A toned body gives the impression of attractiveness and health. Whilst watching the diet along with a regular exercise program are the mainstays of achieving the ideal physical appearance, due to lifestyle and work choices this may not always be possible. In addition to this, there always seem to be certain areas of the body where stubborn fat persists. In these cases, body contouring procedures can help, with liposuction being the most commonly sought body contouring surgery.

Liposuction can be performed on almost any part of the body. The most commonly requested areas are the neck, the arms, the tummy, love handles and the thighs. These areas tend to gain weight the easiest, and retain stubborn fat that is refractory to exercise. In women, another particularly bothersome area are the anterior axillae or armpits, which appear as an additional bulge above the outside of the breast.

The liposuction procedure is best performed on an individual who has excess fat but adequate skin elasticity, to enable skin retraction after removal of the fat is done. A  body mass index (BMI) of <30kg/m2 is also desirable. Lastly, being able to keep a stable or decreasing weight over the course of the months preceding the liposuction procedure should be a pre-requisite, showing that the individual is able to maintain the body shape after healing has occurred.

During the liposuction consult, your surgeon should discuss your desires and expectations with you, along with taking an adequate medical history and examination. As liposuction is an elective procedure, you should be in general good health without any debilitating medical conditions before considering the procedure, to minimize any untoward risks. 

The Liposuction Procedure

The liposuction surgery is usually done under heavy sedation or general anaesthesia with a qualified anaesthetist to enable comfort and pain control. Small, inconspicuous skin incisions are made in well-hidden areas to first allow the infiltration of a wetting solution to the fat. This wetting solution consists of local anaesthetics and adrenaline, which help with pain reduction and bleeding control respectively.

Once the wetting solution has taken effect, usually after 5-10 minutes, the surgery can proceed. There are different methods of liposuction, with the most common ones being manual/syringe liposuction, power-assisted liposuction (PAL - Microaire^TM) and ultrasound-assisted liposuction (UAL – Vaser^TM). In addition, adjuncts such as radiofrequency tightening may be recommended to aid with skin tightening after the procedure. The type of liposuction performed is dependent on the area of the body, skin laxity and consultation with your surgeon. At Polaris Plastic & Reconstructive Surgery, our surgeons are well versed in all forms of liposuction and will optimize your outcomes through proper discussion, choices and selection.

The liposuction procedure can be done as a day surgery as long as less than 2 litres of fat is removed in that session. If there are more than 2 litres projected, the procedure has to be performed in an inpatient setting, with at least 1 night’s stay in hospital. This is to mitigate the risks of larger volume liposuction where significant body fluid shifts or blood loss can occur. Other risks of liposuction include scars from the incisions, asymmetry and contour irregularities. The worst reported complication of liposuction is death, which has received a large amount of press in the past. Performed well, all these risks are very minimal and can be mitigated through proper patient and procedure selection as well as anaesthesia from well-trained specialists. Whatever the choice, liposuction in Singapore has to be performed in an accredited surgery centre, and by an approved liposuction practitioner (the full list can be found on the MOH website).

Where on the body can liposuction be done?

As long as there is excess fat, most areas of the body are amenable to liposuction. The art is in deciding which type of liposuction to be done on each part to produce a beautiful, natural appearing body contour. A brief description of each part and the goals of liposuction for each are as follows:

• Lower face and neck (commonly requested)
• An attractive neck contour includes a visible jawline and defined angle between the chin and the neck. In cases of full necks with excess fat under the skin, this can be achieved through liposuction, which is often combined with energy such as ultrasound or radiofrequency to help with loose skin where present. Neck liposuction can be performed under local anaesthesia. On occasion chin augmentation with fat graft or implants may be recommended depending on your inherent anatomy and desired outcomes.
• Upper arms (commonly requested)
• Stubborn fat commonly exists at the back of the upper arms. Liposuction of the upper arms is usually approached through small incisions in the back of the armpit, which also allows access to the upper back. The goals are to create toned arms by highlighting the natural outline of the muscles, and create a more acute angle between the upper arm and side of the body. When done well, liposuction of the upper arms can achieve a very satisfying result.
• Breast/Chest
• In women, liposuction of the fat pad/accessory breast at the junction of the breast and the upper arm is done to achieve a smooth, concave contour, which is especially important when wearing a bra, swimsuit or tank top. This is done through small, well-hidden incisions in the armpit area.
• In men, liposuction of the chest is requested to achieve a more muscular pectoral outline, as well as to treat the condition of male breasts, also known as gynecomastia. This is potentially a medically necessary procedure, as gynecomastia can be painful and debilitating. Most liposuction is concentrated at the lower part of the chest where fat usually accumulates. Occasionally, to help with a more muscular appearing chest, simultaneous fat grafting can be performed to the upper part of the chest. In cases of fibrous gynecomastia, a small incision around the areola may be performed to aid with the excision of the breast disc.
• Back and buttocks
• The areas of the back where liposuction is commonly performed include the upper outer back (in continuity with the arms) and the posterior flanks. The aim of liposuction is to highlight the natural hills and troughs of the muscles and bony surfaces of the back. Usually, only 3 small incisions are required, one at each posterior armpit line and one lower down just above the buttocks.
• Liposuction of the buttocks is performed to enhance the natural outline of the gluteus maximus. Whilst not commonly requested, in select individuals, this is necessary to compliment liposuction of the lower back or upper thighs. Incisions for liposuction of the buttocks are usually very well hidden.
• Abdomen and Love handles/Muffin-tops (commonly requested)
• This part of the body is probably the most commonly requested area for liposuction. The goals in women are to produce a toned, hour-glass appearance, whilst in men, a more defined outline of the abdominal muscles and ‘six-pack’ is desired. With well-hidden incisions in the belly button and groins, this can be achieved naturally, with surprisingly minimal pain. The careful examination must be performed to assess the skin and integrity of the muscular fascia and exclude abdominal hernias, which can complicate liposuction procedures. A moderate amount of lax skin can be addressed through the addition of energy such as ultrasound or radiofrequency. In cases where there is too much skin laxity, an excision procedure may be required to produce the best outcomes.
• Hips/’Saddle-bags’
• In some females, due to body type and genetic makeup, fat at the hips stubbornly persists despite the rest of the body remaining slim. This area is commonly referred to as the saddle-bags. It is a very satisfying area to treat with liposuction, as the results are instantaneous and immediately, patients are able to wear clothing such as jeans that never used to fit before.
• Inner/outer thighs (commonly requested)
• Inner thigh liposuction is most commonly requested for the legs. In women, it is often difficult to achieve the ‘thigh-gap’ just through exercise alone. Utilizing hidden incisions in the groin crease, the inner thighs can be approached effectively, and the results are often very satisfying. Of note, contour irregularities tend to be more commonly reported in this area. Therefore, great care must be taken by your liposuction surgeon to mitigate this.
• It is worth mentioning that in certain medical conditions such as lymphedema and lipoedema of the legs, liposuction can help to restore normal leg outline, relieve symptoms of heaviness and improve exercise and general quality of life. Patients with these conditions should seek out their doctor for advice on this.
• Calves
• Calf liposuction is not commonly requested as there is often not a large amount of fat deposited in this area. However, if there are small, stubborn deposits or patients request for greater definition, small-volume liposuction can be done to achieve this. Like the inner thighs, contour irregularities are more visible and need to be meticulously avoided.

Pros and cons, and the price of liposuction surgery

Performed well and on the right patient, liposuction can achieve a long-lasting, satisfying result and that beach-ready body. However, it should be viewed more as a body-contouring procedure rather than for weight loss. The amount of fat removed from liposuction does not often correlate to a certain weight, as fat is lighter. Lasting weight maintenance must be done through diet and exercise.

Additionally, patients with moderate to severe excess skin, such as those who have experienced massive weight loss through bariatric surgery, may require excisional procedures in addition to liposuction to restore the correct contours and treat problems such as skin chafing and infection. Liposuction alone should not be viewed as a skin-tightening procedure.

The price of liposuction surgery will depend on the extent of liposuction required. This is often based on a number of areas and/or the time required for liposuction. It is best to approach your surgeon for a thorough assessment, as well as a discussion on costs for this.