Over the last three decades, liposuction has shifted from being a theoretical possibility to one of the most popular treatments used to redefine aesthetics.  Many people are undergoing this procedure to get the body that they desire.
Everybody has an image in mind that they wish to achieve. However, there are some things that you would need to consider before choosing to undergo a liposuction procedure.
As a plastic surgeon, I have worked at prestigious establishments that have enhanced my knowledge about this topic. This guide will help you with your research on whether or not to undergo liposuction treatments, and whether it is right for you.
What is Liposuction?
Liposuction is a surgical procedure that removes the fat from specific areas such as:
This procedure is done to remove fats that cannot be removed with just exercise. Besides removing stubborn fats, liposuction is a body-contouring method. Liposuction is also known under other terms such as body contouring or lipoplasty. 
In Singapore, liposuction is one of the 6 most popular aesthetic procedures alongside double eyelid surgery, eye bag surgery, nose surgery, breast augmentation, and facelift. In fact, it ranked number 3 as the most popular aesthetic procedure in 2018.
What are the types of Liposuction?
There are different types of Liposuction:
1.Power-assisted Liposuction (PAL)
Modified-PAL is now the most commonly practiced method to remove fat.
It has been modified in the sense that it now consists of 3 steps rather than the traditional mechanical liposuction in order to improve the smoothness of the final result:
- First, there is separation of the fat,
- followed by suction of the separated fat
- and finally a fat elevation procedure that distributes the remaining thin layer of fat more evenly.
2. Ultrasound-assisted liposuction (UAL)
UAL procedure uses an ultrasound vibration to transform fat into liquid, then it will be vacuumed out. This is done via ultrasound emitting probe of varying intensities in order to cater to different areas of fat.
3. Laser-assisted liposuction (LAL)
LAL procedure uses a laser to transform fat into liquid, then drained out through a small tube (cannula). Due to the size of the tube, the LAL method is used for small areas such as:
- Jowl (sagging skin below chin or jawline). 
4. Water-assisted Liposuction (WAL)
A waterjet-emitting probe is used to separate and break up the fat globules and subsequently, this is suctioned out.
Each of these methods is employed with the use of a special fluid injection (tumescent liposuction).
This fluid consists of:
- Local anaesthesia (lidocaine), to numb the area for during and after surgery.
- A drug that reduces the size of blood vessels (epinephrine), to reduce bruising, swelling, minimise blood loss.
- Intravenous (IV) salt solution, to help remove the fat easily.
The amount of fluid used is also different depending on the ratio of fluid to fat removed. There is a tumescent technique with a fluid to fat ratio of 3:1 and a super-wet technique, which I personally use, which is a fluid to fat ratio of 1:1.
What are the risks of Liposuction?
Swelling and bruising, as well as initial numbness over the area of liposuction, are what you would commonly expect after the procedure.
If Liposuction is done in an improper manner, it can lead to several possible risks:
- Internal damage (nerves, blood vessels, lungs, etc)
- Loose skin
- Heat injury, if you are doing the UAL. 
Complications can also occur at a slightly higher rate if liposuction is combined with other procedures.
Complications can occur during: 
- Pre-operative period: cardiac and anaesthesia complications
- Early postoperative period: venous thromboembolism, infection, skin slough or loss
- Late postoperative period: delayed seroma formation, oedema and ecchymosis, paresthesia, and contour irregularities
What questions should I ask during the first liposuction consultation?
Before you proceed on doing the liposuction procedure, there are several questions that you need to ask your doctor:
- Are you a certified plastic surgeon with the Singapore Medical Council? A certified medical specialist has demonstrated his knowledge and hands-on experience and went through rigorous exam processes.
- How experienced are you with performing plastic surgery? From asking this, you can understand the surgeon’s knowledge level.
- What kind of result should I expect? Normally, there will be some adjustments in the post-operative procedure. Your surgeon has to be able to guide you through the adjustment process.
- How long will it take for the surgery to be performed and to recover?
- Are there before and after photos that I can see? The photos are to review the surgeon’s work.
- How long do I have to book in prior to the surgery?
- How to take care of the wounds?
How do I prepare for a Liposuction procedure?
Before doing liposuction, you will need to consult your doctor and have your medical history checked. Your doctor will also ask you about medical conditions and if you are currently taking any medication, supplements, or herbs.
Please take into account that you are advised not to take blood-thinning medicine and NSAIDs or smoke at least 1-3 weeks before the surgery. You may also need to do several lab tests before doing the surgery. 
What happens in the pre-surgery consultation?
Before you proceed with the procedure, there will be a pre-surgery consultation. Your surgeon will determine which procedure is suitable for you based on your medical history and medications that you may be taking. Also, before and after photos will be taken after marking the treated areas, and then used as a comparison after the surgery.
How will the Liposuction surgery go down?
After the anaesthesia started working, your doctor will make small incisions in an area that should be well-hidden. Then, a small tube or cannula is inserted to loosen the excess fat beneath your skin. Your excess fat is sucked using the cannula. Usually, the procedure can take up to 3 hours or longer, depending on the number of treated areas. 
There are different anaesthesia that can be used, depending on the complexity and area of fat that you want removed. The options are:
- Local anaesthesia
- General anaesthesia
Your heart rate, blood pressure, and oxygen level will be monitored while your surgeon is performing the surgery.
What can I expect after Liposuction?
After the procedure is done, the treated area will be compressed to minimise swelling and to conform the skin in order to control the new contour. A small, temporary tube may be placed to drain the excess fluid/blood.
You will also be given specific instructions to care for the post-surgery wound, medications to promote healing that you can take orally or apply in order to reduce the possibility of infection and swelling. 
How long will it take to recover?
For about 1 to 2 months, you will have to wear a specialised garment to control swelling. Most people can return to work after a week. However, the speed of your recovery depends on the complexity of your treatment.
You are also prohibited to start exercising right away, as the wounds are still fresh. If you start exercising right away, it will increase the risk of complications. Determining how long before you can start exercising depends on the extent of the liposuction performed. 
How do I maintain optimal Liposuction results?
You need to keep in mind that liposuction procedure is not the same as bariatric surgery. Liposuction is a body contouring procedure, whereas bariatric surgery aims to help you lose weight.
Body contouring procedures such as Liposuction do not help you to lose weight.
In other words, you can still put on weight if you don’t maintain the result. In order to do so, you are required to make changes to your lifestyle such as:
- Eat healthily: avoid eating junk food, count your calorie intake, incorporate lots of vegetables, fruits, protein, and fewer carbs into your diet.
- Exercise regularly: move your body, stretch, do moderate exercise to decrease the risk of health problems. 
- Drink plenty of water: it is important to keep the body tissues moist. It also prevents dehydration. 
Am I suitable for Liposuction?
Everyone has different goals that they want to achieve from liposuction. Some people want to get rid of their excess fats so that they can fit into their favourite pair of jeans, and some people might want this procedure solely to boost their confidence.
However, not everyone is suitable for liposuction. Liposuction does not work if your BMI is higher than 35 because liposuction is a body contouring procedure, not a weight-loss procedure. 
To determine whether you are suitable for liposuction, you have to make sure that: 
- You don’t smoke. If you are a smoker, you will be advised to stop smoking at least 3 weeks prior to the surgery because it can increase the chance of wound infection. 
- You let your doctor know if you are on medication.
- You are in good health. Ideally, you have to be free from life-threatening illnesses as it can increase the risk of complications.
- You have excess fats to get rid of. The aim of liposuction is to get rid of stubborn fats that are hard to remove from exercise.
- Your skin is elastic. Sagging skin can cause wrinkles.
- Your expectations are realistic. Liposuction can permanently remove excess fat, but new fat cells can still grow if you don’t maintain a healthy diet.
Where can I get a Liposuction in Singapore?
In Singapore, there is a wide range of clinics where you will be able to book the procedure. The final choice lies on which clinic makes you feel most comfortable. That includes how you feel about the doctor, the cost of the treatment, and what you would like to achieve. It is always wise to do some research and be extra careful before making a final choice.
How to find the best Liposuction surgeon?
To find the best Liposuction surgeon, you have to make sure that:
- Your surgeon is SMC-certified
- Confirm that your surgeon is experienced in the procedure that you opt for
- Choose the surgeon that has a similar aesthetic sense with you
- Their facility is up to date and complete
- You pay attention to how the surgeon and staff makes you feel
- The clinic’s customer service is good
How much does Liposuction cost?
It is hard to determine the exact cost for liposuction because usually, a different doctor gives different rates. However, the cost estimation is between SGD $3,000 - SGD $5,000 per area.
In total, you can pay up to about SGD $13,000 - SGD $25,000.
The difference in rates is caused by:
- The number of treated areas
- The size of the treatment area
- The amount of fat to remove
- The size and weight of the patient
On top of that, there are also other costs that are varied. Such as:
- The surgeon’s fee
- Operation room fee
- Lab tests fee
- Fee for the post-surgery garment
- Medications (painkillers, antibiotics)
Is it Medisave claimable?
MediSave can only be claimed to pay expenses for medical treatment. Since liposuction is considered cosmetic surgery, it is categorised as elective. Therefore, it is not Medisave claimable.
With the availability of a myriad of treatments, we no longer have to submit ourselves to excessive exercise just to get rid of specific fat zones. The advancements of technology have made it easier for us to get rid of the stubborn fats that cannot be removed by exercise. However, keep in mind that liposuction is a procedure to remove your excess fat, NOT a weight-loss procedure. Therefore, you need to maintain the result by implementing a good lifestyle habit.
It is crucial to consult your doctor before doing the liposuction. You also need to take note of the possible risks and complications. If you suffer from a condition that makes you non-eligible for liposuction, your doctor will not proceed with the procedure.
In Singapore, liposuction can only be performed by medical specialists in dermatology or plastic surgery.  So, please make sure that your surgeon has the necessary qualifications and experience to perform the procedure!
Dr Samuel Ho is a plastic surgeon at Allure Plastic Surgery. He has worked alongside top plastic surgeons at plastic surgery centres in Korea, such as the Hanyang University Hospital, 101 Plastic Surgery Clinic and BIO Plastic Surgery Clinic. Aside from regular work, Dr Samuel is a supporter of a not-for-profit medical volunteer organization that provides reconstructive facial surgery to young children in Indonesia.