Going inside liposuction

Have you ever watched a video of liposuction and thought “that looks pretty brutal”? That was the reaction I had the first time I saw it back in high school. Watching the surgeon aggressively piston the cannula in and out just didn't look right. Fast forward 10 years and I find myself doing the same thing. But do you know why?

Liposuction is a pretty basic concept; use a device to suck out the fat. It begins with preparing the site with a wetting solution used to reduce blood loss and reduce pain. The solution is commonly a combination of lidocaine, saline, and epinephrine. An entire lecture could be given on the different combinations and amounts of fluid injected so I won't delve into that, but we typically use a standard solution of 30mL of 1% lidocaine and 1 amp of epinephrine for every 1L of normal saline. This is injected as a tumescent technique, or large volumes per site. Once the site is tumesced, the actions you’ve normally seen in the videos begin.

Fat is stored in the body by cells named adipocytes. These cells are not just floating under the skin. They are firmly attached by a subcutaneous framework of connective tissue. To be able to suction them out they must first be released from the surrounding tissue. Various cannulas and liposuction machines can help aid in this process, but the majority of surgeons use mechanical force to break the fat free. Another way to think of it is the fat cells being like grapes still on the vine that need to be separated from their stems. We use a power assisted system and begin with a large cannula with a basket to help break up the connections followed by a smaller cannula for extraction of the fat.

Once the liposuction is complete, you're left with the connective tissue framework and overlying skin. In this picture you can see a patient's mons pubis (area below the abdomen and above the genitals) that was liposuctioned during an abdominoplasty. Notice the web of pink connective tissue below the skin and above the deeper fat (the yellow globs). It is because of that pink tissue that the act of liposuction has such an aggressive appearance.

With a better understanding of the physiology behind liposuction, the mechanics of the technique should seem more appropriate and hopefully less brutal.