,PhD
Cleveland Clinic Journal of Medicine June 2020, 87 (6) 367-375; DOI: https://doi.org/10.3949/ccjm.87a.19097

Article Figures & Data

Figures

  • Figure 1
    Figure 1

    Left: Preoperative appearance of a 52-year-old man who presented for liposuction of localized adiposity within the abdomen and bilateral flanks. Right: The same patient 6 months later after removal of 1.4 L of adipose tissue.

  • Figure 2
    Figure 2

    Left: A 38-year-old woman who presented with excess skin and adiposity of the anterior abdomen and excess adipose tissue in the bilateral upper back and hips. Right: The same patient 5 months later after full cosmetic abdominoplasty and liposuction of the bilateral upper back and hip areas (with a total of 2 L of tissue removed), illustrating that these procedures may be combined safely and yield satisfying results.

  • Figure 3
    Figure 3

    The same patient from Figure 2, now almost 19 months after surgery but having lost weight, demonstrating stable long-term results after abdominoplasty and liposuction. Note the stable improvement in bilateral flank and upper-back adiposity.

Tables

  • TABLE 1

    Liposuction techniques

    Suction-assisted lipectomy
    Negative pressure from a syringe applied to a small-volume, blunt-tip suction cannula is used to remove fat.29 Suctioning from the superficial layer should be avoided to prevent dimpling, hyperpigmentation, and contour irregularities.19 The superficial fat layer contains vertical fibrous septa, which would result in contour deformities if disrupted; however, exploitation of this anatomy with the liposuction cannula, also known as abdominal etching, has been demonstrated to produce highly defined abdominal aesthetic contours (eg, “6-pack abs”).33
    Ultrasound-assisted lipectomy
    Transmitting ultrasound energy to emulsify fat prior to its removal,34 ultrasonographically assisted lipectomy (UAL) can be advantageous in fibrous areas, such as the back, chest, and upper flank, that are more difficult to target in standard liposuction. UAL has shown marked benefit in treatment of gynecomastia. However, larger incisions are required in UAL and operations require more time. There is an increased risk of thermal injury to subdermal tissues due to the exothermic energy caused by ultrasound.
    Laser-assisted lipectomy
    Laser-assisted lipectomy (LAL) is performed by inserting a laser fiber via a small incision.35 Although complications of LAL are rare, 1 study observed a complication rate of 0.93% that included skin burns and a local infection.36
    Power-assisted lipectomy
    Power-assisted lipectomy is performed with an external power source, typically an electric vacuum pump.35 This technique can be advantageous for large volumes of tissue removal and in densely fibrous areas, as the power assistance reduces operator fatigue.
  • TABLE 2

    Complications of liposuction

    Short-term complications
    Wound infection
    Hematoma, seroma
    Edema
    Ecchymosis
    Paresthesia
    Fat embolism, pulmonary embolism
    Skin necrosis
    Long-term complications
    Contour deformity
    Hyperpigmentation
    Hypertrophic scarring
    Lymphedema
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