Liposuction in Seoul: Does Removing More Fat Give You a Better Shape?

What does liposuction actually change?

Liposuction removes part of the fat that lies just under the skin (subcutaneous fat) in areas that blur your body's proportions. The fat is drawn out through thin tubes called cannulas.¹ In a word, it is an operation that changes your shape, not your weight.

The American Society of Plastic Surgeons' practice advisory makes the same point: liposuction is not a standard treatment for obesity. You may have little fat gathered in one area, or hope for something far from what surgery can do. In that case, diet, exercise or other medical care may suit you better.¹

Where we reduce, and what we keep

Replay

1. 1Areas to reducefat under the skin that blurs the proportions: upper and lower abdomen, waist and flanks
2. 2What we keepthe curve at the side of the hip is left in place
3. 3Moving fat, if neededremoved fat can go to the side of the hip, where a curve is needed
4. 4Distribution, not weightreduce where needed, keep the curve, and the body's shape changes

In general, the people who do well have two things. One is skin with good elasticity, and the other is a weight not far from their ideal weight (a healthy weight for their height and build). One review, an article that gathers and sums up many studies, puts that range at within 20–30% of ideal body weight.² In other words, liposuction is not a way to solve being heavy; it refines the shape of stubborn areas once your weight is reasonably settled.

Weight gain after surgery can make the remaining fat grow again. That is why the same review advises keeping up a balanced diet and regular exercise.²

What does the fat under the skin look like?

The fat under the skin is not one single block. It sits in two layers. Anatomical research on the trunk and legs, combined with CT scans (scans that show slices of the body), confirmed this structure.³

• Superficial fat layer: right under the skin. The fat sits in small pockets divided by tight fibrous walls.
• Superficial fascia: a thin sheet that separates the two fat layers.
• Deep fat layer: between that sheet and the fascia (the thin covering) of the muscle below. Its pockets have looser walls.³

The deep layer adds considerably to the overall thickness of the abdomen, the lower back and flanks, and the buttock–thigh area.³ So when these areas look thick, the deep layer is a big part of the reason.

Two layers of fat under the skin

Replay

1. 1Fat in two layerssuperficial fat in tight pockets, deep fat in looser ones, with the superficial fascia between
2. 2The deep layer adds bulkit adds much of the thickness on the belly, lower back, buttocks and thighs
3. 3Where the cannula passesnot too close to the skin or muscle; the depth is matched to the area and skin
4. 4The layer left behindadvice to leave at least 5 mm of fat under the skin and above the fascia
5. 5Too shallow or too muchfat right under the skin is removed unevenly and the surface turns lumpy

Because of this structure, what is left behind shapes the surface more than how much comes out. A review lists these causes of a lumpy surface after liposuction:⁴

• Suction that is too shallow or too heavy
• Tissue that becomes firm (fibrosis) or sticks together (adhesions)
• A compression garment that does not fit, or poor posture
• Skin left over once the volume is smaller

The same review quotes the principle that what is left matters more than what is removed. It describes a recommendation to leave at least 5 mm of fat under the skin and over the fascia.⁴ On the other hand, some surgeons report that carefully treating the layer just under the skin helps the skin shrink back.⁴ So the depth worked in each area is matched to that area and to your skin.

Where do we reduce, and where do we keep?

Two people of the same weight can look very different depending on how the waist, hips and thighs relate to each other. So planning looks at the line that runs on from a bulge, not only the bulge itself. Slimming the waist alone may not create a curve. Sometimes the waist line only shows when there is volume at the hips and buttocks too.

Five spots that need extra care

In some places, the tissue under the skin is firmly attached to the fascia below. These attachments create the body's natural hollows and creases. One review names five such spots and explains that suctioning them raises the risk of contour deformity, meaning an outline that ends up dented or misshapen.²

Replay

1. 1Five spotswhere the tissue under the skin is firmly anchored to the fascia
2. 2They shape the contoursthe anchoring makes hollows and creases; suction here risks contour deformity
3. 3The buttock creaseremoving too much deep fat can damage the supporting fibers and let it sag, which is very hard to correct

The buttock crease (often called the banana roll) needs particular care. Over-suctioning the deep fat there can damage the fibrous tissue that supports the buttock, and the buttock may sag. A review describes this kind of sagging as very difficult to correct.⁴

Is the bulge on the outer thigh really fat?

A bulge on the outer thigh (saddlebags) can have two causes: fat that has built up in that spot, or a shape created by the weight of the buttock. If the bulge shrinks when you stand and tighten your buttocks, it is considered a "false" bulge. It then calls for a different plan from suctioning the outer thigh alone.⁴

Replay

1. 1Standingboth people show a bulge on the outer thigh
2. 2Tightening the buttocksone bulge stays, the other shrinks
3. 3Which kind it isif it stays, it is fat in that spot; if it shrinks, it is a 'false' bulge from the weight of the buttock

That is why the examination before surgery is done while you stand. Looking at you relaxed and with your muscles tightened, and marking existing asymmetry and dents beforehand, is the recommended approach.⁴

How much can be removed at once?

There is no scientifically set limit that says "this many liters is safe". What is certain is that the risk of complications rises as the volume and the number of areas treated increase.¹

The American Society of Plastic Surgeons asks surgeons to record the "total aspirate": the fat plus the fluid that comes out with it. It defines large-volume liposuction as 5,000 cc (5 liters) or more of total aspirate in one operation. It recommends that such operations take place in a hospital or an accredited or licensed facility, with vital signs (such as blood pressure and pulse) and urine output monitored overnight.¹ It also notes that in some cases larger volumes are better split into separate operations and not combined with other procedures.¹

How often do complications happen?

One study looked at 31,010 liposuction procedures performed in the US between 2008 and 2013, using a cosmetic surgery insurance database. When liposuction was done on its own, major complications needing an emergency visit, admission or another operation occurred in 0.7%. That is about 7 in every 1,000 people. The most common were hematoma (a pocket of pooled blood, 0.15%), lung complications (0.1%), infection (0.1%) and confirmed venous thromboembolism (a blood clot in a vein, 0.06%).⁵

When liposuction was combined with other cosmetic operations, the relative risk of a major complication was 4.81. Put another way, major complications were about 4.8 times as likely as with liposuction alone. Older age and a higher BMI (body mass index, a number that compares weight with height) also raised the risk on their own.⁵

Rare but serious complications include pulmonary embolism, where a blood clot blocks blood vessels in the lungs, and fat embolism, where droplets of fat block blood vessels. Pulmonary embolism is described as the most common cause of death after liposuction. Fat embolism can appear 12 to 72 hours after surgery, which is why careful monitoring after the operation matters.² Walking on the day of surgery is encouraged.² Before surgery, your clot risk is checked, including hormone use such as the contraceptive pill and any clotting disorder.¹

How is it done, and what is recovery like?

Before suction, a solution is usually infused into the fat. It contains a drug that narrows blood vessels and a dilute local anesthetic.¹ In the tumescent technique, 3 to 4 cc of solution are infused for each cc of fat planned for removal. This brings blood loss down to roughly 1% of the aspirate.¹ For example, when 100 cc is removed, about 1 cc of it is blood. The cannula is then passed through small incisions, and the fat is removed along the layer.

Why a solution goes in before suction

Replay

1. 1A solution goes in firsta drug that narrows blood vessels plus a dilute local anesthetic
2. 23–4 times the amounttumescent technique: 3–4 cc of solution for each cc to be removed
3. 3The cannula removes fatinserted through a small incision, it removes fat along the layer
4. 4Blood loss about 1%about 1 cc of blood for every 100 cc removed

Expect clear bruising and swelling for at least the first 48 to 72 hours (two to three days). Compression garments and elastic stockings are generally worn for several weeks.¹ One review describes the usual course like this:⁴

• First one to two weeks: swelling may increase slightly.
• Around two to three weeks: the swelling feels firm.
• Six to eight weeks: firm areas soften in patches.
• Around three months: depending on the extent of surgery, the area feels close to normal.
• Bruising: darkest at 7 to 10 days, and usually gone within two to four weeks.

Reduced feeling in the treated areas is common, but it usually returns close to normal within a year. After liposuction of the thighs, the skin can darken in places (pigmentation).⁴

Symptoms to report straight away

Contact the clinic straight away rather than waiting if you notice any of these. They can be signs of a clot or an infection.¹

• Shortness of breath or chest pain
• Pain and swelling in one calf
• Pain that keeps getting worse
• Heat or discharge around a wound

Can dents, loose skin or asymmetry happen?

Contour deformity is the most common complication of liposuction. According to one review, up to 9% of patients report dents or bulges, loose skin, folds or wrinkles.² That is up to about 9 in every 100 people.

In the following situations, some skin may be left over after liposuction, and it is worth knowing this before you decide:⁴

• Poor skin elasticity
• A large overhang of skin on the lower abdomen
• Heavy upper arms with loose skin
• Loose skin on the inner thighs

When a lot of excess skin is expected, a skin-removal operation may suit you better.⁴

Asymmetry that existed before surgery can still show afterward, so it is recorded with photos and measurements beforehand.⁴ If an area looks uneven while swelling remains, it is hard to judge accurately. So any corrective surgery is usually planned only after waiting at least six months. For loose skin, six months to a year is suggested so the skin has time to shrink back on its own.⁴ If you already had liposuction elsewhere and were left with dents or asymmetry, see our guide to liposuction revision.

How we approach it at Bonita Clinic

What we check first

• 1Excess fat on the belly and waist

  How the waist curve will remain, not just how much to remove

  Liposuction

• 2Thick thighs or upper arms

  Inner and outer volume, and the line that connects them

  Liposuction

• 3Skin likely to loosen after suction

  Whether to tighten with Renuvion, decided before surgery

  Renuvion

• 4Lumpiness after a previous liposuction

  Remaining fat, adhesions and skin condition

  Liposuction revision

At Bonita Clinic, we perform liposuction as surgery under sedation combined with local anesthesia; you go home the same day, and stitches are used. At our body contouring center, sedation or general anesthesia may be used, and an overnight stay may be needed depending on the extent. For one-day liposuction, we recommend splitting wide areas into separate sessions. Recovery time and follow-up visits vary with the extent of surgery and your condition.

Liposuction options you can discuss in Seoul

Bonita Clinic opened in 1995 and has stayed at the same address since, with Dr. Kwang-Seop Chung, a board-certified plastic surgeon who trained in Brazil, seeing patients himself. For body contouring, the options you can discuss at consultation are the ones on our treatment pages:

• Selective liposuction of the abdomen, waist and love handles, upper arms or thighs, planned around the line that remains
• Moving the removed fat to the buttocks or hips when a curve is needed (purpose of liposuction)
• Tightening with Renuvion when skin is likely to loosen (Renuvion line lifting)
• Revision when dents, asymmetry or sagging remain after an earlier liposuction (liposuction revision)
• A limited scope chosen to fit a short schedule (one-day liposuction)

Which of these you need, if any, is decided only after an examination.

Why the plan and cost differ from person to person

Two people asking for "liposuction of the waist" can need quite different operations. The plan, and therefore the cost, is shaped by the scope of the work rather than the name of the procedure.

• Which areas, and how many
• Expected total aspirate volume
• Whether fat is moved to the buttocks or hips
• Whether skin tightening is added
• Anesthesia, and whether an overnight stay is needed
• Previous liposuction or scarring in the area

Final plan and quote after an in-person exam

A final estimate is given after the in-person consultation, once the areas, the expected volume and any combined treatment are settled. Photos can suggest a direction, but they cannot fix the scope.

What photos can show, and what needs an in-person exam

Photos are a useful first step for liposuction because proportions show well in pictures. But they cannot tell how thick the fat is or how the skin will behave.

Photos can show

• Where the bulges are, and overall proportions
• Silhouette from the front, side and back
• Visible dents, folds or asymmetry
• Scars from earlier procedures

Needs an in-person exam

• How thick the fat is (pinch test)
• Skin elasticity and how much skin may remain
• True fat versus a bulge from buttock weight
• Adhesions or firm areas from earlier surgery
• Health conditions and clot risk

Helpful photos are taken standing, from the front, both sides and the back, in even light and at the same distance. Leave the areas uncovered as far as you are comfortable. If you have had liposuction before, include photos from before that operation if you have them. You can send us a message with your photos, the areas you want to change, and any earlier surgery.

Planning your visit and recovery

What is confirmed in advance is the treatment information above: surgery under sedation with local anesthesia, usually going home the same day, stitches, and a compression garment afterward. How long you should stay in Seoul, when you need to come back for checks, and how long to wear the garment depend on the areas and volume. These are planned with you at consultation.

Long flights and surgery each increase the risk of blood clots, and combining the two raises it further. As general guidance, the American Society of Plastic Surgeons suggests waiting five to seven days after body procedures such as liposuction before flying.⁶ This is a general guide, not a date we can set in advance. When you can travel is decided with your surgeon according to the extent of surgery, your clot risk and how you are recovering. Walking early and regularly during recovery is encouraged to lower the risk of clots.²

After you return home, contact a doctor promptly for breathlessness, chest pain, calf pain or swelling, or a wound that becomes red, hot or starts to discharge.¹ Keeping dated photos of your recovery, and the record of what was done, is useful for any doctor who sees you later.

Real treatment cases

These cases appear on Bonita Clinic's liposuction page. Results vary from person to person.

Thick abdomen and waist (front view)

Lower abdomen that looked pushed forward (angled view)

* Results vary from person to person. Side effects are possible, so please decide after a thorough consultation with a doctor.

Frequently asked questions

Will I lose a lot of weight?

Liposuction is not a weight-loss operation. The aim is a change in the proportions and line of areas such as the waist and thighs, not in the number on the scale. Weight gain after surgery can make the remaining fat grow, so keeping up your eating and exercise habits helps protect the result.²

Will my skin sag after liposuction?

It can, depending on how much is removed and how elastic your skin is. If your elasticity is reduced, we tell you beforehand that some skin may be left over.⁴ If sagging is expected, we explain it before surgery and decide whether to tighten with Renuvion at the same time. When there is a lot of loose skin, skin-removal surgery may be the better option.

I'm worried the area will become lumpy.

The surface depends on how evenly the remaining fat layer is left. For several weeks after surgery, firm swelling can feel uneven. If unevenness remains once the swelling has settled, whether it can be corrected is judged after waiting at least six months.⁴ Irregularities left by an earlier operation are first checked to see whether revision can correct them.

How long do I wear the compression garment?

It depends on the area and the extent of surgery, and we tell you before the operation. In general, compression garments and elastic stockings are used for several weeks after surgery.¹ A garment that fits poorly or leaves creases can cause surface irregularities, so we also show you how to wear it.⁴

Can I combine liposuction with other surgery on the same trip?

It is possible in some cases, but combining operations raises the risk of major complications compared with liposuction alone.⁵ Whether to combine, stage or limit the scope is decided together at consultation, taking your health and travel plans into account.

What to prepare before your consultation

• The areas you want to reduce and any areas you would like fuller
• Any previous liposuction or fat grafting: when, where on the body, and what method
• Weight changes over the last year or two, and whether you plan to lose weight
• Medicines you take (including blood thinners, the contraceptive pill or hormones) and whether you smoke
• Your travel dates, if you are coming from abroad

Bonita Clinic is on the 3rd floor of 565 Gangnam-daero, Seocho-gu, a walk of about 100 m from Exit 8 of Nonhyeon Station on Line 7. For the treatment itself, see our liposuction page and the body contouring center; for planning around a short schedule, see the one-day liposuction page and the guide to one-day liposuction.