Liposuction is the removal of excess body fat by suction using special surgical equipment. A plastic surgeon typically does the surgery.

Liposuction is a popular type of cosmetic surgery. It removes unwanted deposits of excess fat, to improve body appearance and to smooth irregular or distorted body shapes. The procedure is sometimes called body contouring.

Liposuction may be useful for contouring under the chin, neck, cheeks, upper arms, breasts, abdomen, buttocks, hips, thighs, knees, calves, and ankle areas.

However, liposuction is a serious surgical procedure and may involve a painful recovery. Because liposuction can have serious or occasionally fatal complications, you should carefully think about your decision to have this surgery.

Several different liposuction procedures exist:

• Tumescent liposuction (fluid injection) is the most common type of liposuction. It involves injecting a large amount of medicated solution into the areas before the fat is removed (sometimes, the solution may be up to three times the volume of fat to be removed). The fluid is a mixture of local anesthetic (lidocaine), a drug that contracts the blood vessels (epinephrine), and an intravenous (IV) salt solution. The lidocaine in the mixture helps to numb the area during and after surgery, and may be the only anesthesia needed for the procedure. The epinephrine in the solution helps reduce the loss of blood, the amount of bruising, and the amount of swelling from the surgery. The IV solution helps remove the fat more easily and it is suctioned out along with the fat. This type of liposuction generally takes longer than other types.

• The super-wet technique is similar to tumescent liposuction. The difference is that not as much fluid is used during the surgery--the amount of fluid injected is equal to the amount of fat to be removed. This technique takes less time; however, it often requires sedation with an IV or general anesthesia.

• Ultrasound-assisted liposuction (UAL) is a fairly new technique, used in the U.S. since 1996. During this technique, ultrasonic vibrations are used to liquefy fat cells. After the cells are liquefied, they can be vacuumed out. UAL can be done in two ways, external (above the surface of the skin with a special emitter) or internal (below the surface of the skin with a small, heated cannula). This technique may help remove fat from dense, fiber-filled (fibrous) areas of the body such as the upper back or enlarged male breast tissue. UAL is often used together with the tumescent technique, in follow-up (secondary) procedures, or for greater precision. In general, this procedure takes longer than the super-wet technique.

A liposuction machine and special instruments are used for this surgery. The surgical team first preps the operative site and administers either local or general anesthesia. Through a small skin incision, a suction tube with a sharp end is inserted into the fat pockets and swept through the area where fat is to be removed. The dislodged fat is "vacuumed" away through the suction tube. A vacuum pump or a large syringe provides the suction action. Several skin punctures may be needed to treat large areas.

After the fat is removed, small drainage tubes may be inserted into the defatted areas to remove blood and fluid that gather during the first few days after surgery. If you lose a lot of fluid or blood during the surgery, you may meed fluid replacement (intravenously) or a blood transfusion.

The following are some of the uses for liposuction:

• Cosmetic reasons, including "love handles," fat bulges, or an abnormal chin line.
• To improve sexual function by reducing abnormal fat deposits on the inner thighs, thus allowing easier access to the vagina.
• Body shaping for people who are bothered by fatty bulges or irregularities that cannot be removed by diet and/or exercise.

Liposuction is generally NOT appropriate for these uses:

• As a substitute for exercise and diet, or as a cure for general obesity. However, it may be used to remove fat from isolated areas at different points in time.
• As a treatment for cellulite (the uneven, dimpled appearance of skin over hips, thighs, and buttocks).
• In certain areas of the body, such as the fat on the sides of the breasts, because the breast is a common site for cancer.

Many alternatives to liposuction exist, including a tummy tuck (abdominoplasty), removal of fatty tumors (lipomas), breast reduction (reduction mammaplasty), or a combination of plastic surgery approaches.