Liposuction

Liposuction is a surgical procedure involving the vacuum-assisted removal of excess fat from specific areas of the body. It is the second most frequently performed cosmetic surgery worldwide, particularly in patients aged 35–64. Liposuction in Yerevan, Armenia, is increasingly integrated into other aesthetic procedures such as breast lipofilling, abdominoplasty, and buttock lipofilling. Non-cosmetic indications include the treatment of lipomas, lipedema syndrome, and lipodystrophy.

History

The first attempt at this operation was made by Dujarrier in 1921. In 1964, Schrudde removed subcutaneous fat from patients’ legs. The modern era of liposuction began in 1975, when Arpad and Fischer were the first to use cannulas attached to an aspirator. A major breakthrough came in 1977 when Illouz introduced the «wet technique,» involving the injection of hypotonic saline solution and hyaluronidase into adipose tissue to minimize the risk of hemorrhage. In 1983, Fournier began using syringes instead of mechanical aspirators to reduce vacuum pressure and tissue trauma. In 1987, Klein developed the tumescent technique.

It’s important to recognize the five anatomical zones where the skin is closely adherent to the underlying fascia:

Lateral gluteal fossa
Gluteal fold
Distal posterior thigh
Popliteal region
Lateral iliac region

These areas yield minimal extractable fat and present a higher risk for contour irregularities. Liposuction is not a method for weight loss. If you are overweight, lifestyle modifications or bariatric procedures are recommended.

Medical Indications for Liposuction in Yerevan, Armenia:

Removal of lipomas and angiolipomas with minimal trauma and minimal scarring.
Lipedema, which leads to fat accumulation in the lower extremities, affecting mobility and quality of life.
Lymphedema resistant to conservative treatment.
Lipodystrophy syndrome.
Cervical-dorsal lipodystrophy associated with Cushing’s syndrome.
Gynecomastia in men and macromastia in women, alone or in combination with mammoplasty.
Removal of excess fat in the presence of tracheotomy tubes, colostomies, or urostomies.
Subcutaneous fat removal in complex microsurgical flaps to improve reconstructive and aesthetic outcomes.
Use of autologous fat grafts in breast reconstruction, burn treatment, and scar correction due to the abundance of adipose-derived stem cells (ADSCs).

Liposuction targets fat deposits resistant to diet and exercise in areas such as:

Abdomen
Upper arms
Buttocks
Calves and ankles
Chest and back
Hips and thighs
Chin and neck

As weight increases, fat cells grow in size and volume. Liposuction reduces the number of fat cells in treated areas. Results are typically long-lasting if body weight remains stable. Skin gradually adjusts post-procedure, but patients with thin or inelastic skin may experience some laxity. Liposuction does not correct cellulite or stretch marks.

Contraindications:

Coagulopathies or medications that impair clotting (e.g., aspirin, NSAIDs, vitamin E, anticoagulants, herbal supplements).
Use of lidocaine and adrenaline-based medications.
Deep scars or hernias at the treatment site.
Significant skin laxity.
Morbid obesity.
Psychological concerns, including mood instability, unrealistic expectations, or anxiety disorders.

Risk Factors:

Cardiovascular disease, lung conditions, or diabetes.
Tobacco use.
Chronic infections near liposuction sites.
History of venous thromboembolism or pulmonary embolism.

Procedure Volumes and Safety:

Small-volume liposuction (up to 1000 ml) is typically done under local anesthesia.
High-volume or megaliposuction (removal of more than 10% of body weight) requires general anesthesia and should be performed only by highly experienced surgeons.
Complication rates range from 0.7% to 3.5%.

Potential Complications:

Bruising, seromas, swelling
Infection (cellulitis, necrotizing fasciitis, sepsis)
Venous thromboembolism (0.03% risk)
Contour deformities
Fat embolism (rare, 10–15% mortality, onset within 12–72 hours post-op)
Temporary rise in inflammatory markers (IL-6, CRP)
Cannula-induced injuries (bowel perforation, vascular trauma)
Skin necrosis (rare, from superficial cannula use)
Microcalcifications after breast lipofilling (may mimic cancer on mammograms but are distinguishable via MRI)
Hyperpigmentation
Lidocaine toxicity (rare; affects heart and CNS)

Preoperative Preparation:

Discontinue medications affecting clotting at least 3 weeks before surgery.
Surgeon will mark treatment areas and take pre-op photos.

Techniques:

Tumescent liposuction: involves subcutaneous infiltration with large volumes of diluted lidocaine and epinephrine.
Ultrasound-assisted liposuction (UAL): uses ultrasonic waves to break down fat.
Laser-assisted liposuction (LAL): uses laser energy to emulsify fat.
Power-assisted liposuction (PAL): uses vibrating cannulas for easier fat extraction.

Postoperative Care:

Minor pain, swelling, and bruising are expected.
Antibiotics and pain relievers may be prescribed.
Compression garments are recommended.
Swelling generally subsides within several weeks.