What is Liposuction Surgery?
Liposuction is a minimally invasive procedure for both men and women in New York City that removes stubborn fat from specific problem areas. This plastic surgical procedure allows people to contour their body shape and remove unwanted fat.
Liposuction is ideal for people who have isolated areas of fat that are not responding to diet or exercise. Most often, these areas of concern are the abdomen, love handles, arms, thighs, and neck. Men can benefit from liposuction of their chest for male breast reduction. (See gynecomastia treatment)
Although liposuction can help heavier patients to “slim down,” it is not a weight loss procedure, and should not be considered a substitute for a healthy diet and exercise routine. In addition, it may not be recommended for people with skin laxity issues, as skin in the treated area may actually become looser after liposuction. In this case, a surgical procedure to remove excess skin may be the better choice.
This highly customizable surgical procedure usually takes between one and three hours and has a recuperation time of two to five days.
Why is Liposuction Performed?
The goal of liposuction is to treat areas of unwanted localized fat deposits to achieve a more pleasing figure. Dr. Steven Wallach, a board-certified Manhattan New York plastic surgeon, understands the history and evolution of liposuction techniques over the years. Originally, the goal was simply to flatten areas of excess fatty tissue. More recently, techniques were developed to perform “abdominal etching;” to bring out the lines of the abdomen so that a more “cut” look is achieved.
Further refinements of these techniques have evolved to promote even better definition in all areas of the body: the abdomen, flanks, chest, back, legs, and arms. Individuals who have a relatively low body fat concentration and want more definition in specific areas are the best candidates for liposuction in New York. This can be achieved by bringing out the differential natural shadowing and curves that well-framed physiques have.
The History and Development of Liposuction
Liposuction has evolved over the years from its original development in the mid-1970s. Plastic surgeons started out performing this procedure with sharp-tipped cannulas (thin, hollow tubes used to remove the fat) by using a “dry” technique (no wetting solution to help diminish blood loss). The early results were good, but were limited in being able to remove large quantities of fat mainly due to blood loss from the procedure.
The techniques improved when practitioners began using blunt-tipped cannulas and wetting solutions, thereby diminishing blood loss and allowing more fat to be removed in each session. This resulted in better and safer results from liposuction procedures.
Wetting solutions usually have a mixture of a balanced sterile salt solution, lidocaine (an anesthetic), and epinephrine (a blood vessel constrictor). The combination of these three ingredients allows for relatively pain-free treatment with narrowing local blood vessels both by tissue expansion using the salt solution and the vasoconstrictor effects of the epinephrine. This provides for a minimum of blood loss during the procedure.
Since the development of these wetting solutions, many variations in the concentration of fluid infusion and fat removal have been created. This includes techniques described as the wet technique, the “super-wet” technique, and the tumescent technique.
The instrumentation has also evolved over the years, and there are many different tools that can be used for a body contouring procedure. Dr. Wallach performs liposuction using many different tools along with the tumescent technique. He may use standard cannulas, power-assisted liposuction (PAL), ultrasound-assisted liposuction (UAL), the VASER liposuction machine, or laser lipolysis using machines such as Smartlipo for any given liposuction procedure. Dr. Wallach has also presented and published papers on body contouring procedures.
- Traditional Liposuction
- Power-Assisted Liposuction (PAL)
- Ultrasonic Liposuction (UAL)
- Laser Lipolysis (Smartlipo™)
- Alternative Liposuction Options
The term “traditional” is really a misnomer. It suggests that this is an old, outdated technique, when in fact it is the most popular liposuction technique used today, incorporating tumescent fluid infusion. Learn more about traditional liposuction.
Tumescent Liposuction Procedure
First, the tumescent fluid is infused through several small incisions near the area(s) that require treatment. After waiting several minutes for the vasoconstrictor action of the solution to take effect, liposuction is performed. Blunt cannulas with holes near the tip allow for an almost bloodless removal of fat cells without disturbing the majority of sensory nerves or blood vessels in the surrounding tissue.
- It is unlikely to develop seromas (fluid collections) or hematomas (blood collections) from tumescent liposuction. Even less frequent are skin burns because the cannulas do not generate any heat.
- This procedure is somewhat labor-intensive for the operating surgeon because of the back and forth motion required to aspirate fat without assistance from the device.
Power-Assisted Liposuction (PAL)
This technique uses cannulas that are on either a compressed gas-powered or electric handpiece that moves the cannulas back and forth. This allows Dr. Wallach to use less energy to remove the excess fat cells.
PAL Liposuction Procedure
The procedure is similar to that described for “traditional liposuction”. The only difference between power-assisted and traditional liposuction is that Dr. Wallach does not have to manually break up fat tissues, as the handpiece performs most of the work.
- Incision size is the same as traditional liposuction. There is less manual exertion because the oscillating handpiece does most of the work. It is suggested to use this procedure to treat more fibro-fatty regions such as the hips, back, and male chest.
- There may be a slightly increased risk of seroma formation than traditional liposuction.
Ultrasound-Assisted liposuction (UAL)
This technique uses ultrasonic technology to loosen and emulsify fat. Now more surgeons are using the Vaser® machine. Vaser stands for Vibration Amplification of Sound Energy at Resonance. Vaser is different from previous UAL devices because the ultrasonic energy is emitted from the rings on the side of the cannula as opposed to the cannula tip. The heat that is generated from the ultrasonic vibrations is focused on the sides of the cannula. This helps minimize some of the potential complications of using this technology.
Vaser Liposuction Procedure
Incisions for access for UAL procedures require a slightly larger incision than with either “traditional” or PAL techniques. Access protectors are secured at the incision sites while the ultrasonic energy is used. The ultrasonic probe is inserted after tumescing the fatty layers, and the energy from the ultrasonic probe both loosens and emulsifies (liquefies) the fat. Once this step is complete, standard liposuction cannulas are inserted to remove the fatty tissue.
- There is less manual work than performing “traditional” liposuction or even PAL. Vaser may work better on fibro-fatty regions such as the hips, back, and male chest. It also may be able to give better contour definition and skin contraction upon recovery.
- Ultrasonic techniques have a higher seroma rate than other techniques. Ultrasound liposuction techniques also have a higher rate of skin burns due to the heat generated during the procedure. Ultrasound techniques may also have prolonged numbness over the skin as compared to other techniques. The procedure also takes longer than traditional or PAL techniques.
Laser lipolysis (Smartlipo™)
This technique uses laser light energy to emulsify fat. The heat generated from the laser light may also encourage some degree of skin contraction. This added technology allows for more delicate or intricate treatment.
Smartlipo Liposuction Procedure
First, small incisions are made for tumescent access. The treatment area is tumesced using a cannula and then laser light might be used at the beginning of the procedure to emulsify or break up the fat deposits or used at the end of the procedure to heat the skin in an attempt to cause skin retraction. In either case, a traditional cannula is inserted to remove the emulsified fat.
- Laser-assisted liposuction is better for treating small areas. Small incisions are used to complete this procedure. May induce some skin retraction following recovery.
- Laser lipolysis may have an increased seroma rate as compared to traditional and PAL techniques. Laser lipolysis has a higher rate of skin burns due to the heat generated during the procedure. It may produce prolonged numbness over the skin as compared to the other techniques. A laser liposuction procedure takes much longer than other liposuction procedures. There may be very little to no skin contraction after the procedure. For more information on the pros and cons of Laser lipolysis, visit our blog.
Liposuction Under Local Anesthesia
Dr. Wallach also offers liposuction with local anesthesia. If the fat you are looking to remove is localized, then it is perfectly acceptable and safe to remove the fat without the deep sleep of general anesthesia. Depending on the areas you are looking to treat, liposuction under local anesthesia could be a good fit for you.
- The main advantage of local anesthesia is not having to manage the effects of general anesthesia. Many patients like the comfort and safety that comes with local anesthesia. Unlike general anesthesia, you are able to eat a light meal on the day of your procedure. You also avoid the typical anesthesia “hangover”. Local liposuction treatments are also done is less time, so you can get back to your life quicker. Lastly, due to the fact this can be done in the office, local liposuction is offer a cheaper option than liposuction with general anesthesia.
- Due to the fact that you are awake during the procedure, local liposuction is often considered less comfortable for the patient. In addition, you are limited in the amount of fat that can be removed during a liposuction procedure with local anesthesia.
Who is a Good Candidate for Liposuction?
A good candidate for liposuction in New York City is at a healthy, stable weight and is medically cleared to undergo a plastic surgery procedure. People who have stubborn fat deposits that they’d like to get rid of are generally eligible for liposuction treatment.
People with loose skin or who may not experience skin tightening after the procedure may not be good candidates for liposuction, as the procedure can create issues of skin laxity in certain patients.
How Much Does Liposuction Cost?
The fee for liposuction usually is charged per area. This can vary from as little as $2,500-$6,000 per area. Dr. Wallach will provide an accurate, honest quote for your unique procedure during a liposuction consultation in his Manhattan office.
What Are the Risks of Liposuction?
In general, liposuction is a very safe procedure with little downtime and few complications. The most common may be contour irregularities. Less common issues include persistent numbness, fluid collections, and infections. The most common issues that develop include asymmetry and contour irregularities which may be related to under- or over-treatment. Some other less common issues include infection, seroma, hematoma, dysesthesia, unfavorable scarring, and need for revision.
What Should I Expect During My Liposuction Recovery?
Immediately following your treatment, you will be monitored to ensure your vitals are in good shape as you recover from either the local or general anesthesia.Dr. Wallach will place you in compression garments both to help reduce swelling and fluid accumulation as well as help protect your natural-looking results.
Recovering from liposuction usually requires patients take two to five days off of work and normal activities, and refrain from strenuous activity for up to two weeks, depending on Dr. Wallach’s instructions. Your liposuction results will start to become apparent as swelling goes down and incision sites heal, typically taking between four to six weeks. After the six-week mark, most liposuction patients feel back to normal and are starting to see and enjoy the results of the procedure.
Schedule a Consultation For Liposuction in Manhattan, NYC
Something Dr. Wallach frequently tells patients who come in for consultations is that the results of liposuction don’t depend on the specific device, technique, or even procedure performed, it’s about the person performing it. With Dr. Wallach leading your liposuction, you can be sure that you’re getting the best liposuction treatment in Manhattan. To find out if liposuction can help you achieve the body figure of your dreams, feel free to contact Dr. Wallach by calling our office or contacting us online today. We can’t wait to help you get the results you’ve been waiting for!
Liposuction Frequently Asked Questions
Are you put to sleep for liposuction?
Patients can be awake during liposuction. This is often accomplished with some oral medication and local anesthetic to relax the patients. Other patients who prefer can undergo either deep sedation or general anesthesia.
Does fat come back after lipo?
Liposuction decreases the overall volume of fat cells in a given treatment area. New cells will not grow back in the areas treated, however, if you gain weight, the cells that are present in that area will enlarge. I tell patients that if you gain weight then the weight will probably be more evenly distributed and not accumulate as frequently in the areas previously suctioned.
Can I get liposuction if I am overweight?
A patient with a fairly high BMI can have liposuction if they are realistic about the results. I spend a lot of time with my patients discussing realistic expectations in these cases.
Can visceral fat be removed?
Visceral fat can not be removed with liposuction.
Does liposuction get rid of cellulite?
Liposuction does not get rid of cellulite.
Does liposuction really work?
Liposuction does really work and can work very well on the subcutaneous layer of fat.
Does a tummy tuck remove fat?
A tummy tuck will remove fat and skin of the lower belly. Liposuction can be combined with a tummy tuck in some patients.
How can I avoid weight gain after surgery?
I think that maintaining a good diet and maintaining a good exercise regimen should minimize any further weight gain.
How can I lose tummy fat fast?
Losing tummy fat the quickest way is usually by liposuction.
How do you shower after liposuction?
I allow my patients to shower the following day after surgery.
How can I reduce my stomach fat?
You can reduce the fat by diet and exercise, maybe liposuction, or maybe a tummy tuck. I would have to see you.
How does fat transfer work?
Fat transfer works by removing fat from one area and transferring to another area.
How dangerous is liposuction?
Liposuction is a very safe procedure. Issues that mainly develop include contour irregularities, bruising, and some numbmenss.
How does Lipo work?
Liposuction is a procedure in which fat is suctioned out from the subcutaneous layer. Most patients have minimal post-procedure discomfort and pretty quick recovery.
How do I prepare for liposuction?
I have my patients eat healthy and exercise regularly. Avoid smoking and any medication or herbals that can cause bleeding.
How long do you drain after lipo?
I do not drain liposuction patients.
How long do you need off work after liposuction?
Most of my patients feel pretty good within 2-3 days and can return to desk work at that time.
How painful is liposuction recovery?
I find that of all the surgeries that I perform, my liposuction patient usually have the least amount of pain and quickest recovery.
How much does it cost to get liposuction on your stomach?
Liposuction fees will vary from surgeon to surgeon. It can run between $5k- $8K.
Is it easier to lose weight after liposuction?
I find that in some patients liposuction is a "kick start for many of my patients to go on to lose weight.
How much does liposuction cost without insurance?
The cost of liposuction will be determined by the extend of liposuction performed. This is determined by how many areas are treated and how large the patient is.
Is Lipo permanent?
The results of liposuction are permanent.
How much fat can lipo remove?
In general, I find that most patients can have about 60-70% of the subcutaneous fat removed in one session.
Is liposuction an outpatient procedure?
Yes, liposuction as a stand-alone procedure is an outpatient procedure.
Is there a weight requirement for liposuction?
I think that if a patient has a high BMI then they should probably opt for diet and exercise to first lose some weight.
What is Lipo Laser?
This is a term referring to any device that uses laser light to heat the skin or to dissolve fat in the subcutaneous plane.
What can you eat after lipo surgery?
I think that in general I prefer patients to make healthy choices in moderation.
What is the best type of liposuction?
There is no one best liposuction machine/technique in my opinion. Its not the wand (the machine) its the magician (the surgeon) that creates the magic!
What do they do with liposuction fat?
The liposuction fat is discarded unless the patient wants it transferred to another area.
What is ultrasonic liposuction?
Ultrasonic liposuction is just one technique to perform liposuction.
What types of liposuction are there?
There are many liposuction techniques and machines out there. There is no one best liposuction machine/technique in my opinion. What matters more is the skill of the surgeon using the device.
Who is good candidate for liposuction?
A good candidate for liposuction is someone who is healthy, a non-smoker, and has a lower BMI.
Can I do liposuction instead of going on a diet?
Liposuction is not a substitute for a diet. Good nutrition and exercise are important factors to staying fit. Liposuction is ideal for those patients who have defined areas of fatty deposit that they can’t seem to lose by diet or exercise. Common sites for treatment include the abdomen, hips, back, thighs, and arms.
Are you taking all the fat out from the areas you suction?
No, liposuction does not remove every single fat cell from a given treatment area. You want to maintain an even layer of the more superficial fat so that contour deformities do not result. In fact, overzealous liposuction can cause severe deformities that sometimes cannot be corrected.
What are the different types of liposuction techniques that are available today?
There are many different ways to perform liposuction. I like to divide them into those that use heating devices and those that do not. The ones that do not use heat include traditional liposuction and power-assisted liposuction (PAL). Those that use heat include ultrasonic liposuction devices like Vaser and laser lipolysis machines like Smart Lipo. The heating devices in my opinion tend to have a higher risk of fluid collections (seromas), prolonged numbness, and the potential for burns.
What is Vaser Liposuction?
Vaser liposuction is a form of ultrasonic liposuction that can be performed in an office-based operating facility. It uses high-frequency ultrasound that generates heat to melt the fat that is being treated. Once this is performed, the emulsified fat is then suctioned with more traditional cannulas. Some believe that the heat can cause skin contraction, but it does not appear that it improves skin contraction any better than other techniques, including traditional liposuction.
I have some numbness after liposuction, will this get better?
It is pretty common for patients to develop some numbness, or what is called dysesthesia, after liposuction. This is commonly due to swelling and usually improves over a six to eight week period when the swelling subsides. On the other hand, the heating component devices like Vaser or laser lipolysis machines (i.e. SmartLipo) tend to cause prolonged numbness.
I heard that some patients can get burns from liposuction. Why is that?
Burns are more likely to develop with liposuction devices that generate heat. Maneuvers in using the probes leading to what is called “end hits” tend to cause burns. This is more common with the Vaser machine or laser lipolysis devices such Smartlipo or Powerlipo. This is almost unheard of with traditional liposuction or power-assisted liposuction
What is PAL?
PAL stands for power-assisted liposuction. This is a liposuction machine that assists the surgeon to perform the liposuction. The handle oscillates the liposuction cannula back and forth. It is still a mechanical process that is thought to decrease surgeon fatigue during the procedure.
Does skin tightening occur with liposuction devices?
In general, liposuction can cause some skin tightening. But I do not think that any one machine will give you “true” skin tightening in the sense that if the skin is loose, it will tighten up significantly. Although this is suggested as a benefit for using the liposuction devices that heat the tissues, the results in my opinion are not any better than more traditional techniques.
How does traditional liposuction differ from power-assisted liposuction (PAL)?
Traditional liposuction uses standard cannulas that are connected to suction. The surgeon uses these cannulas in a manual forward and back motion to mechanically suction the fat. In my opinion, this is one of the least traumatic techniques available for liposuction.
What is tumescent liposuction?
Tumescent liposuction refers to the infusion of fluid into the tissues during a liposuction procedure. It usually consists of a sterile saltwater solution, usually Lactated Ringers, along with lidocaine (an anesthetic), and some epinephrine (a blood vessel constrictor). This fluid fills the space (or tumesces) where the fat is. It helps with constricting the blood vessels both by the pressure of the infused solution and as a result of the effects of the epinephrine. This in turn decreases the risk of blood loss during the procedure. The lidocaine numbs the area being treated and can help with early post-operative discomfort. The majority of liposuction techniques use variations of the tumescent technique. There are different levels of fluid infiltration referred to as wet, super wet, or the tumescent technique. These three vary by the ratio of infusion solution to fat removal. The true tumescent technique usually uses fluid in a ratio of 3:1 infusion to fat removal. I will most commonly use a wet or super-wet technique to limit the amount of fluid infused in any one patient during liposuction.
Should I have Smartlipo done on my abdomen?
Patients always ask me about the specific technique that they have read about in the press and want to know if a specific technique or device is best for them. In general, I do not think a specific device is any better than any other. Quite frankly, I think it is more surgeon-dependent rather than anything else. I always tell my patients that it is not the wand (the machine) but the magician (the surgeon) that creates all the magic!
How much fat can you remove in one operative setting?
This is a question I get asked quite often. In general, I perform most of my surgeries in an out-patient facility. The ASPS or ASAPS recommends that no more than five liters of fat be removed in any one operation in an out-patient facility. Some states like Florida have limited the aspiration to even less fat.
Do I have to wear a garment after liposuction?
I like my patients to wear a compression garment that is specially made for liposuction post-surgical care. I think that the compression helps minimize the risk of fluid collections, and helps to decrease post-operative swelling. In general, I think that patients are more comfortable during the recovery. I like my patients to wear these garments for three to six weeks. I usually have them purchase two so that they can wear one and have a clean one available to change into. Some surgeons do not recommend garments to their patients.
Can I have liposuction of my hips?
Liposuction of the hips, more specifically the flanks or outer thighs, can be performed as part of a liposuction procedure. However, the only way to be properly evaluated is to be seen in person for a proper evaluation.
Can I have liposuction of my chest?
A common request from men is to ask about liposuction of their chest. If the chest does not have a lot of loose skin or feels more fatty than glandular, liposuction alone may be an excellent choice. For those men who might have a glandular component to the chest that would not be amenable to liposuction alone, then they may require a small glandular resection, perhaps through an incision around the border of the areola. In men who have severe skin laxity, they may require a skin excision and glandular excision as well. This can be performed using several different techniques. Most will require a compression garment.
Will I need a drain after chest liposuction?
If liposuction is the only procedure performed, I do not usually place a drain. However, I will commonly place closed suction drains when large amounts of skin and soft tissue are removed surgically.
Submental liposuction, is it a good idea?
Submental liposuction refers to liposuction of the area under the chin. If a person has a significantly fatty neck, liposuction of this region can be quite satisfying. It can usually be done through a small incision underneath the chin or behind the ears. The fat that is superficial to the platysma muscle is the area best treated by liposuction. It is important to try to maintain a thin layer of fat between the skin and muscle if possible to help minimize the risk of overtreatment. However, if there is a lot of loose skin, subplatysmal fat, or plastyma muscle banding, liposuction alone may not be enough, and there are surgical options that may be able to treat these concerns.
Will liposuction be right for me if I have had a few kids and my skin is loose?
If a woman has had multiple pregnancies and now complains of loose skin and a weak protuberant abdomen, then liposuction may not be the right procedure for her. Loose skin will likely become looser after liposuction in these types of patients. A full tummy tuck may be a better treatment option to treat the loose skin and tighten the muscles. Liposuction can sometimes be performed on the abdomen at the same time when limited abdominal flap elevation is performed, or done before or after a tummy tuck.
Can I have liposuction because I want to lose weight?
Liposuction is really not a good idea for someone who is looking to have liposuction to treat obesity. If a person is significantly overweight or obese, then diet and exercise are the best ways to lose weight. Liposuction is ideal for those patients who are close to their ideal weight but can not get rid of unwanted areas that are recalcitrant to diet and exercise. Liposuction is a great procedure to improve contour. In fact, I have been using it a great deal in combination with fat augmentation in women who want a Brazilian butt lift.