Fat Removal and Body Contouring

What are the aims of this leaflet?

This leaflet aims to provide information on body fat removal/ reduction. It will cover the
available techniques, how they work and the potential risks/ complications.

What fat removal/ reduction techniques are available and how do they work?

1. Liposuction
What is liposuction?
Also referred to as liposculpture or suction-assisted lipectomy, liposuction is a type of surgical
procedure which aims to reduce the amount of fat in areas it commonly collects.1 It may be
used on the abdomen, hips, buttocks, thighs, knees, neck, arms and to reduce the appearance
of male breasts.

What are the results?

The fat is permanently removed but can come back if you put on weight later. It often does not
improve the dimpled appearance (often referred to as cellulite) and, depending on the natural
flexibility (elasticity) of your skin, the skin may not shrink leaving degree of skin-wrinkling over
the treated area. Removal of the fat can permanently alter the shape and contour of your
body.2

What will happen during the procedure?

The technique uses a machine with a thin tube attachment which sucks out fat from beneath
the skin. The amount it is possible to remove may be limited in certain areas and may be less
than you would like.2 Practitioners will likely numb the area for treatment with a local
anaesthetic injection.1 Some practitioners will advise that you have a general anaesthetic. You
would expect the procedure to last from 1-3 hours. Over recent years new techniques have
been used to attempt to make liposuction techniques more successful although there is varying
scientific evidence for their success/ safety. These include:
 Utrasound-assisted liposuction
An ultrasound probe is applied to the surface of the skin in an attempt to break up the
fat cells prior to liposuction
 Power-assisted liposuction (PAL)
A rapid vibration is applied to the liposuction tube to improve the break-up of fat cells
during liposuction
 Laser-assisted liposuction- see section 2 (LAL)
A laserbeam is shone down the liposuction tube to heat up and break down the fat cells
during liposuction. VaserTM is an example of this technique.
 Water-assisted liposuction (WAL)
A fan-shaped jet of water is injected to the fat during liposuction to loosen the fat cells
and minimise damage to the surrounding tissue.
  Radiofrequency- assisted liposuction (RFAL)
High frequency electrical vibration current is applied to the skin prior to liposuction to
break down the fat deposits

What will happen after the procedure?

The points where the tube was inserted will be stitched and you will have dressings over these
areas and elastic compression garments to reduce swelling, which your practitioner will likely
advise you to wear for up to 6 weeks after the procedure1. You may need to stay overnight if
you have had a general anaesthetic. It can take up to 6 months to see the final results of the
procedure. You should, however, expect to recover from the initial effects of the surgery after 2
weeks and may even be back to your normal activities within a few days.

Are there any risks involved?

Liposuction is usually well-tolerated but you may experience some initial pain and stiffness in
the treated areas as well as some swelling and bruising. Some patients describe numbness or
abnormal sensations.3 There is a small risk of infection from the procedure and you may find
the appearance of the treated area to be quite lumpy for a few weeks afterwards.3
It is important that any practitioner providing liposuction treatment is aware of your health
history and any regular medications or allergies. They should discuss the risks and benefits of
the procedure in detail to allow you to make an informed choice about whether to go ahead
with the treatment.

2. Laser Assisted Liposuction (LAL)

What is laser assisted liposuction?

A laser fibre is introduced under the skin and the laser beam is then used to break up the fat
and the strings of tissue which result in the ‘cellulite’ appearance. The fat is then usually
removed with suction or pressure, although some studies show good results without the need
for suction4. The laser beam is used to heat up inner side of the skin to encourage and stimulate
new collagen formation. It may be used on the abdomen, hips, buttocks, thighs, knees, neck,
arms and to reduce the appearance of male breasts and there is good scientific evidence of its
effectiveness

What are the results?

The fat is permanently removed but can come back if you put on weight later. Unlike traditional
liposuction it improves the dimpled appearance (often referred to as cellulite) and, tightens the
overlying skin.5 The technique uses smaller tubes to remove the fat and can be used on areas
more prone to bleeding then could be safely achieved with traditional liposuction eg the upper
back and ‘muffin top’ areas.6 There is a lower risk of bleeding, swelling and bruising after the
procedure and recovery time is quicker.7 Removal of the fat can permanently alter the shape
and contour of your body.2

What will happen during the procedure?

The thin tube attachment through which laser beam is shone is passed under the skin. It
required 3-4 small nicks in the skin and injection of local anaesthesia beforehand. You might be
given oral sedation to calm you down for the procedure and you will be given a course of oral
antibiotics to start on the day of the procedure. Some practitioners will advise that you have a
general anaesthetic. You would expect the procedure to last from 1-3 hours.

What will happen after the procedure?

The points where the tube was inserted do not usually require stiches and they heal in a week
or so without leaving any marks. You will have dressings over these areas and elastic
compression garments to reduce swelling, which your practitioner will likely advise you to wear
for up to 1-2 weeks after the procedure. You may need to stay overnight if you have had a
general anaesthetic. It can take up to 6 months to see the final results of the procedure but
you should expect to recover from the initial effects of the procedure in about 5-7 days and
back your normal activities within a few days.
With laser assisted liposuction skin tightening continues for at least 6 months over which time
you are likely to see continuous improvement in skin texture, cellulite and shape of the area.

Are there any risks involved?

Laser assisted Liposuction is usually well-tolerated but you may experience some initial pain
and stiffness in the treated areas as well as some swelling and bruising. Some patients describe
numbness or abnormal sensations. There is a small risk of infection from the procedure and
you may find the appearance of the treated area to be quite lumpy for a few weeks afterwards.
Some reports suggest that the risk of skin blistering is higher than standard liposuction due to
the additional heating of the skin.8
3. Lithotripsy
What is lithotripsy?
Lithotripsy is a body sculpting technique whereby which creates ‘shock waves’ with the aim of
‘breaking up’ fatty deposit under the skin.

What are the results?

This is a fairly new technique and its effectiveness is not well established.

What will happen during the procedure?

A probe is applied to the skin over a liquid gel. Treatment regimes are likely to vary but
patients are usually offered multiple (eg 10) sessions before the results can be assessed.9

Are there any risks involved?

As the procedure is non-invasive ie no cutting or injecting of the skin is required, the risks of the
procedure are likely to be low, although insufficient scientific testing has not been carried out
to be sure of this. It is not thought to be suitable to be used over the lungs, cancerous tumours
or implants such as pacemaker, in pregnant females, those on anticoagulant medicines or
individuals under the age of 18.
4. Cryolipolysis
What is Cryolipolysis?
Cryolypolysis also known as cryolysis is a new technique which uses very low temperatures to
breakdown fat cells. CoolsculptTM is an example of a cryolipolysis device.10

What are the results?

Although there is little scientific evidence to support the success of the treatment, early studies
report improvements in up to 86% of patients with a 73% patient satisfaction rates. 11

What will happen during the procedure?

Cooling panels are be applied to the treatment area under suction and cooled to a controlled
temperature for 45 minutes. This is followed by 2 minutes of massage11

Are there any risks involved?

Expected side effects include redness, bruising and temporary numbness in the treated areas.
Less commonly, patients may experience pain in the areas up to 2 weeks after treatment and
small numbers of patients have reported increased quantities of fat following the treatment.11

5. Other non-invasive fat reduction techniques

A. Ultrasound and Radiofrequency Devices

The use of high frequency ultrasound (sound energy) and radiofrequency (heat energy) probes
has been described and equipment such as the LiposonixTM device has been manufactured for
this purpose. They have the advantage of not requiring any cutting or injections and work by
breaking up the fat cells under the skin by applying the energy to the overlying skin. 5

What are the results?

As these techniques are fairly new there is limited scientific evidence for their success.

What will happen during the procedure?

It is likely that the treatment would be performed with a probe applied to the skin over some
liquid jelly.

Are there any risks involved?

As the techniques are new it is difficult to be sure about their safety. However, as they are less
invasive than traditional liposuction it is likely that they have fewer risks and side effects.

B. Pharmacological/ Topical Agents

Topical (applied to the skin surface) agents such as Methylxanthines, retinoids (vitamin A-
derived), lactic acid and various herbal agents have been used to try to treat fat deposits,
cellulite in particular.
There is no good scientific evidence to support improvement with any such treatments
although smaller studies suggest that retinoids can improve the appearance of cellulite.
Early scientific studies have suggested that Peroxisome proliferator-activated receptor agonists
may have a future role to play in cellulite treatment.12

FURTHER READING
1. http://www.nhs.uk/Conditions/Liposuction/Pages/Introduction.aspx
2. http://www.bupa.co.uk/individuals/health-information/directory/l/liposuction
3. http://www.bapras.org.uk/resources/plastic_surgery_information_guides/liposuction
4. Dudelzak J, Hussain M, Goldberg D. Laser lipolysis of the arm, with and without suction
aspiration: Clinical and histologic changes 2009;11: 70-3
5. Goldman A, Wollina U, de Mundstock A. Evaluation of tissue tightening by the subdermal
Nd:YAG laser-assisted lipsuction vs liposuction alone. J Cutan Aesthet Surg 2011;4: 122-8
6. Katz B, McBean J. The new laser liposuction for men. Dermatologic Therapy 2007;20:448-51
7. Dibernardo B, Reyes J, Chen Bo. Evaluation of tissue thermal effects from 1064/1320-nm
laser-assisted
lipolysis and its clinical implications Journal of Cosmetic and Laser Therapy
2009; 11: 62–69
8. Palm M, Goldman M. Laser lipolysis: Current practices. Seminars in Cutaneous Medicine and
Surgery 2009;28: 212-9
9. www.lithotripsy.com
10. Shridharani S, Broyles J, Matassaro A. Liposuction devices:technology update. Medical
Devices: Evidence and Research 2014:7 241-251. Accessible
at:http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4114741/
11. Krueger N, Mai S, Luebberding S, Sadick N. Crypolysis for noninvasive body contouring:
clinical efficacy and patient satisfaction. Clinical, Cosmetic and Investigational Dermatology
2014:7 201-205. Accessible at: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4079633/
12. Khan M, Victor F, Rao B, Sadick N. Treatment of cellulite, part II. Advances and
controversies. JAAD 2010; 62: 373-83

AUTHORS
Dr R Urwin ST5 Dermatology The Leeds Centre for Dermatology
Dr Nisith Sheth St John’s Institute of Dermatology

CONTIRBUTORS
Dr Nick Lowe
Dr Sanjay Rajpara

REVIEWED DATE: SEPTEMBER 2016