If you're like me, you've got a lot of back up plans. Things like: if exercise doesn't work, there's always lipo. Maybe it's just my way of whistling in the dark, but deciding that I could deal with even the worst-case scenarios does make me feel better. And then I see an article informing me that liposuction patients should be within five or ten pounds of their ideal body weight, and I realize that maybe that particular backup plan might not be so useful after all.

Liposuction is an amazing procedure, but it does have limits. And like most plastic surgeries, the techniques seem to be continually changing, expanding, and improving. Well, some of them at least.

Think Inches, Not Pounds

"The most important thing to realize is that liposuction is not for weight reduction but body resculpturing," says Dr. Barry Lycka, founder of the Canadian Skin Cancer Foundation and the Ethical Cosmetic Surgery Association. When patients ask him how much weight they will lose, he ignores the question. "It's not a matter of weight," he says, "but inches."

In short, don't expect liposuction to fix extreme weight problems. What it will do, however, is help your jeans fit better by targeting specific areas. "Spot reduction" is the best way to describe it, and Dr. Lycka assures me you can see dramatic results from the removal of less than a pound of fat. In today's market, this translates as "not liposuction, but lipo-sculpture."

Ready to Wake Up Beautiful?

Another important consideration is how the procedure will be done, and whether the surgeon plans to use general or local anesthesia. In the mid-80s, all surgeons put their patients under general anesthesia, which caused a lot of bleeding, often required blood transfusions, and carried bigger risks than today's liposuction. In fact, in the early days, "we removed almost as much blood as fat," explains Dr. Lycka.

In 1989, doctors started using local anesthesia, and began performing what is called tumescent liposuction. The risks went down, along with the recovery times. Today, most doctors use local anesthesia, but it is definitely something you should ask about. Avoiding blood transfusions is particularly important, because while national blood banks are far safer than they used to be, transfusions do carry the inherent risk of disease.

Melt, Cut, or Dissolve?

Traditional liposuction cuts the fat cells away from the skin and removes them through a suctioning process, but there are many other options to consider, such as ultrasonic, thermal, chemical, and laser liposuction. The sheer number of options can be confusing.

Lipodissolve is one option. In this procedure, a chemical is injected into the skin that emulsifies fat cells, which are then eliminated through the patient's stool or urine. A similar procedure is called Lipsonix, which uses ultrasound to melt fat. These non-invasive techniques sound terrific at first glance, but some doctors aren't so sure.

"We're cautioning against it at this point," says Dr. Craig Vander Kolk, professor of plastic surgery at Johns Hopkins University School of Medicine. Dr. Vander Kolk believes further study is necessary to accurately determine how the body will handle absorbing the chemical and dissolved fat. He says we need further testing to see how the side effects-pain, swelling, and thickening-heal in the long-term. Another concern is that the doctor doesn't have as much artistic control over this procedure as they do with the traditional liposuction techniques.

Dr. Lycka tells me that he is concerned over the lack of control in thermal liposuction. While advertisements assure patients that the instrument will not burn them, Dr. Lycka says that he's leery about inserting a hot instrument into a cavity "where you can't see what's happening." The procedure was originally withdrawn due to side effects and malpractice complaints, but is back on the market. As with Lipodissolve, only time will tell.

Laser liposuction, however, is another story. Both of the doctors I interviewed agree that this procedure has great potential, especially for small areas. Laser liposuction is low-energy, less traumatic, and results in less bruising and swelling. In fact, Dr. Lycka says that laser liposuction has shortened recovery-time (including compression garments) to just five to seven days. In his estimation, most doctors have switched over to using mostly laser liposuction except when they are working on very large areas.

But It Doesn't Go With My Purse

Speaking of compression garments, you should know that liposuction does require careful recuperation. Even though the incision is small (only 1.5 millimeters for laser liposuction and a couple centimeters for traditional procedures), the affected area underneath the skin can be quite large. All this needs to heal, and while it is healing, it can involve extreme swelling, or "edema."

By pressing down on the skin, elastic surgical compression garments help reduce swelling and prevent the types of infection that can, in rare cases, cause the cells to die. Be prepared to wear these less-than-glamorous garments under your clothes for up to several weeks following surgery. If that doesn't sound fun, you may want to consider one of the smaller area, quick-recovery treatment options, like laser liposuction.

Can the Fat Come Back?

When I began my research, one of my biggest worries was that the fat could come back. Dr. Lycka explains that this won't be a problem. "Once the fat cells are gone, they're gone," he explains. It turns out that the body doesn't make more fat cells when you gain weight, the existing fat cells just get bigger.

If you gain weight after the procedure, it will probably be in other areas. In fact, some women notice that after having liposuction, their breasts can increase by up to a cup size. For some of us, that might be an unintended perk.

"Because it's so long-lasting," says Dr. Lycka, "the procedure has high patient satisfaction." There are even ways to treat cellulite with liposuction, which wasn't possible with traditional techniques. When a person gets cellulite, it's "five pounds of fat in a two pound bag," explains Dr. Lycka. Little tensors and connective tissues pull the top layer of skin down the bottom, resulting in dimpling, and resulting in very small pockets of fat. With laser liposuction, these little pockets can be targeted.

So What's It Gonna Cost Me?

Dr. Vander Kolk thinks of the future of plastic surgery lies in "tailoring of fat. Liposuction works great," he tells me, "and we know the risks." The risks do include an imbalance of fluids, infection, and embolism. And every surgery carries the risk of fatality, but these numbers are extremely low for liposuction.

In terms of financial cost, lipo varies widely according to surgeon, state, and specific body area being targeted. You may be able to spend as little as $2,000, but if you plan to have more than one area worked on, that number can jump to $20,000 or more. Be sure you do your research. So many procedures are called lipo: you need to know what you're getting. After all, you only get one body, no matter how many backup plans you have.