VASER® LIPOSUCTION AND

LIPOSCULPTING
MEDICAL INFORMATION AND ANSWERS TO FREQUENTLY
ASKED QUESTIONS

MEHMET SURMELI, M.D., FEBOPRAS,

PLASTIC, RECONSTRUCTIVE AND AESTHETIC SURGEON

(This article is subject to change and it is updated as needed) LAST UPDATED ON 10/17/2019)

What is VASER®?
VASER® (Vibration Amplification of
Sound Energy at Resonance) is an
ultrasound-assisted liposuction (UAL)
device that acts selectively on fat tissues,
sparing the nerves, muscles, and blood
vessels, and melts the fat in a way that
there is no need to traumatize the tissues
to remove the fat. Since the amount of
energy given to the fat tissues can be
standardized, this method decreases the
incidence of irregularities and makes it
possible to perform high definition
liposculpting techniques, that is why it is
also called as “hi-def liposculpting”.
We routinely perform VASER® liposuction,
with a special VASER® probe which we
introduce
through 3-5mm incisions (like 3-5mm
holes) to reach the under-skin fat. The
VASER® probe transfers an ultrasonic
(sound vibration) energy much more
evenly and less traumatic than traditional
liposuction, it melts down (emulsifies) the
solid fatty tissue into an oily fluid. Then
we introduce the liposuction cannulas
through the same holes and aspirate that
fluid and further shape the fat contour of
the body. So, with VASER®:
 We have more balanced (evenly)
distributed fat destruction and
removal
 It takes much less time (shorter
operation)
 VASER® selectively destroys the fat
tissues, it minimally injures the
vessels, nerves, muscles, and
fascia. Therefore, it is less
traumatic than the traditional
methods with less bleeding and
more control.
1
Common (typical) Incision
Sites (“holes”, “entrance
sites”, “entrance holes”)
We usually open incisions (holes) to these
sites:
● For the abs and the
flanks:
Two incisions on the groin line (on
the line of underwear) and one hidden
inside the belly-button.
If the patient is tall and has plenty
of fat on the sides we may open two more
holes on the line of underwear on the
sides.
● For the lower back:
Two incisions on the points of
“dimples of Venus” (the sacral dimples)
● For the upper back:
Two incisions on the level of the
bra strap
● For gynecomastia (in
men):
Two incisions 5-7 cm below and
outside the nipple
And if needed two to the front line
of armpit (anterior axillary line)
● For the upper thighs:
Two incisions on the buttock-thigh
transition line, on the outer surface of the
thighs, hidden behind the line of
underwear
● For the lower thighs:
Two incisions on the inner-back
surface of the knee
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The limits of Liposuction If the amount of fat that is removed is

more than 5 litres, patients:
(fat removal)
“Safe Liposuction”
The term safe liposuction describes
liposuction less than 5 litres.
If the amount of fat that is removed is less
than 5 litres, patients:
▪ Will recover much faster
▪ Will be mobilized earlier (less
complications)
▪ Hospitalized shorter
▪ The need for blood transfusion will
be lower
▪ The need for extra-medications
will be less (blood-thinners,
Clexane®, antibiotics, etc.).
▪ Minor problem risks will be lower
(prolonged fatigue, fluid
accumulation on the dependent
areas, irregularities on the skin of
the liposuction areas, prolonged
hospitalization, blood and plasma
transfusions etc.)
▪ Major problem risks will be lower
(fluid imbalance related heart
attack, pulmonary
thromboembolism, deep vein
thrombosis, death)
▪ Will recover much slower
▪ Will be mobilized later (more
complications)
▪ Hospitalized longer
▪ The need for blood transfusion will
be higher
▪ The need for extra-medications
will be higher (blood-thinners,
Clexane®, antibiotics, etc.).
▪ Minor problem risks will be higher
(prolonged fatigue, fluid
accumulation on the dependent
areas, irregularities on the skin of
the liposuction areas, prolonged
hospitalization, blood and plasma
transfusions etc.)
▪ Major problem risks will be higher
(fluid imbalance related heart
attack, pulmonary
thromboembolism, deep vein
thrombosis, death)

Massive liposuction
“Massive liposuction” refers to liposuction
more than 5 litres. Conventional upper
limit for massive liposuction is 10% of the
body weight. Above this limit the rates of
all the aforementioned risks of liposuction
increase and the risk of major or fatal
complications may increase considerably
(particularly in patients with concomitant
diseases and/or age >45)
 3

“Fat embolism” and 4. to keep operation time as short as

possible
“Pulmonary
5. to follow safe liposuction guidelines
Thromboembolism” rare but
(removing less than 5 L, atraumatic
life-threatening complications technique, etc.)
of liposuction 6. to encourage patient to get mobilized
4-6 hours after surgery
Fat embolism is a rare (less than 1 in
400,000) but is a life-threatening
complication of liposuction. It happens
because of the occlusion of important
vessels with fat particles or fat globules
(droplets). It may cause permanent
damage to lungs, brain or other major
organs of the body or even to death.
Pulmonary thromboembolism is again a
rare (less than 1 in 200,000) but a life-
threatening complication of liposuction.
This happens because of the formation of
blood coagulation (clots) in deep veins of
thighs and legs and then, mobilization of
these blood clots and obstruction of vital
vessels of the lungs. It may cause acute
cardiac failure, hypoxemia and even
death.

What do we do to decrease
these serious complications?

The key points to prevent fat embolism

and pulmonary thromboembolism (as well
as many other complications) are:
1. to avoid muscle injury. (because most
of the veins that cause fat embolism are
the veins inside the muscles.)
2. to give antithrombotic medications (e.g.
Clexane® subcutaneous injection)
3. using pressure socks during operation

Blood counts after liposuction
The blood count (Hemogram) is the most
important laboratory test for liposuction
both before and after the procedure. The
important relevant parameter among the
blood count test is “Haemoglobin (Hb)”
test. There are significant fluctuations in
the blood counts of the patients after
liposuction. The most commonly observed
change is a steep decrease in the blood
counts during and after the operation.
The normal values for Hb are:
Adult males: 14-18 gm/dl
Adult women: 12-16 gm/dl
(The above values are average means and
may change according to age, health
status, living place and laboratory
calibrations.)
These values may decrease by 2 to 3
gm/dl in non-massive liposuction and may
decrease by 5 to 6 gm/dl in massive
liposuction.
The main reasons for this decrease are:
1. Hemo-dilution
2. Fluid retention
3. Bleeding
1. Hemo-dilution
a) Hemo-dilution because of
infiltration with liposuction fluid
4
We use the “super-wet” technique of
liposuction. In the super-wet technique,
we infiltrate the fat tissues with a special
liposuction fluid to prevent bleeding and
injury to the tissues. When the liposuction
is planned to be applied to an extensive
area, we need to infiltrate the tissues with
large amounts of fluids. This extra fluid
load usually results in a dilutional
decrease in blood counts.
b) Hemo-dilution because of IV
(intravenous) fluid overload
As we remove fat (or other tissues) during
surgery we need to replace that change in
volume with special IV fluids. These extra-
fluids are called as the “replacement
fluids”. We also administer extra-fluids for
the normal maintenance of the body, and
hence, these fluids are called
“maintenance fluids”. If there is a lack of
this replacement and maintenance, the
patients may have a severe hypotension,
which may in turn results inability to
recover from anaesthesia, acute kidney
problems and even myocardial infarcts.
Therefore, there is a very delicate fluid
balance that should be monitored and
regulated during and after the course of
surgery. This replacement and
maintenance fluids may cause an overload
of fluids which results in a dilutional
decrease in blood counts.
2. Fluid retention
Liposuction is a major trauma for the
patient. The body also reacts to
liposuction in a manner which is very
similar to that of another major trauma
(like a traffic accident). Whenever we
have a major trauma, our body secretes
 5

some hormones which try to increase But, as we mentioned before, early

blood pressure and increase the
intravascular volume by holding more
water than needed. This is called as “fluid
retention”. The body can hold extra 2-4
litres of water which may manifest itself
as a dilutional decrease in blood counts.
3. Bleeding
Bleeding is uncommon in liposuction
unless the patient has a bleeding
tendency, uncontrolled hypertension or
anatomic abnormalities. Poor surgical
technique leading to muscle injury is
another reason of excessive bleeding.
mobilization of the patient (standing up,
walking around) is the key measure to
prevent the major complications of the
surgery. Extreme fatigue and sickness
usually prevent the patients to get
mobilized early after surgery. Therefore, if
the patient experiences a problem with
early mobilization because of the
symptoms of decreased blood counts, we
may act early by supporting the patient
with protein (fresh frozen plasma) or
blood (erythrocyte suspension)
transfusions. Because we want our
patients to stand up and get mobilized as
quickly as possible.

Whichever the cause of the decrease in

the blood counts, the possible symptoms
after the surgery are:
● Hypotension (low blood pressure)
● Resting tachycardia (>100 heart
beats per minute while resting)
and palpitation
● Extreme fatigue
● Dark urine colour
● Extreme dizziness and sickness
(and vomiting) while trying to
stand upright

Normally, the steep decrease in the blood

counts leading to those symptoms gets
back to non-symptomatic values within
approximately 2 weeks and to almost
completely normal values within 2 months
without any external intervention,
without any blood transfusion or
medication.
 6

Sample Case: If this patient had high resting heart-beat

counts (tachycardia >100 beats per
35-year-old healthy woman undergoing a
minute), we would have acted earlier to
6-region extensive liposuction
transfuse blood and/or fresh frozen
Before the operation, the patient had a plasma.
Hb: 13 gm/dl.
If this patient had severe fatigue without
Six litres (6000cc) of fat was removed with any other problem about her blood
VASER® liposuction. pressure and heart-rate, we still would
have preferred to transfuse blood and/or
8000cc of IV fluids were administered
fresh frozen plasma.
during and after the operation.
If this patient had also undergone a
After the operation, in the following
tummy tuck and/or breast surgery in the
morning the Hb: 7.2 gm/dl
same session, again, we would have been
There is a moderate amount of fluid more aggressive to transfuse blood
discharge but its colour was lightly blood and/or fresh frozen plasma.
stained
Within the first 2 weeks patients lose the
Resting heart rate is around 90 per minute extra fluid load in their body, therefore,
and blood pressure was 100/60 mm-Hg the blood counts usually approach to
normal values.
The patient feels a bit tired but was able
to walk 2 times after the operation After 2 weeks, we usually recommend
patients to use iron supplements.
We DO NOT recommend patients to use
Management of Sample Case:
iron capsules in the first 2 weeks because
In this case, we should not make blood iron capsules may cause severe
transfusions for now. We should monitor constipation in the first weeks of use.
the blood pressure and resting heart Constipation can cause abdominal
beats per minute. If everything is normal distention, may increase the need to
and the patient does not have severe strain, all of which, in turn, would increase
dizziness, we could discharge her without patient discomfort and cause intense
blood or protein transfusion. In the first pain.
week follow-up, we could see an even
further decrease in the blood counts for 1-
2 gm/dl but unless there are evident signs
of hypotension or rapid strong heart-
beats (palpitations with heart rate >100
per minute).
If this patient was older (over the age of
50), she would have reduced cardiac
reserve, therefore, we would have acted
more aggressive to transfuse blood
and/or fresh frozen plasma.

Fluid discharge and Fluid
accumulation in the areas of
liposuction (under-skin) after
VASER® liposuction
Fluid discharge and early fluid
accumulation (early seroma) in the areas
of VASER® liposuction is not a
complication but a part of the recovery
process of VASER® liposuction.
As many of the modern methods of
liposuction, the VASER® liposuction
induces damage to the tissues. Even the
extent of this injury is less than many
other methods it is more pronounced on
the lymphatics, the function of which is to
remove the circulating tissue-fluid in your
body.
The interruption of this system
consequently causes insufficient drainage
within the first 2-3 weeks and hence the
early-seroma (fluid accumulation) may
occur.
In extensive (more than 3 region) VASER®
liposuction the occurrence of fluid
accumulation can be seen in 80-90% of
the patients. We routinely perform “check
and drain” with rechecking the holes or
using a sterile syringe in the routine
controls, and drainage takes 2-5 minutes.
But as we already mentioned the healing
of the lymphatics may take 2-3 weeks and
during this period if the patients return to
their countries there is still a period that
the patient may have fluid accumulation.
The body almost always resorbs that fluid
after some time without any medical
intervention. However, many of our
patients report that Lymphatic Drainage
Massages (LDMs) have a positive effect on
7
the resorption of the fluid, decreasing the
pain and preventing irregularities.
But if the amount of fluid collection is very
high (more than a litre), we recommend
our patients to have it drained because
this will shorten the healing time.
The drainage should be performed by or
under the supervision of the professionals
(surgeons or surgical nurses with syringe
aspiration or radiologists with USG
(ultrasound-guided) puncture. Sometimes
it is needed to put drains (Hemovac®
drainage pipes) for a few days or
recurrent aspirations-drainages may be
required. We have observed that many of
the foreign surgeons are unwilling to help
the patients who have been operated on
by other surgeons. So, this point should
be kept in mind.
What do we do to decrease the
risk of fluid accumulation
(early-seroma)?
We may leave the holes open and cover
the holes with under-pads. So, you’d
better be prepared and bring enough
underwear and cotton clothes with you.
Leaving the holes open may increase the
infection rates only slightly but this is a
trade-off and the beneficial effects are
more than its side-effects.
Sometimes we may place Hemovac or
Jackson-Pratt drains to monitor the fluid
leakage and to keep the wounds dry,
usually if:
● this is a combination surgery
(combined with tummy tuck,
hernia repair, etc.),
● this is a secondary case (a major
revision operation or a liposuction
after a tummy tuck)

● there is active bleeding or
excessive fluid leakage.
After the first day, we remove the drains’
negative (vacuum) pressure and switch it
to free-drainage state. We usually remove
the drains on the 5-7 days, therefore as
you can understand. Placing drains will
not discard the risk of early seroma.
Compression Garments (Corset,
Faja) and Bimodal Compression
We recommend compression garments in
the first 6 weeks, the first 2 week of which
is crucially important. Specifically in the
first 2 weeks, we do not recommend more
than 10 min of pressure garment removal
because it causes over the areas of
liposuction because these areas may
become swollen within a few minutes
(because of tissue engorgement with
blood and tissue fluids) and may cause
acute hypotension, fainting, palpitations,
passing out, may increase the body's fluid
retention.
Bimodal compression is a new term
which defines the tight compression
within the first 2-3 days postoperatively
and a gradual lighter compression after
these initial days which is thought to help
more rapid lymphatic healing after
liposuction.
We usually recommend 6 weeks of
regular use of compression garments,
then you can start a “weaning period” for
one week, during which you only wear the
compression garments half of the day
(day or night), and then you stop using it
altogether.
8
Lymphatic Drainage Massage
Lymphatic massage is thought to help the
lymphatic drainage of the tissues which
tends to collect more on the dependent
sites of the body (lower half of the tummy
and lower back) and thought to help to
soften and smoothen the minor
irregularities that are normally seen after
the liposuction. It can be applied by the
patients or masseuse with herbal or
natural oils. It can be started as early as 2
days after surgery and may be continued
for up to 2 months. In the first 2 weeks its
main function is to move and force the
tissue fluids away from the accumulation
sites to the areas with less swelling and
intact lymphatics. After the first 2 weeks,
its main effect is to reduce the tissue
swelling and stretching-softening the skin.
Even though it is scientifically and
medically not an obligatory step that
should be done by every patient,
depending on the feedback from the
patients, we could say that many of our
patients are very happy and satisfied by
having this massage done. The masseuses
are usually familiar with the liposuction
patients, they could remove collected
fluids, they could help the patients with
getting used to their body, and may help
patients during the contraction phase of
the skin redraping.

Lower Extremity Liposuction
Lower extremity liposuction is the
liposuction of the ankles, legs and calves
and thighs. According to our and many
other senior plastic surgeons’
experiences, lower extremity liposuction
has the least satisfaction rates, and the
highest complication rates. The main
reason of dissatisfaction is related with
the skin and fat characteristics of the
lower extremity that even a slight
liposuction is likely to leave significant
irregularities. The skin does not contract
evenly and effectively, the fat packs does
not have a good fibrous network, which
all would end up with irregularities or
sagging skin much more easily than the
other parts of the body.
Lower extremity liposuction leaves a very
long lasting edema (swelling) in the legs
and feet, which may last at least 1 year to
become normal, and even sometimes it
may become permanent.
Lower extremity liposuction also increases
the likelihood of the medical need for
blood and/or fresh frozen plasma
transfusions and would delay early
mobilization and would prolong healing
time.
Because of these reasons, we usually
restrict lower extremity liposuction to
very mild inner or outer thigh liposuction,
just to give a better contour.
9
Recommended Exercises after
liposuction
In the first month (4th week), the best
exercises are walking and stretching the
body in every direction, a few times a day.
Between 4th to 8th weeks, the best
exercises are walking, swimming and
stretching exercises.
After the 8th week, patients can do every
kind of fitness exercise in addition to
swimming and stretching exercises.
Effects of Previous Liposuction
Previous liposuctions (whether with
traditional methods or with assisted
methods) will significantly decrease the
success of the secondary (or tertiary)
liposuction procedures. As we mentioned
above, the liposuction heals like an
ordinary wound and leaves a widespread
scar on the areas of liposuction, even
though they are hidden under the skin.
The scarring means fibrosis (plastic like
unorganized connective tissue) which
entraps the remaining fats and causes
scar contractions, which stands as an
important obstacle on the way to achieve
a predictable and satisfying result.
 10

The phases of healing after secondary swelling could become

more evident on the arms and
VASER® liposuction legs, and a long-lasting moderate
level swelling would start.
● low grade inflammation starts
The first 2-3 days which may cause slight redness on
In the first 2-3 days, the patients usually in the sites of liposuction holes and
an immediate postoperative period, that on the areas of fat injection (if it is
they will have: done). Anti-inflammatory
medications are prescribed and
● blood-stained fluid leakage in
used during this time. Fever with
copious amounts
chills, redness and/or purulent
● Unstable blood pressure, mainly
discharge are the signs of a wound
low blood pressure in standing
infection which necessitate
position (orthostatic hypotension),
immediate medical attention.
which also causes dizziness, light-
● Compression garments are very
headedness, rapid and feelable
important to prevent fluid
heartbeats (palpitations), nausea
accumulation, to decrease tissue
and vomiting.
swelling, to help a smoother re-
● Haemodilution (relatively low
draping of the floating skin.
blood counts) and low blood
● Most of the serious complications
pressure leading to fatigue.
of the operation (such as infection,
● A urinary catheter is placed to
thromboembolism) occurs almost
monitor fluid input and output.
always within the first 2 weeks
● During this time, you will be under
after the operation.
direct control of your doctor and
● Early onset seromas (fluid
nurses.
collections) usually happens during
● The body reaches a maximum
that time and surgeon, nurses
swelling approximately on the 3rd
and/or the patients drain this fluid
day which would continue for up
with massage maneuvers and/or
to a week and then it starts to
with re-opening the liposuction
decrease gradually.
holes.
● Compression garments are very
● A good time to start lymphatic
important to prevent or stop
drainage massage sessions (or you
bleeding and to prevent fluid
can do it yourself).
accumulation
● Patients can go for long walks or
After the first 2 days, in the first even jogging, but fitness exercises
are not recommended in the first
2 weeks 6-8 weeks. Walking is a very good
● bleeding stops, way to keep the weight stable,
● fluid discharge decreases because patients usually are more
● blood pressure becomes stabilized likely to put on weight because of
● acute swelling begins to decrease inactivity after the surgery.
after the first week, but the

Between 2 weeks to 4 months
● After the 2nd week the patients
start to feel tension and stiffness
on the areas of liposuction as if
they have worn an iron armor that
restricts their comfortable
movement. This happens because
of the start of fibrous (proliferative
and early maturation) phase of
wound healing, it is completely
normal and an expected finding.
This usually reaches a maximum
level on the 2nd-3rd months and
then gradually decreases over 12
months, but may still be slightly
felt many years after the surgery.
● The irregularities could be very
visible particularly on the tummy,
arms, thighs. This is again very
closely related with the fibrous
(proliferative and early
maturation) phase of wound
healing.
● There can be palpable and visible
lumps, or areas of skin with
asymmetrical swelling or even
small areas of entrapped fluid.
Unless it is very abundant and high
in volume, they usually disappear
with time and massaging. If you
feel fluid entrapped in a certain
region 2 months after surgery, first
inform your doctor. Then you
should have an USG
(ultrasonography) to verify the
collection and to have it drained
by needle aspiration by a medical
professional.
● You can start using iron or
multivitamin supplements, two
weeks after surgery
11
● You can do stretching exercises,
you can swim and care not to gain
weight.
● After 2 months, you can start
(even heavy) fitness exercises.
● The overall swelling of the body
would decrease significantly
during this time
● The liposuction hole scars would
be visible, red-pink in colour and
elevated.
Between 4 months to 12
months
● Most of the maturation phase of
wound healing would take place
during that time
● Month by month, particularly after
the 4th month, the liposuction
areas would look much more even,
most of irregularities would get
smoother, the feeling of hardness
would become softer in the
following 12 months
● The liposuction hole scars would
get softer, paler and less visible.
● It is relatively safe to be pregnant
after 6 months (preferably, safer
after 1 year)
After 12 months (1 year)
● More than 90% of the healing
would be completed.
● If there is still a major asymmetry
present at this time, it would not
change.
● If there are some minor
irregularities, these usually
improves in the follow up as the
body remodelling continues.
● It is completely safe to be
pregnant.

Answers to common
questions:
Which type of anaesthesia do
you use?
Unless liposuction is very limited to a very
specific single zone, we prefer liposuction
under general anaesthesia.
Why:
 The patients may develop the side
effects of local anaesthesia which may
extend after the operation (post-
operative period).
 We are usually performing extended
liposuction (involving more than 3
zones).
 HD liposuction typically needs no
patient movement and no twitching
muscle movements.
How long does VASER®
liposuction surgery take (to
perform)?
The duration of the operation is highly
dependent on the number of areas that
liposuction will be performed and
whether the patient is going to be turned
from supine to prone position but for the
standard 3 region liposuction (abs, flanks,
lower back) it takes approximately 2-3
hours. If it is a combination surgery, it will
take much longer.
How long am I going to stay in
hospital?
If the liposuction is limited you need to
stay one night in the hospital, if it is
extensive-massive or performed with
other surgeries, you may need to stay for
2 nights.
12
When could I be able to return
to my normal life?
If we perform limited liposuction the
patient is supposed to get back to her/his
normal life within 5-7 days, if it is
extensive-massive liposuction or a
combination-surgery, the patient should
rest for at least 2-3 weeks.
When can I start exercises?
You can go out for a walk 3-5 days after
liposuction. We recommend our patients
to start doing some stretch exercises as
early as 1 week after surgery to smoothen
the re-draping and contraction of the skin.
But you should wait for 4-6 weeks for
hard fitness exercises and swimming.
When can I take a shower?
You can take shower 4-5 days after the
operation (before coming to your second
control visit) with warm water (neither
cold nor hot).
The main reasons for delaying the shower
this long are:
● when you take off your
compression garments your blood
pressure would drop suddenly,
and you may faint, we do not want
to risk it.
● we put a very tight (package like)
compressive dressing over your
body to prevent bleeding and to
make compression over the areas
of liposuction to decrease the
swelling. It usually stays for 4-5
days. It is very difficult for you to
remove it.
● It is not very easy to take off and
re-wear the compression garment
in the first few days for the
patients.
But people accompanying you can help
you for cleaning your body by washing
your hair, by soaking and soaping a towel

to clean your lower body and genitals,
your armpits, etc. without wetting your
dressings or compression garments.
Bruises and swellings are normal in the
postoperative period and it may last for a
couple of weeks. Some patients may
complain that their thighs, legs have
become “larger” after the operation
which is because of the edema (swelling)
of the surgical procedure.
The back liposuction (upper and lower
back) is more painful than the sides and
the front areas.
What happens if I put on
weight after liposuction?
The number of fat cells in an adult stays
almost the same. The changes that we
observe in the weight and fattiness of a
person is not because of a change in the
number of fat cells but rather it is related
with the change in the amount of fat
deposited in each cell. This simply means
that when we put on weight, the number
of fat cells does not change but each of
the cells becomes bigger and bigger with
the deposition of fat granules, when we
lose weight, each of the fat cells becomes
smaller, the total number of fat cells does
not change.
Example:
Let’s assume that you gain 10 kg (22 lbs)
of weight. On average 5 kg (11 lbs) of that
weight would be deposited over your
waist.
If we do liposuction and you gain 10 kg
(22 lbs) of weight, on average 2 kg (4.4
lbs) of that weight would be deposited
over your waist.
13
This means that, if the patient puts on
weight after liposuction, since we have
permanently removed the fat cells in a
certain part of the body, he/she would get
a lesser percent of this fat on the areas of
liposuction.
It is worth mentioning that liposuction will
not protect you against gaining weight nor
would you be more likely to become fat. It
only affects the fat distribution of the
body.
Are there any beneficial effects
of liposuction for my health?
Firstly, by improving the self-body
perception and self-confidence, it directly
affects the psychological health in a
positive way.
It is a motivational trigger for starting a
healthier life, eating healthier foods and
keeping a stable weight.
There are some hypothesized beneficial
effects of liposuction most of which have
not yet been scientifically proven but
there are some preliminary studies with
promising results.
One of them is its possible effect to
decrease the insulin-resistance by
decreasing the total fat content of the
body. There is a well-documented
relationship between the decrease in the
amount of fat and the decrease the
insulin-resistance. (Insulin-resistance is
considered to be the earliest phase of
diabetes mellitus)
Another postulated effect, that is still
under investigation, is the decrease in the
amount of the estrogen-receptor positive
breast cancer cells in the total fat volume.
There are preliminary findings that the
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estrogen-receptor (+) breast cancer is

susceptible to healthy intentional weight
loss or weight loss by liposuction.
But it should be kept in mind that
liposuction is not a healthy way of losing
weight, on the contrary, it should only be
used to shape the body fat to achieve an
aesthetically pleasant contours and
proportions.

The common problems in
the postoperative period
Wrinkles, irregularities,
lumps, and bumps
Immediately after liposuction, because of
the removal of most of the subcutaneous
fat tissue, your skin would float over the
deeper structures (muscles). The skin has
an expansion and contraction potential;
however, it is vastly different from person
to person. After liposuction, it is expected
that your skin will recoil-contract over
time (6-10 months) and during this time
there can be wide-spread wrinkles and
irregularities on the areas of liposuction.
After you stop wearing your compression
garments and you return to your normal
daily life and begin exercises, the natural
daily stretching forces will help re-shaping
your skin, your underskin attachments
and the irregularities will become
smoother with time. This late healing
phase (scar maturation) may last for at
least one year. Therefore, the final results
of liposuction are achieved not earlier
than a year after surgery.
But you should know that some
irregularities may remain permanent. The
elastic recoil of the skin is not predictable,
it is also different on the same patient
from region to region. Therefore,
sometimes the skin contraction is not
effective enough or may leave a
significant irregularity which is particularly
true for lower tummy and inner thighs.
These problems are usually not
correctable by non-surgical methods and
may require a revision or another
operation later. The risk of this problem is
higher in secondary-revision liposuction
15
patients or for the patients with a
previous history of abdominal surgery, or
non-optimal skin quality.
Depression and
Dissatisfaction
The VASER® liposuction procedure, when
it is performed over many regions of the
body, is a major surgical procedure and
the healing process is long with some
minor-major problems, the early period is
painful such that there can be fluid
accumulations, irregularities, wrinkles
which, during the process, may trigger
dissatisfaction or even depression in many
patients. The psychological preparations
and postoperative supports are as
important as the medical preparations
and postoperative treatments after the
surgery.
The satisfaction rates after VASER®
liposuction is around 80%. The satisfaction
rates are highest in overweight (BMI
between 25 to 30 kg/m2), and lowest in
obese (BMI >30kg/m2) and normal (BMI <
25kg/m2) patients. Almost 50% of the
patients have some degree of
irregularities. The satisfaction rates are
highest for arms, flanks, and abs, outer
thighs; lowest for inner thighs and legs.
Some patients have different body builds,
they do not have a narrow waist
circumference, narrow hips, and have bad
skin quality with worse skin recoil, more
elastic-loose skin, intra-abdominal fat
(male type abs) and the result may vary
from patient to patient.
The social media (and the Instagram
world, in particular) has changed the
world of realities and misshaped the
expectancies of the patients in unrealistic
ways.
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Mehmet Surmeli M.D. FEBOPRAS

Plastic, Reconstructive, and Aesthetic
Surgery
2019
Istanbul-Türkiye