Talk:Liposuction/Archive 1

Misleading image
The image of the woman before and after liposuction is misleading. The background is white on one side and black on the other, and the black side makes her look thinner than she actually is. If you look carefully you can see that it has been coloured in because the original shadowed area is still visible in the same position as it was on the white side. In other words the photo has been shopped. 82.30.13.134 (talk) 17:29, 18 December 2011 (UTC)

furthermore i do not understand which side is "before" and which side is "after" (for real) — Preceding unsigned comment added by 94.21.205.126 (talk) 21:44, 15 January 2012 (UTC)

"As shown previously..."
The first sentace of the 4th paragraph begins with "As shown previously..." What is this referring to? There is nothing in the article that "shows" that reports of 50+ pounds being removed are exaggerated. This and a few other spots in this article make me think that much of this info was copy/pasted from another source. —Preceding unsigned comment added by 12.180.230.178 (talk) 22:41, 7 December 2007 (UTC)


 * No kidding. The last two thirds of the article reads like it came almost directly from a lonnnnnnnng pamphlet in a cosmetic surgeon's waiting room. Why on earth is this article giving us the fine details on how to prepare for liposuction? Last I checked, this is an encyclopaedia, not PubMed. 65.189.147.101 (talk) 07:14, 15 January 2008 (UTC)

Yup - I stumbled over that too. It needs to be sorted out, either by a citation and rewording, or restructuring the paragraph. I'll take a crack at the latter approach to get the ball rolling. Xarqi (talk) 01:44, 21 February 2008 (UTC)

Do you realize that this link is here?
In the laser-assisted section, the company "Cynosure" is mentioned as the manufactuer of a laser device used in a variation of laser liposuction. The term is linked to an article for this entry:

Cynosure is also the name of a common ground-like plane in the Forgotten RealmsCynosure is the name of a fictional pan-dimensional city that exists within the First Comics multiverse. It is described as floating in a "bubble" in the "pan-dimensional vortex." Because of its unique situation, Cynosure is an important center of multi-versal commerce and much of the city's government is geared toward maintaining favorable trading conditions.

''' Are you kidding me?!!!? 149.2.82.2 (talk) 20:29, 28 January 2008 (UTC)

dangers
Someone should talk about the dangers of Liposuction here as well. Antonio BDSM Master Martin

I posted an article yesterday that goes into detail about the side effects and potential complications. It follows what was the stub. Should I have removed the stub?

Someone has changed my Liposuction heading to History. My article begins with that heading.

This is my first attempt to contribute anything to Wikipedia and I'm still very ignorant about how to do it. Learning as I go here. I want to make this article into editable sections but haven't yet figured out how to do that. Now it's 11:30 pm, so I'll have to try on Wed. evening May 10. Jenny305@earthlink.net —Preceding unsigned comment added by Pinkgalah (talk • contribs) 9 May 2006


 * To make sections, use the section tags (i.e.  == ). For nested sections, use more = signs.  For example:


 *  ==Main section== 
 *  ===Subsection=== 


 * And it will render like you see it in the article. By the way, I just cleaned up the whole article so you don't have to.  But you can look at the source to see how I did the sections. &mdash; Frecklefoot | Talk 17:57, 9 May 2006 (UTC)

Cleaned it up, eh? The latest edition of the article is a bloody mess. —Preceding unsigned comment added by 216.73.222.11 (talk) 12:32, 27 April 2009 (UTC)

There are many dangers of liposuction / adipose removal that are not mentioned or explained in this article. I'm trying to learn how to use Wikipedia and edit the page. Juliet Sabine (talk) 06:14, 15 June 2017 (UTC)Juliet Sabine

clots.. of fat!
Has fat embolisation ever been reported? i can't see why it should happen - it occurs when long bones are shattered, not from someone rummaging around in adipose tissue. THe phrase about clots forming around the area operated and then getting into the circulation suggests to me that whoever wrote it does not understnad venous trhomboembolism at all either. I've not got actual figures for VTE/DVT/PE with liposuction. If it is done under local I'd assume people can wriggle a bit, so it is low risk, even if they are - one assumes - not slim to start with. Midgley 23:02, 3 June 2006 (UTC)

Yes. Hyperlipidemia is the presence of elevated or abnormal levels of lipids and/or lipoproteins in the blood, and is a major risk factor for cardiovascular disease. Fat embolus syndrome (FES) is a disorder caused by fat particles that enter the circulatory system and is characterized by respiratory, hematological, neurological, and skin symptoms. Liposuction causes mechanical trauma to fat deposits, which leads to systematic fat mobilization. Studies conclude that FES occurs after liposuction. One clinical study done on rats published in the ‘Aesthetic Plastic Surgery Journal’ in 2009 revealed that: “Although there were no fat particles in the blood before liposuction, blood specimens obtained following the procedures and in the long-term had fat particles.”

Also, fat embolism has been reported as a cause of death in liposuction, (I can look up links), and coroners I have spoken with have told me this is a problem.

-- — Preceding unsigned comment added by Susan SO81255 (talk • contribs) 03:31, 13 April 2017 (UTC)

lots ... of sources coming
I've been busy and haven't come back here to finish posting this article properly. I'll work next on giving sources. Pinkgalah 03:09, 6 June 2006 (UTC)

I provided some sources and will give more shortly. Pinkgalah 23:00, 4 July 2006 (UTC)

Cost
I came here looking for information on the costs involved with liposuction. And perhaps whether liposcution is covered by health plans.

I would add the information myself if I knew the answers.


 * Probably not appropriate in a Wikipedia article--costs vary between providers/plans let alone countries. Seems like it'd be turning this into an ad for liposuction rather than an article of information on it.
 * -Rj101 05:27, 25 August 2006 (UTC)


 * I agree. Though I think I copyedited that section (and others), I thought it was an inappropriate topic for an encyclopedia.  Costs change and vary too much for us to give any estimates or reliable information. &mdash; Frecklefoot | Talk 14:27, 25 August 2006 (UTC)


 * Perhaps a ballpark figure, or an average statistical cost for a given year would suffice. —Preceding unsigned comment added by 12.75.199.119 (talk • contribs)


 * No, I don't think an encyclopedia is an appropriate place for prices for such procedures. They vary too much, from area to area, from type to type.  If we did include such information, there is no way we could guarentee it is at all accurate.  Covering the general topics of the procedures is the correct scope for this article. &mdash; Frecklefoot | Talk 20:29, 25 September 2006 (UTC)

Emulsifier
I was convinced that some sort of surfactant was also added to the fluid in liposuction, but I don't find any references to this being done. Can anyone confirm this? --Slashme 11:04, 10 October 2006 (UTC)

Pictures
I think the addition of before/after pictures would improve the article, and also pictures of some of the machinery used in the procedure.

Ultrasound lipo
I was rummaging around the net when I found a bit of info about ultrasound lipo. The section is very small in wikipedia so info there but I found a company Ultrashape ( http://www.ultrashape.com/ ). They say they've been featured on an irish show. Here's the video: http://www.ultrashape.com/data/uploads/Video/TV3%20Ireland%20AM%20LOW%20Band.wmv Something the doctor says in that video feels fishy to me. He says the fat tissue is destroyed permanently because fat cells are not produced in the body instead the old ones grow and they're killing the old ones.--Energman 13:06, 3 January 2007 (UTC)

Engerman: That's actually true. Almost any surgeon will tell you that. And there are numerous cosmetic surgeons who offer ultrasound assisted lipo. I don't believe that being featured on TV makes them more credible than any other provider. It isn't hard for them to get on TV. -New User —Preceding unsigned comment added by 149.2.82.2 (talk) 18:44, 28 January 2008 (UTC) -If some wants to put it up, I found a good article (see reference below) that wikipedia could cite while reading "Sonoluminescence: How bubbles turn Sound into Light", by S.J Putterman and K.R. Weninger. Though Putterman's article makes an interesting points about ultrasonic liposuction relationship with sonoluminescence I though that the reference below would be more relevant, -Weninger KR, Camara C, Putterman SJ. 1999a. Physical acoustics of ultrasound assisted liposuction. In press. 128.61.93.31 (talk) 13:07, 20 November 2008 (UTC)

What the!?
I don't know what's wrong, but this article will not let me revert on it. -- Abce2 | Access  Denied  19:48, 17 June 2009 (UTC)

Vandalism?
The mouseover text on the 31 May 2010 episode of Dinosaur Comics (http://www.qwantz.com/index.php?comic=1723) mentions that there are zero Google search results for "laser thigh surgery". The next day 130.243.175.198 added the phrase to the "Laser assisted liposuction" section. A Google search now finds only references to Dinosaur Comics and the new text from the article. Is this subtle vandalism? --98.246.182.140 (talk) 06:44, 8 June 2010 (UTC)

areas affected
The overview states that fat is removed "from many different sites on the human body" particularly "the abdomen, thighs and buttocks," ... "the neck, backs of the arms and elsewhere". But does the concerned fat have to be subcutaneous? Or can the cannula enter somehow the greater omentum? --91.120.150.162 (talk) 16:37, 20 November 2010 (UTC)

Section on ineffectiveness of liposuction for overall health
I'm referring to http://www.nejm.org/doi/full/10.1056/NEJMoa033179 which states "[a]bdominal liposuction does not significantly improve obesity-associated metabolic abnormalities. Decreasing adipose tissue mass alone will not achieve the metabolic benefits of weight loss." —Preceding unsigned comment added by Shawmutt (talk • contribs) 16:32, 15 May 2011 (UTC)

Fat level after liposuction
It would be beneficial if the article included a section describing what happens after liposuction. Liposuction removes not only fat but also fat cells. Does this mean that after liposuction people tend to remain thinner since the fat cells are no longer there to absorb calories and produce fat? Or, assume no change to diet, do remaining fat cells in those locations do what they can to recreate the fat storage as before? Or is more subcutaneous fat generated in other parts of the body, where fat cells remain, to compensate for the lost capacity of the removed cells?

Having some information on the long-term prognosis post operation would be an extremely useful addition to this article. FreeFlow99 (talk) 13:15, 19 February 2013 (UTC)

Reassessment
This article was assessed as B-class in February, 2008. I've re-assessed it as Start-class, as it's full of poor prose, unreferenced assertions, and prescriptive advice. -- Mikeblas (talk) 02:39, 30 June 2013 (UTC)

Introduction
Should not be a scare paragraph. 79.241.81.17 (talk) 17:39, 10 February 2014 (UTC)

SAFELipo Inclusion
It was suggested recently that a page I created for a type of liposuction procedure called SAFELipo be merged with the current liposuction page. The 'SAFE' portion is an acronym identifying the 3-step process of the procedure: S-Separation A-Aspiration FE-Fat Equalization

I believe this would be a good addition to the list of liposuction techniques and is contextual under the liposuction topic. At the current length (400 words) this would be a fairly detailed description of the technique compared to the others.

Etna-research (talk) 20:35, 29 April 2014 (UTC)

State of page
This is a strange page. It contains a lot of good information, but relatively few citations/references for such a long article. The prose in general reads more like a brochure from a plastic surgeon's office than a neutral POV. Cmlloyd1969 (talk) 19:21, 6 August 2015 (UTC)

Why is liposcution so controversial
Liposuction has been controversial recently. It might because of the side effects of surgery. There is some important reason why liposuction is so controversial among people. The considerable part of surgery is basically the price. Most of the cosmetic surgery offers the heavy costs for the surgery by the cosmetic specialists. The general cosmetic surgery is usually costs about $10,000 or more. Liposuction demands really expensive prices to the patients, and also it depends on which of body part that patient is going to have the surgery. After finishing the liposuction, patients should care their surgical bodies, which followed with regular schedules to prevent side-effects. This process also costs substantial amount of money. Care service for liposuction-patient is the most expensive care between other cosmetic surgeries. It takes for a long time to make their body to adjust from taking care services. — Preceding unsigned comment added by 74.62.206.150 (talk) 06:22, 9 October 2015 (UTC)

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Alternatives
Why do we have a section on alternatives, this seems does not seem relevant. If I look up about diets that page does not explain about Liposuction. If I look up about a subject a very small section referring to other associated subjects is expected but not the detail and banner waving we find here. — Preceding unsigned comment added by 79.173.144.213 (talk) 08:40, 14 June 2017 (UTC)
 * Agreed it is WP:SYN. Jytdog (talk) 16:54, 14 June 2017 (UTC)

I'm trying to get to the Liposuction Talk page. Currently I only see this one section. Juliet Sabine (talk) 03:53, 16 June 2017 (UTC)Juliet Sabine
 * This is the talk page. Doc James  (talk · contribs · email) 02:14, 17 June 2017 (UTC)


 * Why was the rest of the Liposuction Talk page archived and where can it be found? Juliet Sabine (talk) 04:17, 18 June 2017 (UTC)Juliet Sabine
 * Talk pages are archived regularly. If you look up, in the yellow box above, you will see a link to the archives. Jytdog (talk) 09:08, 18 June 2017 (UTC)

History
There is a statement in the history section that says, "Overall, the advantages of 30 years of improvements have been that more fat cells can more easily be removed, with less blood loss, less discomfort, and less risk," however, removing more cells creates more long-term negative outcomes and risk. Fat, of course, is an important endocrine organ. I would like to add this information:

An article in the Anesthesiology News, “As Liposuction Deaths Mount, Study Exposes Cracks in Safety,” states that a quarter-century after the nation's plastic surgeons received what amounted to carte blanche to perform liposuction, a new analysis suggests that the procedure is no safer than it was back then. http://www.anesthesiologynews.com/ViewArticle.aspx?ses=ogst&d_id=1&a_id=21743

I'm trying to figure out which paragraph to add this to.

Thank you,

Juliet Sabine (talk) 00:53, 22 September 2017 (UTC)
 * The source does not comply with MEDRS. You will save us all a lot of time if you take the time to understand what is OK per MEDRS. Jytdog (talk) 01:09, 22 September 2017 (UTC)


 * Yes, there is a learning curve to editing Wikipedia. Thank you. Juliet Sabine (talk) 07:50, 22 September 2017 (UTC)

Uses/ Please give specific explanation for why valid information about increase in insulin resistance with a good source was undone. Thank you.
Under the USES section, the last line says, "Liposuction does not help obesity related metabolic disorders like insulin resistance.'

I added the following:

and in fact a study in Brazil in 2013 concluded that "insulin resistance shows a significant increase in liposuction, and is correlated to the volume of aspirated fat..." I gave this study listed just below as a valid source of the information.

Oliveira S de S, Cibantos JS, Ripari WT, Aguilar-Nascimento JE de. 2013. Impact of the aspirated volume of fat tissue in the insulin resistance after liposuction. Rev Col Bras Cir 40:17–22.

The change was undone by Jytdog. I have read the definitions of primary and secondary sources. This is a good source, and I would appreciate a specific explanation as to why this valid information was removed from the page.

Here, (below), is the I the revision and undo revision from September 19, 2017

(cur | prev) 06:57, 20 September 2017‎ Juliet Sabine (talk | contribs)‎. . (27,695 bytes) (+612)‎. . (→‎Uses: Someone had written that liposuction doesn't help insulin resistance, but this study shows it increase insulin resistance in the long-term.) (undo)

(cur | prev) 07:13, 20 September 2017‎ Jytdog (talk | contribs)‎. . (27,083 bytes) (-612)‎. . (Undid revision 801531905 by Juliet Sabine (talk) primary source; we don't use them per MEDRS. Please see WP:MEDDEF for definitions of primary and secondary) (undo | thank)

Thank you. Juliet Sabine (talk) 22:44, 20 September 2017 (UTC) Juliet Sabine, September 20, 2017
 * 1) Did you read WP:MEDRS
 * 2) What source are you wanting to use? Doc James  (talk · contribs · email) 03:56, 21 September 2017 (UTC)
 * This is a small primary source Doc James  (talk · contribs · email) 03:57, 21 September 2017 (UTC)

1) I did read the page. 2) I used this source ~ Oliveira S de S, Cibantos JS, Ripari WT, Aguilar-Nascimento JE de. Impact of the aspirated volume of fat tissue in the insulin resistance after liposuction. Rev Col Bras Cir. 2013 Feb;40(1):17–22. Juliet Sabine (talk) 23:47, 21 September 2017 (UTC)Juliet Sabine, September 21, 2017
 * Great so all is settled than. Doc James  (talk · contribs · email) 23:52, 21 September 2017 (UTC)

How is it settled? This is a good source, but the contribution to the page was undone. Thank you Juliet Sabine (talk) 00:55, 22 September 2017 (UTC)
 * PMID 23538534 is a primary source. It is not OK per MEDRS. Jytdog (talk) 01:10, 22 September 2017 (UTC)
 * You said you had read WP:MEDRS so I assumed Juliet that you know you need to use review articles. That is NOT a review article. Doc James  (talk · contribs · email) 01:13, 22 September 2017 (UTC)


 * As a new editor here, there is learning curve. I have read the whole Wikipedia: Plain and simple guide for medial editors, several times. I appreciate the help. At this point, I'm assembling my references and will check though them before posting. Juliet Sabine (talk) 08:38, 22 September 2017 (UTC)

Complications - puncture

 * Puncture of an internal organ: since the surgeon cannot see the cannula, sometimes it damages an internal organ, such as the intestines during abdominal liposuction. Such damage can be corrected surgically, although in rare cases it can be fatal. An experienced cosmetic surgeon is unlikely to puncture any internal organ.


 * The above is an incorrect and misleading statement. The damage cannot always be corrected, and there are plenty of unskillful plastic or cosmetic surgeons who have been in practice for a long time.


 * An article in the Anesthesiology News, “As Liposuction Deaths Mount, Study Exposes Cracks in Safety,” states that a quarter-century after the nation's plastic surgeons received what amounted to carte blanche to perform liposuction, a new analysis suggests that the procedure is no safer than it was back then. http://www.anesthesiologynews.com/ViewArticle.aspx?ses=ogst&d_id=1&a_id=21743 Juliet Sabine (talk) 08:33, 22 September 2017 (UTC)
 * Doc James and I have advised you several times about what reliable sources are for content about health. Wikipedia content is built solely from reliable sources.  Jytdog (talk) 13:35, 22 September 2017 (UTC)
 * We even have a box at the top of this page that helps you find them. This is the link. Doc James  (talk · contribs · email) 19:31, 22 September 2017 (UTC)

I suggest moving the paragraph in quotations below to WP:LEAD from the Recovery section. In summarizing liposuction, one ought to be informed of this essential info right away.
The lead serves as an introduction to the article and a summary of its most important contents. The average Wikipedia visit is a few minutes. The lead is the first part of the article that most people will read. The lead should stand on its own as a concise overview of the article's topic. Wikipedia:Manual of Style/Lead section, https://en.wikipedia.org/wiki/Wikipedia:Manual_of_Style/Lead_section

"The suctioned fat cells are permanently gone, however, the study done at University of Colorado Denver entitled, "Following Suction Lipectomy: Defense of Body Fat and Patterns of Restoration," found that fat came back for all participants after it was suctioned out; it took some time, but it all returned despite maintaining the previous diet and exercise regimen. At 1-year out, overall body fat returned to the same level as before treatment. While the fat returned somewhat to the treated area, most of the increased fat occurred in the abdominal area. Visceral fat - the fat surrounding the internal organs - increased, and this condition has been linked to multiple life-shortening diseases such as diabetes, stroke, and heart attack." http://onlinelibrary.wiley.com/doi/10.1038/oby.2011.64/abstract;jsessionid=2449577EE4B39DDEBF19D420FD5CCD2F.f03t04 Juliet Sabine (talk) 06:06, 21 November 2017 (UTC) Juliet Sabine (talk) 01:41, 24 November 2017 (UTC)


 * I further suggest taking this line from the top paragraph, "Evidence does not support an effect on weight beyond a couple of months and it does not appear to affect obesity related problems," and moving part of it to the opening of the paragraph that begins, "The suctioned fat cells are permanently gone." It might read better to the lay person and lead in to the informaton about the fat restoration and consequences. I would also suggest adding the word, "loss."


 * Thus, the paragraph would read, "Evidence does not support an effect on weight loss beyond a couple of months. The suctioned fat cells are permanently gone, however, the study done at University of Colorado Denver entitled, "Following Suction Lipectomy: Defense of Body Fat and Patterns of Restoration," found that fat came back for all participants after it was suctioned out; it took some time, but it all returned despite maintaining the previous diet and exercise regimen. At 1-year out, overall body fat returned to the same level as before treatment. While the fat returned somewhat to the treated area, most of the increased fat occurred in the abdominal area. Visceral fat - the fat surrounding the internal organs - increased, and this condition has been linked to multiple life-shortening diseases such as diabetes, stroke, and heart attack."


 * I would suggest dealing with this part of the quote, "and it does not appear to affect obesity related problems," in a separate paragraph. Ultimately, liposuction does affect obesity related problems -- negatively so -- by, among other things, removing healthy fat and increasing toxic, visceral fat. I would suggest checking the source of this quote to see if it written is in context. The part of the quote seems misleading and / or poorly worded as it is. Juliet Sabine (talk) 02:43, 24 November 2017 (UTC)

Techniques
There are eight liposuction modalities listed beginning with Suction Assisted Liposuction and ending with Tumescent Technique. These descriptions are unsourced, promotional and misleading -- they read like WP:OR and sound like a sales pitch. Each technique has complications and has been associated with a subgroup of problems that should not be overlooked, so says the American Society of Plastic Surgeons in their Complications of Liposuction document, and many other sources. I suggest removing this biased, promotional list from this online encyclopedia. Juliet Sabine (talk) 07:18, 24 November 2017 (UTC)


 * There is a bullet-pointed list under Techniques that says that certain things *should* be done. This list is unsourced and misleading. One example is that it mentions that a consent form is signed on the day of surgery, however, not all surgeons use the same consent, and to my knowledge, "informed consents" for liposuction are not fully informed; they do not explain, (among other things), how the fat returns and visceral fat increases, which may lead to long-term disfigurement and iatrogenically created health problems. Health problems caused by increase in visceral fat can lead to disease processes which may result in early death. I suggest removing this unsourced list that sounds promotional and like WP:OR. This poorly written list doesn't describe liposuction, it's risks, or outcomes. Juliet Sabine (talk) 06:27, 30 November 2017 (UTC)

Long-term outcome
I challenge the edit that was made that shortened the information.

Fat came back in 100% of the participants of the "Fat Redistribution Following Suction Lipectomy: Defense of Body Fat and Patterns of Restoration" study, and that was only at a year out, so to change / shorten the wording makes the encyclopedia less accurate. Removing adipose cells isn't magic -- the remaining cells experience hypertrophy.

The reading was: "The suctioned fat cells are permanently gone, however, the study done at University of Colorado Denver entitled, "Following Suction Lipectomy: Defense of Body Fat and Patterns of Restoration," found that FAT CAME BACK FOR ALL THE PARTICIPANTS AFTER IT WAS SUCTIONED OUT; it took some time, but it all returned despite maintaining the previous diet and exercise regimen. At 1-year out, overall body fat returned to the same level as before treatment. While the fat returned somewhat to the treated area, most of the increased fat occurred in the abdominal area. Visceral fat - the fat surrounding the internal organs - increased, and this condition has been linked to multiple life-shortening diseases such as diabetes, stroke, and heart attack."

The reading of it was shortened to, "The suctioned fat cells are permanently gone, however, fat GENERALLY CAME BACK. At 1-year out, overall body fat returned to the same level as before treatment. While the fat returned somewhat to the treated area, most of the increased fat occurred in the abdominal area. Visceral fat - the fat surrounding the internal organs - increased, and this condition has been linked to life-shortening diseases such as diabetes."

In my challenge here, I put the change in bold to make the reading easier. There may be an easier way to do it, but I'm still on a learning curve with Wikipedia editing. Juliet Sabine (talk) 08:43, 25 November 2017 (UTC)


 * I would agree with Juliet's challenge. Her edit provides what 'fat comes back' actually means and that it happened for all participants in a controlled study. Saying it 'generally comes back' in my thinking does not provide the reader with the correct information. In other words it's not as precise as it needs to be, given that this is a medical procedure. Coyotesun (talk) 20:24, 25 November 2017 (UTC)

Few things: Thus shortened. Doc James (talk · contribs · email) 01:40, 26 November 2017 (UTC)
 * This is not really true "body defends it's fat"
 * This is not needed "The study at UC Denver found that" It is a review article and the underlying studies were not all done at UC Denver. If we were to start every sentence with the university of the primary research WP would turn into a disaster.
 * How about "While the suctioned fat cells are permanently gone, after a few months overall body fat generally returned to the same level as before treatment"
 * The word "generally" is important as it reflects the overall change in the study. Some people had more than when they started some had less than when they started but on average as a group there is no improvement. Doc James  (talk · contribs · email) 01:45, 26 November 2017 (UTC)


 * I agree about not starting all sentences referencing the Denver study but using citations when needed.


 * About the body defending its fat, in the cited reference there is this - "These results corroborate the evidence from experimental and clinical studies, which support fat redistribution and compensatory fat growth, as a result of feedback mechanisms, triggered by fat removal." I would argue that is the body defending its fat, meaning the body wants the fat that was removed back.
 * The word *generally* means usually (but not always) and I think that may be the sticking point. Also the word *generally* is used three times in the wiki article and therefore the meaning of the word itself could be confused with how it is used in those other instances. For that reason I think the word should be removed from this section in order to be precise and clear. Coyotesun (talk) 21:24, 26 November 2017 (UTC)
 * That the fat recurs is supported by the study. Defense is generally an immune response which this is not.
 * Yes in health most things are generally true when evidence supports them as such. Doc James  (talk · contribs · email) 00:32, 27 November 2017 (UTC)


 * I agree that taking the name of the study out of the text is helpful, thank you, Doc James. Also, adding the source info twice is helpful, and taking out the word multiple improved the last sentence. The point I challenge is the word "generally," as stated, this makes the information less accurate. Removing fat cells causes compensatory fat growth in untreated areas for all participants. This study only shows a year out. I'll revisit this issue later as I have time. I suggest removing the word generally and reverting back to how it was written, "fat came back for all participants." Juliet Sabine (talk) 03:44, 27 November 2017 (UTC)
 * Were does the text say it returned for all participants? Do not see it in the abstract. Doc James  (talk · contribs · email) 01:18, 28 November 2017 (UTC)
 * I'll get you the info from the study. It may take a few days due to my time constraints - I usually come on Wiki to edit with limited tiime. Also, in numerous animal studies across multiple species, (I know Wiki does not accept animal studies as sources), scientists have observed that the removal of fat from one part of the body subsequently increases fat depots in other parts of the body. This phenomenon is consistently demonstrated. Fat tissue has many benefits, and it is as if the body attempts to compensate for the loss of this vital tissue. 08:30, 2 December 2017 (UTC)

Recovery
"Bruising will fade after a few days or maybe as long as two weeks later. Swelling will subside in anywhere from two weeks to two months, while numbness may last for several weeks." This is unsourced misleading and seems like WP:OR and like a sales pitch. I suggest removing it. Disruption of blood vessels, lymphatic channels, and cellular injury result in bleeding, bruising, and swelling; bruising may last longer than two weeks, swelling longer than two months, and numbness many be permanent. Juliet Sabine (talk) 06:51, 24 November 2017 (UTC)


 * Bruising, swelling, and numbness are also mentioned in Side Effects, but the wording there is also misleading, and numbness ought to be moved to the Complication section. Juliet Sabine (talk) 01:06, 25 November 2017 (UTC)


 * I suggest removing the following as it is unsourced, misleading, sounds like WP:OR and like a sales pitch: "Depending on the extent of the liposuction, patients are generally able to return to work between two days and two weeks." Liposuction is often paid by cash and done in outpatient ambulatory centers -- the harm and deaths are and not followed in a comprehensive way. No unbiased systematic data have been collected on mortality risks of outpatient surgery. Also, I suggest removing, "A compression garment which can easily be removed by the patient is worn for two to four weeks, this garment must have elasticity and allow for use of bandages. If non-absorbable sutures are placed, they will be removed after five to ten days." This also is unsourced, misleading, sounds like WP:OR and like a sales pitch. The garments often hook all the way up the sides and not always easy to remove by the patient. Also, surgeons who perform liposuction vary their techniques; there is no saying that everyone operates in the same way, and therefore, this doesn't belong in an encyclopedia about liposuction. Juliet Sabine (talk) 00:48, 3 December 2017 (UTC)

Liposuction and tightening / lifting skin
Right now, the text reads as follows, "The level of skin retraction following liposuction is affected by the age of the patient, quality of skin, presence of underlying disease or smoking and the presence of previous skin damage such as caused by childbirth and surgery. Liposuction techniques such as subdermal undermining using fine cannulas can stimulate further skin retraction but are more frequently associated with contour irregularity. While subdermal undermining may help the skin contract, patients with severe elasticity loss and heavy stretch marks prior to liposculpture may require removal of redundant skin by surgical means after liposculpture. Usually this can be performed after 6 months.

Surgical lifts such as a rhytidectomy (facelift), mastopexy (breast lift), abdominoplasty (tummy tuck), Lipotuck (combination abdominoplasty and liposuction), or lower body lift, thigh lift, or buttock lift can be utilized when sagging skin alone is the issue or after massive weight loss when the combination of large amounts of skin and shrunken fat cause significant skin droop.

Large volume Liposuction (SAL) in combination with other surgery is common but may have higher complication rates. When done simultaneously, SAL is done minimally in the areas of the undermined tissues to minimize further insult to the blood supply, however a new technique in tummytuck surgery involves vigorous liposuction first before excising the redundant skin." - end text

I suggest removing this section, it is unsourced, misleading, sounds like WP:OR, selling other surgeries that also have risk. For example, the natural weight loss community is proof that skin often cannot keep up with the changes the body has been through; skin may not shrink back to the same size as the body, leaving unsightly and uncomfortable excess skin behind, so to limit the problems of a post-liposuction loose skin suit to these items listed here, is misleading. People of any age may experience loose skin after fat removal. My point is just to remove this info.

The second paragraph that begins, "Surgical lifts," is unsourced and seems to be selling these other procedures - which all come with risk not talked about on this page, rather than defining liposuction.

The last paragraph that begins "Large volume liposuction," again refers to a term - large volume - that varies in the liposuction literature, and is not a one-size-fits-all. The sentence that begins, "When done simultaneously," suggests the procedure is done minimally, without defining minimally -- again each doctor does his or her own technique without scientific reason to remove fat tissue. Also, it says, "to minimize further insult to blood supply," this is unsourced, poorly worded in any case. Juliet Sabine (talk) 01:18, 3 December 2017 (UTC)

Complications
The FDA liposuction page; the 'Complications of Liposuction' document issued by the American Academy of Cosmetic Surgery as an update on the ‘Guidelines of Liposuction,’ and the 2009 version of the consent for Suction-Assisted Lipectomy Surgery and Ultrsound-Assisted Lipectomy Surgery, list more complications than are listed on this Wikipedia page. I wonder where this list came from. Some of the descriptions read like WP:OR and sound promotional; I suggest making them neutral, accurate, and adding other complications, including the complications that result as a result of increase in toxic visceral fat.

One example from the current list that I suggest changing now reads: "Contour irregularities: sometimes the skin may look bumpy and/or withered, because of uneven fat removal, or poor skin elasticity. Not all patients heal in the same way, and with older patients the healing may be slower and a bit imperfect," however liposuction may cause contour irregularities on people with good skin elasticity and of any age. Referring to healing as a 'bit imperfect,' is promotional and misleading; people can be - and are - incredibly disfigured by liposuction. I suggest changing this line, adding to the complications list, making it an easier and more comprehensive read. Juliet Sabine (talk) 05:45, 30 November 2017 (UTC)
 * Would be good to base that section better on sources. Doc James  (talk · contribs · email) 08:01, 1 December 2017 (UTC)
 * A Complication of liposuction is disfigurement. I suggest to add "disfigurement" to the list of complications. Juliet Sabine (talk) 05:25, 3 December 2017 (UTC)
 * As long as we have a good ref, which I imagine should be easy to find, am happy with that. Doc James  (talk · contribs · email) 16:52, 3 December 2017 (UTC)


 * I'm still learning about how to find the secondary sources. Do you know if there's a way to find this article in a secondary source? There is little regulation in this industry. In the Anesthesiologist News journal from Oct 2012 called "As Liposuction Deaths Mount, Study Exposes Cracks in Safety," it says, "A quarter-century after the nation’s plastic surgeons received what amounted to carte blanche to perform liposuction, a new analysis suggests that the procedure is no safer than it was back then. Making matters worse, the researchers said, the surgery has been oversimplified in the popular media..." Many operations are done for cash in private ambulatory centers, and no one is following the harm. Juliet Sabine (talk) 07:28, 4 December 2017 (UTC)


 * I could cut and paste the nine page consent form that includes many bad complications, but that's not a secondary source, and it's not reliable since it omits important information and is not truly informed. Juliet Sabine (talk) 07:33, 4 December 2017 (UTC)
 * I often use pubmed and restrict the search to review articles. At the top of this talk page you will notice a box that helps with finding secondary sources. Doc James  (talk · contribs · email) 17:33, 4 December 2017 (UTC)
 * Thank you. I'll do that. I thought I used an article from pubmed before that was taken down. I'll run what I find by you as I have time. Juliet Sabine (talk) 05:09, 5 December 2017 (UTC)

Side Effects
It doesn't seem clear to me how this pag categorizes the difference between side effects and complications: scarring, ongoing pain, and numbness are complications.

Under side effects, I suggest changing the term, "Post-operative weight gain," to "Post-liposuction fat redistribution and / or weight gain." The "Fat Redistribution Following Suction Lipectomy: Defense of Body Fat and Patterns of Restoration" study may be cited. Juliet Sabine (talk) 05:21, 30 November 2017 (UTC)
 * They are sort of the same. Doc James  (talk · contribs · email) 08:00, 1 December 2017 (UTC)

I suggest removing the following for being unsourced and misleading, it sounds like WP:OR and a sales pitch. "There could be various factors limiting movement for a short while, such as: Wearing a compression garment. Keeping the head elevated Temporary swelling or pain." Liposuction is surgery, the surgeons use a "blind hand" and stick a cannula into the body; people can be disabled and killed, and pain and lack of mobility may be permanent. Juliet Sabine (talk) 05:17, 5 December 2017 (UTC)

Suggest to combine Side effects and Complications into a heading entitled RISKS AND COMPLICATIONS
Currently, the Side effects section reads:

There could be various factors limiting movement for a short while, such as:
 * Bruising: can be painful in the short term, and should fade after a few weeks.
 * Swelling (medical): should subside gradually over a month or two.
 * Scars: will vary in size depending on the particular procedure, and should fade over the weeks. Scarring is an individual thing, partly dependent on heredity. For some, scar healing may take as long as a year.
 * Pain: should be temporary and controlled by either over-the-counter medication or by a prescription, but may become chronic.
 * Numbness: sometimes persists for a few weeks or be permanent.
 * Post-liposuction fat redistribution or post liposuction weight gain[8]
 * Limited mobility: will depend on the exact procedure.


 * Wearing a compression garment
 * Keeping the head elevated
 * Temporary swelling or pain"

Currently, the Complications section reads:

"There is a spectrum of complications that may occur due to liposuction -- risk is increased when treated areas cover a greater percentage of the body, incisions are numerous, a large amount of tissue is removed, and concurrent surgeries are done at the same time.

When done using local anesthesia the risk of side effects appear less than with general anesthesia.[4] In Europe between 1998 and 2002, 23 deaths mostly from infection occurred.[4]

The more serious possible complications include:


 * Death
 * Allergic reaction to medications or material used during surgery.
 * Infection: any time the body is incised or punctured, bacteria can get in and cause an infection. During liposuction, multiple small puncture wounds are made for inserting the cannula that can vary in size depending on the technique.
 * Seroma: Sometimes the entrapped liquified fat may get accumulated beneath the subcutaneous plain as a seroma. Small seromas get absorbed spontaneously, but larger seromas need aspiration to avoid secondary infection.
 * Damage to the skin.
 * Sometimes the cannula can damage tissue beneath the skin, which may show up as a spotted appearance on the skin surface.
 * Skin necrosis occurs when the skin above the liposuction site changes color and falls off. Large areas of skin necrosis may become infected with bacteria or microorganisms.
 * Puncture of an internal organ: since the surgeon cannot see the cannula during liposuction, sometimes they perforate an internal organ, such as the intestines.
 * Contour irregularities: sometimes the skin may look bumpy and/or withered, because of uneven fat removal, or poor skin elasticity.
 * Thromboembolism and fat embolism: although liposuction is a low-risk procedure for thromboembolism including pulmonary embolism, the risk cannot be ignored.[9]
 * Burns: sometimes the cannula movement can cause friction burns to skin or nerves. Also, in UAL, the heat from the ultrasound device can cause injury to the skin or deeper tissue.
 * Lidocaine toxicity: when the super-wet or tumescent methods are used, too much saline fluid may be injected, or the fluid may contain too high a concentration of lidocaine. Then the lidocaine may become too much for that particular person’s system. Lidocaine poisoning at first causes tingling and numbness and eventually seizures, followed by unconsciousness and respiratory or cardiac arrest.
 * Fluid imbalance: since fat contains a lot of fluid and is removed in liposuction, and since the surgeon injects fluid for the procedure, even a very large amount of it for tumescent liposuction, there is a danger of the body’s fluid balance being disturbed. This could happen afterwards, after the patient is at home. If too much fluid remains in the body, the heart, lungs and kidneys could be badly affected.

While much of this is true, some of it is poorly written, unsourced, and misleading, and the list is incomplete. I can pull from other sources later. A few weeks ago we talked about having a better sources and a clearer presentation of the information listed under Side effects and Complications, which seem to be broken down randomly into these two categories.

I propose to combine the Side effects and Complications sections into one section entitled RISKS. The FDA consumer update page is by no means complete, but the wording from their RISK page is worded more clearly than the current text on the liposuction page. I propose we use the FDA list in addition to a brief lead in and the risks of death, pain, post liposuction fat redistribution, (which has long-term health and contour effects), and the other risks currently listed on this page.

Also, I will find the name for damage to the skin that causes discoloration and add that. I can't think of it right now.

The new combined section would read like this:

RISKS AND COMPLICATIONS

There is a spectrum of complications that may occur due to liposuction -- risk is increased when treated areas cover a greater percentage of the body, incisions are numerous, a large amount of tissue is removed, and concurrent surgeries are done at the same time.

Some side effects and complications include but are not limited to the following:


 * Death
 * Pain, which may be temporary or chronic
 * Post-liposuction fat redistribution or post liposuction weight gain,
 * Limited mobility
 * Bruising
 * Infections can become serious issues. Keep the wounds clean.
 * Embolisms may occur when loosened fat enters the blood through blood vessels ruptured during liposuction. Pieces of fat can wind up in the lungs, or even the brain. Fat emboli may cause permanent disability or, in some cases, be fatal.
 * Puncture wounds in the organs (visceral perforations) may require surgery for repair. They can also prove fatal.
 * Seroma is a pooling of serum, the straw-colored liquid from your blood, in areas where tissue has been removed.
 * Paresthesias (changes in sensation that may be caused by nerve compression) is an altered sensation at the site of the liposuction. This may either be in the form of an increased sensitivity (pain), or numbness in the area. In some cases, these changes in sensation may be permanent.
 * Swelling, in some cases, may persist for weeks or months after liposuction.
 * Skin necrosis occurs when the skin above the liposuction site changes color and falls off. Large areas of skin necrosis may become infected with bacteria or microorganisms.
 * Burns can occur during ultrasound-assisted liposuction if the ultrasound probe becomes hot.
 * Fluid imbalance may impact you after you go home. The condition can result in serious ailments such as heart problems, excess fluid collecting in the lungs, or kidney problems.
 * Toxicity from anesthesia due to the use of lidocaine, a skin-numbing drug, can cause lightheadedness, restlessness, drowsiness, a ringing in the ears, slurred speech, a metallic taste in the mouth, numbness of the lips and tongue, shivering, muscle twitching and convulsions. Lidocaine toxicity may cause the heart to stop.
 * Scars at the site of the incision are usually small and fade with time, although some may be larger or more prominent.
 * Deformities, Bumpy or wavy appearances or more severe deformities may occur at the liposuction site after the procedure. Juliet Sabine (talk) 04:38, 12 December 2017 (UTC)

Candidacy
I would suggest deleting the following, "It is not a good alternative to dieting or exercising. To be a candidate, one must usually be over 18 and in good general health, have an ongoing diet and exercise regimen, and have fatty pockets of tissue available in certain body areas. Significant disease limiting risk (e.g. diabetes, any infection, heart or circulation problems) weigh against the eligibility of a person for the procedure.[citation needed] In older people, the skin is usually less elastic, limiting the ability of the skin to readily tighten around the new shape. Liposuction of the abdominal fat should not be combined with simultaneous tummy tuck procedures due to higher risk of complications and mortality. Laws in Florida prevent practitioners combining liposuction of the upper abdomen and simultaneous abdominoplasty because of higher risks.[citation needed]"

It is unsourced, unproven, misleading, and seems like WP:OR and a sales pitch. Juliet Sabine (talk) 04:12, 15 December 2017 (UTC)

Preparation
I suggest removing the Preparation section from the liposuction page. This is an encyclopedia, not a how to manual. Other surgery pages on Wikipedia do not give preparation instructions -- that is for the doctor's office to do for each individual. This section is also unsourced and misleading.

Liposuction results in loss of tissues and bruising regardless of whether one smokes or not. Juliet Sabine (talk) 04:30, 15 December 2017 (UTC)

Lead
There is a quote in the lead that I question and suggest be changed. It now reads, "People operated on should generally have a normal weight and good skin elasticity." What does the word generally refer to? Should they have normal weight or not? Surgeons do liposuction on many obese people, so how does this comment relate to them? Also, they do liposuction on many people who have lost weight or been pregnant or have compromised skin elasticity for other reasons, so how does this comment relate to them also?

Also, what does "normal weight," refer to? Body Mass Index, (which ought to be discussed on this page), may be higher in lean, muscular athletes and other fit people.

I find this article confusing, vague, promotional, and misleading. Juliet Sabine (talk) 09:01, 25 November 2017 (UTC)
 * Ref says ideal candidates. https://books.google.ca/books?id=p9MGCAAAQBAJ&pg=PA2014&redir_esc=y#v=onepage&q&f=false


 * Adjusted Doc James  (talk · contribs · email) 19:43, 26 November 2017 (UTC)


 * This link leads to a page that says "Unavailable for viewing." The word generally is a problem again, which is part of what my questions relate to. Where is the science behind who should have fat tissue removed? Research shows that some healthy people die, are disfigured, and all participants have increase of unhealthy visceral fat. Juliet Sabine (talk) 04:00, 27 November 2017 (UTC)
 * Changed it to "It is believed to work best on people with a normal weight and good skin elasticity." Doc James  (talk · contribs · email) 01:19, 28 November 2017 (UTC)

In the lead I suggest adding the types of surgery that liposuction is a part of. People have told me they think of liposuction solely as a contouring procedure and are surprised to learn the other surgeries it is a part of. I'm unsure exactly how to add this information -- something like this, "Fat tissue may be suctioned out, chemically dissolved, cut out, or removed via laser and cooling methods. Liposuction or lipectomy is done as part of some breast reconstruction after cancer; breast reduction; abdominoplasty; stem cell harvesting from fat; Buttock augmentation, some face lifts, or other fat transfers; abdominal etching, non-surgical liposuction, and and other surgery aimed at contouring." Then lead into the bit about how the end result leaves the patient with fewer fat cells, which causes unhealthy increase in visceral fat and fat redistribution long-term. Juliet Sabine (talk) 04:22, 30 November 2017 (UTC)
 * What ref would support that? Doc James  (talk · contribs · email) 07:58, 1 December 2017 (UTC)


 * It's common knowledge among people that work in the field, however, I will gather references. On the Liposuction page, it already mentions abdominal etching. The Abdominoplasty page says, "Liposuction is often used to refine the transition zones of the abdominal sculpture." the Breast Reduction page talks extensively about breast reduction using liposuction. The Stem Cell Therapy page [] page says, "Stem cells intended for regenerative therapy are generally isolated either from the patient's bone marrow or from adipose tissue." The Breast Augmentation page says, "The fat-graft transfer approach augments the size and corrects contour defects of the breast hemisphere with grafts of autologous adipocyte fat tissue, drawn from the woman's body." There is a whole section about this type of approach using autologous adipocyte fat tissue -- this fat is "harvested," from the women's own body. On the page Facial Autologous Muscular Injection, [], it says, "The technique is a non-incisional pan-facial rejuvenation procedure using the patient'own stem cells from fat deposits," and talks about fat transplantation. There are references to liposuction on the Buttock Augmentation page. As an aside that Buttock Augmentation page needs to be improved. Surgeons are removing the supportive structure of the buttock, the infragluteal crease collapses, and the gluteus then is left unsupported -- this is explained in The Zones of Adherence and other journal articles, I will have to find the correct secondary sources. I will come back and edit this answer as I gather more more sources in order to improve this article. Juliet Sabine (talk) 23:10, 1 December 2017 (UTC)
 * Sounds good :-) Doc James  (talk · contribs · email) 19:03, 2 December 2017 (UTC)
 * Do I need to find secondary sources in order to explain that liposuction is part of these procedures, or would it be acceptable to do hyperlinks to these pages? Juliet Sabine (talk) 04:55, 3 December 2017 (UTC)
 * A reference. Do not consider Wikipedia articles reliable sources... Doc James  (talk · contribs · email) 16:52, 3 December 2017 (UTC)


 * I'm not sure yet how I will reference this. I'm trying to improve these pages because people do look on Wikipedia. The search engines often direct them here. It's such a shame that there is misleading information especially about procedures that can maim and kill and leave people worse off than before. Juliet Sabine (talk) 06:52, 4 December 2017 (UTC)


 * I suggest removing the LEAD PHOTO that seems like WP:OR and a visual sales pitch as it doesn't show anything about liposuction. I suggest replacing it with the photo in the suture section that shows the cannula inserts to what they say is 80%, which shows more of the process than a surgeon in goggles and scrubs. I don't know how to exchange pictures yet. Juliet Sabine (talk) 08:31, 9 December 2017 (UTC)

I suggest removing this text, "The safety of the technique relates not only to the amount of tissue removed, but to the choice of anesthetic and the person's overall health. Several factors limit the amount of fat that can be removed in one session. Negative aspects to removing too much fat include "lumpiness" in the skin," which is unsourced, misleading, sounds like WP:OR and a sales pitch. As for the last sentence, the skin can look lumpy, but this makes an a supposition on what is "too much" and supposes that any amount is okay, and there are many more negative aspects than lumpiness in the skin, and this sentence is misleading. Juliet Sabine (talk) 08:48, 9 December 2017 (UTC)


 * How do I use the outdent correctly? Juliet Sabine (talk) 08:49, 9 December 2017 (UTC)


 * I suggest adding this information, "Stored BF is regarded as an energy source in the setting of stress and caloric deprivation. When AT mass increases or decreases, neurohormonal signals stimulate individual responses that promote a return to the original level (16). Weight-loss itself creates a context for weight regain linked to increases in appetite, food intake, and increased insulin sensitivity (17)" in the lead portion of this particle after the sentence that ends with, "Visceral fat - the fat surrounding the internal organs - increased, and this condition has been linked to life-shortening diseases such as diabetes, stroke, and heart attack." This information was referenced in the "Fat Redistribution Following Suction Lipectomy: Defense of Body Fat and Patterns of Restoration" that is a secondary source. I'm unsure at this time whether I would reference this study, or the original studies this info comes from. ... I could write out the words BF = body fat, and AT = Adipose Tissue Juliet Sabine (talk) 22:14, 9 December 2017 (UTC)


 * You almost had it, it´s, not OUTDENT . Gråbergs Gråa Sång (talk) 12:34, 10 December 2017 (UTC)


 * Thank you... hmm, I'm still not getting it though. Juliet Sabine (talk) 00:51, 11 December 2017 (UTC)


 * We´re getting there. Remove the "nowiki" bits you don´t actually see on the saved talkpage. They are just code that prevent the outdent code from actually working as code. Simple, huh? Gråbergs Gråa Sång (talk) 06:24, 11 December 2017 (UTC)


 * :) Juliet Sabine (talk) 06:32, 11 December 2017 (UTC)
 * TADAH! Gråbergs Gråa Sång (talk) 06:47, 11 December 2017 (UTC)

I suggest removing this line, "Areas operated on can include the abdomen, thighs, buttocks, and backs of the arms." This is unsourced and misleading, sounds like WP:OR and a sales pitch. There are structural damages and other risks; negative long-term health and contour changes and 'Zones of Adherence' to consider, among other concerns. In the buttock, as one example, there is the possibility of destroying the infragluteal crease and removing tissues needed to pad the body to sit on. Juliet Sabine (talk) 05:04, 15 December 2017 (UTC)


 * I challenge this line and suggest removing it from the article as it is misleading and seems like a sales pitch, "It is believed to work best on people with a normal weight and good skin elasticity." I don't see this line in the abstract that is referenced and the article is protected from the public by a price wall. It's believed by whom that liposuction 'works best,' on people with a normal weight and good skin elasticity? Also, when stating that the liposuction procedure 'works best," what does that mean -- that the risks and / or long-term consequences that the Hernandez study and others have concluded do not exist for people of 'normal weight' and good skin elasticity? Two people may be the same height and weigh the same amount but be of vastly different fitness levels -- 'weight,' is a misleading barometer of fitness. New discoveries are being made about fat and it's role in metabolism. This line is poorly worded and I don't see proof from all sources considered that liposuction 'works best' on people with a normal weight. Juliet Sabine (talk) 06:06, 15 December 2017 (UTC)

Ultra sound assisted liposuction
I suggest changing the line that says, "Third-generation UAL devices address this problem by using pulsed energy delivery and a specialized probe that allows physicians to safely remove excess fat." I see the abstract - how do I tell if that is a secondary source, by the way? In any case, using a definitive term saying that the procedure is "safe" is misleading and I believe WP:OR and a sales pitch. Liposuction carries many risks along a spectrum of harm, and long-term changes that are not positive. The abstract says that this VASER allows for "greater emulsification of fat." Since the emulsification of fat leads to increase in visceral fat long-term, then then what does the word "safely" refer to? That it doesn't kill as many people right away? If this line has to stay up, if it's correctly sourced, (is it, by the way?), then I would change it so that the public is not misled.

Where is the research that shows which fat cells, an important endocrine organ, is "excess?" To my understanding, surgeons pinch the patients tissues and stick a cannula into the body without accurate means to measure what is white fat or brown fat, or how removal of fat -- which serves important, essential biological purposes; stores excess calories in a safe way so you can mobilize the fat stores when you’re hungry; pads, protects, and insulates the body; helps to transport vitamins; and releases hormones that control metabolism -- will affect a person.

Fat is ¾ fat -- the rest is collagen fibers that hold in place veins, nerves, stem and immune cells.

When liposuction was introduced to the U.S. circa 1982, the effects that surgically removing fat had on the body had not been comprehensively studied. Scientific studies over the past decades, however, have concluded many serious long-term results. Aaron Cypess, PhD., Harvard Med School states: “We are just beginning to understand fat.” https://www.webmd.com/diet/features/the-truth-about-fat#1

For these and many other reasons, I believe this line, as written is misleading, and I would change it. Juliet Sabine (talk) 07:27, 10 December 2017 (UTC)


 * I suggest removing the sub-suction bold title that says "Ultrasound-assisted liposuction." It seems like an a sales pitch for Ultrasound-assisted liposuction as it's the only type listed. Also, the line, "Third-generation UAL devices address this problem by using pulsed energy delivery and a specialized probe that allows physicians to safely remove excess fat," is poorly worded and misleading. Where is the scientific definition and proof that this fat is "excess?" Excess in what way? Adipose tissue is an important endocrine organ, not a decoration. Juliet Sabine (talk) 06:59, 15 December 2017 (UTC)

Usage
The paragraph begins with this, "Removal of very large volumes of fat is a complex and potentially life-threatening procedure. The American Society of Plastic Surgeons defines "large" in this context as being more than 5 liters (around 10½ pints)." The hyperlink leads to the Wikipedia page of The American Society of Plastic Surgeons, which has multiple issues, reads as an unbiased advertisement, and is unsourced -- leading only back to their own website. The lines quoted in the usage section are attributed to a biased page without oversight.

The definition of "large volume liposuction" varies in the plastic surgery literature. In fact, no strict definition exists and the term is arbitrary. Every body is unique, so there is no "One Size Fits All" definition: the percentage of tissue removed on an obese, six foot tall person, would vary considerably from that of a lean 5'2" person. This distinction ought to be made evident if "large volume" is referred to at all on Wikipedia. As I mentioned, "large volume liposuction" is an arbitrary, not scientifically accurate term -- we can do better in presenting information about this important topic.

I suggest removing the section that reads, "Removal of very large volumes of fat is a complex and potentially life-threatening procedure. The American Society of Plastic Surgeons defines "large" in this context as being more than 5 liters (around 10½ pints)." Under Complications, it is already more clearly stated, "There is a spectrum of complications that may occur due to liposuction -- risk is increased when treated areas cover a greater percentage of the body, incisions are numerous, a large amount of tissue is removed, and concurrent surgeries are done at the same time." Juliet Sabine (talk) 04:29, 24 November 2017 (UTC)


 * This line, "Liposuction was the most common plastic surgery procedure performed in 2006 with 403,684 patients and in the year 2011 with 1,268,287 patients," is duplicate information as the LEAD already says, "In the United States it is the most commonly done cosmetic surgery." Caution is urged when observing year-to-year comparisons, because studies such as this can experience substantial variances within specific procedures. The pool of responding physicians varies from year to year and the sample sizes for specific countries may significantly fluctuate between years. Many liposuction procedures are done in combination with other surgery, and are paid in cash and are uncounted. I suggest removing this line. Juliet Sabine (talk) 08:02, 16 December 2017 (UTC)


 * I suggest removing this line, "Most often, liposuction is performed on the arms, abdomen, buttocks, and thighs in women, and the chest, abdomen, and flanks in men," for the same reason as I listed above -- Caution is urged when observing year-to-year comparisons, because studies such as this can experience substantial variances within specific procedures. The pool of responding physicians varies from year to year and the sample sizes for specific countries may significantly fluctuate between years. Many liposuction procedures are done in combination with other surgery, and are paid in cash and are uncounted. Juliet Sabine (talk) 08:10, 16 December 2017 (UTC)

History
I suggest rewriting the History section, deleting unsourced material, and focusing on explaining how we got to the point where fat tissue is begin taken from the body without full understanding of how fat works, and the risks and negative consequences of these procedures. Also, the use of what is called "informed consent," but is not truly informed is a topic I suggest to include in this section, as well as the well respected Fat Redistribution study and where it's part comes into the history of liposuction now and as we move forward. I will begin on this as I have time. I will likely ask for help to make sure sources are acceptable. Juliet Sabine (talk) 21:50, 1 January 2018 (UTC)


 * I appreciate the effort on the rewrite of the history section. I suggest adding an explanation of how we got to the point where fat tissue is begin taken from the body without full understanding of how fat works, and the risks and negative consequences of these procedures. Also, the use of what is called "informed consent," but is not truly informed is a topic I suggest to include in this section. I also suggest including the fact that the well respected Fat Redistribution study published results in 2011, but still this vital information about negative long-term change to health and contour are not part of the informed consent -- the field is lagging on being transparent with this. Juliet Sabine (talk) 02:22, 12 January 2018 (UTC)

Move to lipectomy
so the MESH term here is Lipectomy/Methods. No doubt liposuction is the most prevalent, but having this article called this, kind of leaves us no place to put other methods of fat removal.. Here is the pubmed search for reviews under the broader title. How to handle the other methods? Jytdog (talk) 12:08, 4 January 2018 (UTC)


 * I just saw this comment. All methods of fat removal removal result in the same long-term problems with health and contour. I will think of how to address them. I'm still thinking of how to get the information about the inherent problems made clear on this page. Juliet Sabine (talk) 23:13, 14 January 2018 (UTC)

Infobox image?


What image should be in the infobox? I'm not terribly happy with either one of the images mentioned here being in an infobox. power~enwiki ( π, ν ) 02:55, 10 December 2017 (UTC)


 * Thank you for removing the promotional picture. Would you let me know how you did that? Also, I'm unsure what objection there would be to the second photo since liposuction is an invasive surgery that is done by using a blind hand, the surgeon is unable to see the cannula, and they can and do puncture organs and cause other structure and long-term damage. I believe the procedure ought to be transparently shown so those considering it have awareness of the process. The hand drawn picture from "The Belly Finds What The Thighs Lose," article in the New York Times, from April 30, 2011 represents what often happens long-term after liposuction, regardless of diet and exercise. Juliet Sabine (talk) 03:11, 10 December 2017 (UTC)


 * There is also a picture - a drawing - of a liposuction needle that could be used as a placeholder until a decision is made. It shows a needle entering layers of skin and fat. I can find it online, but I don't know how to find the source to show you. I could cut and paste the picture, but I don't know if it's free to use -- like this one, http://roguehealthandfitness.com/wp-content/uploads/2017/04/liposuction-needle.jpg although I do believe this photo of the cannula in the body is a good depiction of what is done. Actually, this photo link I put here is not good. It says "liposuction in a natural crease," which is also misleading. Juliet Sabine (talk) 03:57, 10 December 2017 (UTC)


 * The diff is Special:Diff/814652918; for this infobox just put the filename as the "Image", and add a caption as "Caption". I like the drawing better than either picture; but don't have strong opinions on the matter. power~enwiki ( π,  ν ) 06:08, 10 December 2017 (UTC)


 * Thank you for the information. I agree that the drawing is better than either picture. It's not that the picture of the surgeon is promotional for that surgeon in particular, but for the procedure itself. I will continue to look for pictures in public domain such as the drawing that might be used in the infobox on this page. Juliet Sabine (talk) 06:29, 11 December 2017 (UTC)


 * To a layman such as myself, the top one doesn´t come across as promotional, ("professional", maybe). It has the elements of surgeon, patient and big-ass needle. But as I rambled on my talkpage awhile back, what is a good WP:LEADIMAGE here is not super-obvious. Gråbergs Gråa Sång (talk) 12:42, 10 December 2017 (UTC)
 * I have restored the image. Not seeing how it is promotional. Feel free to remove the surgeons name from the file name. But most readers will not see that. Doc James  (talk · contribs · email) 20:48, 10 December 2017 (UTC)


 * I agree that the first image is 'professional' but it's not realistic. It looks like the type of image that might be on the package the liposuction equipment comes in. The second image actually represents what liposuction looks like as the procedure starts. My strong opinion on this is based on the fact that many people come to wiki for representations of what medical procedures entail and so therefore imo it should not be a cleaned up image but an actual one that is representational of the actual procedure. Coyotesun (talk) 22:24, 10 December 2017 (UTC)

I don't believe that having a picture like this is informative. Its too promotional, because it appears staged, and is meant to convey the appearance that this is surgery, but it is not, surgery is not conducted in this manner. Peter Martinez — Preceding unsigned comment added by Peter Martinez (talk • contribs) 05:36, 12 December 2017 (UTC)


 * I agree with you. It's not informative and appears staged. It's WP:OR and a visual sales pitch. This photo needs to be removed and replaced by an informative photo. Juliet Sabine (talk) 08:13, 12 December 2017 (UTC)


 * I'm not sure what context you're using the word professional --- The picture of the surgeon performing liposuction is promotional for liposuction whether reader see the surgeon's name or not on the file. As I've said, I don't see how that is appropriate or helpful for an encyclopedia. Juliet Sabine (talk) 06:29, 11 December 2017 (UTC)


 * The appendectomy page, for example, shows an appendectomy in progress in the infobox. https://en.wikipedia.org/wiki/Appendectomy I believe the same ought to be shown for liposuction, a procedure in which a cannula is thrust repeatedly with a blind hand deep into the body and has a spectrum of structural and systemic harm as outcomes. Also, the kidney transplantation page shows an illustration in the infobox. I suggest the promotional photos of be taken off of the liposuction and the other plastic surgery pages as well. The promotions for the plastic procedures are so common that it seems they are not even realized to be such Juliet Sabine (talk) 07:03, 11 December 2017 (UTC)


 * That's a good point about the appendectomy. If liposuction is a surgery (which it is) it should be presented as such. Many people's first stop for elective procedures is Wikipedia so they should be able to get a realistic medical image. Coyotesun (talk) 15:49, 11 December 2017 (UTC)


 * The cardiac surgery page is another example of a page that shows a photo of the named procedure in progress in the infobox of this online encyclopedia. https://en.wikipedia.org/wiki/Cardiac_surgery#/media/File:Coronary_artery_bypass_surgery_Image_657B-PH.jpg -- Cardiac surgery, https://en.wikipedia.org/wiki/Cardiac_surgery#Open_heart_surgery. Liposuction is misrepresented to the public as being minimally invasive, when in fact it can puncture organs, disfigure, disable, cause long-term harm, and kill people. The picture in the suture section of the liposuction page is tame compared to much of the process, and even if it wasn't, I'm repeating my suggestion that the proposed photo of the woman with the cannula inserted into her body be shown in the infobox of this page and the promo shot of the surgeon in googles and scrubs be removed. I don't see that the promo shot of the surgeon gives the public any needed information, but it does seem to be WP:OR and a visual sales pitch for those who wish to sell liposuction. Juliet Sabine (talk) 03:34, 12 December 2017 (UTC)


 * If the top image is staged (looking at it closely, the comments above have persuaded me that it is) and the lower one is from the procedure actually being performed, then let's use the one illustrating the actual procedure. --Andreas JN 466 10:58, 14 December 2017 (UTC)


 * This LEAD PHOTO is still misleading and staged. Liposuction ought to be treated like other surgeries such as cardiac surgery, which shows the actual procedure, not a glossy staged ad. Juliet Sabine (talk) 23:15, 14 January 2018 (UTC)

Remove link to Curlie
There a link at the to a site that linked to Curlie. This site is promotional, biased, and misleading. They give a link to the site promoted by Dr. Jeffrey Klein. I suggest removing this link from the liposuction page. Juliet Sabine (talk) 23:10, 14 January 2018 (UTC)
 * Curlie is a site that is community run. You can join and make suggestions. Usually it is a reasonable source. Doc James  (talk · contribs · email) 03:30, 23 January 2018 (UTC)

Lipoplasty Claims Experience of U.S. Insurance Companies
The following is a single paper, not from a Review article (the preferred type of source mentioned); however, I could not find any review articles covering the aspects of Lipoplasty, (liposuction), claims in the U.S. so this is the best source available. Of course, it’s extremely difficult to even get a lawyer for medical malpractice, and harder still to get to court and get a judgment, so many complaints go without attention, or there are small, unfair settlements with a full gag clause attached.

The public ought to be aware that there are cases of malpractice associated with liposuction; that women are most often harmed: and that two-thirds of the claims (sixty-seven percent) arose from informed consent or breach-of-contract issues, far higher than the twenty-six percent aggregate claims norm.

I suggest adding this to the liposuction page ~

START

“Lipoplasty Claims Experience of U.S. Insurance Companies

An analysis of medical liability claims for Lipoplasty (liposuction) from January of 1985 through June of 1998 compared the insurance industry experience of plastic surgeons with that of other physicians.

Nearly two-thirds of claims (65.4 percent) during this thirteen-year survey period were the result of hospital-based Lipoplasty; 20.9 percent were office-based claims. The prevalence of hospital-based claims may be a consequence of both historical biases introduced by hospital-based specialty surgery in the early years and prudent patient safety considerations during performance of complex or prolonged procedures in more recent years.

Two-thirds of the claims (sixty-seven percent) arose from informed consent or breach-of-contract issues, far higher than the twenty-six percent aggregate claims norm.

Women brought eighty-seven percent of claims and men brought thirteen percent.”

END

The whole abstract reads as follows:

--Juliet Sabine (talk) 00:58, 23 February 2018 (UTC)
 * a 17 year old primary source. No thanks. Jytdog (talk) 22:32, 24 February 2018 (UTC)


 * Here's another article from just five and a half years ago. I suggest that we use this one. The fact is that liposuction is not any safer now than it was back then, although it is difficult to bring a lawsuit. Juliet Sabine (talk) 00:40, 27 February 2018 (UTC)
 * News about a primary source. Please use reviews in the biomedical literature or statements by major medical/scientific bodies. Thanks. Jytdog (talk) 05:10, 27 February 2018 (UTC)

Psychology -- suggested changes
People who are looking to undergo the procedure of liposuction should have reasonable expectations. They should also have a plan to change their way of living as far as diet and exercise.


 * This statement is misleading and a form of victim blaming that suggest that bad outcomes, which will happen because the body has a limited number of fat cells and when some are removed the remaining cells experience hypertrophy and visceral fat increases, and this is an outcome that cannot be controlled by the patient. Many doctors, in fact, do liposuction on people who are of their top fitness levels, so there would be no way to improve upon their diet and exercise. The problem with fat redistribution lies in the biology of fat, and the fault lies in the way practitioners of liposuction mislead their clients and do not prepare them for true dangers, acute problems, or long-term health and contour problems causes innately by removing fat cells.


 * We might also add information to the topic of the "Psychology of Liposuction" regarding that some people have to deal with surgical assault and having their bodies modified in non-consented ways when they are under anesthesia. Following surgical harm, victims are gas lit, denied, minimized, slandered, and their are cover-ups and gas clauses, similar in a sense to rape victims. Juliet Sabine (talk) 22:55, 25 November 2018 (UTC) Juliet Sabine (talk) 23:01, 25 November 2018 (UTC)


 * Not happy with the statement on 'Psychology' that focuses on a 'patient's expectations.' That is not really about psychology but it is a dog whistle in a sense that surgeons et al use to as a prophylactic excuse any misrepresentations about liposuction and any mistakes they themselves might make.DrCoyote (talk) 01:31, 26 November 2018 (UTC)


 * I agree with you, DrCoyote. I propose we remove this misleading statement from the page. Juliet Sabine (talk) 01:43, 26 November 2018 (UTC)
 * I disagree. Rather than removing the statement outright, it should be rephrased to reflect what the cited source actually says: "Patients should be generally healthy and demonstrate a commitment to long-term lifestyle changes including both healthy diet and exercise. Additionally, patient goals and expectations should be appropriate and realistic. Furthermore, patients who are either obese or who have generalized adiposity, adolescents, and patients with certain preexisting medical conditions that place them in preclusive risk may not be suitable candidates."
 * "Reasonable" and "realistic" expectations are not the same thing. And the source says nothing about "a plan to change their way of living", it says that they should be generally healthy and demonstrate a commitment to lifestyle changes", meaning a patient who is a lard-ass couch potato and intends to remain that way isn't a liposuction candidate.
 * Context matters. The statement in the article doesn't provide the proper context. ~Anachronist (talk) 06:56, 26 November 2018 (UTC)


 * I read the article referenced in the 'Psychology' section and the sentences on the wiki page don't reflect that article at all. AND even if the statement was made to reflect the article (patients should be....) is not an issue of 'psychology.' Why not just remove that heading and replace it with What Doctors Tell Their Patients During a Consult (or something like that). Using the word psychology automatically implies that there is a high chance of a psychological issue with the patient.The problem with this is that it is biased and this page is supposed to be unbiased.People who promote liposuction have a certain litany (both in advertisements and journal articles) that is biased; not neutral. Because there is no evidence base that actually supports what they are saying. So I think the heading should be replaced with something neutral. (ps:I don't know why it shows my name with the red; I actually created a page etc when I signed up) DrCoyote (talk) 22:54, 26 November 2018 (UTC)


 * Liposuction is done as part of many procedures including but not limited to: breast reduction, breast reconstruction after cancer, stem cell harvesting, face-lifts, abdominoplasties, and for supposedly cosmetic purposes. Liposuction procedures are often sold to healthy, fit people with the promise of smoothing a generic contour deformity that is exercise and diet resistant. Fit people don't need to change their already healthy lifestyles. No matter how fit and active a person is, the body has only a limited amount of fat cells. Liposuction leaves a person with less fat cells, and the remaining cells get larger; the reason the body changes is not a matter of psychology or behavior, it's biology. Large cells are less effective and change metabolism and deposition. Here on this liposuction page there is the quote, "While the suctioned fat cells are permanently gone, after a few months overall body fat generally returns to the same level as before treatment. This is despite maintaining the previous diet and exercise regimen. While the fat returned somewhat to the treated area, most of the increased fat occurred in the abdominal area. Visceral fat - the fat surrounding the internal organs - increased, and this condition has been linked to life-shortening diseases such as diabetes, stroke, and heart attack.” Diet and exercise or mindset cannot overcome biology and it's irresponsible to tell people that it can. This statement under psychology is misleading propaganda. Wikipedia needs to do better than that. This ought to be removed. Juliet Sabine (talk) 08:38, 28 November 2018 (UTC)


 * OK, I get it, and I agree it should be removed. My original disagreement was based on the fact that the sentence being discussed misrepresented the source, and if we are going to cite a source, any statement we make should be accurate. But I agree, if it has nothing to do with psychology, remove it. I have just done so.
 * answering your p.s.: Your contribution history shows a total of four edits, all to this talk page. Your username is red because there is no content on the page User:DrCoyote. And you have no deleted contributions, so it wasn't deleted. Perhaps you had created it but forgot to click the "Save" button? I do that occasionally myself. ~Anachronist (talk) 06:28, 29 November 2018 (UTC)
 * You are probably right (re: red text and no talk page for me). I set this up a while ago so I'll have to look into what's going on (since I've contributed more than four edits) Thanks for removing the 'psychology section.' DrCoyote (talk) 01:21, 30 November 2018 (UTC)
 * It's also possible that you have contributed while logged out, without knowing it. That happens to me occasionally also. ~Anachronist (talk) 01:54, 30 November 2018 (UTC)


 * Thank you for removing that, ~Anachronist (talk). There are a few other issues on this Liposuction page I'd like to talk about in this Talk section as soon as I have time. Also, can you remind me how I answer on a Talk page when the margins are getting so far to the right? As you can see, I just moved mine one to the left. What is the correct protocol? Juliet Sabine (talk) 05:52, 30 November 2018 (UTC)

If you want to reply to someone but it's already too far to the right, you can use the od 'outdent' template like I just did. If you want to start a new conversation, which sounds like what you have in mind, then create a new section on this page. ~Anachronist (talk) 03:10, 1 December 2018 (UTC)

Power-assisted liposuction
I'm going to gather information about power-assisted liposuction. I'd like to remove this section. Power assisted liposuction is extremely dangerous and can perforate organs and destroy bodies, etc. This section seems to be propaganda and as we know, liposuction is has many severe risks, visceral fat increases, and people are killed. Juliet Sabine (talk) 06:45, 12 May 2019 (UTC)