The Limitations Of Liposuction

Quick Answer: Liposuction removes localized fat beneath the skin, but it does not remove excess skin, repair separated abdominal muscles, or serve as a weight-loss treatment. The best candidates have localized fat, relatively firm skin, good elasticity, and realistic expectations. If loose skin is the main concern, a tummy tuck, arm lift, thigh lift, neck lift, or another skin-removal procedure may be more appropriate.

Understanding What Liposuction Does Not Do

At least once a week, I find myself explaining to a patient that the liposuction procedure she expected to have will not be a good option for her. When explaining why a particular patient is not a good candidate, the main challenge is clarifying what liposuction does not do.

I have been surprised over the years by how many people, including physicians in other medical specialties, do not fully understand what liposuction can and cannot accomplish. Therefore, I will attempt to provide some clarity.

Liposuction removes fat. It does not remove excess skin. If the skin is already loose, removing the fat underneath it may make that looseness more noticeable.

Who Is a Good Candidate for Liposuction?

Liposuction is appropriate for decreasing subcutaneous fat, meaning fat located directly beneath the skin, in people whose skin is reasonably firm.

If someone’s skin is not already loose and still has good elasticity, that person may be a good candidate for liposuction to remove a localized area of excess fat.

While that may seem obvious, patients who have had children, lost significant weight, or experienced age-related skin changes can become confused by common liposuction marketing.

These patients see advertisements showing strong results from liposuction, CoolSculpting, or Kybella and naturally want the same outcome. However, the patients who get the best results from fat-reduction procedures usually share one important quality: Their skin is firm enough to adapt to the smaller contour.

Many people assume that liposuction will reduce the fat and that the skin will automatically snap back into place over the thinner body. That assumes the skin has enough elasticity to do so.

People often imagine skin behaving like Spandex. In reality, skin gradually loses elasticity with age. That loss may happen more quickly when the skin has been significantly stretched by pregnancy or weight gain.

People may think of liposuction as taking air out of a rubber balloon that shrinks while keeping a smooth shape. Loose skin may behave more like a Mylar balloon that collapses, folds, and wrinkles as it deflates.

Without enough elasticity and skin that is reasonably firm to begin with, liposuction alone may not be the answer.

Liposuction After Pregnancy

I commonly see women in their 20s, 30s, or 40s who have had children and are unhappy with their abdomens. These patients often schedule liposuction consultations expecting the procedure to flatten their stomachs and restore their pre-pregnancy shape.

Pregnancy may stretch the abdominal skin enough that it becomes too loose for liposuction alone. It can also contribute to separation of the abdominal muscles, which liposuction cannot repair.

Many patients have both excess abdominal fat and excess skin. However, removing the fat without addressing the loose skin may make the laxity more noticeable.

If the skin is loose enough to fold over the pubic area, creating what is called a pannus, liposuction alone could cause the skin to hang even lower.

For these patients, removing the excess skin through some form of tummy tuck, or abdominoplasty, may be necessary.

A tummy tuck can create a tighter and flatter abdomen by removing loose skin. When needed, it may also address separated abdominal muscles. The procedure is often combined with some liposuction to reduce fat thickness while the extra skin is removed.

There are different types of tummy tucks depending on the amount and location of the loose skin, but the basic principle is the same: If excess skin is present, some of it may need to be removed to make the area tighter. Liposuction alone cannot accomplish that.

Can Liposuction Treat Loose Arms?

The same concept applies to other areas of the body.

Many patients ask for liposuction of their upper arms. If the arm skin is not already loose or drooping and still has good elasticity, liposuction may produce a strong result.

If the skin is already sagging, removing fat may leave the arm looking more deflated. An arm lift may then be needed to remove the excess skin.

An arm lift creates a longer scar than liposuction, so the choice involves a tradeoff. A patient must decide whether the expected improvement in shape justifies the scar required to remove the loose skin.

What About the Thighs, Back, and Love Handles?

The same principle applies to the thighs. Liposuction may be appropriate when there is localized fat and the skin remains firm enough to contract after treatment.

If the inner or outer thigh skin is already loose, removing fat alone may not produce a smooth contour. A thigh lift may be more appropriate when hanging skin is the primary concern.

In contrast, patients can often benefit from liposuction alone in the love handles or back because the skin in these areas may be thicker and have better elasticity.

As a result, back skin may be less likely to fold or droop after fat removal. However, candidacy still depends on the individual patient’s anatomy, skin quality, and the amount of fat being removed.

Liposuction Under the Chin

In older patients, skin laxity and loss of elasticity can become a greater concern. This applies to all areas of the body, including the face and neck.

A patient in his or her 20s may develop a better jawline from liposuction under the chin if the skin is firm and the fullness is primarily caused by fat.

A patient in his or her 60s may have too much skin laxity to get a meaningful result from liposuction alone, even when some excess fat is present beneath the chin.

In that situation, a neck lift may be needed to remove or reposition loose tissue. Liposuction may still be used to reduce fat, but it would be combined with a procedure that addresses the excess skin.

Age alone does not decide whether someone is a candidate. Some older patients have excellent skin elasticity, while some younger patients have significant laxity. The decision must be based on an examination rather than age by itself.

Liposuction After Significant Weight Loss

In addition to pregnancy and aging, significant weight loss can create skin that is too loose for liposuction alone.

If someone has been considerably overweight for a long time, the skin stretches to accommodate the additional volume. After losing the weight, the patient may be left with hanging skin that looks more noticeable than the original fat.

This problem may be less severe in younger patients who still have good elasticity, but their skin may still be looser than it would have been without the previous weight gain.

In older patients with reduced elasticity, significant weight loss may leave large amounts of loose skin that require surgical removal.

In some cases, there may be little or no role for liposuction because the remaining concern is no longer excess fat. It is excess skin.

Depending on the areas affected, a patient may need a tummy tuck, arm lift, thigh lift, lower-body lift, or another body-contouring procedure.

There Are Exceptions

There are exceptions to these general rules.

I have seen young mothers with four children who have no loose abdominal skin. I have seen women in their 70s with firm neck skin and well-defined jawlines.

I have also seen women in their 20s who have never been pregnant or significantly overweight but developed enough loose abdominal skin to need a mini-abdominoplasty.

Much of this comes down to genetics, skin thickness, sun exposure, weight history, age, and individual anatomy. That is why photographs or a brief online description cannot determine whether someone is a good candidate.

Alternatives When Liposuction Is Not Enough

When loose skin or weakened muscles are the main concern, another procedure may provide a better result.

Possible alternatives include:

  • A tummy tuck for loose abdominal skin or separated muscles
  • An arm lift for hanging upper-arm skin
  • A thigh lift for excess skin along the thighs
  • A neck lift for loose neck skin or age-related tissue changes
  • A body lift after significant weight loss

Liposuction may still be combined with one of these procedures when excess fat is also present.

Patients who want to understand the available techniques can review Dr. Weniger’s liposuction options.

What Is Liposuction Recovery Like?

Recovery varies depending on the areas treated, the amount of fat removed, the type of work the patient performs, and whether liposuction is combined with another procedure.

Patients may experience swelling, bruising, soreness, temporary numbness, and drainage from the small incisions during the early recovery period.

A compression garment may be recommended to help manage swelling and support the treated areas. Patients are generally encouraged to walk carefully after surgery, but strenuous exercise and heavy lifting remain restricted until the surgeon provides clearance.

Some patients return to light or desk-based work within one or two weeks. Patients with physically demanding jobs or more extensive treatment may need additional time.

Swelling can take several weeks or months to fully resolve. The treated area may initially look larger, uneven, or firmer than expected, so the final contour should not be judged immediately.

Risks and Limitations of Liposuction

Like any surgical procedure, liposuction has risks.

Possible complications include bleeding, infection, fluid accumulation, changes in sensation, uneven contours, asymmetry, loose or rippled skin, poor wound healing, anesthesia complications, blood clots, and the possible need for revision surgery.

Liposuction also cannot treat obesity, remove deep abdominal fat surrounding the internal organs, repair separated muscles, remove stretch marks, or guarantee that loose skin will tighten.

Patients should understand that the goal is improved body contour, not a specific amount of weight loss or a guaranteed clothing size.

Frequently Asked Questions

Liposuction removes fat rather than excess skin. A patient with firm, elastic skin may experience some natural contraction as the area heals, but liposuction should not be expected to correct meaningful sagging. When loose skin is already present, removing the fat beneath it may make folding, wrinkling, or hanging skin more noticeable. A tummy tuck, arm lift, thigh lift, neck lift, or another skin-removal procedure may provide a better result.

Liposuction is not intended to produce substantial weight loss. Its purpose is to reshape selected areas by removing localized fat beneath the skin. The amount that can be safely removed depends on the patient’s health, body size, treatment areas, surgical setting, and whether other procedures are being performed. Patients seeking significant overall weight loss should address that goal before considering liposuction for contouring.

Liposuction may flatten the abdomen when the fullness is caused mainly by localized fat and the skin remains firm. It cannot remove a significant amount of loose skin, repair separated abdominal muscles, or reduce deep visceral fat located around the organs. Patients who have loose skin or muscle separation after pregnancy or major weight loss may need a tummy tuck, sometimes combined with liposuction.

Many patients can return to light work within one or two weeks, but recovery varies according to the number of areas treated, the amount of fat removed, and the physical demands of the patient’s job. Swelling, bruising, soreness, and numbness are common early in recovery. Although patients usually feel better before then, swelling may continue to improve for several months before the final contour becomes clear.

The fat cells removed through liposuction do not grow back. However, the remaining fat cells can enlarge if a patient gains weight. Aging, pregnancy, weight fluctuations, and continued loss of skin elasticity may also change the treated area over time. Maintaining a relatively stable weight can help preserve the result, but liposuction cannot stop the normal aging process.

Schedule a Liposuction Consultation in Bluffton

Hopefully, these explanations and examples help clarify what liposuction does and does not do.

There are always gray areas, and it can be difficult to determine whether someone is a good candidate without a careful examination.

For this reason, it is important to speak with a board-certified plastic surgeon who offers a full range of treatment options and can recommend a procedure based on the patient’s anatomy rather than trying to make every concern fit one treatment.

During a consultation, Dr. Frederick Weniger can evaluate your skin quality, fat distribution, medical history, and areas of concern to determine whether liposuction alone is appropriate or whether another body-contouring procedure may provide a better result.