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Liposuction has long held a position among the most popular plastic surgery procedures, yet it might also be the most misconstrued. Despite the significant advancements in fat removal techniques over time, making lipo increasingly secure and refined, the process is still frequently regarded as straightforward or even crude – "when, in reality, the opposite is true," remarks Dr. Adam Kolker, a board-certified plastic surgeon in New York City. "It's truly one of the more demanding procedures in plastic surgery." Not only is it "exceptionally sculptural," he adds, requiring both an artistic perspective and an in-depth understanding of anatomy, but it's also uniquely considered, demanding that surgeons predict which bodies will – and won't – respond positively to what Dr. Kolker refers to as "a shift in the relationship" between skin and fat.
For clarification, the traditional liposuction procedure is a minimally invasive cosmetic operation that involves extracting body fat through a small incision in the targeted areas of the body. The cannula is inserted along with a tumescent solution (a combination of saline, local anesthesia such as lidocaine, and epinephrine) into your tissue, where it then removes the necessary amount of fat to achieve the desired outcome. There are newer variations of this method, such as ultrasound-assisted liposuction (UAL), which utilizes ultrasonic energy to break up fat.
It's not a weight loss approach and can't assist with obesity or cellulite; rather, it's most suitable for those who are already at a healthy body weight. The ultimate results may take a few months to become noticeable until the swelling subsides. And, similar to any surgical procedure, there's a risk of side effects, like hematoma, fluid pockets, and, rarely, blood clots.
It's also important to remember: While liposuction results are technically lasting, any weight gain can cause the remaining fat cells to expand or result in the formation of new ones. Therefore, a healthy lifestyle (consider: a balanced diet and a regular exercise routine) is crucial for maintaining the results.
When seeking the ideal lipo surgeon, be discerning, especially when browsing through before-and-after photo galleries. Because often, our experts say, it's a few distinct particulars – those outlined below – that will combine to produce the most remarkable outcomes.
Inconspicuous Cannula Scars
On the journey to natural results, the finest plastic surgeons strive to conceal their actions. While lipo doesn't involve extensive cuts with a scalpel, accessing fat deposits requires inserting a stainless steel cannula beneath the skin in multiple locations, leaving small marks. "Frequently, the cannula sites are the sole visible evidence of liposuction surgery, so as with all other cosmetic surgeries, the aim is to position incisions in natural lines of skin tension, shadows, or areas hidden by clothing," explains Dr. Umbareen Mahmood, a board-certified plastic surgeon in New York City. Some body parts generously offer hiding places – the belly button when treating the abdomen, or a buttock crease when slimming the outer thigh – but others, like the middle back, lack the creases and folds that can camouflage cannula access points. In such areas, surgeons typically aim for a section of skin on areas of your body that are typically covered by undergarments, such as within the bra line or bikini line.
Smooth Contours
Here, we're addressing two matters: avoiding contour irregularities, such as lumps and bumps, and guaranteeing that one treatment zone transitions smoothly into the next.
Contour irregularities are among the more common complications of lipo. These textural disruptions can occur if surgeons remove too much fat (particularly from areas prone to divots, like the outer thighs) or if they target an incorrect plane. As Dr. Kolker explains, "There's a system of fascia, or connective tissue, that envelops the entire body, and there's fat above and below it, but the proportions vary in different regions." These ratios can also differ from person to person. Extracting superficial fat – the padding just beneath the skin – instead of the deeper reserves in specific areas can leave visible lumps, so defatting the appropriate plane is essential for an untouched-looking outcome. That said, certain individuals are simply more prone to lumps, notes Dr. Mahmood, like those with "soft, easily malleable or 'doughy' tissue."
To minimize dents during body contouring with lipo, surgeons employ a technique called fat equalization. "It involves passing over the liposuction sites with a specific cannula, known as an exploded tip or basket cannula, without suction, essentially to help disperse any loose fat particles so they can act like small fat grafts over the treated areas," Dr. Mahmood explains, filling in the gaps for a smoothed effect.
Preventing bulges also means approaching the body in three dimensions. While 360 lipo has become something of a buzzword, it's actually more of a standard practice than a trendy technique, since every body part has not only a front but also two sides and a back to consider. Take the abdomen: "There are some individuals who have very specifically focused localized fat and might be candidates for just anterior [frontal] abdominal contouring, but in most cases, you need to address these areas in 360 degrees," says Dr. Kolker.
Reducing one area in isolation tends to emphasize neighboring problem areas, even if they weren't overly bothersome initially. "To undergo liposuction of the abdomen but neglect the flanks will result in a flat, boxy abdominal appearance," explains Dr. Mahmood. Similarly, suctioning only the lower back to smooth a posterior muffin top will make bra rolls more prominent. For this reason, she adds, "I typically suggest performing liposuction of the abdomen and flanks together, followed by the upper and lower back together."
Natural Muscle Definition
"Overemphasized high-definition lipo results almost always make me wince," Dr. Kolker states. The best approach to delicately define the musculature is to follow the inherent peaks and valleys of the area being contoured. On the female abdomen, Dr. Mahmood says, "The key elements to emphasize are the linea alba – the vertical line extending from the top of the abdomen to the belly button – and the linea semilunaris, or the vertical lines on each side of the abdomen."
When striving for authenticity, it's also vital to respect areas that should never be completely flat, like the space between the belly button and the pubic region, notes Dr. Kolker, "where there should always be a bit of convexity."
While the sculpted appearance is highly desired, it's not suitable for everyone. "Many patients observe the results of others and aspire to the same, without realizing that their body characteristics are significantly different at the outset," says Dr. Mahmood. "Ideal candidates have a BMI less than 28, are healthy, fit, non-smokers, have good underlying muscle tone, and have no excessive skin laxity."
Tight Skin
When asked about the secret to a non-surgical-looking lipo outcome, both experts responded: the right candidate. And one of the most significant shared traits among strong contenders is firm, elastic skin. It's why lipo results in those in their twenties almost always appear better than in those in their thirties, Dr. Kolker notes, and why those in their thirties tend to look better than those in their forties, and so on.
During consultations, plastic surgeons will conduct a series of pinch tests to assess the quantity and quality of excess fat as well as skin elasticity – how quickly the skin rebounds after being pinched. In most cases, "There will be a certain degree of skin retraction with liposuction, especially if patients adhere to wearing postoperative compression garments," says Dr. Mahmood. Surgeons may also be able to induce a little more tightening by integrating radiofrequency or plasma energy during the surgery. But these devices have their limitations for loose skin. According to Dr. Mahmood, "Existing hanging folds of lower abdominal tissue or significant stretch marks are clear indicators that the skin will not retract adequately" after fat removal – and that a tummy tuck might be necessary.
