Hello, I'm Dr. Jaeho Cho, Director of TheLINE Plastic Surgery.
Just 10 years ago, people thought of liposuction as a very major operation. In consultations, they would always ask, "I heard there was an accident at some clinic recently." When something happened at one clinic, so many media outlets covered it that if ten outlets reported it, it felt as if there had been ten accidents. Today, far fewer people come in with that kind of worry. Having worked alongside the history of liposuction in Korea from around the time I started performing it until now, I'd like to explain what has changed.
Why Was Liposuction Once Considered a Dangerous Operation?
When I started performing liposuction, it had only just been introduced in Korea, so experience was not very extensive. Bleeding after surgery was fairly common, and there was a great deal of debate about how much fat to remove and how. There wasn't much equipment, and opinions varied widely among the doctors who first adopted liposuction.
There was also a period when liposuction surgeons around the world were confused. With fat lying in several layers, some argued for suctioning the upper layer, others the lower layer, others the middle layer, and still others all the layers. Today, I believe the result depends less on how much is removed than on how evenly the remaining fat layer is left. I covered this in detail in "Is Liposuction About the Fat You Remove, or the Fat You Leave Behind?"
Why Does Liposuction Today Cause Less Swelling and Allow Faster Recovery?
The biggest change is in how bleeding is prevented. In the past, fat was often suctioned directly without injecting anything into the fat layer, so there was considerable bleeding. Today, it has become standard to infiltrate the fat layer with plenty of fluid before suction, which constricts the blood vessels and helps the fat come out more easily.
Of these changes, the reduction in bleeding has been confirmed by research. A 1994 study in Aesthetic Plastic Surgery analyzed 25 patients who had liposuction after fluid infiltration: an average of 1,658 mL was removed, yet the blood mixed into each liter of aspirate averaged only about 10.5 mL. The authors concluded that bleeding was dramatically reduced compared with the older method without fluid[1].
What goes into the fluid, and how much, differs from clinic to clinic. At our clinic, we combine several medications in this solution, and sometimes it feels almost like brewing a magic potion. We have continued to refine this solution to reduce bleeding and swelling and even to improve the survival of fat when it is transferred elsewhere.
How Has the Body Shape People Want from Liposuction Changed?
In the past, people who came in for liposuction asked for only one thing: "Just make me smaller." Today, many want to go in where it should go in and come out where it should come out. There is now a preference for a body with volume and a waist that curves in sharply.
So people want waist-curve areas such as the love handles suctioned as much as possible, and many more now want a waistline with a clear inward curve rather than a soft, gently sloping one. In the past, almost no one asked for this kind of line. Where they want more fullness, the removed fat is sometimes transferred to the buttocks or breasts. In effect, liposuction has changed from surgery that only takes away to surgery that removes and then refills to create curves.
What Has Changed in Fat Grafting?
The techniques for transferring fat have also advanced a great deal. In the past, people thought only about how to inject the fat, but I believe graft survival is determined from the moment the fat is removed. The fat has to be harvested carefully so it isn't damaged, processed well, injected well, and then cared for afterward so it survives. It's a complex process that takes years of know-how, but in my experience as a surgeon, it has raised graft survival far above what it used to be.
Research likewise shows that every step, from harvesting and processing to injecting the fat, affects graft survival. A 2015 review in Plastic and Reconstructive Surgery reported that more fat was retained when it was injected slowly and into less mobile areas, and that in patient studies, fat processed by centrifugation had better results[2]. However, the authors added that no single standard method has yet been established as the best[2].
In the past, injecting large amounts of fat into the buttocks or breasts all at once was sometimes controversial. Today, at our clinic, we inject fat in small portions, little by little, with a 1 cc syringe. Beyond grafting, removed fat is now being used in more ways, such as ECM, the material that remains after fat is processed.
Individual Differences and Precautions
- Which areas to treat, how much to remove, and whether to add fat grafting are decided by examining your body shape, fat distribution and the line you want.
- Fat graft survival varies with the recipient area, the amount grafted and individual condition.
- Even though surgery is safer than before, the risk of complications rises as more fat is removed, so a reasonable plan matters.
- If one side suddenly swells a lot or pain worsens after surgery, contact us right away regardless of the schedule.
Three Key Takeaways
- Liposuction used to involve considerable bleeding and much debate over how much fat, and which layer, to remove.
- Today, infiltrating the fat layer with fluid before suction is standard and bleeding has dropped sharply; in liposuction with fluid infiltration, each liter of aspirate contained only about 10.5 mL of blood on average[1].
- As the body people want has shifted from "smaller" to "curvier," fat grafting, which moves removed fat to the buttocks or breasts, has also advanced toward careful handling of every step from harvest to injection.
Where to remove fat and where to add it to achieve the line you want is best judged by your care team after examining your body shape in person.
By Dr. Jaeho Cho (PhD in Surgery)
--- Sources
1. Samdal F, Amland PF, Bugge JF. Blood loss during liposuction using the tumescent technique. Aesthetic Plast Surg. 1994;18(2):157–160. DOI 10.1007/BF00454476
2. Strong AL, Cederna PS, Rubin JP, Coleman SR, Levi B. The Current State of Fat Grafting: A Review of Harvesting, Processing, and Injection Techniques. Plast Reconstr Surg. 2015;136(4):897–912. PubMed 26086386
This article summarizes how liposuction has changed over time, based on Dr. Jaeho Cho's clinical experience and papers published in academic journals. Please confirm your own condition through an examination by a specialist.