Liposuction

Fat in the body exists in two forms: that surrounding the organs and that under the skin. Although fat around the organs contributes to obesity, it is the underskin fat that people usually find unsightly. The amount and distribution of fat under the skin contributes to the contours of the body and the shapeliness of form, as well as cushioning and insulating the body. Exercise and diet can shrink the overall amount, but not in targeted areas. For example, to remove “dinnerroll” waist fat, you need to reduce the overall fat percentage of the body. Situps may target waist muscles, but not waist fat. Exercise can only remove fat indirectly, by changing the total body composition. Liposuction is a direct procedure to remove fat in specific areas. A common misconception is that liposuction is done for weight loss. In fact, the majority of fat is deep and cannot be removed this way. The purpose of liposuction is for body contouring. It is usually done under local anesthesia. First, a numbing solution is injected to anesthetize the area. Small incisions are then made into the skin so that a tube can be inserted to suck out the fat tissue. Newer procedures make use of ultrasound machines to break up fat before it is extracted, allowing smaller, more precise cannulae — the blunttipped hollow tubes — to be inserted. After the surgery, patients may feel sore and look bruised for several days.

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"The old expressions for body fat — “love handles,” “saddlebags,” and “turkey wattle,” — have expanded to describe more recent body shaping. Now, patients ask to get rid of a “buffalo hump” (upper back), “wings” (bulges around the bra area), “doughnut” (around the belly button), “banana fold” (below the buttocks), “piano legs” (calves), and the “chubb” (bulges around the kneecap).

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Liposuction is a delicate procedure that needs the skill of a properly trained plastic surgeon. The techniques are becoming increasingly precise and sophisticated, with the best doctors able to remove as little as an ounce from areas such as the chins, necks, backs, upper arms, knees, ankles, and even toes! It is more a matter of art and aesthetics than medicine. Dr. Luiz S. Toledo, a plastic surgeon in São Paulo, Brazil, who teaches this precise method to American surgeons, calls it: “liposuction for skinny people.” Now, says Dr. Peter B. Fodor, a plastic surgeon in Los Angeles, “surgeons who a few years ago would not have touched areas like kneecaps, inner thighs, back rolls, calves, and ankles have extended their practices.” Sometimes, the offending bit of fat is barely noticed by others. For example, Judy Goss, a former Ford model, has a very trim figure at 5 feet 10 inches and weighs 126 pounds. “By normal standards,” she admits, “I’m pretty skinny. But my arms were getting a little flappy. I could feel it wiggle every time I shook hands.” That was enough to convince her to get liposuction on her upper arms. For such small concerns, some plastic surgeons ask patients to wear their favorite jeans or bra right before surgery so they can mark the areas and reshape them more exactly.