LIPOSUCTION (LIPOSCULPTURE) By Joshua Zuckerman, MD, FACS in New York City

Dr. Zuckerman performs liposuction on virtually all areas of the body including the abdomen, back, legs, and neck.

Due to pregnancy, aging, weight gain and other factors, stubborn deposits of fat can develop which may seem nearly impossible to eliminate even with an exercise regimen and a healthy diet. Liposuction by Dr. Zuckerman is designed to physically remove the fat from these areas, leaving targeted areas with improved contouring and a more athletic appearance. For both men and women, Dr. Zuckerman can perform this procedure on areas all over the body.

Liposuction of Abdomen, Flanks / Love Handles, and Chest (“Tummy Liposuction”)

The abdomen and flanks, or love handles, are the most popular areas on which Dr. Zuckerman performs liposuction. Stubborn excess deposits of fat in both regions are common in women after pregnancy or due to weight gain or aging. Dr. Zuckerman can help you achieve a flatter stomach and regain your hourglass figure and is an expert in creating smooth, toned contours in this area. As discussed above, this procedure cannot address excess skin, only excess fat, and the most common question Dr. Zuckerman receives from prospective patients regarding the midsection is if they would be best suited with a tummy tuck (abdominoplasty). In many cases, the answer is yes. Dr. Zuckerman can also address the upper abdomen with liposuction if needed. If you are interested in targeted liposuction to enhance the appearance of the abdominal muscles, see the section below on abdominal etching.

Liposuction of the Upper and Lower Back

Excess deposits of fat in both the upper and lower back can be addressed with this procedure, but the lower back is more common. Often as part of buttock augmentation (Brazilian Butt Lift), Dr. Zuckerman will perform targeted liposuction to the lower back to both increase the projection of the buttocks and to harvest fat for grafting.

Liposuction of the Thighs

Liposuction of the thighs, typically the inner thighs, is the most common area of the legs on which Dr. Zuckerman performs this procedure. Fat deposits in this area can be extraordinarily difficult to address with diet and exercise. Dr. Zuckerman can help you reduce the prominence of the inner thighs by physically removing this fat. This area must be addressed with care by the plastic surgeon: over-removal of fat can lead to contour irregularities.

Liposuction of the Arms

Liposuction is most commonly performed on the upper arms, but Dr. Zuckerman also performs the procedure on the axillary rolls (“bra rolls”). Liposuction of the arms must be performed carefully, because most patients do not have extreme amounts of fat in this area. Over-removal of fat can cause adhesions and irregularities of contour. If you suffer instead from excess skin of the arms, you may require an arm lift, or brachioplasty, although this is most common in older patients and weight loss patients.

Liposuction of the Neck, Chin, and Face

The most common area of the head and neck addressed with this procedure the is submental, or under the chin, liposuction to reduce a double chin. While there is a relatively new FDA-approved non-surgical submental fullness (double chin) reduction treatment called Kybella that Dr. Zuckerman offers to address this area, liposuction is the far more definitive solution. If desired, Dr. Zuckerman is happy to administer the non-surgical treatment first and proceed afterward to the surgical solution if you desire a more dramatic result. Dr. Zuckerman can also perform liposuction of the jawline and face. These are less common, but Dr. Zuckerman can help you decide which treatments are best-suited to your goals at your initial consultation. Jowling and other facial sag may need to be addressed via facelift surgery or a neck lift.

Liposuction of Other Areas: Legs, Knees, Ankles and Buttocks

Dr. Zuckerman can also remove fat from other areas of the legs including the knees, ankles, and buttocks.

Male Liposuction & Abdominal Etching (“Liposuction of the Abs”)

Abdominal etching is targeted liposuction of the abdomen to enhance the appearance of the abdominal muscles, or “six pack”. While both male and female patients may undergo this procedure, it is more common in men. Moreover, the surgical goals of male liposuction patients may differ somewhat than those of female patients. Male patients often have less overall fat content in the midsection and are generally not interested in an hourglass figure. As a result, Dr. Zuckerman strives to achieve a gender-appropriate and more defined, muscular appearance to the abdomen. For the abdominal etching procedure, Dr. Zuckerman creates meticulous preoperative markings between the major abdomen muscles and in others areas, which he follows carefully during surgery when suctioning. This targeted liposuction technique must be performed with precision, because over-removal of fat from targeted locations may be easily apparent and may compromise the appearance of the abdomen as a whole.

Dr. Zuckerman is often able to combine liposuction of different areas into a single operative procedure, minimizing operative time and downtime. Good candidates for this operation are those with medium to high quality skin elasticity. Note that liposuction is a sculpting procedure, not a weight loss procedure. Significantly overweight men and women are not good candidates and should lose weight before undergoing the procedure. Men and women who have excess loose skin and/or muscle separation may be better candidates for an Abdominoplasty (Tummy Tuck). Dr. Zuckerman will also be able to help you make that determination.

At your initial liposuction consultation, Dr. Zuckerman will discuss your aesthetic surgical goals and address any concerns or questions you may have.

Dr. Zuckerman describes the liposuction procedure and its possibilities and showcases some of his patient results.

To begin the liposuction procedure, Dr. Zuckerman makes small, strategically located, “poke-hole” incisions, each only a few millimeters in width. Then, he injects a liquid called tumescent solution into the areas that are going to be suctioned. This solution contains saline, a local anesthetic, and epinephrine and provides three benefits:

• Fluid separates the fat globules from one another, allowing Dr. Zuckerman to more easily remove them.
• Lidocaine is a numbing agent and provides pain control.
• Epinephrine is a vasoconstrictor, which makes small blood vessels contract, and helps minimize blood loss during the procedure.

After instilling the tumescent solution, Dr. Zuckerman performs suctions of fat cells in the targeted region with long, sterile metal tubes, or cannula. These instruments are blunt-tipped to minimize trauma to the targeted area. He inserts the cannula through the poke-hole incision and moves the cannulas back and forth underneath the skin over the treatment area. In the process, Dr. Zuckerman vacuums out the targeted excess fat cells until the desired contour is achieved. The key to a great liposuction result is the experience and artistic eye of your plastic surgeon, who is also your sculptor. Dr. Zuckerman creates fit, athletic contours and maximizes the amount of fat removed.

This procedure is typically performed on an outpatient basis. The vast majority of liposuction procedures are completed in two hours or less, but operative time does depend on the number of targeted areas and on the extent of fat removal desired. Dr. Zuckerman can perform your procedure at his accredited, in-office, state-of-the-art operatoring room in midtown Manhattan. Accredited by the American Association for Accreditation of Ambulatory Surgery Facilities, Inc. (AAAASF), this facility is certified as offering an equally high standard of care as a hospital. The privacy, discretion, and convenience of Dr. Zuckerman’s private in-office operating room facility is an exclusive benefit of Zuckerman Plastic Surgery that many patients appreciate.

Liposuction with Local Anesthesia, Conscious Sedation, Or General Anesthesia

Dr. Zuckerman may use either local or general anesthesia for your procedure, depending on the extent of liposuction to be performed and, if needed, your preferences. For procedures with medium to large amounts of fat targeted, general anesthesia is recommended as the safer, more comfortable option. Local anesthesia may be a suitable option for small volumes of targeted fat. While local anesthesia may be a slightly cheaper option because an anesthesiologist is not involved, Dr. Zuckerman cannot be as aggressive with removing fat, and the procedure cannot be made 100% painless for the patient. General anesthesia is extremely safe, and Dr. Zuckerman contracts only with board-certified anesthesiologists who are experienced in cosmetic surgery procedures. In many cases, Dr. Zuckerman has worked with these anesthesiologists for years. If you have an anesthesia preference, Dr. Zuckerman is happy to discuss it with you at your initial consultation.

Full recovery from this procedure usually requires about two weeks, but most patients return to work within a few days. Final results appear at approximately three months but are typically aesthetically pleasing well before. Following postoperative care instructions after this procedure is important, because the body tends to fill with fluid any empty spaces, like those created by the physical removal of fat deposits. As a result, patients will predictably experience some bruising and swelling after surgery. Dr. Zuckerman may recommend that some liposuction patients wear a compression garment for a few days to a week to facilitate the healing process and prevent fluid collection. He may recommend lymphatic drainage massages as well. In rare cases involving large volume fat removal, Dr. Zuckerman may place a temporary surgical drain, but this is unusual. Major swelling generally is resolved by two weeks post-op. Most patients are able to resume their normal daily routines within one week after the procedure and many return to work three to four days after surgery. Recovery varies by individual, but it is possible to undergo surgery on a Thursday or Friday and return to work on Monday. Dr. Zuckerman will make customized recommendations based on the scope of your procedure and any specific goals or time constraints that you may have.

Posterior (back) view of liposuction of the abdomen, flanks (love handles), and back by Dr. Zuckerman. Approximately 3 Liters of fat removed. Images were taken before surgery and one month after surgery.

Left profile view of liposuction of the abdomen, flanks (love handles), and back by Dr. Zuckerman. Approximately 1.2 Liters of fat removed. Images were taken before surgery and one week after surgery.

More Before & Afters

Dr. Zuckerman publishes many of his previous liposuction (liposculpture) results with patient consent. The before and after image gallery has pairs of high resolution images from three to four angles for each patient. Many prospective patients enjoy finding a similar case to their own that Dr. Zuckerman has performed in the past. Take a look through the gallery by clicking on the button below.

BEFORE AND AFTER IMAGE GALLERY

Liposuction is an overwhelmingly safe procedure when performed by a board-certified plastic surgeon, and the main risk is an unsatisfactory aesthetic outcome when undergoing the procedure by a the wrong practitioner: a non-plastic surgeon. The most common issue Dr. Zuckerman sees in patients who request corrective secondary liposuction after a previous procedure with another practitioner is unsightly divots, bumps, or irregular texture left by uneven or over removal of fat.

Undergo liposuction with a board-certified plastic surgeon.

Unfortunately, due to its popularity, Dr. Zuckerman believes that liposuction is the most commonly attempted aesthetic surgery procedure by unsuitable practitioners both in the United States and aboard, so choose your doctor with care. Liposuction should be performed by a trained board-certified plastic surgeon. (Generally speaking, “cosmetic surgeons” are not plastic surgeons and may have as little as one year of surgical training but often attempt to perform liposuction.)

Avoid liposuction under local anesthesia alone unless your procedure involves small volume fat removal.

As mentioned above, undergoing the procedure under local anesthesia may be a seemingly attractive option but, in most cases, is not in the best interests of the patient. In addition, an unsuitable practitioner may be more likely to advocate for this option, which may not be performed in an accredited operating room, because they would be unable to procure operating privileges at an accredited facility or hospital.

Dr. Zuckerman is an extremely skilled board-certified plastic surgeon who takes every precaution to eliminate risks of even the slightest complication. All aspects of the procedure will be discussed with you at your initial consultation.

Below are the answers to some questions Dr. Zuckerman most frequently receives from prospective patients. If you don’t see your question below, feel free to contact Dr. Zuckerman’s office, and a member of his staff will be glad to reach out to you.

Is there a BMI weight limit for Liposuction?

Ideally, those who undergo this procedure or other cosmetic procedures of the body should have not have a BMI that significantly exceeds 30. Moreover, while I may remove up to several pounds of weight in fat during the procedure, liposuction is a sculpting tool, not a method of weight loss. A healthy preoperative weight leads to an easier recovery and helps patients achieve a better overall result.

Should I try to lose weight before undergoing Liposuction?

Both before and after surgery, it is important to maintain a healthy lifestyle of diet and exercise for your recovery and to ensure an enduring result. However, I generally advise patients that straining to lose a few pounds prior to the procedure is unlikely to have much effect on the final outcome. However, the number of fat cells in adults is relatively fixed, and these cells contract or expand in response to weight loss. Because fat cells are physically removed from the body during liposuction, posoperative weight gain may compromise the surgical result and may be distributed in atypical locations of the body.

How does Liposuction affect weight loss?

As noted in the question above, you should consider liposuction as a sculpting tool, not a shortcut to losing weight. I remove fat from specifically targeted areas, and in a good candidate, it can dramatically improve the contours of the abdomen, hips, and waistline. I highly recommend that patients continue to maintain a healthy diet and exercise regimen postoperatively. Areas that were treated may be somewhat less sensitive to weight loss, though post-liposuction distribution of fat can be unpredictable.

How much weight can I lose from Liposuction?

I encourage patients not to think about the weight of the fat itself that I remove via the procedure. While the patient will lose a few pounds (up to possibly 5lbs approximately) during large volume liposuction, the procedure is mainly a sculpturing tool: the main effect is to reshape the contours of the body by removing stubborn pads of fat.

Liposuction versus Tummy Tuck (Abdominoplasty)?

Although I must see a patient in person to fully evaluate them, more often than not patients require a tummy tuck if they are unsure. Liposuction is a tool for the removal of fat, and fat alone. It cannot address skin laxity. Abdominoplasty is almost certainly the procedure needed after massive weight loss. Dr. Zuckerman does combine liposuction with almost all of his tummy tuck (abdominoplasty) procedures.

Is Liposuction for men?

This procedure is suitable for patients of both genders. Men tend to have slightly different problem areas than women, but liposuction is a tool that can be used all over the body. It’s a great tool for sculpting the abdomen, love handles, and waistline. In the right patient, I can even perform “abdominal etching” to give beautiful, masculine definition to the trunk.

Does Liposuction last?

The longevity of your result after this procedure depends on you, and as noted above, I encourage patients to maintain a healthy regimen of diet and exercise postoperatively to maximize the endurance and quality of your result. Due to the approximately fixed number of fat cells in an adult and the removal of a portion of these cells during liposuction, postoperative weight gain would result in fat will be preferentially stored elsewhere and in a decreased ability to store fat at the site of the procedure. This can result in an unusual distribution of fat, relative to patterns you may have experienced before surgery. If you are able to maintain a constant weight, the results of liposuction are more or less permanent, with the caveat that the distribution of fat in the body does change naturally as we age.

What is Lipo 360?

Lipo 360 is a colloquial term for liposuction of the abdomen, flanks and lower back performed together in one operative period. Dr. Zuckerman is an expert at performing this combination and commonly recommends it for tummy tuck and buttock augmentation patients as well. Liposuction of these three areas can dramatically reshape the midsection and increase the projection of the buttocks.

Would Liposuction of the outer thighs make the buttocks look smaller?

While it is difficult to judge a particular patient’s anatomy without examining them, liposuction to the buttocks can indeed result in an unfavorable contour. However, treating the “saddlebags”, the area of the outer thigh just below the buttock, can enhance the shape and projection of the buttocks if done correctly. It is a relatively small area and requires an experienced surgeon like Dr. Zuckerman.

What is Laser Liposuction (Laser Lipo)?

Laser liposuction involves the same techniques as tumescent liposuction, except that heat is used to cause fat cell lipolysis, “melting” them, before removal via the traditional liposuction suctioning mechanism. Some practitioners also advertise skin tightening benefits, but the effect is minor and has not been proven. It has been repeatedly concluded in academic plastic surgical studies that there is no additional clinical benefit to laser, “smart”, or ultrasound-assisted liposuction versus standard tumescent liposuction. There is no proven benefit of accompanying skin tightening, shorter or easier recovery, better postoperative contour, shorter operative time, or less intensive anesthesia. These modalities, which are often expensive, are largely marketing tools. In addition, given the use of heat, there is some risk of possibly severe burns or scarring, which is not a factor with traditional liposuction. Note that “melting” fat before removal does not prevent or reduce the risk of bumps or lumpy contours. The key to a great liposuction result is a plastic surgeon who is experienced enough to be aggressive with removal of fat without creating divots or contour irregulatities and is not affected by the use of heat before suctioning out fat.

What is SmartLipo (Smart Lipo)?

SmartLipo, or smart lipo, is the branded product name of a laser liposuction product. As described above, laser liposuction uses heat to “melt” fat cells before removal but is largely a marketing tool and does not generate superior results. There is also the possible risk of burns due to the use of thermal energy.

What is Ultrasound Liposuction (Ultrasound-Assisted Liposuction) and Vaser?

Similar to so-called laser liposuction, ultrasound liposuction uses ultrasonic energy to cause fat cell lipolysis to “melt” fat cells before removal via the traditional liposuction suctioning mechanism. Like laser liposuction, Dr. Zuckerman sees little additional benefit beyond traditional liposuction and considers this modality largely a marketing tool. As above, “melting” fat cells before removal does not lower the risk of bumps or a lumpy contour. The key to a great liposuction result is your plastic surgeon: he/she must remove fat strategically to create a smooth, flat contour.

What is Radio Frequency Liposuction, Radio Frequency Assisted Liposuction (RFAL), and Skin Tightening with BodyTite?

Dr. Zuckerman considers radio frequency liposuction and the BodyTite products as more efficacious than the modalities mentioned above. BodyTite uses radio frequency energy to both “melt” fat cells and can produce skin tightening of up to 40% in manufacturer’s studies. It is typically an add-on to a traditional liposuction procedure. The device is relatively new and was approved by the FDA in the United States in late 2016 with testing since 2009. Previous iterations of the device had a small risk of thermal injury, but the device has since been improved. If you are interested in adding BodyTite skin tightening to your liposuction procedure, Dr. Zuckerman can accommodate this request. Please mention this during your cosmetic consultation.

What are Ultrasonic Cavitation (Cavi-Lipo), truSculpt, CoolSculpting, UltraShape, Exillis Ultra, SculpSure, and Vellashape?

Each of these are non-surgical products designed to cause apoptosis, or cell death, of fat cells and thereby improve contours without undergoing a surgical procedure. Because liposuction is so popular, companies have developed many competing non-surgical “solutions”. Arguably the most popular is CoolSculpting which involves freezing away fat. These can be a good option for those not ready to undergo surgery. However, there are significant caveats. Dr. Zuckerman advises that these tools work on some patients, some of the time, and provide some result. The more definitive solution by far is still surgical liposuction, which itself leaves very little scarring. In addition, most of these products involve energy sources or temperature gradients and may involve risks of burns or other complications. Each of these treatments also requires several sessions, and the total cost may approximate that of surgical liposuction without providing the same results.

Are you ready for your liposuction (liposculpture) consultation with Dr. Zuckerman? He will perform a thorough evaluation of your desired outcome and needs based on your anatomy and medical history. Dr. Zuckerman will also address any questions or concerns you may have about the surgery and discuss with you the details of his approach: incision location(s), procedure length and techniques, likely operative outcome, etc. Contact his office by clicking the button below or by calling 212-231-9897. Dr. Zuckerman also offers consultations via Skype and a process for out-of-town patients to visit New York City to have surgery with him.

REQUEST YOUR CONSULTATION