How is liposuction performed?
The first step is marking each of the areas to be treated. Concentric circles are drawn much like a topographic map: the innermost circle defines the highest point of fat protuberance, and the outermost circle represents the transition point to normal contour (Figure 2). These markings are critical references because body contour changes when lying down or positioned on the side during the procedure.
All methods of liposuction accomplish fat removal by very similar means despite differences in technology. Hollow metal tubes called cannulas are passed back and forth through small skin incisions to dislodge and remove fat that lies between the muscles and skin. Cannulas come in various diameters. Larger sizes remove fat in bulk whereas smaller ones are used for final shaping and finishing touches (Figure 3). They typically have several openings at the tip (Figure 4). Cannulas are attached by a hose at the handle end to a canister on the vacuum machine (Figure 5).
There are usually at least two incisions next to each area to be treated, each no more than ¼ of an inch in length. They are placed in body creases and other inconspicuous locations as much as possible. They are positioned in relation to one another so that the surgeon can pass the cannulas in perpendicular directions parallel to the body surface. This contributes to a smoother result and helps to prevent grooves and irregularities that can be otherwise caused by suctioning in one direction only. Although the scars are permanent, they are usually quite inconspicuous after a year.
After making the incisions the areas to be treated are filled with fluid containing dilute local anesthetic and adrenaline. This fluid is administered under pressure through a specialized injection cannula. This process is called tumescent technique. It minimizes bleeding, bruising, and postoperative discomfort. Tumescent technique is integral to all methods of liposuction.