Updated 03 October 2013

Liposuction guide

Liposuction is the most popular local procedure. Here is your guide to everything you need to know about this.


Liposuction is the most popular local procedure. And thanks to new techniques it is now even easier and safer to look slimmer and more beautiful. Here is your guide to everything you need to know about the procedure.
By Mari Hudson, Health24

“See, my love handles are gone. Without the spare tyre around my hips, my shoulders suddenly seem broader. And it didn’t even hurt.”  

Francois Malherbe (36) is an ex-Craven Week rugby player, model and almost 2 m tall. He is a very satisfied customer.    

“I always had these small handles on my hips, even when I was fit and slim. After I stopped modelling, they became three times as large. If I knew liposuction was so quick and easy, I would have had it done a long time ago.”  

Francois is one of thousands of South Africans who managed to overcome their fear of cosmetic procedures over the last five years or so. We don’t recoil in fear at the idea of Botox and fillers. On the contrary! Many women know their Botox doctor better than their dentist. 

Nowadays the same tendency applies to liposuction (lipoplasty). Thanks to new techniques it is an easier and safer procedure than as little as three years ago.  

It is a procedure that removes excess fat from under your skin and is done by a plastic surgeon or a well-trained general practitioner – mostly in the doctor’s consultation room under conscious sedation: your body is numb, but you are able to talk to the doctor. You do however not remember anything about the operation.

In a small number of cases the operation is done in a theatre with full anaesthetic, says Dr Henry Claassen from Johannesburg, who has been doing the procedure for the last twelve years.  

Lipoplasty can literally be done anywhere on your body where there’s an accumulation of fat, according to Dr Barlodien Kotzé from Cape Town, who does ultrasound-lipoplasty on chins, upper arms, stomachs, thighs, backs, buttocks and even ankles and knees. The process is also used to remove non-cosmetic fat, e.g. a benign fatty tumour (lipoma), or breasts, in the case of a man.  

Locally it is becoming especially popular for upper legs, stomachs and double chins.   

It is a suitable procedure if:

  • You have a small fat roll you just cannot get rid of, notwithstanding any amount of dieting and exercise, e.g. around your hips, waist or on your thighs. Perhaps your genes are preventing your fat cells from shrinking, says Henry Claassen.
  • Your expectations are realistic. Little Lotta cannot be transformed into Charlize Theron through liposuction.
  • Your weight is normal or you are slightly overweight, but your weight remains constant. If you are seriously overweight, it will not be of much help to remove one roll, if you’re left with another three.
  • Your skin is firm and elastic. The younger you are, the more elastic your skin and the better your results will be.  
  • You are healthy and without aches and pains.  
  • You don’t have a lot of cellulite. If you do, you are not a good candidate. Your skin then tends to end up looking uneven and lumpy.  

This is how it is done:

A thin, hollow metal or optic fibre pipe with a suction apparatus attached to the front is pushed through a keyhole incision (3 mm) to where the fat is situated. The incision is made in an unobtrusive spot, e.g. under your bikini line or underneath your arm. The fat can be loosened in three ways: by hand, by laser or with ultrasound.

The laser and ultrasound procedures are newer techniques and make liposuction a more viable procedure. People are therefore more willing to undergo the operation because there is less bruising, no need for hospitalisation and the patient can be back at work within 2 to 3 days. It is almost a walk-in procedure, as it can be done in a doctor’s consultation room, albeit under sterile conditions.

The loosened fat is then sucked out through the pipe, about 2 litres at a time. The maximum is 3 to 5 litres of fat, which is between 4% and 5% of your body weight. The process takes around one to three hours, depending on the number of areas being treated.

If it takes longer than 3 hours, more than 3 areas are being treated, or if a greater percentage of your body weight is removed (more than 5%, or around 5 – 7 litres), the procedure should be done in a hospital theatre and the patient should preferably stay overnight for observation. 

Three techniques

1. Manually   
This procedure is mostly done by a plastic surgeon in a hospital theatre. The surgeon pushes the pipe into the fat and loosens it with powerful movements. (Some doctors even develop tennis elbow because of all the exertion.) If it is done on your stomach, it can be combined with a tummy tuck, says Henry Claassen.

Duration: About an hour per spot and about 1½ to 2 hours if it’s done in two to three areas.

Results: Good, but not better than the other two techniques. Your skin could look uneven and lumpy. The results can only be seen clearly once the swelling has gone down, which can sometimes take months.  

Advantages: A lot of fat can be removed at one time, especially in a theatre.

Disadvantages: Because the fat is forcefully separated from the skin and other tissues, there is a possibility that connecting tissue and blood vessels may also be loosened and sucked out. It is not dangerous, but it increases the risk that your skin may end up looking uneven.

Release from hospital: The very same day. You might need to spend one night in hospital if it is a major procedure.

Bruising: You tend to bruise more than with the other two techniques. The swelling can start going down within days, but it could take months before it is completely gone. Bruises may take days or weeks to disappear.    

Normal activities: You can resume your normal activities after one or two days.

Cost: In a doctor’s consultation room: between R12 000* and R18 000*. In a theatre: about R 75 000*.  

2. With a laser
It is usually done by a plastic surgeon, but any doctor who has been trained to work with this apparatus can perform the procedure. For the past three years it has been done locally, usually in the doctor’s consultation rooms under conscious sedation. The laser attached to the tip of the metal pipe heats up the fat, causing it to melt, says Dr Alex Nikolic, a Cape Town doctor who focuses on aesthetic procedures.

Duration:  About 1½ to 2 hours.

Result: Your skin usually becomes nice and tight where the fat was removed. The results are only completely visible after all the swelling has gone, something that can take months. Because the tissue tends to get slightly burnt and scar tissue is formed, there is a small chance that the skin surface may be slightly uneven.  

Advantages: The doctor can immediately seal any bleeding with the laser. More fat can be removed at one time than with the manual method. Usually only 2 litres or less are removed during one procedure.  

Disadvantages:  Your skin usually becomes so nice and tight because of the scar tissue that is formed where the fat is removed. To prevent the laser from becoming too hot and the heat damaging the surrounding healthy tissue, the doctor uses a special infrared thermometer, which measures the skin temperature very accurately. The constant temperature ensures that the skin tightens just enough for a positive result. With an infrared thermometer and experienced doctor the risk of unfavourable results is small.

Release: The same day. In case of a major procedure, one night in hospital.  

Bruising: One or two days. There is much less bruising than with the manual technique.  

Cost: Between R11 000 and R16 000, depending on the procedure.

3. With ultrasound
This is done by plastic surgeons and other well-trained doctors. Researchers only recently found the right frequency at which ultrasound waves need to move (oscillate) to literally cause fat skins to implode – without damaging the surrounding tissue. There are only a few of these apparatus available locally. The procedure is performed in a doctor’s room with conscious sedation, and usually no more than three litres of fat are removed. (Otherwise it is done in a theatre.) The ultrasound waves turn the fat cells into a liquid that can easily be sucked out, explains Barlodien Kotzé.

Duration: Longer than the manual procedure, but seldom more than three hours.

Results: Good, with a smooth and even effect. It works especially well in areas with dense fat, like on you back.  

Advantages: Only fat cells are removed, without any damage to connecting tissue and blood vessels. The fat-removing action is gentle. Henry Claassen compares it to drawing a bow over the strings of a violin. Tissue damage is therefore minimal. The fat cells that are removed may be used to fill up deep furrows or lines on your forehead or along your nose or mouth.

Disadvantages: It is more time consuming than the other procedures.  

Release: The same day.   

Bruising: There is very little bruising and it disappears within days.  

Cost: About R12 000 for one area with R4 000 extra for each subsequent area. 

(All quoted prices are approximations) 

(This is an edited version of a story that originally appeared Sarie magazine. Buy the latest copy, on newsstands now.)

Read more:

Lipoplasty basics


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