Brace yourself for both the expense and the graphic description! Ranging from $2,500 to $5,000, liposuction is a general term for a procedure where localized collections of fatty tissue are removed from the thighs, calves, ankles, buttocks, abdomen, back, arms, face, neck, and chin using a thin tube that literally sucks up fat tissue. Sometimes this fat is just sucked away and discarded and sometimes it can be reused on parts of the face to improve facial contour and plump up lines. Liposuction has also been used to reduce extreme sweating (Source: Dermatologic Surgery, May 2008, pages 709-716), excessive and persistent body odor (Source: Journal of the European Academy of Dermatology and Venereology, January 2008, pages 30-35), and to reduce risks of heart disease and diabetes (Source: Current Diabetes Reviews, November 2006, pages 367-73).

Many different tools and techniques are used for liposuction ranging from ultrasound-assisted to tumescent, laser procedures, and something called powered liposuction. When liposuction was first introduced, the method involved simply inserting a cannula (vacuum device) into an area and sucking out some of the fat. This "dry method" required general anesthesia and was associated with many risks, including bleeding and leakage after the procedure.

Tumescent liposuction, a refined version of the dry liposuction method. It involves injecting a sterile saline solution into the area about to be worked on. The saline stretches the fat cells before suctioning begins, allowing a greater volume of fat to be removed. To minimize bruising, bleeding, and discomfort, the saline solution is mixed with xylocaine (a local anesthetic) and the vasoconstrictor epinephrine.

Ultrasound-assisted or Ultrasonic liposuction uses high-pulse sound waves to liquefy excess fat, which is then removed by the same vacuum device used in other liposuction procedures. Ultrasonic liposuction is thought to be more effective for loosening the fat cells attached to muscles or organs and is also useful in breaking down fat cells so they are easier to suck up into the cannula. Risks for Ultrasonic liposuction were once believed to be higher than for other liposuction procedures, but current research indicates that it appears to have benefits and risks similar to the tumescent method. (Sources: Aesthetic Plastic Surgery, March-April 2003, pages 146-153; British Journal of Plastic Surgery, April 2003, pages 266-271; Plastic and Reconstructive Surgery, December 2002, pages 1748-1751.)

Powered liposuction A relatively new type of liposuction, powered liposuction, uses a cannula that moves in a rapid back-and-forth motion. This vibration allows for easier removal of more stubborn or "tough" fat. Powered liposuction causes less pain and swelling and allows a more precise procedure which is especially helpful on smaller areas, such as the arm, knees or ankles.

As easy and helpful as all this sounds (and it can be truly impressive), it is important to keep in mind that sucking fat out of your body (especially a lot of fat) is an intense medical procedure. Liposuction is an operation that can be painful, the pain can last for several weeks, and there is risk of complications that can range from mild to serious (Source: www.fda.gov/cdrh/liposuction/risks.html). Adhering to postoperative guidelines is essential for success. "Touchup" work may be necessary because even the best techniques can remove fat unevenly resulting in unwanted bulges and contours. And please keep in mind that liposuction absolutely does not take the place of a diet or a healthy life style. If someone is obese, gains and loses weight frequently, or has an eating disorder, he or she is not a candidate for liposuction.

When it comes to complications there are several issues and concerns you must discuss with your physician. For example, liposuction does remove fat, but if too much fat is removed your skin will stick unnaturally to the underlying muscle and tissues creating an abnormal appearance. Also, liposuction cannot eliminate dimpling (cellulite) or correct skin laxity, which are the result of the skin's structure and not caused by the presence of the fat itself. For some patients whose skin has lost much of its elasticity, the plastic surgeon may also recommend a skin-tightening procedure such as a thigh lift, buttock lift, or arm lift, all of which leave scarring that can be more extensive. Depending on the area treated other side effects may including scarring and numbness in the area treated. Infection can also be a serious risk and there are studies showing this is more common in countries where discount liposuction procedures are performed, (Source: Clinical Infectious Disease, April 2008, pages 1181-1188).

An article in Plastic and Reconstructive Surgery (November 2001, pages 1753-1763), reviewed 631 liposuction cases over 12 years and found "Results showed the majority of patients to be women, aged 17 to 74 years old. Of the preoperative weights, 98.7 percent were within 50 pounds of ideal chart weight... Cosmetic results were good, with a 2- to 6-inch drop from preoperative measurements, depending on the area treated. Ten percent of patients experienced minor skin contour irregularities, with most of these patients not requiring any additional surgical procedures. One year after surgery, 80 percent of patients maintained stable postoperative weights. No serious complications were experienced in this series. The majority of the complications consisted of minor skin injuries and burns, allergic reactions to garments, and postoperative [swelling]. The more serious complications included four patients who developed mild pulmonary edema and one patient who developed pneumonia postoperatively. These patients were treated appropriately and went on to have [successful] recoveries. The results show that large-volume liposuction can be a safe and effective procedure when patients are carefully selected and when anesthetic and surgical techniques are properly performed. Cosmetic benefits are excellent, and overall complication rates are low."

Another study published in Dermatologic Surgery (July 2004, pages 967-978), reviewed current data and found that "The overall clinical complication rate... was 0.7% (5 of 702). There was a minor complication rate of 0.57%. The major complication rate was 0.14% with one patient requiring hospitalization. Seventy-five percent of the patients reported no discomfort during their procedures. Of the 59% of patients who responded to a 6-month postoperative survey, 91% were positive about their decision to have liposuction (rating of 4 or 5 on a scale of 1-5) and 84% had high levels (4 or 5 on a scale of 1-5) of overall satisfaction with the procedure. Conclusions. Our findings are consistent with others in that tumescent liposuction is a safe procedure with a low complication rate and high patient satisfaction."

Is liposuction permanent? If you gain weight, depending on how your body distributes fat, it can all show up exactly where the liposuction was performed. The good news is that adults only have a set number of fat cells and liposuction can remove a certain amount of them. You won't add more fat cells but the remaining fat cells can grow bigger, which can return the liposuctioned area to its previous appearance. Now that is some fat to chew on!

(Other sources for this article: Seminars in Cutaneous and Medicine Surgery, March 2008, pages 72-82; Plastic and Reconstructive Surgery, June 2008, pages 396-403; and www.mayoclinic.com)