Local anesthesia or Tumescent anesthesia, in which a patient is awake, I feel has three areas of advantage. To begin with, safety. Studies have shown that local anesthesia is far safer than liposuction under general anesthesia where the patient is completely asleep. One of the main reasons is that liposuction using general anesthesia typically has a higher risk of complications such as clot formation. The second advantage to liposuction under local anesthesia is the local anesthesia prepares the area of fatty tissue to allow for  generally more pure fat removal with less bleeding leading to less bruising and less discomfort after the surgery itself in most cases. The third and probably the most important advantage is a better result and that is because liposuction surgery is a contouring and sculpting procedure and one of the only surgeries I can think of where you actually want your patient moving during the surgery to obtain the optimal position so that the muscle is never poked or jabbed or the skin is never poked or jabbed from underneath. Remember that we are using straight instruments on curved areas of the body and it is very difficult when a patient is under general anesthesia and completely asleep to optimize positioning during the contouring procedure itself and I feel that this strongly affects results from the liposuction surgery itself.

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Liposuction surgery in men, as with other cosmetic procedures, is on the increase. In my practice approximately 30% of the patients I do our male. The common areas for men are the flank area, also known as the love handles, followed by the abdomen, followed by the male chest, also known as gynecomastia, followed by the neck.

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When liposuction was first developed the trend was to use large cannulas of 6 mm in size or greater. Over the past couple of decades there has been a trend to using much smaller cannulas called micro-cannulas to perform liposuction surgery. I find personally that it is important to use small cannulas such as micro-cannulas at the surface which are usually only 2 mm in diameter. For the deeper removal of fat, to de-bulk the deeper layers typically, I prefer to use cannulas at approximately 3 mm in size. As I gradually move up in the fat layer towards the surface of the skin I change over to using a very small micro cannula to fine-tune the surface of the skin. I personally find that using a very small spatula cannula at the surface of the skin is ideal to obtain a very smooth contour of the surface of the skin and to control exactly how much retraction of skin I choose to get into each area.

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Many times liposuction surgery is combined with other surgeries commonly under general anesthesia. It is my feeling as well as the support of several studies that show that as surgical procedures are combined with longer operating room times that the risk for the patient increases. It is for this reason that I strongly prefer to do liposuction surgery by itself and to ideally not combine it with other procedures. There are cases when I do agree to do liposuction surgery in combination with another surgeon doing another type of procedure as long as I feel that there are no increased risks for the patient. Under local anesthesia, which is the way I perform liposuction surgery, I will usually agree to do smaller cases of one or two areas combined with other procedures. But once again it can be combined with other procedures but one must remember that if you’re combining it with a lot of other operating room procedures, that operating time increases as the number of procedures increase and that risk does go up.

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Encouraging patients to be patient when looking for their final result is one of the biggest challenges that I have with patients after surgery. The final result from liposuction surgery does not usually occur for 6 to 12 months and for this reason the patient must be patient with their results. The reason for this is that there is still swelling within the tissues and remodeling that takes place in terms of these areas does not finally occur for several months. Usually I tell almost all patients that they will look at least as good before the surgery and usually better after the 2 to 3 week point. At this point, if there is any bruising it is usually gone, however there usually still is some swelling.  In most patients, at about the six-week mark, there is about 60 to 70% of their final improvements, sometimes more sometimes less. Usually at the 3 to 4 month mark they have about 80 to 90% of their final improvements. Their final improvement is usually at 6 to 12 months. The general rule is that patients who had the most amount of fat removed from areas chance to see the results quicker. If one thinks about it, it makes sense because in those areas that have that bigger fat layer, when you bring them down with liposuction surgery, usually after a week or two patients will see a huge improvement. It is the patients who are on the thinner side, normal weight, that it actually takes longer to see their final results. Once again this makes sense because those patients don’t have a very big fat layer and many times in the healing process there is more proportionate swelling that takes time to resolve for the patient to really see their final results. In my practice I see patients back within the first week for a quick post operative check and then I usually don’t see them back for approximately 3 months. At that point results are assessed and typically post operative photographs are taken.

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