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Swine Sign

A Valuable Audible Sign in Liposuction

van der Lei, Berend M.D., Ph.D.; Smittenberg, Marije M.D.

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Plastic and Reconstructive Surgery: February 2014 - Volume 133 - Issue 2 - p 234e-235e
doi: 10.1097/
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Liposuction is a very commonly used procedure in plastic surgery. In general, this procedure is used to contour and thin certain areas of the body without taking out too much, as this may lead to unwanted irregularities and depressions. The result is determined not by the amount of fat sucked out but by the amount of fat left behind and the even distribution of it. However, in some procedures, liposuction is used to get rid of as much fat as possible (e.g., in the planned area of a dermolipectomy of an arm or leg, where skin excision can be performed only after thorough liposuction of the planned redundant area; or in the lower abdominal region beneath the Scarpa fascia, so that the Scarpa fascia can be saved without too much fat left beneath in the liposuction abdominoplasty procedure).1

The problem in these examples might be determining the endpoint of liposuction, when almost all fat has been sucked out; thus, the question during such a procedure will be what the right moment is at which to stop liposuction without leaving too much fat. During such procedures, we always noticed an audible sign that helped us in making the decision to stop liposuction because of an ample amount of remnant fat: this audible sign is a sound made by the liposuction cannula when there is almost nothing left to suck anymore in the treated area. This sound resembles the sound of a child that is finishing his or her soft drink with a straw, or the sound of a pig or a swine that is eating from a trough. When this sound is heard, we stop the liposuction procedure in these specific indications, and always have observed that there is almost no fat left that should have been sucked. Because of this experience, we would like to advise that this “swine” sign be used as a cue during the specific liposuction procedures to help deciding when one has reached the moment to finish the procedure when almost all fat has been sucked out. (See Video, Supplemental Digital Content 1, which demonstrates the swine sign, a valuable audible sign during liposuction,

Supplemental Digital Content 1 demonstrates the swine sign, a valuable audible sign in liposuction,


The authors have no financial interest to declare in relation to the content of this communication.

Berend van der Lei, M.D., Ph.D.

Marije Smittenberg, M.D.

University Medical Centre Groningen

Groningen, The Netherlands


1. Brauman D, Capocci J. Liposuction abdominoplasty: An advanced body contouring technique. Plast Reconstr Surg. 2009;124:1685–1695


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