Fat Removal Surgery (Liposuction) FAQs

Only a consultation will be able to determine if you are an acceptable candidate for a liposuction procedure. Determining your suitability will partly be defined by the quality of your skin and of course the amount of fat present.

Ideally, you need good skin elasticity for this to work. In most cases, as the skin is a dynamic organ, it is able to shrink and accommodate to the new body contour after liposuction. In some patients, however, there may be reduced skin elasticity suggested by loose, hanging, or crepey skin.

In these cases, liposuction alone will not produce the desired result and you may, therefore, require some form of skin removal/reduction instead (i.e. tummy tuck) and or perhaps in combination with liposuction. It’s also important to keep in mind that the best patients for liposuction are those individuals who are active and healthy, of average or near average weight within 10-15% of their ideal weight.

Age on its own is not enough of a determining factor to say whether you are suitable or not, and in fact, any number of patients from age 16 -65 can benefit from liposuction. You should also understand that liposuction by itself will not improve the dimpled skin condition known as cellulite.

Liposuction or Suction assisted Lipoplasty (SAL) as it’s technically called, is the removal of localised unwanted lumps and bulges of fat by the use of thin straw-like metal tubes, called cannulaes.

In women and men, these localised fat deposits may be formed virtually anywhere on the body but are more commonly deposited on the abdomen, hips, flanks, inner and outer thighs, knees and chin. In men, a condition called gynaecomastia (localised fatty breast enlargement -see below) is commonly encountered. These cannulaes are placed into the body fat through small incisions.

A vacuum is subsequently applied through a small hose attached to the cannula and the fat is drawn out of the body. Liposuction is not an alternative to weight loss and exercise, but a means of re-sculpting the body into a slimmer profile by removing the fat not responsive to the most diligent efforts. This is the most widely available method for removing fat cells in certain areas.

One of the most significant developments in liposuction has probably been the development of the Tumescent Technique, devised by Dr Klein in the United States over 30 years ago. The tumescent technique of liposuction involves the injection of relatively large volumes of a saline solution containing dilute local anaesthesia and adrenaline (called Tumescent solution) into the fatty tissues, thus forming a safety cushion on which the cannulas can slide.

More importantly, these elements contribute to the loosening of bonds between the fatty cells, thereby facilitating their removal. As a result of the adrenaline, there is a decrease in the bleeding from blood vessels thus allowing us to remove larger quantities of fat more safely. Less bleeding also means less bruising. The infiltration of large volumes of dilute anaesthesia also allows the procedure to be performed under local anaesthesia with or without sedation if desired.

To begin the operation a number of tiny incisions (about 3-4 mm) are made in the skin in the areas to be treated. These slit incisions are made, when possible in inconspicuous places. Subsequently, the areas are injected with the Tumescent solution mentioned previously. The solution is then allowed to diffuse and take effect (about 10-15 mins) throughout the targeted fat.

As mentioned the solution will numb the areas as well as reduce bleeding by temporarily closing down the capillaries. The appropriate cannulaes are then inserted into the fat. Through back and forth movements of the cannulaes, the fat is loosened and drawn off by a strong vacuum pump. Since the fat is removed by suctioning small ‘tunnels’ through the fat, the skin remains intimately connected to the underlying muscles by multiple attachments called fibrous septa.

These can be described as being the body’s ‘Velcro’. It is this process and these structures, which assures us that the skin will not hang in loose folds after Liposuction. The fat is removed by doing little damage to the fibrous septa, which importantly also contains blood vessels, nerves and lymph vessels.

For this fat to be removed without serious damage requires an excellent knowledge of anatomy, an appreciation of body proportions and of course, surgical and mental stamina. Throughout this procedure, Mr Karidis is always conscious of leaving a smooth layered thin blanket of fat attached to the underside of the skin, in order to minimise the possibility of any irregularities or rippling of the skin.

Mr Karidis has been one of the pioneers in the UK in the use of the Power-Assisted Lipoplasty technique (PAL) and has been using it with great success for over 15 years. Mr Karidis feels that this is the gold standard in the field of Liposuction as it offers consistent results in his hands whilst reducing the possibility of side effects. He also feels that this is the technique by which all other lipoplasty devices should be judged. He is therefore happy to continue to offer this routinely to all his patients.

In order to extract the fat cells, a fair bit of effort is required with the back and forth movement of the cannulaes using conventional Liposuction. With the advent of the Power-Assisted Lipoplasty (PAL) the back and forth motions, have become much gentler and smoother, yet faster because of there is a mechanical drive mechanism within the power handle doing the work for us.

The results are a vibrating cannulae with a frequency of about 100 times a second (much lower frequency and heat generation than any energy-based Lipo device). This allows the surgeon to progress through the fatty tissue with much more ease and to channel his efforts and concentration into sculpting the treated area much more reliably and efficiently, rather than expending his energy into manually pushing the cannulaes back and forth.

In order to understand this concept better, consider the difference between a normal toothbrush and an electrically operated Oral B toothbrush! An electrically operated toothbrush is usually much more efficient at cleaning your teeth. The PAL benefits from a similar principle. This technique can be used to great benefit in all areas of the body.

Power-Assisted Lipoplasty is especially of benefit in male patients who desire a reduction of their chest. In these patients, the nature of their firm, dense breasts, makes the improved penetration of the Micro-aire power handle an asset. Apart from this important difference, the other steps of the Liposuction are the same.

When you return to your room after your Liposuction surgery, you’ll notice a drip in the back of your hand through which intravenous fluids will be administered. As you’ll lose some fluid, along with the fat during liposuction, it is normal practice for the anaesthetist to give you intravenous fluids to replace those lost in the procedure.

Moreover you will be wearing a snugly-fitting compression garment. This must be worn over the treated area to control swelling and bleeding, and to help your skin shrink to fit your new contour. You may feel a little drowsy as a result of the anaesthesia but are likely to feel otherwise quite well. It is very common to have some bruising, swelling and minor initial lumpiness to the area.

It is also fairly common to appear slightly uneven. This is often completely normal and will settle over the course of the coming weeks. You may feel numb or tingly in some areas due to some nerve irritation. This usually resolved within the first 6 months of surgery.

There are very few forms of surgery that are completely painless. Discomfort is a euphemism for pain and many doctors use these interchangeably. In the case of liposuction, the degrees of pain varies from patient to patient and area to area, but this can be controlled by pain killers, which will be prescribed.

The initial pain lasts around 1 week however there may be residual soreness in the treated area, mainly upon palpation, for up to 4-5 weeks. Along with the soreness, you may experience some stiffness which usually abates as your mobility increases.

You should be up and about within a day or so, although you may feel slightly ‘washed out’ from the whole experience. You will steadily improve day by day after this. Despite wound drainage, you are still likely to experience swelling and bruising to varying degrees. Sometimes this bruising is quite spectacular.

Bruising can take up to 3 weeks to disappear although very occasionally a light tinge of yellow can still be seen in the skin up to 2 months following treatment. Tissue swelling, while expected, can last up to 4 weeks. In fact, because of this swelling, you will probably not notice any change in your size immediately after surgery.

It is important to remember that when the abdominal area is treated, the swelling and bruising can migrate downwards to the groin and genital region. In men, this would mean substantial swelling, bruising and discomfort of the external genitalia. This usually lasts about 7-10 days, and one may benefit from the use of support underwear instead of boxer shorts, in this instance.

At around 2-3 weeks after surgery, you will discover that the areas treated will feel hard and irregular. This is part of the normal healing response. The body starts to lay down scar tissue (which is hard in nature) in response to surgery in an attempt to ‘heal’ itself.

This scar tissue can also block lymph drainage channels temporarily and occasionally cause the skin overlying the treated area to look dimpled or take on an ‘orange skin’ appearance. Thankfully the scar build up ceases and eventually resolves completely, along with its manifestation. You will be instructed on how to massage this area. However, this period of hardening and irregularity can take between 4-9 months to resolve. You will also likely experience sensory changes in the area treated.

This may result in numbness of the skin or, alternatively, it may feel hypersensitive. Either way, this is usually temporary and returns to normal in about 6-8 weeks. Overall because of these effects, it’s not unusual to feel depressed in the days or weeks following surgery. Try to keep in mind though that this is normal and will subside as you begin to look and feel better.

Learn more about the liposuction recovery timeline.

In a word, no. After your surgery, you will very likely notice some bloody fluid draining from your tiny incisions. This is because the incisions are not stitched, and are left open. This facilitates the drainage which is very helpful as there is almost always some blood and fluid build-up that develops in the treated areas in the first 24-36 hours postoperatively.

Your incision sites effectively act as “drainage holes” and will be invaluable in reducing your overall post-operative swelling and bruising. The downside of this practise is that during the first day or two, your dressings and clothing will usually get soaked quite quickly and therefore you will require regular changes. Thankfully however all this usually stops by the end of the first 48 hours after surgery.

Moreover, as the incisions are very small, they rapidly heal on their own once the drainage stops and the ensuing scar is no different, if not better, compared with the use of stitches. With this method, there is also the obvious advantage in that it eliminates the unpleasant need for any stitch removal.

Scars are not a complication but a normal event after any surgery. Depending on the area(s) needed to be treated, tiny scars about 3-4 mm in length will form. These are usually placed in natural folds of the skin where possible.

Generally, about 2-3 incisions are required for any given area. Thankfully the scars in Liposuction are very small and generally heal quite well, gradually fading with time. However, it is important to keep in mind that this may take up to two years to complete. If you are of a darker skin type, however, then expect your scars to be darkly coloured for a longer period of time (about 3 years).

Daily massage of the scars during this time period is advised to expedite and facilitate this process. You must understand however that no responsible surgeon will ever be in a position to predict any scars ultimate appearance.

All surgery carries some uncertainty and risk. When liposuction is performed by a qualified and experienced Plastic Surgeon, complications are infrequent and usually minor. Still, individuals vary greatly in their anatomy, their physical reactions, and their healing abilities, and the outcome is never completely predictable.

Complications that can occur include thickened, deeply coloured or unattractive scars at the site of the small incisions; irregularities of contour or dimpling of the area treated; unevenness or asymmetry between sides; prolonged numbness and swelling; haematoma or seroma formation (a collection of blood and fluid under the skin that must usually be drained by the surgeon), and infections.

In extremely rare cases, skin loss resulting in permanent scarring has been reported. Risks such as blood and fat clots are rare. You will be asked to wear special stockings (TED) just prior to coming to the theatre, to reduce this likelihood. Furthermore, during your operation, special pump devices (Flowtron) are wrapped around your calves to stimulate continued blood flow to this region and avoid any stagnation of blood which can lead to blood clots.

Early mobilisation by moving around as soon after the surgery as possible also reduces this considerably. Despite any surgeon’s best efforts, it is possible that a small number of patients may require a secondary tidy up procedure, usually after 9-12 months, to correct or improve any residual uneven contour or shape irregularity. This will be determined at the follow-up checks.

All these newer energy-based Lipolysis (Fat melting) and Fat removing devices have their advocates. Most of these use a variety of different energy sources to effectively melt rather than suck out fat (although some combine the two) and most of them have received significant media attention with some of them touting these to be a ‘lunch hour’ procedure with reduced pain, bruising and recover.

Mr Karidis has been in a position to trial and use a wide number of lipoplasty energy devices on his patients such as the Smart Lipo, Slim Lipo, Vaser, and Bodyjet devices. After using these, he has come to the conclusion that all these devices can work and all can deliver good results. However, more importantly, he found no clear advantage to using these over the Power-Assisted Lipoplasty (PAL) that he has been using in the last 15 years. He did, however, find some disadvantages with the energy devices.

Using any energy source such as a laser (Smart Lipo, Slim lipo etc.), Ultrasound (VASER) or Radiofrequency (Body Tite) will, by definition mean that heat will be dissipated or soaked into the surrounding areas. Unfortunately, any excessive heat dissipation into the surrounding fatty tissues can have a detrimental effect by potentially causing fluid or seroma formation.

Seroma formation is very rare with the use of Power-Assisted Lipoplasty (PAL) as there is very little heat generated with this device. Whenever seroma formation happens this usually leads to longer healing and recovery periods and is very similar to the inflammatory effects seen from any kind of burn.

The advocates of these devices will have you believe that the heat dissipation that results from these energy devices is beneficial in that this subsequently leads to ‘tightening’ or ‘shrink-wrapping’ of the skin and therefore better results. This theory plays beautifully into the hands of these practitioners as there is a general perceived fear in the public that if one sucks out the fat from under their skin, the skin will just sag!

So if someone sells a product that purports to significantly tighten the skin then presto you have an instant convert! The truth is that there are no published results that actually show any practically better or more significantly, real-life visual tightening of the skin following any of these devices compared to say a properly performed Power-Assisted Lipoplasty.

In his experience with the energy-based lipo devices, Mr Karidis found no difference in bruising, swelling, postoperative pain, or recovery times when compared to the PAL technique. Both PAL and the Energy devices, depending on the patients and areas treated of course, can leave a patient with very little or a lot of swelling and bruising.

This is because every patient differs in terms of their tissue consistency, quality, and bleeding propensity as well as their blood vessel fragility. Of course, the theory is that the energy devices target only the fat and leave the other tissues such as nerves and blood vessels unscathed. Unfortunately, these theories work best in the lab and in ideal situations. The reality is that in practice there are a number of variables that shatter these theories.

This was simply not Mr Karidis’s experience. Apart from the Body jet-which he found took approximately the same amount of time with the PAL device – on the same given area; the others took on average 30-50% more time to perform.

Any surgeon worth their salt has to take into consideration the time a patient spends on the operating table and always has to ensure that a patient spends no longer than they absolutely have to under any anaesthetic. As a result of this and other above personal observations, he has not embraced the energy lipoplasty devices.

Mr Karidis is always prepared to take on new procedures, technology, and any techniques that can maximise results yet improve the postoperative period or recovery of his patients. Indeed he is usually amongst the first of his colleagues to embrace such things where it is clear that these are an overall improvement.

However, he refuses to take these on if he feels the advantages are not as clear cut to his patients or when he feels that any declared benefits are based more on marketing hype than reality.

In summary, Mr Karidis believes that there is no reason to suggest that nice results cannot be achieved with these devices in the appropriately trained hands. And, of course, herein lies the crux of the matter. The truth is that surgeons who can get good results with energy devices will also likely get good results with any form of lipoplasty but more importantly without the possibility of the added untoward effects already mentioned.

So like all things surgical, in the end, it’s not necessarily about any perceived advantage of any particular equipment or device. It’s all about, and always has been, the expertise of the surgeon that makes the difference. And as Mr Karidis has been removing fat for over 20 years, from thousands of patients, it is clear he has the expertise to match any result with any device.

Liposuction can be performed successfully either with a local anaesthetic alone, local anaesthesia with mild sedation (twilight anaesthesia) or with a General anaesthetic (completely asleep). If you decide to have it done with a local anaesthetic, you will probably feel some vibration and friction during the procedure. You may also occasionally feel a stinging sensation as the cannulae moves closer to the muscle.

Obviously, if you are put to sleep then you will not be aware of anything. The decision very much depends on the number of areas treated, the amount of fat to be removed, any pre-existing medical conditions or unique circumstances and of course the individual patient’s desires. Such decisions are best made after a thorough consultation and discussion with Mr Karidis.

This very much depends on the number of areas treated and the amount of fat that is removed. It also depends on the individual’s preference and circumstances. Some people prefer day surgery so that they can recover at home whilst others prefer the reassurance of a hospital environment on the first night following surgery.

Certainly, with small areas, where less than 1.5 litres of fat is removed, day surgery can comfortably be undertaken. When the amount of fat exceeds this, it may then be preferable to decide on an overnight stay. The decision for this can be made at the time of the consultation visit.

This depends on the number of areas treated and the amount of fat which will be removed. Therefore this can be anywhere from 30 minutes to 2 hours.

The answer is very little. In fact in the first few weeks after surgery, you may notice a slight increase in weight due to water retention. The reason that you don’t lose much weight is that taking out up to 2.5 or even 3 litres of fat (which is the safe maximum limit) is not enough for you to see a significant drop in your weight.

This is because fat cells don’t actually weigh that much. On the other hand, however, depending on the treated area of course, you will notice a significant decrease in girth measurements in due course once the swelling dissipates completely.

It is important to understand that there is a maximum safe limit to the amount of fat that can be extracted during any one operation. This is usually between 2.5 – 3 litres. In some instances, therefore, you may want to repeat or have more removed at another time. It is usually best to wait at least three months between procedures.

More recently technology has improved to such a degree that fat reduction using non-surgical is now possible. These technologies work by harnessing the power of some of the energy-based systems such as Ultrasound, Radiofrequency and Cooling technology. These are all applied externally and they target fat cells leading to their destruction and absorption.

In general, although there is usually no downtime with these treatments they do usually require multiple sessions and are good for relatively smaller areas of fat removal as compared to liposuction. Although they are based on proven principles and do in fact work, they simply cannot lead to impressive fat reductions as one sees with surgery.

The other non-surgical treatment mainly involves the injections (lipolysis or fat-busting injection) of small quantities of phosphatidylcholine – a cholesterol-lowering drug – into the fat in order to produce a reduction of fat deposits. This technique has been used for a number of years now and although there are clinical reports of significant and positive results, they are all anecdotal, and unfortunately, there is currently insufficient scientifically valid evidence to support the long term safety and efficacy of injection lipolysis.

Furthermore currently in the UK, the Medical Devices Agency (MDA) has banned the use of these injections pending further evidence of safety. In general, the success of any body contouring technique, particularly the non-surgical ones, requires selecting the right treatment for the right patient and making sure the patient has realistic expectations

The short answer to this is no. As fat cells have achieved their set number in any given part of the body by puberty, increasing your caloric intake will not lead to overall volume gains in the treated site. However, if you continue to take in more calories than your body can burn, you will notice that other areas of your body may be then be affected.

The only exception to this rule is if there is a massive weight gain. In this case, new fat cells will also be seen in the previously treated area. It is important therefore to maintain your weight afterwards by sensible eating and regular exercise.

The recovery time varies with how many areas are treated, the amount of fat removed and the type of activity the patient intends to resume. It is important to realise that although only tiny incisions are made, liposuction creates a large wound hidden under the skin and therefore as healing is a gradual process, adequate rest in the days after surgery will be required.

Of course, a compression garment aids in the support of the skin and wounds. You should start walking around as soon as possible to improve the circulation and avoid stagnation of blood which could lead to the formation of blood clots. Most patients resume light activities within 2-3 days and depending on their work can be back between 5-7 days.

However because of variations in swelling and bruising, occasionally this may be delayed up to 7-10 days. Exercise is usually recommenced at about 2-3 weeks. Don’t be depressed however if it takes you longer to resume your full activities. Remember every individual is different and great variations occur.