The surgery is usually done under general anesthesia. In certain cases, local anesthesia is used, or a local (awake) anesthetic with sedation, but this is not appropriate for every patient.

The operation involves removing excess fat tissue by inserting a narrow metal tube through a small incision in the skin and applying suction. The tube has one or several openings close to the tip. By passing the instrument forward and backward as suction is applied, fat tissue is sheared off, and fat globules pass into the tube.

The fat globules are removed similarly to a "tunneling" procedure, creating a "sponge-like" effect within the tissues. By forming numerous such interconnecting and closely related spaces within the tissue, this reduces the fullness, firmness and size of the area. Eventually, the treated area collapses or shrinks, with an accompanying change in the surface contour.

The reason for leaving small areas of tissue intact between the tunnels is that it preserves the larger blood vessels and nerves that nourish the overlying skin. If all the fat tissue were removed, creating one large cavity, greater shrinkage would be created but it would also reduce the normal blood circulation to the skin. This would result in loss of skin, and the occurrence of scarring, infection and deformity. As a result, the object is not to remove all the fat tissue. A layer must be preserved to avoid undesirable effects. However, this layer can be thinner in some areas of the body than others.

New modifications

  • The "syringe method": When the operation was first introduced, suction was obtained from a powerful vacuum machine. However, for the past few years, simply using a large syringe which is locked into the "open" position has resulted in less trauma to small blood vessels and better control of the amount removed.
  • The "tumescent technique": By injecting large quantities of a solution containing very diluted local anesthetic, adrenaline and salt water, bleeding is reduced, there is less bruising, and in some cases it is possible to do the surgery under local anesthesia.
  • Smaller suction tubes allow more precision to be obtained, with less trauma and bleeding, and less bruising.
  • Ultrasonic-assisted liposuction (UAL): UAL, as it is known, uses ultrasonic energy to liquefy the fat first, then gentle suction to remove the fat. The advantages are that it requires less effort for the surgeon: it is supposed to result in less bleeding, allowing the removal of larger quantities of fat; and more easily removes fat in areas where there is a lot of tough fibrous tissue, such as in male breast development, and deep in the lower back of men. A task force to study the technique and determine its safety was set up by the American Society of Plastic and Reconstructive Surgeons in order to determine whether the equipment should be approved for general use by the FDA in the USA. A similar working group was set up in Canada. The technology is still evolving, but it appears to be a significant advance in terms of giving a better, smoother result, in former "problem" areas.
Benjamin Gelfant, MD, 
in association with the MediResource Clinical Team