Losing either localized or generalized fat is one of the most common requests from patients seen by plastic surgeons today. In 1981 the liposuction procedure was introduced in the U.S. from Europe. Before this the procedure for removing fat was to literally cut it out along with the overlying skin, leaving a long scar. Liposuction was a giant step forward.

The liposuction procedure consists of inserting a thin tube called a cannula through a small incision in the skin and essentially vacuuming out the fat.

Although initially liposuction had unfavorable PR, if performed by trained, skilled surgeons, liposuction is one of the safest and most popular procedures performed today, and with minimal discomfort and recovery time.

In the early days, the amount of fat that could be safely removed was limited to 2 liters (2000 cc or about 4 pounds) to prevent excess bleeding that could occur with the old techniques.

With the advent of tumescent fluid injections, larger amounts up to 5 liters (5000 cc or about 10 pounds) can safely be removed at one time. The tumescent fluid contains an anesthetic to reduce discomfort, and epinephrine, which constricts blood vessels, thus reducing bleeding.

In the past few years, non-surgical procedures have been introduced and become popular, such as Thermage, Ultherapy, Coolsculpting, Thermitight, Thermismooth and many more.

The results of these non-surgical modalities are more effective at reducing localized areas of fat, such as arms, neck, abdomen, “love handles,” and thighs. Generally, patients 20 pounds above their normal weight are not good candidates for these non-surgical procedures.

Liposuction procedures are by far the gold standard for removal of large amounts of fat. There are now many different methods of liposuction, such as the Tickle Lipo and laser or ultrasonic liposuction. However, general anesthesia is usually required for removal of larger amounts.

Liposuction is not a permanent weight loss substitute. Patients can still gain weight. While most surgeons stress that this procedure works best if the patient changes her poor eating and exercise habits, a certain percentage will return after several months claiming that the surgeon “didn’t remove enough.”

When weighed, it is not surprising that such patients have not only regained the weight lost from the fat removal but often gained additional weight as well.

One of the newest non-surgical modalities showing promising results are the ThermiTight and ThermiSmooth procedures. This is because they not only reduce fat but also tighten the skin at the same time. They are also indicated for cellulite reduction.

In conclusion, surgical liposuction is a very popular and safe procedure and can have permanent long-term results providing there is no excess weight gain afterwards. To achieve this, diet and exercise regimes must change.

Non-surgical fat removal can work well for those patients with limited areas of fat; however, if loose skin is also a factor, a modality that offers fat removal plus skin tightening might be best. Non-surgical procedures do have the advantage of being done without general anesthesia in an office setting and a rapid recovery time.

E. Ronald Finger, MD, FACS is a board certified plastic surgeon with offices in Savannah and Bluffton. www.fingerand associates.com