"The battle of the bulge." That tiny, five-word phrase has been shoved in our faces for years, thanks to television, newspapers and magazines. Sometimes, no matter how hard you fight, the bulge has a tougher army. The fact is that certain people have fat cells that will not shrink, despite diet and exercise. You can thank heredity for that in some cases.

Liposuction is an option to remove small bulges that won't budge and to improve your body's shape. The areas most commonly treated include the hips, abdomen, thighs and buttocks and face. Liposuction does not remove cellulite, only fat.

A good candidate for liposuction should have realistic expectations about the results of this procedure as well as these basic qualities:

• Average or slightly above-average weight
• Firm, elastic skin
• In good overall health
• Concentrated pockets of fat that do not respond well to diet and exercise

Patients with poor skin quality (cellulite) are not good candidates for liposuction because they may develop skin irregularities due to under- or over-correction of localized fat deposits. Age is generally not a major consideration when discussing liposuction; however, older patients often have less elasticity in their skin and thus may not achieve the same benefits of liposuction that a younger patient with tighter skin might achieve.

The first step before undergoing liposuction will be to arrange a consultation with your surgeon. During the consultation, your surgeon will discuss which options are best for you, your skin type, the effectiveness and safety of the procedure, the potential financial cost and what your expectations should be. Do not hesitate to ask the surgeon any questions you may have. Now is not the time to be shy.

Once you have decided to undergo liposuction, your surgeon will give you any instructions you need to prepare for the surgery. This may include dietary or alcohol guidelines restrictions or the taking or avoiding of certain vitamins. Be sure to tell your surgeon of any allergies you have as well as any and all medications you are taking. This includes over-the-counter and prescription medications as well as herbal supplements.

Depending on the type of liposuction you are undergoing, the procedure may be performed as an outpatient procedure at the doctor's office or surgery center, or if large amounts of fat are being removed, the procedure will be done in a hospital and may require an overnight stay.

Before the procedure begins, you will be given anesthesia. Again, depending on the degree of fat being removed and the type of liposuction being performed, anesthesia varies and may only be locally applied or it may require a general application in which case the surgery will be done while you are sleeping.

Once the anesthesia has taken effect, the liposuction procedure is performed using a suction device attached to a small, stainless steel instrument called a cannula. Through small incisions, the cannula is inserted into fatty areas between skin and muscle where it removes excess fat either using a suction pump or a large syringe. This results in a smoother, improved body contour. The length of the procedure will vary with the amount of fat needing removed.

Though the basics of liposuction described above remain the same, there are a couple of different techniques that can be used during liposuction. These include:

• Tumescent liposuction. During this technique, the surgeon will inject a solution is injected into your fatty areas before the fat is removed. It is made up of a saline solution, a mild painkiller and epinephrine, a drug that contracts your blood vessels. The solution not only helps the surgeon removed the fat more easily but it helps reduce blood loss and provides pain relief during and after surgery.
• Ultrasound-assisted liposuction. During ultrasound-assisted liposuction, ultrasonic energy is used to liquefy the fat, after which it is removed from the body.

Under most circumstances, when liposuction is an outpatient procedure, recovery is usually quick. Most people can return to work within a few days and to normal activities within about two weeks. You should expect bruising, swelling and soreness for a least a few weeks. However, every person's outcome will vary based on factors such as volume of fat cells removed and area of removal. Your doctor will discuss what results you can expect to achieve and how to best maintain your new body shape.

The fat cells are removed permanently, so if you gain weight after the procedure, it usually will not concentrate in the area that was treated. However, it is important to note that liposuction will not prevent you from regaining weight. To keep your new shape and new weight after liposuction, you must follow a proper diet and exercise plan.

All surgical procedures involve some risk. However, liposuction has a good safety record and the risks associated with the procedure are minimized when performed by a specially trained, board-certified plastic surgeon.

Although rare, risks include infection and skin discoloration. As with all surgery, common sense is important. The risk of medical problems can be minimized by avoiding extremely long procedures or excessive removal of fat.

Like all cosmetic procedures, liposuction is not covered by health insurance plans. Ask to talk with a representative who can explain the costs of the procedure and payment options.

Reviewed by the doctors at The Cleveland Clinic Department of Plastic Surgery

Edited by Charlotte E. Grayson , MD, Sept. 2003.

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