Liposuction in São Paulo, Brazil: Safety, Limits and Recovery

I recommend liposuction for:

• localized deposits resistant to diet and regular exercise;

• stable weight for at least 6 months, close to ideal weight;

• good skin tone in the area;

• most common areas: abdomen, flanks, back, thighs, arms, submental region;

• good general health, with clinical and laboratory evaluation within expected parameters.

I do not recommend — or I postpone — when:

• the goal is weight loss: liposuction is not a bariatric procedure;

• there is significant skin laxity in the area — the indicated procedure is a different one (abdominoplasty, brachioplasty), sometimes combined;

• the planned volume and extent approach a large-volume surgery or no longer fit within my conservative planning: I prefer to split it into stages, always respecting the limits of CFM Resolution No. 1.711/2003 and individual risk;

• there is uncontrolled diabetes, a coagulation disorder or decompensated heart disease;

• the patient smokes and is not committed to quitting.

A patient who comes to me asking for “lipo on the belly” and who has diastasis recti and redundant skin will hear that liposuction alone will not fix it and may make it worse. I would rather lose the surgery than do the wrong one.

I map the areas with the patient standing, contracting and relaxing the muscles, to distinguish subcutaneous fat — which liposuction treats — from visceral fat, which sits inside the abdomen and is not accessible. I assess skin retraction: age, stretch marks, history of weight fluctuation, dermal thickness and the pinch test in each area. Where the skin does not retract, the answer is a different surgery. I estimate the total expected volume and, based on it, decide whether it fits in a single session or needs to be staged. I review BMI, medications and history of thrombosis.

In my surgical practice, I use vibration-assisted liposuction (Vibrolipo / power-assisted liposuction), in which a device assists the movement of the cannula. This technology can facilitate aspiration, and some studies describe differences in pain, bruising or efficiency in certain contexts, but I do not consider the technology by itself to determine safety or outcome. Technology does not replace judgment about indication, volume, aspiration plan, fluid balance and skin retraction — which remain the central elements of planning.

In hospital, under general anesthesia or sedation depending on the extent, in 1 to 3 hours. After infiltrating the solution appropriate to the anesthetic and surgical plan, I introduce thin cannulas through incisions of a few millimeters, at points hidden in skin folds or along the underwear line, and aspirate the fat with uniform movements in defined planes to reduce irregularities. I monitor in real time the infiltrated volume, the fluids administered and the total aspirated volume. CFM Resolution No. 1.711/2003 establishes limits related to body weight and treated area; within them, I also maintain a conservative clinical approach and do not pursue large volumes as a goal. At the end, I use a compression garment as appropriate for the case.

Depending on the area being treated, the aspirated volume, the surgical time and the clinical conditions, I prefer to keep the patient in the hospital overnight. I evaluate the patient myself the following day before discharge home or to a hotel. For smaller procedures performed in the morning, same-day discharge may be possible after careful evaluation.

• Fat embolism and hemodynamic changes — these are among the serious possible complications of liposuction and require immediate recognition and support. This is one of the reasons why, in my practice, I perform the procedure in hospital, with dedicated anesthesiology, continuous monitoring and backup support. The risk is influenced by volume, extent of the areas, combination of procedures, clinical conditions and fluid management; that is why I respect Brazilian regulatory limits and adopt conservative planning.

• Venous thrombosis — compression stockings, pneumatic compression during surgery, early ambulation and prophylaxis according to individual risk.

• Seroma — fluid accumulation; compression garment and, when necessary, aspiration.

• Contour irregularities — avoided by working in planes with thin cannulas; small irregularities can resolve with skin retraction; significant ones can be revised after 6 months.

• Bruising and swelling — expected; lymphatic drainage, starting between day 7 and day 10, helps resolution.

• Sensory changes — common and transient in most patients.

• Infection — rare, with prophylactic antibiotics and a hospital environment.

I do not use the phrase “minimal risk.” The risks exist, they are known, and there is a plan for each one.