Liposuction, or simply lipo, is a type of fat-removal procedure used in plastic surgery. Evidence does not support an effect on weight beyond a couple of months and does not appear to affect obesity-related problems. In the United States, liposuction is the most common cosmetic surgery.
The procedure may be performed under general, regional, or local anesthesia. It involves using a cannula and negative pressure to suck out fat. As a cosmetic procedure it is believed to work best on people with a normal weight and good skin elasticity.
While the suctioned fat cells are permanently gone, after a few months overall body fat generally returns to the same level as before treatment. This is despite maintaining the previous diet and exercise regimen. While the fat returns somewhat to the treated area, most of the increased fat occurs in the abdominal area. Visceral fat—the fat surrounding the internal organs—increases, and this condition has been linked to life-shortening diseases such as diabetes, stroke, and heart attack.
Cosmetic liposuction
There are two different uses for liposuction: cosmetic liposuction to change the body's contour or shape and reconstructive, medically necessary liposuction. Reconstructive uses include treatment of lipedema, to remove excess fat in the chronic medical condition lymphedema, and to remove lipomas from areas of the body.
Cosmetic liposuction should not be used as a weight-loss plan but to aesthetically improve the appearance of body parts and contour. Benefits from cosmetic liposuction appears to be of a short-term nature with little long-term effect. After a few months fat typically returns and redistributes. Liposuction does not help obesity-related metabolic disorders like insulin resistance. The fact that the effects of liposuction are short term, it cannot be depended upon to improve the appearance of the body or its contours.
Reconstructive, medically necessary liposuction
There are many articles and references to liposuction as "cosmetic" and not reimbursed by medical insurance companies. Most of this information is outdated. If the documentation supports the liposuction for a medical reason (lipedema, lymphedema, lipomas) as reconstructive, and not investigational, experimental, or unproven, the claim is medically necessary and should be reimbursed. While most insurance companies may initially deny the claim, many can be won upon appeal if the documentation and patient's need supports the criteria for reconstructive surgery.
The techniques and terms listed below: tumescent, lymph-sparing, Tumescent Local Anesthesia (TLA), Water-Assisted Liposuction (WAL), Power-Assisted Liposuction (PAL), Laser-Assisted Liposuction (LAL) all apply to reconstructive, medically necessary liposuction.
Techniques
In general, fat is removed via a cannula (a hollow tube) and aspirator (a suction device). Liposuction techniques can be categorized by the amount of fluid injected, and by the mechanism by which the cannula works. If the removed fat is used as filler for the face, lips, or breasts knowledge of the precise technique used to remove the fat is indicated. There are numerous types of liposuction. Some can be described as techniques or modalities. These techniques of liposuction are categorized depending upon the type of energy used for the liquifaction of fat. Often surgeons will use two or more of the different techniques below in the same session.
Suction-assisted liposuction (SAL) This is the most generic term for liposuction. In the CPT manual it is referred to as "suction-assisted lipectomy" and includes codes: 15876–15879.
Micro-cannula
This does not address a particular technique but the diameter of the cannula, a stainless steel tube which is inserted into subcutaneous fat through a small opening or incision in the skin. The outside diameter of micro-cannulas range from 1 mm to 3 mm.
Lymph-sparing liposuction
This technique does not require a particular wand and is most often performed with either tumescent liposuction or WAL (below). It refers to the specific surgical technique, the skill of the surgeon, and the extensive training that is unique to removing lipedema fat. Because the scope is different for removal of lipedema fat versus cosmetic contouring, if lymph-sparing is not addressed in the surgical operative notes, a medical necessity review committee could determine that the procedure poses “a risk to the lymph system.”