Sydney

Liposuction

No. Liposuction is not a treatment for obesity and is not a substitute for changes to diet and activity. The amount removed is usually modest and the change on the scales is smaller than most people expect. It is a contouring procedure for localised fat in people already close to a stable weight.

Weight matters for safety, too. The heavier you are, the riskier surgery becomes, so liposuction is never the safer option when weight management is what is really needed. Want to lose weight? That is a GP conversation, and there are more options now than most people realise. Liposuction suits a narrower situation: your weight has been steady for a while, and one or two spots simply will not shift no matter how carefully you eat or how much you train.

No. Liposuction removes fat, not skin. Skin has some capacity to retract afterwards, but it is limited and varies with age, genetics and how stretched the skin already is. Where laxity is significant, removing the fat underneath can leave the skin looser than it was before.

This is why skin quality is assessed alongside the fat at consultation, and why some patients are told they need skin excision instead of, or as well as, liposuction. Compression garments help with swelling and comfort while you heal, but they do not make skin retract to any set degree and no garment can promise a particular contour. If you have had significant weight loss or several pregnancies, be prepared for the possibility that liposuction on its own is not the right answer for you.

There is no magic cut-off. Volume still matters, though. The American Society of Plastic Surgeons draws its line at 5,000 cc of total aspirate, that is fat plus fluid together, and calls anything past that large volume liposuction. Their advice for those cases: an acute-care hospital or accredited facility, with vital signs and urine output watched overnight.

ASPS also notes there is no scientific evidence supporting one specific volume beyond which liposuction stops being safe, but that the risk of complications rises unavoidably as the aspirate volume and the number of areas treated increase. Larger volumes involve substantial fluid shifts within the body, which is why fluid balance is monitored carefully during and after surgery. If a large volume is planned in your case, ask where the operation will be performed, what monitoring is in place afterwards, and how long you will be staying.

Often, but not without consequence. Complication rates increase with the number of areas treated and with combined procedures. ASPS specifically notes that large volume liposuction combined with certain other operations has resulted in serious complications, so the two decisions need to be weighed together rather than separately.

Liposuction is frequently and safely combined with procedures such as abdominoplasty or breast surgery when the volume involved is limited. The caution applies to large volumes plus additional surgery, particularly where the total operating time becomes long. Cost is sometimes offered as a reason to combine, since one anaesthetic and one admission costs less than two. That much is true, but cost should not be the deciding factor on what is a clinical question. Ask how long a combined operation would run, and what a staged plan would look like instead.

The list is long and worth reading properly. Bruising, swelling, infection, bleeding and fluid collections are all reported. So are contour irregularities such as lumps or rippling, asymmetry, altered skin sensation, skin laxity, injury to nerves or deeper structures, pain or swelling that drags on, reactions to the anaesthetic, and needing revision surgery later.

Serious complications are uncommon but include fluid overload, local anaesthetic toxicity, skin necrosis, blood clots including pulmonary embolism, and fat embolism, and in rare cases these can be life-threatening. ASPS notes their frequency increases with the number of sites treated and the volume aspirated. Contour irregularity is the most common cosmetic disappointment and is not always fully correctable. Stopping smoking at least six weeks beforehand is required. If you develop chest pain, breathlessness, calf pain, fever or spreading redness afterwards, seek medical help urgently rather than waiting.

Liposuction is performed under general anaesthetic in a fully accredited private hospital. Incisions of roughly two to five millimetres are made, a suction cannula is passed beneath the skin and moved back and forth to break up and remove the fat, and a compression garment is applied afterwards.

How long it takes depends on how much fat is being removed and how many areas are treated. Most patients spend a few hours in hospital before being discharged, though a longer stay applies where a large volume has been removed. You will not be able to drive afterwards, so arrange for someone to collect you. Expect noticeable bruising and swelling over the first 48 to 72 hours, which is an ordinary part of healing rather than a sign that something has gone wrong.

Most patients resume light activities, driving and work after about two weeks, provided the work is not physically demanding. Heavy lifting and regular exercise are avoided for at least six weeks. A compression garment is worn for several weeks after surgery.

Expect pain, swelling and tenderness early on. It usually eases as the area heals, and pain relief is prescribed if you need it. Move about gently and often from day one, since that lowers clot risk, but leave strenuous activity alone for now. Line up help at home for the first few days. Most swelling goes within one to two months, though the treated area can stay firm or lumpy well past that while it settles. Timelines differ by area, so ask about yours.

Think in months rather than weeks. Swelling tends to go within one to two months, but the contour keeps changing after that, and judging it early will only mislead you. For a while the treated areas feel firm, or a bit uneven, before they soften and settle down.

The result also depends on how many areas were treated and whether liposuction was combined with other surgery. Skin quality plays a large part in the final appearance, and two patients having the same volume removed can end up with visibly different contours. No particular shape or measurement can be promised in advance. If something still concerns you once the swelling has fully settled, raise it at a follow-up appointment rather than assuming nothing can be done about it.

The fat cells removed do not grow back, but liposuction does not prevent you gaining weight. The fat cells remaining elsewhere can enlarge, so weight gain after surgery can change your proportions and alter the result, sometimes in places you did not expect.

This is the most common reason people feel a result has not lasted. Keeping a stable weight is the practical thing within your control. Pregnancy and ageing continue to change body shape afterwards as well. None of this means the result disappears, only that liposuction changes the starting point rather than fixing it permanently. If you are planning significant weight loss or a pregnancy, it is generally worth waiting until afterwards.

Generally not. Liposuction performed to improve body contour is cosmetic surgery and attracts no Medicare rebate, and private health funds will usually not contribute to hospital or theatre costs either. Expect to pay the full cost, including surgeon, anaesthetist and hospital fees.

Limited exceptions exist where liposuction forms part of a procedure that is itself rebatable for a recognised clinical reason, and that is assessed against the wording of the relevant item and your individual circumstances rather than assumed from the procedure name. Medicare benefits are not available for surgery performed for cosmetic purposes. Ask for a written estimate covering all the fees before you commit, and check that any figure you are quoted includes the anaesthetist and hospital rather than the surgeon’s fee alone.

Yes, where liposuction is performed to improve appearance, which is the usual case. The Medical Board of Australia’s cosmetic surgery guidelines apply, including a cooling-off period of at least seven days after informed consent before the surgery can be booked or a deposit paid.

The guidelines also require a referral from an independent medical practitioner, at least two pre-operative consultations with one of them in person with the surgeon who will operate, and assessment for psychological conditions using a validated screening tool. Patients under 18 require independent evaluation and a cooling-off period of at least three months. A GP referral is essential to see A/Prof Bish Soliman in any case, and consultations are booked by paying the consultation fee in advance at the time you make the appointment.