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liposuction techniques

Once you have decided that liposuction is for you, you will find a variety of techniques performed. In the past, liposuction was performed under general anesthesia to prevent pain (the patient is unconscious), with the surgeon mechanically breaking up the fat with a long hollow tube known as a cannula, and suctioning the fat out from as few incisions as possible. This procedure is called "suction-assisted liposuction", or SAL.

tumescent liposuction

A safer technique called tumescent liposuction has revolutionized liposuction and become the standard type of liposuction performed today. Tumescent anesthesia is a technique commonly used for liposuction whereby a solution of Lidocaine, Epinephrine, and saline (salt water) is injected into the surgical area. (The term tumescent, meaning swollen or puffy, comes from the appearance of the area immediately after injection, before the medicine is absorbed into the surrounding tissues. The volume of fluid injected is sometimes up to three times the amount of fat to be removed.)

The saline helps to separate the tissues, making the dissection less traumatic. Epinephrine causes the tiny blood vessels in the area to constrict, minimizing bleeding and bruising. Lidocaine numbs the area to provide pain control. With this technique, large volumes of anesthesia are used in much lower concentrations. This means that a large area can be anesthetized with significantly less anesthesia than the traditional infiltrative method, and the risk of Lidocaine toxicity is greatly reduced.

This fluid separates the tissues, reduces bleeding, and allows the cannula to move easily under the skin during the procedure. Since only the area to be operated upon is anesthetized, this enables the patient to sit or stand during the procedure, allowing the doctor to make sure the contour is even and smooth in various positions. Tumescent liposuction using local anesthesia is often times used in combination with IV sedation to improve your comfort.

Following the operation, some of the tumescent solution will remain inside the body, which will gradually be absorbed or will drain out of the incision sites. Compared to traditional liposuction techniques, tumescent liposuction is much safer, with much less blood loss during the procedure (eliminating the need for a blood transfusion), and a reduction in post-operative bruising, swelling, and pain, resulting in a faster recovery.

Tumescent liposuction does not require a hospital stay, and since general anesthesia is not used, anesthesia-related complications are greatly reduced. After tumescent liposuction, the treated area remains fairly numb for up to 24 hours following the procedure, greatly minimizing post-operative pain without the nausea and fogginess that usually follows general anesthesia.

wet liposuction and super wet liposuction

Traditionally, liposuction was performed by suctioning fat out without first instilling any fluids. With the wet method, some fluid containing saline and adrenaline (to control bleeding) are first instilled. Because the wet method of liposuction does not include instillation of anesthetic, IV sedation or general anesthesia is required. (Tumescent liposuction involves larger amounts of fluids to help prevent a fluid shift - see risks of liposuction - and also contains Lidocaine as an anesthetic).

A variation on tumescent liposuction is the "super-wet method". The difference is that less fluid is injected into the area to be operated on, usually equal to the amount of fat to be removed. The disadvantage of super-wet liposuction is that it causes about 8 times greater blood loss when compared to tumescent liposuction. However, since there is less fluid being injected, the chance of pulmonary edema (a build-up of fluid in the lungs) is greatly reduced, and compared to the tumescent technique, this method is faster to perform.

ultrasonic liposuction (ual)

Another technique called Ultrasonic Assisted Liposuction (UAL) was invented as an improvement over the tumescent technique, and has become fairly popular. During this procedure, ultrasound waves are used to assist in breaking up the fat to make it easier to remove. The sound waves affect the fat in two ways: mechanically, by literally shaking it apart; and thermally, by heating it up. Together, they also emulsify the fat, turning it into a liquid state. Once the fat is treated with ultrasonic waves, a suction cannula is used to remove the fat. UAL causes much less bleeding than even tumescent liposuction, and is particularly effective in areas with very fibrous fat, such as in some regions of the back, and in cases of gynecomastia (fatty tissue in the male breast). This procedure takes longer to perform than tumescent liposuction and sometimes requires leaving drains exiting through the skin for a few days. There have been reports of increased complications with UAL. Because of the sonic energy and use of heat in this procedure, there is a possibility of skin burns and fluid accumulation under the skin (seroma). The risks are greatly reduced when the UAL is performed by a surgeon experienced with the equipment.

VASER-Assisted Lipoplasty (VAL)

LipoSelectionSM only by VASER(r) represents a major advance over
traditional liposuction and earlier-generation UAL by combining advanced
technology and optimized surgical techniques.

The LipoSelection procedure uses ultrasound energy to selectively break
up and remove fat deposits from the body. Fatty tissue contains a large
percentage of fat cells as well as blood vessels, nerves and connective
tissue. Ultrasound energy provided by the VASER selectively breaks up
and emulsifies fat, while leaving those other tissues relatively intact.
Because of this, LipoSelection typically results in low to minimal pain
and low incidences of bruising or prolonged swelling and healing time.

During the LipoSelection procedure, small incisions are made in the area
to be sculpted. Through these small incisions, the area is infused to
numb the site, shrink blood vessels, and enhance emulsification. A small
ultrasound probe is then inserted to break down and permanently destroy only the fat. Emulsified fat is then readily removed with suction and massage. Physicians are able to sculpt stubborn areas and achieve
smooth, predictable results.

microliposuction

Microliposuction refers to the the removal of small areas of fat through tiny tubes and very small incisions. Microliposuction is commonly performed on the face, especially the cheeks, neck, under the chin, and the jowls. When liposuction is done on other small pockets of fat using tiny cannulas, it may also be referred to as "micro liposuction".

Cannulas used to remove the fat range in diameter from 1.5mm to 6 mm in diameter. In general, smaller cannulas are preferable to larger ones for smaller areas (such as with microliposuction), and for more refined contouring. Larger cannulas speed the surgery for the doctor, but may put the patient at greater risk for rippling and lumpiness. Sometimes, a larger cannula will be used initially to remove the bulk of the fat, and then progressively smaller cannulas employed for fine contouring and sculpting.

power assisted liposuction (power lipo or PAL)

Another variation of liposuction surgery is Power Assisted Liposuction (PAL). With PAL, the cannula vibrates at a very high speed, loosening fat cells so they can be suctioned with less trauma to the surrounding tissues. As a result, bleeding, bruising and recovery time are reduced. The PAL is also physically easier for the surgeon to perform without tiring, as the vibrating cannula assists with the mechanical work. PAL has been found to be especially beneficial in fibrous areas such as the back and flanks, and in areas with scar tissue from previous liposuction surgery.

large volume liposuction (liposuction for weight loss)

You may be considering liposuction for weight loss rather than spot reduction of localized accumulation of fat. Because of the dramatically larger volume of fat removed, "large volume liposuction" varies greatly compared to normal tumescent liposuction. The American Society of Plastic Surgery generally considers any liposuction procedure where more than 5 liters of liquid removed from the body as large volume, usually equal to about 6 pounds of fat. This procedure can remove at least 10-12 pounds of fat from a person 30 pounds overweight. Taken from specific areas to re-contour the body, this may result in a reduction in 1-2 clothing sizes, even without any extra weight loss from diet or exercise.

With large volume liposuction, it may be possible to reduce waist size by up to 6 inches. Because of the complexity, length, and much increased trauma of this procedure, large volume liposuction is done at a hospital, general anesthesia is almost always used, and several nights stay may be required. Compared to the local anesthesia used in tumescent liposuction, general anesthesia has a dramatically higher rate of complications. The recovery time of this procedure is also much longer; most patients take at least 1-2 weeks off from work. Due to the amount of fat removed, and depending on skin elasticity, saggy or loose skin may result. If this occurs, patients may also need a tuck or lift on the affected areas to remove loose skin.

Despite the often excellent results liposuction yields, it is important to remember that liposuction is not a solution for obesity. For outpatient surgery, about 4.5 pounds of fat is the maximum amount that can be safely removed at once from the body. More can be removed with large volume liposuction, requiring a hospital stay and deeper anesthesia.

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