Liposuction is the most frequently performed cosmetic plastic surgery operation, particularly if you are considering the surface area of the body regions being treated. While liposuction is uniquely successful at removing fat below the skin, it’s most common complication is an aesthetic one, skin irregularities. Because it is a ‘blind’ procedure, one cannot tell with great precision as to the evenness of the fat removal underneath the skin.
Skin irregularities, often called ripples or waveness, are a direct reflection of the remaining thickness of the underlying fat layer. The risk of this happening after liposuction surgery is dependent on many factors, one of the most important being the quality of the skin over the treated area. Skin that is loose, of lesser elasticity, is damaged by stretch marks or has the appearance of cellulite has a much higher likelihood of having some form of irregularities after liposuction surgery.
But even in the face of what appears to be good quality skin, the risk of skin irregularities also differs by what area of the body is being treated. Liposuction results and risks differ throughout the body. For example, that risk is quite different if the flanks are being treated vs. the inner thighs…or the abdomen vs. the arms. The thickness and tightness of the skin accounts for these differences.
In an effort to lessen the risk of skin irregularities, the concept of conservative vs. aggressive liposuction is used. As these terms imply, the amount of fat removed is adjusted for the area based on its skin quality. Think of a certain thickness of fat between the skin and the deeper muscles. In conservative liposuction only the deeper fat is removed, leaving a certain thickness of fat underneath the underside of the skin. By so doing, the risk of skin irregularities is less by the buffer of the underlying fat left behind. The trade-off is that less fat is removed. Conversely, in aggressive liposuction both the deep and the more superficial layers of fat are removed. This approach produces more volume removal but also increases the risk of skin contour issues.
Conservative vs. aggressive liposuction illustrates the principle that the higher the risk the greater the reward. But when it comes to liposuction the reward is almost never worth that risk. Few patients, in my experience, would prefer the trade-off of a dramatic fat reduction for an irregular skin contour. Now the amount of skin contour irregularities and what body area has to be qualified. A little irregularity might well be acceptable, but a lot never is. If the irregularities were on the back or arms they were be more acceptable than on the abdomen or thighs for example. I have seen more than a handful of patients who have come in for treatment of liposuction irregularities that now state they preferred the way it was before than how it looks now.
Liposuction is not, nor should be, the same for every patient or is every body region treated exactly the same way. While most patients state (usually right before surgery) to ‘remove all you can’, this is often not the best treatment strategy. The risk of undesireable skin contour changes must be considered and the principle of conservative vs. aggressive liposuction judiciously applied.
Dr. Barry Eppley
Indianapolis, Indiana