What to expect at an initial liposuction consultation
From the patient's perspective...
It is important that an individual feel completely comfortable with the cosmetic surgeon they have chosen. Just as important is making sure to select a medical professional who is a specialist in their field with appropriate qualifications and board certification. Any specialist should be open to questions regarding their experience, skills and qualifications, as well as the kinds of results they have been able to achieve in other patients (with verifiable references).
A patient is likely to have plenty of questions relating to the procedure itself. Most specialists will encourage a patient to ask as many questions as they feel necessary in order to gain clarity before making the decision to go ahead with the procedure.
Some questions a patient may like to ask include:
- Which liposuction technique do you recommend for me and why?
- With the recommended technique in mind, how much pain, swelling and bruising can I expect to experience after the procedure? How is this best treated post-op?
- How much down-time will be required for recovery?
- Will stitches, bandages and dressings be used? How long should these be left in place? How often should they be changed? Will the stitches used need to be removed? If so, when?
- How bad is scarring likely to be? Are there ways to minimise this?
- What is the likelihood of complications during or after surgery? What can be done to minimise or prevent these?
- How likely is it that a follow-up procedure may be necessary (due to complications experienced)?
- If I am not satisfied with the results following the procedure and opt for another, will there be additional costs? If so, what are the costs likely to be?
- Should any of the medications I am currently on be discontinued or altered before surgery?
It is also a good idea to get a clear idea of the costs involved beforehand. Costs will likely cover the fees of the surgeon, anaesthetist, hospital / clinic and medications, dressings and support garments used. As a cosmetic procedure, private health insurance organisations may not cover the costs related to liposuction. It is a good idea to double check what may or may not be covered before proceeding with the decision to have the surgery.
From the surgeon's perspective...
Before a surgeon will clear a person as a candidate for liposuction, he or she will ensure to obtain a thorough medical history (including health history and related treatment, past surgeries, and medication usage).
A surgeon will carefully assess any possible risk factors relating to pulmonary, cerebral vascular or cardiovascular problems (both from a personal and family history), medication interactions (including any known adverse reactions to anaesthetic or drug-related allergies) and any other potentially known allergies. A patient must mention if any seizures, chest pain / angina, heart attack, heart failure, or liver dysfunction have been experienced in the past. If past surgeries are relevant, a surgeon may ask questions in relation to scarring and their severity (i.e. to determine the healing quality of incision scars).
It is important to disclose as much detail as possible regarding medical history and medication use during the consultation. In some cases, this may impact a person’s ability to have the surgery at all, but for the most part, the information provided can assist the surgeon in planning a procedure with as few potential risk factors for complications as possible. Purposefully withholding information in order to be deemed a candidate for liposuction is extremely dangerous and can put one’s life at risk.
Things a surgeon may wish to question so as to define necessary details include:
- The specifics about what changes a patient would like to make to his / her body.
- Current weight and the duration a person has maintained this weight for.
- Whether any significant weight gains or losses have recently been achieved.
- Current nutrition habits and exercise activity routines, including the total length of time this has been maintained.
- Use of medications or supplements specifically for weight loss (where relevant).
- Whether a liposuction procedure has been done previously.
- Whether personal responsibilities will allow for a person to achieve adequate recovery following a procedure.
A medical review will typically be followed up with a physical examination (assessing the patient’s overall condition and the related trouble spots intended for liposuction contouring). During the examination, the surgeon will evaluate the thickness of a patient’s adipose layer (i.e. fat layer) in the relevant areas. A pinch test can help to provide a surgeon with an estimated idea as to the amount of fat cells which can be removed safely. To perform the pinch test, a surgeon will select an area of the body intended for contour correction and pinch the skin between the thumb and index finger. The width of skin between the fingers should measure to at least 2 cm (or 1 inch) in order for there to be any real expectation of visual improvement following a procedure. The only exceptions in this regard would be the face and neck whereby this pinch test measurement may not provide an accurate indication.
If the abdomen area is a portion of the body to be targeted with liposuction, a surgeon will take into careful consideration the volume of intra-abdominal fat (visceral fat or organ fat), as well as the potential for hernia formation.
A surgeon will also check the elasticity of the skin during the examination. He or she will be looking for a satisfactory level of inherent elasticity (and may assess this by manually stretching the skin).
Skin with a degree of natural elasticity has a better chance of contracting favourably following fat harvesting and the completion of the healing process. A surgeon will look out for any signs of poor elasticity, such as the appearance of stretch marks, or a delayed rebound (retraction) of the skin following physical stretching.
While assessing the skin, the surgeon will note any potential need for more than one procedure to be performed in order to effectively correct the trouble spots. Skin overhang (sagging) may be further corrected with procedures such as a thigh lift or tummy tuck (abdominoplasty). Secondary procedures may be recommended as it is entirely possible that the harvested fat may accentuate redundant skin and lead to the formation of fibrovascular tissue (known as a pannus). Secondary procedures may be recommended if a surgeon can determine them to be beneficial so as to avoid dissatisfaction due to contour or skin structure abnormalities or irregularities.
A surgeon may make notes throughout the physical evaluation and also document assessments – he or she may also take photographs of trouble areas. This helps with pre-operative and post-operative comparisons. Once a physical examination has been completed a surgeon will discuss in detail what is and isn’t possible so as to ensure that a patient has realistic expectations.
There are certain areas of the body that a surgeon may not recommend for liposuction. Reasons for this relate to these areas being more prone to complication risks, such as superficial contouring problems. Areas which may be mentioned or discussed during the consultation include:
- The gluteal sulcus (crease or fold) – this area relates to the horizontal crease where the base of the buttocks meets the upper thigh.
- Lateral gluteal depression (hollows located on the sides / lateral areas of each buttock)
- Distal posterior thigh (outer portion at the back of the thigh)
- Middle medial thigh
- Inferolateral iliotibial band (associated with the thigh and the knee)
A surgeon also will discuss possible port sites on the body during a consultation. Port sites refer to the incision areas where a surgeon will plan to use the cannula and vacuum equipment to harvest fat cells. Multiple sites are more than likely to be required – one of the reasons for this is to reduce risk of contour abnormalities.
Where a surgeon feels applicable, a psychological evaluation or check-up with a general practitioner (GP) may be recommended. A GP can help to determine a patient’s overall quality of health. A psychologist can assess whether a person’s true intensions for such a drastic physical change are indeed of a mentally healthy nature. Liposuction is considered a major surgery and must be taken seriously, particularly where risk factors and complications are involved.
Some considerations as they relate to specific anatomical areas
Some testing may be required depending on a person’s physical condition and the nature of the targeted areas being evaluated. Certain tests may specifically relate to a person’s age and medical history.
Face and neck
Photo documentation combined with computer modelling will help a surgeon to portray a projected outcome of what a patient can realistically expect as a result.
- Laboratory tests: A urinalysis may be recommended should the surgeon wish to check glucose or bacterium levels. Another laboratory test which a doctor may recommend is a haematocrit (a blood test which assesses the amount of red blood cells in the total volume of the sample, measured as a ratio). Additional laboratory tests may be recommended by the doctor as he or she sees applicable to an individual patient’s physical condition.
- Imaging tests: These should not be required unless a patient has other medical conditions which are currently under treatment. In these instances, a surgeon may recommend imaging tests such as a CT (computerised tomography) or MRI (magnetic resonance imaging) scan as they see fit. If imaging tests are performed, a doctor may be looking for irregularities which can impact the safety of the procedure or the desired outcome – these can include the likes of thyroglossal duct cysts (irregular masses or lumps in the neck area), thyromegaly (an abnormally large thyroid gland causing thyroid disorders and abnormalities) or branchial cleft cysts (lump formations on one or both sides of the neck, present since birth).
- Qualitative testing: A patient will be requested to extend his or her arms out horizontally and bend the arms at the elbow. The surgeon will then take a look at the arms from the side to assess fat placement and skin laxity / sagging. A patient (especially if they are significantly overweight) may also be requested to hold their arms at their sides as sometimes fat can be more obviously seen from this angle.
- Prognostic testing: This may involve contracting the biceps and triceps at the same time. The doctor will be looking for a degree of skin retraction – this gives him or her an idea as to what can be achieved with surgery (the retraction observed during testing is similar to that which can be achieved following a liposuction procedure).
- Pinch test: A surgeon will be looking for approximately 1.5 cm of fat when a patient’s arm is held horizontally at 90 degrees with a flexed elbow.
Excess skin can be categorised in the following:
|Grouping (I, II or III)||Skin excess category||Fat excess category||Proposed suitable treatment|
|I||Minimal||Moderate||UAL or SAL (tumescent) liposuction|
|II||Moderate||Minimal||Resection (removal of tissues – partially or completely in other recommended procedures)|
The surgeon will then categorise an individual as a:
- Favourable candidate: Typically, those who fall into this candidate category are young, have satisfying skin tone and quality, and display moderate fat irregularities (fat hypertrophy).
- Poor candidate: A patient will be categorised as a poor candidate for liposuction if he or she has sagging and excessive fat hypertrophy. Those who are older, or who have lost a considerable amount of weight may fall into this category.
- Borderline candidate: A surgeon may not have a clear ‘yes’ or ‘no’ result following qualitative and prognostic testing. The surgeon may feel that liposuction alone may be able to achieve some degree of the desired result, but additional surgical procedures could be recommended to provide further contour correction. One example is a brachioplasty (arm lift) which can be performed following liposuction in the targeted area, helping to remove any sagging skin.
Trunk / abdomen
- Laboratory tests: A complete blood count (especially if a patient is intending to undergo a large volume liposuction), clotting analysis, electrolyte check and a urinalysis may be required. A urine cotinine test (nicotine testing) may be recommended for individuals who habitually smoke to assess tobacco exposure.
- Imaging tests: Radiography (X-rays) of the chest, an ECG (electrocardiogram)
Lower body – thighs, knees, calves and ankles
1. Thighs and knees
A surgeon will assess a patient and categorise them in one of the following capacities:
- Excess fat deposits are well localised, skin tone and quality (elasticity) is favourable and a person is not heavily overweight or obese.
- Excess fat deposits are more generalised along the thigh and knee area. Skin elasticity may be good or partially sub-standard.
- Excess fat deposits are either localised or generalised. Skin tone, quality and laxity are fairly poor. Other cosmetic procedures (excision lifting surgeries) may be recommended to individuals in this instance.
Some testing may be recommended:
- Laboratory tests: Complete blood count (CBC), urinalysis, electrolyte assessment (normally if indicated that a patient has taken diuretics recently), a pregnancy test (applicable to all women of reproductive age), HIV and hepatitis.
- Imaging tests: Chest X-ray (radiograph) – more typical if a patient has not had one for more than a year or is a habitual smoker, ECG (electrocardiogram) – especially in the case of middle age, or if high blood pressure, history of stroke, diabetes, arrhythmias and habitual smoking are indicated during consultation.
If a person is in generally healthy physical condition, testing may be unnecessary. Weight and measurements will be taken (and dated) for accurate reference.
2. Calves and ankles
- Pinch test: A patient will be asked to remove their shoes and stand flat-footed on a stool. A surgeon may also request that a patient stand on their toes or rest their leg on a chair in a horizontal position with the knee bent at a 90-degree angle (while standing on the other leg). A surgeon will be looking for a minimum of 2cm excess in the calves or at least 1 cm in the ankles.
A surgeon will factor in a person’s age along with skin quality and tone. Younger age-groups with good quality skin tone tend to be appropriate candidates, but if an older individual has good skin quality, a surgeon may consider them.
- Laboratory tests: Complete blood count (CBC), haematocrit, platelet count, blood sugar levels measurement and a prothrombin time (blood test which measures how long it takes for a person’s blood to clot).
- Imaging tests: Ultrasound scan (both breasts) or mammogram – this is compulsory for all patients as obtaining an accurate fat tissue percentage is required before one can qualify for the procedure. Mammograms may be preferred as a surgeon can obtain a more accurate glandular-fat tissue ratio. A chest X-ray or ECG may be recommended based on personal medical history, relevant physical examination findings or suspicions of possible irregularities.
Photographic documentation may also be required, sometimes for medical health insurance authorisation (should the procedure be covered by a plan), but generally for comparison (before and after the procedure). A surgeon may also file photographic documentation for medicolegal purposes should a legal dispute arise following the procedure.
There are no specific testing requirements for buttock contouring or reconstruction provided that a patient is generally in good physical condition and does not display signs of nerve dysfunction (particularly in the spinal cord or lower extremities). During a physical examination, a surgeon will pay close attention to any signs indicating otherwise.