Invasive cosmetic surgery procedures are no longer rare, and there are numerous private clinics and public hospitals that provide such services.

Last month, the Ministry of Health (MOH) introduced draft regulations on liposuction, which is considered a high-risk aesthetic treatment.

According to the MOH guidelines, general practitioners can carry out liposuctions that only involve removing less than a litre of fat under local anaesthesia. Any procedure which removes more than a litre of fat, or which is carried out under general anaesthesia, can be performed only in an ambulatory surgery centre or a hospital.

MOH also introduced a minimum 'cooling off' period of 15 days, in which the patient is given time to reconsider the procedure, as well as basic requirements for doctors who wish to perform liposuction.

However, although the media spotlight has been on liposuction, not much has been said about the actual procedure itself.

Liposuction, invented by Yves Gerard Illouz in 1977, removes excess fat deposits from the body, said Dr Jane Lim, senior consultant in the Division of Plastic, Reconstructive & Aesthetic Surgery, Department of Surgery at the National University Hospital.

She emphasises though that liposuction should be coupled with a healthy lifestyle, as 'it is not a treatment for weight control, obesity or stretch marks'.

The removal of fat is done by making small incisions, usually no more than 2cm long, in the area to be treated.

Using cannulas (hollow tubes) of varying sizes and configuration, the fat is then aspirated, said Dr Lim.

While the ultimate aim of liposuction is to sculpt the body by removing excess fat, there are different methods that can be used.

These methods are categorised by the amount of liquid injected into the patient before the removal of fat, as the liquid serves to reduce blood loss, reduce bruising and make it easier to remove the fat cells.

Dry liposuction: No fluid is injected. This was the earliest method used, but is hardly practised today.

Wet liposuction: A mix of a local anaesthetic, adrenaline (which constricts the blood vessels to minimise bleeding) and saline solution - less in volume than the amount of fat to be removed - is injected.

Super-wet liposuction: The volume injected is roughly equal to the amount of fat to be removed; the patient would need to be under general anaesthesia, or sedated. This is the preferred method for high-volume fat removal.

Tumescent liposuction: The amount injected is roughly three parts to one part fat, which creates more space for the cannula to manoeuvre. This is the only method which does not require general anaesthetic.

Liposuction usually takes one to two hours per area and most patients do not need to be hospitalised unless there is a medical illness that needs observation or complications arise, said Dr Lim.

Although the liposuction process may be quick, there are side-effects and risks.

After the procedure, it is common for pain, bruising and swelling to occur around the site, although these will eventually subside.

The complications that could result from liposuction, however, could potentially be fatal.

The patient may have 'unexpected reactions to anaesthetic agents, medications or fluids used', said Dr Lim.

Also, the patient could develop deep vein thrombosis, known colloquially as 'economy class syndrome'. This happens when passengers, who spend long hours in cramped airplane seats without adequate movement, develop blood clots in a deep vein.

These blood clots can be fatal if they are dislodged and travel to a vital organ.

There is also the risk of fat embolism, when the fat 'gets into the blood vessels, travels to the lungs and causes a blockage. This is a potentially fatal event', said Dr Lim.

But though the risks of liposuction are well-known, there are still people who choose to undergo it. Most refuse to talk about it though.

But Ms Sarah Fitzgerald, 31, agreed to speak to Mind Your Body. Her liposuction was performed six months ago by Dr Martin Huang of The Cosmetic Surgery Clinic at the Paragon.

'I'm actually quite slim, and I go to the gym and eat well. I just had these stubborn fat deposits that I couldn't get rid of,' she said.

She had liposuction performed on her 'saddlebags', or hips and upper thighs.

Although the area was tender for about a week after the surgery, she said she is 'really, really pleased with the results'.

'I'm more confident in a bikini now,' said Ms Fitzgerald, who went from an 'almost-size-10' to a 'regular UK size 8.'

She has no regrets and said that she would do it again in a heartbeat.

This article was first published in Mind Your Body, The Straits Times on May 7, 2008.