There have been many modifications in liposuction equipment over the years. All are variations on the theme of a metal tube being placed in the area of concern and a vacuum pump aspirating the unwanted fat. This is referred to as “suction assisted liposuction.” Tumescent super-wet technique is almost always used, which means that a dilute solution of lidocaine and epinephrine are instilled into the subcutaneous tissue first. Tumescent fluid infiltration improves the safety of liposuction by preventing blood loss and increasing comfort to the patient while increasing the dimensions of the fatty space for safe cannula passes.
Various adjuncts have been added to this basic construct to improve results. These include, for example, technology to liquefy the fat (ultrasound) or melt it (laser). These newer technologies introduce additional variables into the procedure and therefore can have the potential for more complications. True of many technologies that are designed in the hope of expanding market share, aggressive marketing by the manufacturer generates a patient-driven demand for specific approaches. Patients should discuss the choice of technique in detail with their surgeon. Newer is not necessarily better. A board certified plastic surgeon can help you determine which approach is right for your specific body type and needs.
Tumescent Technique – The tumescent technique is a method that infiltrates a dilute solution of epinephrine and local anesthesia to the subcutaneous fat prior to any fat removal. The fluid is called tumescent fluid, and it prevents bleeding problems while adding to patient comfort. Super-wet means that the volume of tumescent fluid going in is similar to the amount of fat taken out. The American Society of Plastic Surgeons Practice Advisory Committee has recommended the use of the super-wet tumescent technique for safe liposuction.
Ultrasonic (UAL) – Ultrasonic Assisted Liposuction (UAL) requires the use of super-wet tumescent technique and uses a metal probe to deliver ultrasonic energy and heat into subcutaneous fat. The fat is liquefied as a first step, then immediately evacuated with blunt cannulas and a vacuum pump like any other standard liposuction procedure. It is indicated in areas of dense or fibrous fat, or in areas that have previously been treated with liposuction, when there is scar tissue in the subcutaneous tissues. In these situations, the blunt cannulas have a hard time passing through the tissue, and the ultrasound probe facilitates even passes with less resistance, so that the fat can be removed, and the desired results obtained. The male chest (gynecomastia) and the upper back are areas that have very dense and fibrous fat with thick overlying skin. The ultrasonic technique assists with fatty tissue extraction in these hard-to-treat areas, so that noticeable contour improvements are obtained. It is generally not recommended in other areas, as the fat in other areas such as the abdomen and thighs sucks out easily, and adding the element of heat to these areas increases complications such as fluid collections, burns, and contour irregularities.
Vaser Liposuction – Vaser liposuction, also called LipoSelection, is another ultrasonic liposuction technique. It is a 3rd generation ultrasonic liposuction machine. The Vaser equipment is made by Sound Surgical in Colorado and you can read about it on their website, www.vaser.com. I have used it and get the same results across the board with the various ultrasonic liposuction devices available. Remember, it’s not technology; it’s the skills of your surgeon.
Power Assisted Techniques (PAL) – PAL devices use power supplied by an electric motor to vibrate and motor the liposuction cannulas. It is my personal preference to use power-assisted cannulas for fat removal. It improves the efficiency of fat removal, while reducing the length of the procedure.
Laser Liposuction – Laser Liposuction also requires the use of tumescent fluid and uses a small cannula inserted through a small incision to deliver laser energy and heat and liquefy subcutaneous fat. It is similar in a way to ultrasonic technique; only it uses a laser instead of ultrasound to liquefy the fat at the first stage. The fat is immediately extracted by cannulas and a vacuum suction pump, just like all of the other techniques. There are a number of different types of liposuction that use laser assistance, known by the brand names SmartLipo, CoolLipo, LipoLite, LipoTherme, and ThinLipo, among others. These procedures differ in the wavelength and intensity of the laser light used. The companies who sell these pricey lasers also advertise that the laser energy may also help to tighten loose skin or reduce the appearance of cellulite, which has not be proven. They also advertise less downtime, better results, and safety for use in the office setting. This is simply NOT TRUE. Safety comes from using a board certified plastic surgeon and a fully accredited operating room with board certified anesthesiologists. Life threatening complications are reported on a regular basis when this technology is used in an office setting by untrained practitioners. There are also additional risks due to the use of laser energy; these include burns, contour irregularities, and damage to vital structures. In addition, laser assisted liposuction treatments often take longer because of the time required to pass the laser device over the skin, followed by the same evacuation process with traditional liposuction.
Water Jet Assisted Liposuction – Water jet assisted liposuction is another method of liposuction being used by cosmetic surgeons today. Water jet assisted liposuction actually uses a slightly pressurized stream of saline to dislodge fat and simultaneously remove the cells. Instead of destroying fat cells, this type of liposuction loosens the fat cells to facilitate more gentle removal. Water assisted liposuction techniques, such as Water-Jet and Body-Jet liposuction, use a stream of high-pressure water to break up the fat. Then, the water and fat are suctioned out. It is thought that this method may reduce trauma to surrounding tissues and lead to a shorter recovery period. However, there is little conclusive data about the safety and efficacy of this method. As with lasers, it is expensive due to the high cost of specialized equipment.
When considering the various techniques or technologies for liposuction, it is important to realize that it’s the practitioner and not the tools that give you the good results. Just like when you go to an experienced hairdresser and get a great haircut regardless of whether they use scissors, a razor, a blow dryer, or any other styling device. If you go to a terrible hairstylist with no training, you are doomed regardless of the method.
Smooth skin retraction is also mostly related to an individual’s inherent skin elasticity and tone, and not the technology being used. With a well-trained, experienced liposuction surgeon, you can get good results with any of the instruments or techniques. If there were one instrument or technique that was by far the best, then everyone would be doing it the same way. I would be doing it that way. The goal is to remove the fat safely in a smooth and even fashion, with minimal downtime and low risk of complications. Do a little research and choose your liposuction doctor based on credentials, board certification, and referrals, not the fancy laser that they are advertising. If I owned a $200,000+ laser, I would need to do some heavy advertising too…to make the monthly payments on the laser.
Dr. Hayley Brown MD, FACS
Plastic Surgeon in Las Vegas
Desert Hills Plastic Surgery Center, Henderson and Las Vegas, Nevada
