Liposuction is the ‘largest’ cosmetic procedure performed around the world if it is rated based on surface area alone. It is certainly by sheer numbers one of the top five aesthetic body procedures performed every year as shown by annual statistics. But the extent of the surface area it treats is what really distinguishes liposuction from any other plastic surgery where tissues are excised (e.g., tummy tuck)
But because it does not remove loose skin, the body contouring effects of liposuction rely upon a phenomenon created by the often large underlying surface area that it treats…skin retraction. Once some of the underlying fat is removed, there is actual skin excess. It is important that this skin shrink down to create an optimal contour reduction result. The shrinkage of the skin is primarily important to reflect the volume of tissue that has been removed. But it is secondarily important to help make the skin surface smooth.
It is the skin’s retractive ability that is important to a satisfying liposuction result. And this is often a physical characteristic patients overlook or hope that it won’t have a big impact on their result. Many times patients, understandably, want to avoid an excisional procedure like a tummy tuck or an arm lift to achieve a contour change. But a smaller contour that has a lot of skin irregularities and unevenness may be less appealing that a fuller contour that has a very smooth skin surface.
Skin that does not respond well to the effects of liposuction is either damaged or aged. Women that have a lot of stretch marks around the belly button and lower abdomen is the classic example of lost skin elasticity. Older women, usually around age 60 and older, have skin that is thinner with almost equally poor retractive capability even if no stretch marks are present. Conversely men usually not have the same skin retraction problems, not because they do not get pregnant which helps, but because their skin is thicker and often has hair. (which ensures a greater number of elastic fibers)
When liposuction is done on skin of poor retraction potential, it is important that patients understand the trade-offs. Deflated looking skin is often the result. And while many new energy-based liposuction technologies exist, none of them have a magical ability to create a substantially improved retraction of the skin…despite how they marketed and promoted.
Dr. Barry Eppley
Indianapolis, Indiana