Liposuction: how it works and who it is for

What is liposuction?

Liposuction is surgery that removes excess fat tissue that remains in specific areas ^[2]. A thin tube called a cannula, connected to a suction device, is inserted through small incisions to remove fat, refining the contours and proportions of the body ^[1]. Since it emerged in the early 1980s, it has advanced greatly and has become a commonly performed cosmetic surgery today ^[4].

In both men and women, fat under the skin often builds up in predictable areas ^[1]. Together with fat grafting, liposuction plays a role in both cosmetic and reconstructive surgery ^[5].

Who is it considered for?

Liposuction is used to treat localized fat deposits in people who do not have generalized obesity ^[1]. It is therefore better understood as surgery to refine the contours of specific areas rather than as a way to lose weight.

It is also used to treat a medical condition. Lipedema is a chronic, progressive condition that mainly affects women, in which fat under the skin increases out of proportion to other parts of the body, especially in the legs ^[6]. A 2025 systematic review considered that current treatments only partially relieve symptoms and do not cure the condition, and summarized that multidisciplinary treatment combining conservative care, tailored exercise, and liposuction in advanced cases is needed ^[6].

Whether someone is a candidate for surgery is not decided by fat distribution alone. Assessment before surgery is treated as a basic element in improving the safety and results of liposuction ^[4].

Differences in techniques and devices

Liposuction technologies currently in use include standard suction, ultrasound-assisted, power-assisted, laser-assisted, and radiofrequency-assisted methods, and the choice of technology is often based on the patient's characteristics and the surgeon's preference ^[1].

A 2018 review selected 25 of 9,972 publications that met its criteria and compared standard suction-assisted liposuction with ultrasound-assisted and laser-assisted methods ^[3]. Advantages were found for the ultrasound-assisted method in treating male breast enlargement (gynecomastia), for the laser- and ultrasound-assisted methods in large-volume liposuction, where the suctioned material had lower hemoglobin and hematocrit (measures of blood content), and for the laser-assisted method in skin tightening in certain areas such as under the chin ^[3].

In other comparisons, the results were mixed, making it difficult to say that any one method was clearly better, and the authors concluded that apart from these exceptions, no additional benefits were found that would justify changing practice ^[3]. It is therefore a good idea to first check that the plan suits the purpose of the surgery and the area being treated, rather than focusing on the name of the device.

Abdominal etching, which removes fat separately from the deep and superficial layers to reveal the contours of the abdominal muscles, has also been described, but this is an article explaining the authors' own technique and classification ^[7].

How often do complications occur?

A 2024 systematic review and meta-analysis selected 39 studies from 2,957 publications and analyzed data from 29,368 patients ^[2]. The participants' average age was 40.62 years, and their average body mass index was 26.36 kg/m² ^[2].

The most common complication was contour deformity (uneven contours), with a prevalence of 2.35% ^[2]. This was followed by pigmentation (1.49%), seroma (fluid collection, 0.65%), hematoma (0.27%), superficial burns (0.25%), and allergic reactions (0.16%) ^[2].

Rarely reported complications included skin necrosis (0.046%), generalized swelling (0.041%), infection (0.020%), venous thromboembolism (blood clots in the veins, 0.017%), and local anesthetic toxicity (0.016%) ^[2]. The authors concluded that liposuction is a safe operation with few complications, but stressed that informing patients of specific risks improves surgical outcomes and mutual understanding between patients and surgeons ^[2].

These figures are pooled values from multiple studies, and the ethnicity of the study participants is not given in the research summaries. Actual risk can vary depending on the extent of surgery, the volume of fat removed, and your individual health.

Factors that improve safety

A 2019 educational article explained that safe liposuction is built on knowledge of the relevant anatomy, assessment before surgery, technique during surgery, and care after surgery, and that the prevention and management of complications must also be prepared for ^[4]. A 2020 review also summarized the indications for liposuction along with the main safety considerations ^[5].

Some people consider noninvasive devices instead of surgery. A 2020 review pointed out that noninvasive or minimally invasive devices are increasingly being used to replace or supplement tummy tuck (abdominoplasty), but that there are problems such as conflicting reports of experience, energy-related complications, and exaggerated marketing ^[8]. Whatever the method, it is a good idea to hear an explanation of both the expected benefits and the risks.

What to check during your consultation

The results and recovery from liposuction vary from person to person depending on the area treated and the volume of fat removed, the condition of the skin, and overall health. It is a good idea to check the following during your examination.

• Whether your concern is a localized fat deposit
• The areas to be treated and the expected volume of fat to be removed
• The technique and devices to be used, and why they were chosen
• Common complications such as contour deformity, as well as rare complications
• The anesthesia method, care after surgery, and the recovery period