The purpose of liposuction, also known as lipoplasty, is to remove undesirable subcutaneous fat from specific areas of the body. Traumatic cannulas, inserted through long and overlapping incisions, were originally used to extract fat in an attempt to emulate the suction-induced fat dislodgment observed in fatal accidents. Liposuction has also evolved into a cosmetic surgical procedure designed to improve body aesthetics and patient self-esteem. Since the early 1980s, numerous refinements and new techniques have allowed this procedure to be performed using smaller instruments, cannulas, and incisions. Procedures now include tumescent liposuction, which account for approximately 15% to 20% of all cosmetic surgical procedures.

Patients seeking liposuction for improved body image and self-confidence may choose to have this procedure performed. Physical examination and pre-operative tests to exclude internal illnesses are required. The contribution of liposuction to weight loss, however, is minimal, on the order of approximately 1.6-3.7 kg of fat removed. Liposuction procedures are classified by the amount of anesthesia or sedation administration used for surgery and various ways of applying, converting, melting, or liquefying fat cells medication before or during surgery. Many patients question the wisdom of undergoing a purely elective surgical intervention. Although there are risks associated with most surgeries and aesthetic procedures, each patient must carefully consider the risks and benefits associated with each treatment alternative before consenting to undergo surgery. Moreover, in many instances, it is essential that the physician, anesthetist, or nursing staff become familiar with the patient’s history, illnesses, allergies, and medications prior to the operation. Standard and safety procedures ensure that the patient’s medical care remains safe.

Suitability Criteria for Liposuction Patients

Several criteria should be met to consider a candidate as particularly suitable and deserving of excellence in liposuction treatment. Some of the factors that all providers consider, however, are the specific evaluation of every single patient, which does not exclude a previous personal medical examination by a qualified surgeon. Some absolute contraindications are the presence of certain medical conditions that would significantly increase the incidence of complications, such as renal, lung, and hepatic dysfunction, and complicated diabetes, as well as the use of corticosteroids.

The majority of candidates for liposuction are of normal weight and simply want to improve some details of their body profile, which exercise and nutrition have not addressed. If the goal is to achieve a body that perfectly matches a biotype or current fashion, it is essential that careful adjustments of body proportions are carried out. These features are most common in models and athletes who seek only small contour adjustments. Particular fashion dictates, especially regarding body shape in some regions and fat reduction in others, strongly influence the indications for this surgery. There are still medical and personal conditions that suggest whether it is safe to perform liposuction on any patient. For example, the elderly are particularly susceptible to any surgery because of their usual diminished overall anesthetic and post-operative tolerance. The psychiatric and psychological state is also a particularly important consideration in patients who want elective surgery, crucial in understanding the psychological motivations that led to that decision and in evaluating whether the patient has realistic expectations about the results that are achievable with surgery. Only those patients who are well motivated, emotionally stable, and in good, healthy condition are considered suitable for this type of surgery. It is difficult to treat a patient who has overeaten and developed this large problem if they have resistance to adopting a healthier lifestyle. The so-called ‘yo-yo’ dieters present a high risk for post-operative complications. A good candidate for liposuction is an adult within about 30% of their ideal body weight with localized fat that has not responded to diet and exercise. A good candidate for liposuction should also be well-motivated and willing to change their life.

The Recovery Process After Liposuction

The immediate post-operative phase lasts from the time of the liposuction procedure itself until the patient is off pain medication and feels comfortable caring for themselves at home. Patients remain in the hospital or surgical facility for a varying amount of time judged according to their health status and the extent of the work they have undergone. In the healthcare system of some countries, patients will typically be in the hospital for two days following liposuction of the lower body, while others will send them home on the day of surgery. Since liposuction was initially developed by cosmetic surgeons, most patients in the early years had their procedures performed on the abdomen, waist, and hips, where it is easy to conceal the tiny scars. There is not usually a noticeable volume of drainage from the incision sites in patients who have had liposuction of the outer thighs, upper thighs, and buttocks, so a bandage is not normally necessary at these sites.

Following liposuction, most patients experience some leakage of the tumescent fluid from the incisions made in the skin. The discharged fluid is usually the tumescent fluid that was not removed in the sutured cannula incision sites. The fluid appears to be slightly red or pink right after surgery because it mixes with the blood in the area. The oozing of the fluid from the incision sites is normal and tends to last for about 24 hours.

Eventually, the incision heals while the discharged fluid is resorbed, typically over the next one to four weeks. Patients who have undergone extensive liposuction of the hips and inner thighs (or who had liposuction of these areas along with an abdominoplasty) can expect significant bruising and swelling along the sides and front of the thighs and on the lower abdomen. Pain is generally not a significant problem after liposuction.

Since many surgeries are performed under general anesthesia, most patients experience no discomfort in the post-anesthetic recovery area. Once patients are home, localized pain or discomfort is typical.

The degree of pain depends on the extent of the liposuction, how many areas were treated, and the patient’s pain tolerance. The normal timeline for return to exercise is as follows: patients may walk at any time up to the day of liposuction; no jogging or aerobics for two weeks following surgery; no weight lifting or impact exercise for four weeks; yoga is prohibited for six weeks.

It is crucial for patients not to overdo their activity in the early days because this may worsen their swelling and delay their recovery while increasing their risk of complications. It is important to be patient during the recovery period, appreciating that after three to five months, most of the post-operative swelling will have subsided. The full results extending to over a year often make the wait worth it.

We advise that smokers must quit for at least two months before and following the procedure. For ex-smokers, smoking cessation is advisable, since recent research indicates that even months or a year of not smoking may not yet completely eliminate smoking-related risks.

Post-Operative Care and Aftercare Requirements

In a safe and effective liposuction surgery, as with any other surgical procedure, the collaboration of the patient and the surgeon is of utmost importance. After the surgery, the guidelines explained by the surgeon need to be followed to avoid complications, for conducive and faster healing, and to gain the maximum benefit from the procedure. Some important aspects of post-operative care required following a liposuction procedure are:

• Wound care and dressings/support garments.
• Skin care regimen with topical products.
• Diet and hydration requirements.
• Daycare following the surgery.
• Recommendation of light physical activity.
• Dos and don’ts during the recovery phase.
• Complications: signs to watch out for. 
• The first follow-up with the surgeon.

Regarding the intake of diet and fluids, it is recommended not to starve after surgery, since it will prevent the body from the healing process. Regular intake of light, non-spicy, and non-oily foods is encouraged with a lot of fluids.

Fluids can also lead to dehydration, especially after the body has gone through a procedure, and should be avoided as much as possible. After the surgery, the surgeon typically suggests that their patients go for small walks and move around every hour to prevent blood clot formation. However, strenuous physical activity and heavy exercises must be avoided for the time being. After the surgery, a lot of swelling might occur in the patient, which further gets supported by the intake of fluids.

Special compression or anti-embolism stockings are also advised to the patient, as they help reduce and decrease any leg swelling and improve recovery time. This is also usually advised to patients post any surgery done under general anesthesia, as sitting for long hours can lead to the formation of blood clots in the legs.

Additionally, the compression leggings or stockings help in achieving better results post-liposuction, molding the skin over the new body shape with reduced swelling. These garments help squeeze the veins and prevent the blood from collecting in the legs, hence allowing normal blood flow to the heart. Post-operatively, one might feel a little uncomfortable or experience heaviness with the fitted stockings or garments.