Introduction It is quite normal for people to want an aesthetically pleasing body that is well proportioned sans excess and unwanted fats in noticeable parts of the body. Women are particularly vulnerable to that and at times, it can lead to personal dissatisfaction and negative perceptions of self. Self-esteem is your idea of yourself and thus, a healthy self-image is important for your continued mental and emotional well-being. It is one of the key factors that will determine the choices you make, the goals you set and your future success in life. Liposuction is one of the most popular plastic surgery procedures that eliminate excess fats in areas where we are genetically predisposed to accumulate it such as the thighs, buttocks, flanks and the abdomen for women and the abdomen and hips for men. It must be stressed that liposuction is not a weight-loss method, but a surgical technique that contours and sculpts the body by removing stubborn and localized fat deposits. It is an excellent and highly effective method that can reshape the body to create more symmetry and harmony. This type of plastic surgery intervention has been successfully performed since the 1980s, and is considered as one of the most routine cosmetic surgery intervention in the United States. Who can benefit from liposuction? Patients with stable weight that is close to the person’s ideal weight can greatly benefit from liposuction. Other criteria are, to wit: – firm, elastic skin with good muscle tone; – Physically and emotionally healthy; – Have excess fat deposits localized in certain areas of the body. While age is of no importance when performing liposuction, it is good to keep in mind that the skin loses elasticity with age and the results achieved after the intervention might not be as impressive as those performed on younger patients. The risks of the intervention There is no plastic surgery intervention that is risk-free. The complications of liposuction are generally rare, especially if the patient is a good candidate for the procedure, if the operating room is well equipped, and the plastic surgeon is experienced. There is this tendency to consider liposuction an easy procedure that can be performed by any type of surgeon and under any conditions. Nothing could be further from the truth! Liposuction can indeed be considered simple and easy but only when performed by a board certified plastic surgeon with wealth of experience in doing this procedure and with easy access to all the necessary equipment and devices. Yet, even if the plastic surgeon is extremely skilled and the medical facility is equipped with all the latest technology, there can be no guarantees that the intervention will be free of complications. Keep in mind that the risks increase exponentially if multiple areas are treated in one sitting and if the amount of fat suctioned is more than 2 or 3 liters. Blood transfusions might be necessary for high volume fat extraction in a single procedure. After liposuction, there could also be other complications like infections, hematoma and seroma. The most severe complication is the formation of blood clots that can migrate through the blood stream towards the lungs and can cause death. Patients with poor skin elasticity, as well as sensitivity issues may also have uneven skin irregularities and bumps that may or may not be permanent. Pre-operative indications for liposuction Don’t eat or drink anything after midnight the day before the intervention. Don’t take any aspirin or medication containing aspirin for at least two weeks before the intervention. In general, the intervention should be performed when you do not have your menstrual cycle. You will need to let the surgeon and anesthetist know if you have any medical conditions (diabetes, pulmonary problems, blood coagulation issues, neurologic problems or allergies to certain medication). If you smoke, you should quit smoking for at least two weeks prior and after the intervention. Avoid excess sun exposure before the intervention, especially in the area that will be treated with liposuction. Don’t follow a strict or restrictive diet before the intervention as it might interfere with the healing process. If you catch a cold or develop any type of infection, the intervention will need to be postponed. How to get the best results after liposuction Liposuction is a surgical method that eliminates unwanted adipose deposits. At a glance, a liposuction procedure might seem like a simple body contouring intervention that removes the excess fat with the use of a cannula attached to a vacuum. While it may look like any surgeon can perform this simple procedure, the truth is there are not many surgeons that can properly remove the excess fats and produce an aesthetically sculpted body with skin that remains smooth and even. That takes highly specialized skill and artistry! What is the satisfaction level after liposuction? Through the years, liposuction has evolved and methodologies have improved to ensure patient safety and produce impressive results. Cutting edge technology and advances in medicine have further honed and refined liposuction techniques. Nonetheless, there are still cases, albeit isolated, of patient dissatisfaction and disappointments. Some of the reasons are explained below: 1. The fat deposit stayed approximately the same after liposuction In this case, the problem might be due to the type of liposuction chosen. Manual liposuction, wherein the fat is extracted with the help of syringes or the traditional liposuction, during which the suction cannula is connected to a vacuum device, has certain limitations if the fat deposits are fibrous or localized in regions that are characterized by dense tissue such as the back, flanks or the chest in men. The tool used in these types of liposuction have limited capacities primarily because it cannot break through the fibrous tissue or if it does, the trauma produced is significant, too much bleeding occurs which will make the surgeon decide to stop in order to avoid the need for blood transfusions or put the patient’s life at risk. Tumescent liposuction is a method that allows the safe removal of the fat in any area regardless of density of tissues. It uses small incisions so the trauma on the area is smaller. Bleeding and bruising are minimal, areas of treatment can be expanded, and it produces smoother results with no significant skin irregularities. Recovery is also faster. 2. Asymmetries that surfaced post surgery in between the left side and the right side of the body Actually, every human body has all kinds of asymmetries. Some are simply less visible or it becomes more noticeable following liposuction since attention is drawn on the area or areas treated. If no obvious asymmetries were present before the intervention, the only explanation would be that the surgeon extracted different quantities of fat from the right and left side of the body. When considering pre-operative asymmetries, he has to keep in mind that what is left behind is more important than what is extracted. Thus, during the procedure, the plastic surgeon needs to carefully monitor the volume of fat extracted to preclude irregular liposuction. 3. Skin waves and bumps even after edema gone This is a condition that can be attributed to several factors. When using traditional liposuction technique, it is possible that there are areas where fats cannot be easily extracted and areas where removal can be easily done. In an attempt to suction as much fat as possible, the surgeon can accidentally remove more fat from areas where he repeatedly inserts the cannula in order to get to the denser and impenetrable areas. When we have a fat tissue with a soft consistency, inadvertent mistakes such as this can happen because of the ease of fat extraction. The cannulas used during the cosmetic intervention can also influence the results. Ideally, the surgeon should use small cannulas measuring 3-3.5 mm in diameter, but this also means that the procedure will take longer and will be more difficult for the plastic surgeon. At the moment, we have mostly discussed the things that fall under the purview of the surgeon. There are, of course, other factors that entirely rests on the patient. Please note that the way the skin will retract and reshape itself depends on skin elasticity and skin tone. Poor skin elasticity and tone can mean disappointing results. It is also important to know that the areas treated by liposuction have to be supported by compression garments that must be worn all the time for as long as recommended. It behooves the patient to strictly follow instructions on post-operative care to ensure optimal results. It is also important to assess the area to be treated. If there is loose, excess skin before liposuction, then it will look much worse after the procedure is performed unless combined with other procedures. Liposuction on its own can only be used to improve the contour of the body, not to eliminate the excess skin. When the patient has loose, saggy skin in the abdomen, a tummy tuck or body lifting procedure is usually recommended at the same time or separately. Conclusion When talking about liposuction, many of us feel like we already know everything there is to know about the procedure, even if the information was gathered randomly from glossy magazines and reality TV shows. Truth to tell, there are liposuction facts that are rarely openly discussed over mass media that the patients need to be aware of before considering the procedure. Before even going to the initial meeting with your plastic surgeon, you need to know if you are a good candidate for the intervention. It saves you time and disappointment to know beforehand if you meet the criteria. You must also know and have the discipline to follow the pre-operative conditions in preparation for surgery. These are all necessary for the success of the intervention. It cannot be stressed enough that liposuction is not a miracle weight loss technique. It cannot also eliminate the excess, saggy skin already present before liposuction. Liposuction is a body contouring procedure that can improve the shape and appearance of specific areas of the body through the removal of unwanted localized fat deposits that are resistant to diet and exercise.