David B. Reath, MD
Knoxville, TN (865) 450-9253
HKB Knoxville Staff

The Real Skinny on Liposuction

Liposuction 101

Anyone who reads a magazine, listens to the radio, and watches TV here in Knoxville is being inundated with information about the latest and greatest technique of liposuction.  Without knowing much about the different claims, it would seem that each year the technology is being completely reinvented. I thought it might be helpful to give you some background information about the different techniques so you can make an informed decision about what is right for you.

Liposuction: Back to Basics
Liposuction has been around for about thirty-five years, in one shape or form. With its inception, plastic surgeons were able to remove large amounts of fat through very small incisions by introducing cannulas that were attached to a suction device.  This became known as suction assisted lipectomy (SAL).  We now take this pretty much for granted, but it was a real innovation when it was first introduced.

Tumescent Liposuction
One of the first innovations, which in used in virtually all liposuctions, is the tumescent technique.  This technique introduced fluid into the tissues prior to the liposuction.  Usually there is also some local anesthetic mixed in with the fluid to help with pain relief.  Additionally, small amounts of epinephrine (adrenaline) are mixed with the tumescent fluid to reduce bruising and blood loss.

Alphabet Soup:The Different Techniques of Liposuction

Several different techniques have been introduced over the years.  Some involve different technologies, and some are variations on the basics of the original technique.  All use the tumescent technique as the first step of the operation, and basic liposuction as the final step.  The difference in many of these techniques is the energy used to remove the fat, or move the cannulas within the tissue during the suctioning.  In SAL (suction assisted lipectomy, or traditional liposuction) it is the strength of the surgeon that moves the cannula through the tissue to remove the fat.  This is why I go to the gym to lift weights!

Ultrasound Assisted Liposuction
In the early 1990’s, an Italian surgeon, Michele  Zocchi, began to work with ultrasound as an adjunct to liposuction.  This technique became refined, introduced into this country in the mid 1990’s and has become known as Ultrasound Assisted Liposuction (UAL). After the tissues are tumesced, a cannula emitting ultrasonic energy is introduced into the tissues.  This energy breaks up, or emulsifies the fat to assist in its removal.  This is very effective in most areas, and is of greatest benefit in areas where the fat is very dense, such as in the chest or abdomen.  After the fat is emulsified or broken up, it is removed with traditional suction cannulas, SAL. I had the pleasure of taking several courses taught by Dr. Zocchi and become intrigued with this method.  Subsequently, I became the first plastic surgeon in East Tennessee to perform UAL, and have been doing so for about twelve years.  I continue to find this to be an excellent method of liposuction, and use it in most of my liposuction cases.


Vaser Liposuction

About six years ago, another device for ultrasound assisted liposuction was developed and marketed: VASER liposuction.  The technology behind this machine is virtually identical to other UAL machines.  I have used this machine and believe it is a good device.  However, I prefer the other UAL device that I have been using.  Other surgeons prefer the VASER device.  A marketing gimmick associated with VASER has been to use the term liposelection.  To me, this term is meaningless, as in all liposuction cases the surgeon must be careful to determine which fat is selected for removal, and which fat should be left in place.


Power Assisted Liposuction

Towards the end of the 1990’s, after UAL had come into clinical use, another form of liposuction was developed: power assisted liposuction (PAL). In this, the cannula is moved back and forth in the tissues driven by a small motor.  I have also used this machine and have found it to be effective.  It’s main advantage is that it takes less strength on the part of the surgeon as opposed to SAL. Like UAL, this is very effective in areas where the fat is dense.  In some cases, I continue to use this in combination with UAL and SAL.

Laser Assisted Liposuction aka “Smart Lipo”

The latest addition to the liposuction arena is laser assisted liposuction (LAL). This uses laser energy to disrupt the fat cells to assist in their removal.  The laser itself is introduced within a specialized suction cannula.  A very good scientific study compared this method, LAL, to traditional SAL.  There was no difference seen in the results or the time of recovery.  The only real difference seen was that the laser assisted liposuction took a bit more time in the operating room.  Further, there is a risk of burns to the skin due to the heat generated from the laser. As you might expect, there has also been some marketing hype with this technology.  The proponents of this have termed this term “Smart Lipo”. It occurs to me that the machine for this type of liposuction is quite expensive, as all lasers are.  Who do you think will end up paying for the cost of this machine?


Liposuction: The Bottom Line:

So what is one to make of all these different technologies?  Which is the best, and which of the claims of superior technology should you be listening to?  Frankly, you can have a good result from any of these techniques, and you can have less than optimal results with any of these techniques. What matters most is how well the technique is performed which is ultimately dependent upon the surgeon on the other end of the suction cannula.  What you should be looking for, when considering liposuction, is a board-certified or board-eligible plastic surgeon with a wealth of experience with liposuction.  It is this experience that will guide the surgeon in knowing how much fat to remove from which area(s), which technology to use, and whether or not liposuction is the best treatment for the area of concern.

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