Liposuction: what it removes, and what it doesn't

How much does liposuction remove?

There is no set amount, the American Society of Plastic Surgeons (ASPS) sets no maximum, and the scale moves little.¹² A review of 10 studies of abdominal fat removal in women found a significant weight loss in four of the five that followed women for one to two months, and in none of the five that followed them for 3 to 20 months.³

ASPS found no scientific data to support a specific maximum, but says the risk of complications rises with the volume and the number of areas treated.¹⁴ It records the volume as total aspirate: the fat plus the fluid removed with it.¹ It calls 5,000 cc (5 litres) or more "large-volume" and asks for that to be done in a hospital or an accredited or licensed facility, with overnight monitoring; this guidance dates from 2003.¹⁴ Across 23 studies of large-volume liposuction (3,583 patients), 3.35% had a major complication, most often blood loss needing a transfusion.⁵

What can't liposuction do?

It is not a treatment for obesity, does not tighten skin or remove cellulite, and does not bring the metabolic benefits of losing weight.⁶⁷⁸⁹ It is designed for the fat under the skin.⁴ In a study with no control group, 15 obese women (8 with normal blood sugar, 7 with type 2 diabetes) had large-volume abdominal liposuction and lost an average of 9.1 kg and 10.5 kg of fat respectively; 10 to 12 weeks later their insulin sensitivity, blood pressure, blood sugar and blood fats had not changed significantly.⁹ A meta-analysis of four controlled studies of abdominal fat removal (140 women) found no significant change either; two other reviews, which looked at changes from before to after surgery, report small improvements.¹⁰¹¹¹²

Can the fat come back?

The fat cells taken out do not grow back, but the body can store fat elsewhere, and substantial weight gain can change the result.¹³¹⁴¹⁵ In a randomised trial of 32 non-obese women, after a year the 14 who had small-volume liposuction of the lower abdomen, hips or thighs no longer differed significantly in body fat from the 18 who had none: the thighs stayed smaller, but fat came back on the abdomen.¹⁴

In another trial, all 36 normal-weight women had small-volume abdominal liposuction, and six months later the fat around the organs, called visceral fat, had risen by 10% in those who did not exercise; a four-month exercise programme counteracted that rise.¹³ One surgeon's non-randomised series found no sign of fat returning in 46 patients measured a year or more later.²

What are the risks?

Most complications are minor, but serious ones happen, and in rare cases liposuction has caused death.¹⁶⁴ In two large reviews (29,368 and 21,776 patients), uneven contours affected about 2%, seroma (a pocket of fluid under the skin) 0.65% in one and 2% in the other, and changes in skin colour 1.49% and 1%.¹⁷¹⁸ In a US insurance database of 11,490 liposuction procedures done alone, 0.7% led to emergency care, a hospital admission or another operation within 30 days; combining it with other surgery made that almost five times as likely, and the risk rose with age and body mass index.¹⁹²⁰

One review names the five most serious complications: blood clots, fat entering the bloodstream (fat embolism), fluid in the lungs, toxicity from the numbing drug lidocaine, and injury to abdominal organs.¹⁶ A survey of North American plastic surgeons covering 1994 to mid-1998 counted 1 death in 5,224 procedures, with a clot in the lungs the leading cause; we found no newer figure from a registry.²¹

Contact the clinic at once for pain that keeps getting worse, a change at a wound, or anything unexpected.¹⁷ Pain and swelling in one leg can be a clot; sudden breathlessness, chest pain or coughing up blood can mean a clot in the lungs.²²²³ For chest pain or severe breathlessness, call emergency services.²³²² The riskiest days for a fatal clot in the lungs are days 3 to 7 after surgery.¹⁶ Breathing trouble, confusion or a pinpoint rash in the first one to three days can signal fat embolism.¹¹⁶

When does the final shape show?

The final shape shows once the swelling has gone, which can take up to six months.⁸⁷ ASPS expects a return to work at two to three weeks, depending on the job, and bruising to be gone and swelling to start easing by weeks 4 to 5.²⁴ The NHS suggests gentle exercise at about 3 to 4 weeks and nothing strenuous for 10 to 12, and says numbness should go within 6 to 8 weeks, though occasionally it lasts months.⁷

The NHS says to wear a compression garment constantly for several weeks,⁷²⁴ though a 2023 review found no randomised or comparative study of compression after body contouring.²⁵ In 15 women volunteers who had not had abdominal surgery, abdominal garments slowed blood flow in the main vein of the thigh.²⁶ Firm areas or lumps under the skin, called fibrosis, were reported in about 1% of patients across 60 studies.¹⁸ The NHS advises not flying for 5 to 7 days after liposuction because of the risk of a clot, and warns that clinics abroad may not provide follow-up.²⁷

Who may perform it?

Only a doctor, in Turkey and in England.²⁸²⁹ Turkish law requires a medical degree to treat patients and reserves surgical operations for doctors.²⁸ A facility treating patients from abroad needs Ministry of Health authorisation (the Ministry publishes the list of authorised facilities) and complication insurance for surgery in an operating theatre.³⁰³¹ In England, the clinic must be registered with the Care Quality Commission, because liposuction under any anaesthetic is a regulated surgical procedure.³²³³²⁹