How It's Done

During your initial consultation, the doctor will take a good look at your body. You'll be expected to stand there in your underwear while he studies the parts of your body that you like the least; your "saddlebags," wide hips or thighs, sagging stomach or facial jowls. Sometimes the doctor will draw on your skin to show you which areas might be slimmed down. You'll go home with markings that look like a baby has finger-painted on you. You'll also go home excited about the prospect of transforming those areas into something that makes you feel proud.

The doctor should be able to see you in three dimensions. If he just marks a circle on your lower abdomen, he is thinking in two dimensions and you may not get the result you desire. For the "torso" cases, we may be able to sculpt everything from the bra-line to the lower hip all the way around the body, front and back (of course, for some young, fit people this isn't necessary). Properly done, this produces a figure that looks good from every angle.

Upon arrival at the surgical center the morning of your procedure, you may be given a pill such as Valium® if you're nervous. We ordinarily use a slow drip of intravenous medicine that puts you in a very light sleep. Other physicians may use shots or general anesthesia with a tube in your throat. You'll lie on the table and have your fatty areas filled with the "tumescent solution" of sterile salt water, adrenaline and anesthetic (please refer to chapter 13 to learn more about tumescent anesthetic). Patients who need large volumes of fat removed are also given intravenous fluids after the procedure.

When the local anesthetic has taken effect, tiny openings are made in the skin surface (you shouldn't feel a thing). These openings are made in the areas where the fat is to be removed, most often under the buttocks, on each hip, and in the navel. A thin tube called a "cannula" (about 2.5 to 4 millimeters in diameter) is then inserted through these openings directly into the fat. The fat is then sucked out through a plastic tube into a disposable container. The whole procedure is usually painless, and depending on the quantity of fat being removed, can take anywhere from 30 minutes to several hours. Inexperienced surgeons take longer. An average liposuction procedure in our office removes about two to six quarts of fat. During the procedure, you can be awake the whole time, but most people prefer to have the medicine so they sleep (for more information on anesthetics, read chapter 13, "What Kind of Anesthetic is Recommended for Cosmetic Surgery? and my scientific paper about our "PK" anesthesia technique). Some patients request mild sedation and are content to lie quietly listening to music and relaxing. The experience can actually be fun, and it can give you an opportunity to bond with your doctor by telling stories and using this time to get to know each other better. One British socialite came to our office for liposuction carrying a cup of coffee, a Walkman with headphones and blackout eye covers. She armed herself with these things because she was nervous, but 20 minutes into the surgery she removed all the paraphernalia and entertained us with stories for two hours.

When you're finished, you'll be "wrapped up" in a girdle that stays on most of the time for about a month. Many doctors use 6" x 12" foam pads placed directly on your skin over the treated areas (one of our patients refers to them as "giant post-it notes"). The girdle will be worn to hold your skin tightly and help keep the foam pads in place. You may feel a little cold or uncomfortable as you wake up, but that should pass relatively quickly. You can often go home an hour or two later (you will need to have someone drive you home, since there may still be some medication in your system).

When you get home, you may be sleepy and want to relax for the remainder of the day and evening. Most of our patients are advised, for a day or two, to take up to 1,000 mg of Tylenol® (acetaminophen) every four hours while awake if they have no contraindications to this medicine and dose (liver disease or alcoholism, for example, are contraindications). The next day, you'll feel some discomfort, depending on the amount of fat that was removed, and you will probably feel a bit bound-up by the foam pads and the garment. Some patients say they feel as though they'd spent the whole day doing sit-ups with an over-zealous trainer. Moving from one position to another seems to increase the discomfort. The third or fourth day is usually the worst. Then things begin to improve.