Liposuction

Liposuction is surgery that removes localised fat from under the skin using cannulas connected to a suction system, in order to reshape the body contour. It is one of the most frequently performed cosmetic surgical procedures in the world. It is used on the abdomen, flanks, thighs, hips, arms, double chin or back, and it is not a weight-loss treatment: it changes shape, not weight.

What liposuction is

Liposuction, technically suction-assisted lipectomy, removes subcutaneous fat, the fat between the skin and the muscle, from specific areas. Through small incisions the surgeon inserts cannulas, thin blunt tubes connected to a suction device or a syringe, and removes fat selectively to create the desired shape. Today there are variants assisted by ultrasound, laser or powered cannulas that make extraction easier, and the technique can treat areas that used to be difficult, such as the neck.

The most commonly treated areas are the abdomen, the flanks (“love handles”), the hips, the thighs (inner and outer, “saddlebags”), the buttocks, the arms, the double chin and, in men, the chest when there is gynecomastia with a lot of fat.

How liposuction is done

Steps of the operation

Once the patient is anaesthetised, liposuction follows these steps:

1. Small incisions of a few millimetres are made in discreet places.
2. The area is infiltrated with a solution (saline with local anaesthetic and adrenaline) that swells the tissue, reduces bleeding and makes extraction easier.
3. The cannulas are inserted and, with repeated movements, the excess fat is loosened and suctioned, shaping the contour.
4. The incisions are closed and a compression garment is put on.

Anaesthesia and duration

Liposuction can be done under local anaesthesia with sedation, epidural or general anaesthesia, depending on the extent of the areas, the amount of fat and the patient’s health. It usually takes 1 to 3 hours, longer if many areas are treated or it is combined with other surgery.

Preparation

Before liposuction there is a consultation with the surgeon to review goals, areas and expectations, a review of the medical history and pre-operative tests. Some medicines that increase bleeding may need to be stopped, and smokers are asked to stop a few weeks before. On the day of surgery the tests are checked and informed consent is signed.

Liposuction vs liposculpture

Liposuction and liposculpture use the same fat-removal technique. The difference is what is done with the fat:

• Liposuction focuses on reducing volume and the removed fat is discarded.
• Liposculpture aims to sculpt the figure: as well as removing fat, it often purifies it and reinjects it elsewhere (fat grafting or lipofilling), for example to add volume to the buttocks or face.

In practice, many clinics use the two names almost interchangeably.

Types of liposuction

Tumescent liposuction

Tumescent liposuction is the basis of today’s technique. A large amount of solution containing saline, lidocaine (a local anaesthetic) and adrenaline is infiltrated, which firms the fat and reduces bleeding and pain. The fat is then suctioned with fine microcannulas of 1 to 3 mm in diameter, which allows more precise shaping.

Ultrasound-assisted liposuction (VASER)

In ultrasound-assisted liposuction (UAL or VASER) a probe emits ultrasonic energy that liquefies the fat before it is suctioned. It helps in areas with fibrous fat, such as the back or the male chest, and underpins many high-definition techniques.

Laser-assisted liposuction

Laser liposuction (sold as SmartLipo, among other names) uses a laser fibre to liquefy fat and heat the tissues, with the aim of improving skin retraction.

Power-assisted liposuction (PAL)

Power-assisted liposuction (PAL) uses a motorised cannula that vibrates rapidly. It reduces the surgeon’s effort and makes it easier to remove larger volumes precisely.

High-definition liposuction

High-definition liposuction also works on the superficial fat to show the outline of the muscles. In a systematic review of almost 7,000 patients, satisfaction was 92.6%; complications were nearly always minor (temporary pigmentation, seromas, temporary hardening) and only 0.2% were major. Its abdominal version is abdominal etching, explained below.

The technique has evolved a great deal since the late 1970s, with finer instruments and devices that allow more precise results and a more comfortable recovery. The choice depends on the area, the type of fat and the surgeon’s experience: no technique replaces the skill of the surgeon.

Expectations and limits of liposuction

Liposuction is not a weight-loss method

Liposuction is not a weight-loss treatment but a way to change body shape. Removed fat is measured in volume and a litre of fat weighs less than a kilo, so the change on the scales is small even when the change in silhouette is large. The amount that can be removed is limited by safety: the more volume is suctioned, the higher the risk.

It does not remove loose skin either, and it is not a treatment for cellulite, which can sometimes become more noticeable. When there is excess skin or the abdominal muscles are separated (for example with diastasis recti), the indicated operation is a tummy tuck, which can be combined with liposuction (lipoabdominoplasty).

Liposuction results

The change is visible almost immediately, but the final result shows once the swelling goes down, from the first month and especially after a few months. The fat cells removed do not grow back, but the remaining ones can grow larger if weight is gained. That is why keeping a stable weight with a good diet and exercise is what makes the result last.

Who is a good candidate for liposuction

A good candidate for liposuction is someone close to a healthy weight, in good health, with localised fat deposits that have not gone with diet and exercise (abdomen, flanks, saddlebags, double chin…). Skin with good elasticity helps it adapt to the new contour. It is not suitable for people seeking to lose a lot of weight, people with a lot of loose skin or people with health problems that increase surgical risk.

Abdominal etching

Abdominal etching, first described in 1993, is high-definition liposuction of the abdomen. It aims to bring out the outline of the muscles: the linea alba in the centre, the semilunar lines at the sides and the tendinous intersections of the rectus muscle (the “six-pack”). It is not a weight-loss procedure and suits slim people with good muscle tone and some fat hiding the outline.

Cost of liposuction in Spain

According to prices published by clinics, liposuction in Spain usually costs between €1,500 and €6,000 per area or group of areas, depending on how many are treated, the amount of fat, the technique and the type of anaesthesia. When comparing quotes it is worth checking what is included: operating theatre, surgeon’s and anaesthetist’s fees, hospital stay if any, compression garment and follow-up visits.

History of liposuction

Before liposuction, excess fat was treated with dermolipectomies, which removed skin and fat and left large scars. The modern technique was born in the 1970s: Italian surgeons Giorgio and Arpad Fischer described fat suction in the middle of that decade, and the French surgeon Yves-Gérard Illouz popularised it from 1977 with blunt cannulas, which reduced bleeding. In the mid-1980s the dermatologist Jeffrey Klein developed the tumescent technique, which made it possible to do liposuction under local anaesthesia with less bleeding and greater safety.

Risks and complications of liposuction

Most common complications

Liposuction is safe surgery when performed by qualified surgeons in a suitable facility. A 2024 meta-analysis of 39 studies and more than 29,000 patients found an overall complication rate of about 2.6%. The most common was contour irregularity (2.35%), followed by skin darkening (hyperpigmentation, 1.49%), seroma or fluid collection (0.65%) and haematoma (0.27%). Serious complications were very rare: skin necrosis, infection, venous thrombosis and local anaesthetic toxicity were all below 0.05%.

Factors that increase risk

Risk increases with the volume of fat removed, the number of areas treated in the same operation and combination with other surgery. The most serious complications described in the literature, such as fat embolism, thrombosis or fluid imbalance, are mainly associated with large-volume liposuction, long combined operations and facilities or practitioners without proper training.

Sensation changes and anaesthesia

After liposuction it is common to notice changes in sensation (tingling, numbness or tenderness) in the treated area, which usually improve over weeks or months and rarely persist. The lidocaine in the tumescent solution can cause toxicity if the safe dose is exceeded, with dizziness, ringing in the ears or drowsiness, although this is very uncommon when doses are respected.

Risks of medical tourism

Having surgery abroad for price or speed carries extra risks: difficulty assessing the surgeon’s training and the quality of the facility, flying soon after surgery (which increases the risk of thrombosis) and lack of follow-up when a complication appears back home. US health authorities have documented deaths of patients after cosmetic surgery abroad, many from embolism after combined liposuction procedures.

How to choose a surgeon for liposuction

Liposuction should be performed by a plastic surgeon experienced in body contouring, in an authorised healthcare facility with an operating theatre and an anaesthetist. A good professional explains the alternatives, what can and cannot be achieved and the risks, and does not promise results. Choosing the right surgeon is the main way to avoid complications and irregularities.

Recovery after liposuction

After liposuction a compression garment is worn for several weeks, usually 3 to 4, to reduce swelling and bruising and help the skin adapt. In the first days, aches similar to muscle stiffness, bruising and swelling are normal and settle over the first and second months. Drains are sometimes left for a few days. Most people return to light activity within a few days and to intense exercise within a few weeks, as advised by the surgeon.

Other uses of liposuction

As well as its cosmetic use, liposuction has reconstructive uses:

• Lipedema: in lipedema, a disorder of painful fat build-up in the legs and arms, liposuction improves pain, swelling, bruising and quality of life according to a 2024 meta-analysis, although more than half of patients still needed conservative treatment afterwards; the authors consider it an adjunct rather than a cure.
• Lymphoedema and lipomas, in selected cases.
• Gynecomastia in men, when the chest enlargement is mainly fat.

Non-surgical liposuction

What non-surgical liposuction is

“Non-surgical liposuction” refers to treatments without incisions that reduce localised fat from the outside: cryolipolysis (cold), radiofrequency, high-intensity focused ultrasound (HIFU), non-invasive laser and fat-dissolving injections (such as deoxycholic acid for the double chin). It is not liposuction in the strict sense, because no fat is suctioned.

Results of non-surgical liposuction

The results of non-surgical liposuction are more modest than those of surgery and need several sessions; they appear over weeks or months. How long they last depends on the mechanism: according to a 2026 review, treatments that irreversibly destroy fat cells, such as cryolipolysis, maintained the effect for 12 to 36 months, while externally applied energy devices produce real changes that fade within 3 to 6 months. As with surgery, keeping weight stable is key.

Non-surgical laser liposuction

Non-surgical laser liposuction uses low-level or diode laser applied over the skin to damage or partly empty fat cells. It is comfortable with no downtime, but its effectiveness is limited and variable, and it does not replace surgical liposuction.

Non-surgical liposuction and cellulite

Non-surgical liposuction is not designed for cellulite, although some technologies, such as radiofrequency, may slightly improve how the skin looks. With cryolipolysis there is a rare complication, paradoxical adipose hyperplasia, in which the treated area grows instead of shrinking.

Cost of non-surgical liposuction

The cost of non-surgical liposuction depends on the technique, the area and the number of sessions. Each session usually costs much less than surgical liposuction, but because several sessions and maintenance are needed, the total cost can come close in some cases.

Frequently asked questions about liposuction

How much weight do you lose with liposuction?

You lose little weight with liposuction, because it is not a weight-loss treatment: fat is measured in litres and a litre weighs less than a kilo. What really changes is the shape and measurements of the treated area.

Does fat come back after liposuction?

The fat removed by liposuction does not come back, because those cells are eliminated. But if weight is gained, the remaining fat cells grow, both in the treated area and elsewhere, and the result can be lost.

Does liposuction hurt?

Liposuction does not hurt during the operation because of the anaesthesia. Afterwards, the discomfort is like intense muscle stiffness, controlled with painkillers, and it improves over the first weeks.

When are liposuction results visible?

Liposuction results are partly visible from the start, but the final result appears once the swelling has gone, from the first month and fully after a few months.

Can liposuction be done under local anaesthesia?

Yes, liposuction can be done under local anaesthesia with sedation when the areas are small or few, thanks to the tumescent technique. For extensive or combined liposuction, general or epidural anaesthesia is usually used.

Is liposuction dangerous?

Liposuction carries a low risk when done by a qualified surgeon in a suitable facility: in published studies, complications are around 2–3% and almost all are minor. Risk increases with the volume removed, combined operations and facilities without proper guarantees.