Liposuction Techniques
Liposuction is a term that encompasses a variety of surgical procedures involving the removal of fat deposits from under the skin using a hollow stainless steel tube (otherwise known as a “cannula”) in conjunction with a powerful vacuum.
The cosmetic benefits of liposuction include improving one’s body shape in areas where dieting and exercise have not shown results. Such problem areas typically include the hips, thighs, buttocks, abdomen, and face. There are numerous liposuction techniques available ranging from those that are no longer considered safe (such as Dry Liposuction) to those that meet more current industry standards (such as Tumescent Liposuction).
Liposuction Techniques & Guidelines
Depending on the liposuction technique chosen and the amount of fat removed, the performing surgeon may choose to use either local or general anaesthetic. Patients removing smaller pockets of fat can have the procedure performed in a doctor’s office or clinic and return home on the same day, whereas a stay overnight may be in order for those removing larger amounts. Age is not typically a consideration in choosing a liposuction technique, although older patients may have less skin elasticity and consequently may not experience the same results as a younger person. Results are most often measured in terms of patient happiness as a function of safety, comfort (before and after surgery), finesse, and visible cosmetic improvement(s).
The fat cells are permanently removed during liposuction. Consequently, the weight gained following the procedure will typically not gather in the area performed. However, to maintain optimal results, patients should maintain a healthy diet and exercise regimen, as liposuction does not prevent future weight gain. Like any surgical procedure, liposuction carries certain risks, although these are minimized when it is performed by a specially trained, board-certified plastic surgeon.
Tumescent Liposuction
Tumescent Liposuction is the most commonly used technique of removing localized fat deposits with a high degree of precision and safety. In this form of surgery, the practitioner injects a large amount of lidocaine (a targeted local anaesthetic) and epinephrine (capillary constrictor) into subcutaneous fat (the fat that lies underneath several layers of skin and is an optimal region for surgery due to its low volume of blood flow). As a result, the targeted tissue becomes swollen and firm, and thus more easily extracted. The use of a localized anaesthetic such as lidocaine permits surgeons a window of 10 hours to perform surgery safely, and includes the benefit of avoiding the post-operative nausea and vomiting associated with general anesthesia.
In the past, liposuction often required blood transfusions because of the significant amount of blood loss. The dry technique, for instance, which does not inject fluids into the tissues, resulted in 20-45% blood loss. The wet technique, which injects 100-300 ml of saline into the tissues, helped mitigate the blood loss, reducing it to between 15-30%. This was still, however, a fairly high amount of blood loss. The tumescent technique is now the method of choice for liposuction, as it has reduced blood loss to as little as 1%. (Studies show that with the tumescent technique, blood loss generally ranges between 1-7.8%.) This surgery, therefore, marks a large improvement in safety standards compared to older methods.
The improvement in safety in this technique owes itself largely to the dilution of the lidocaine and epinephrine, a method that delays the rate at which the drugs are absorbed into the bloodstream. As such, the body processes the substances over a period of 24 to 36 hours, reducing potential toxicity. In the majority of cases, the localized anesthesia eliminates pain during the surgery. In a small percentage of instances, however, patients may experience varying degrees of discomfort during and following the procedure. Similar to other liposuction techniques, surgeons employ highly efficient tools called microcannulas to remove localized fat. These are stainless steel tubes possessing a diameter ranging from 1 mm to 3 mm. Since the microcannulas enter through incisions in the skin, patients benefit from their minute size, which minimizes the formation of large scars.
Ultrasonic Assisted Liposuction (UAL)
Ultrasonic Assisted Liposuction (or UAL) is a liposuction technique involving the use of a large amount of tumescent fluid (causing swelling in the tissue) in conjunction with a metal probe that delivers ultrasonic energy and heat into targeted subcutaneous fat. This technique utilizes the high-pitched sound waves of the ultrasonic energy to liquefy fat cells, making them easier for the surgeon to remove. This technique is particularly effective at aiding in the excavation of undesired fat from more difficult body areas such as the chin, neck, cheeks, knees, calves, and ankles. It is also popular for more conventional locations such as the back, sides, and abdomen. Ultrasonic Assisted Liposuction is often performed alongside Tumescent Liposuction, “tummy tucks,” and Body Lift Surgery for patients seeking more precise body contouring. Like other liposuction techniques, UAL is meant to help patients shape body areas not responsive to diet and exercise; UAL is not a method of weight control or a solution for obesity.
During UAL, surgeons first inject a tumescent fluid consisting of anaesthetic, saline solution, and epinephrine into the targeted area. This helps prevent fluid loss along with making the chosen fat deposits easier to remove. Following this, a thin metal tube (known as the cannula) is inserted through an incision to deliver the ultrasonic energy. The cannula liquefies fat cells on contact, making them easier to remove. It should be noted, however, that Ultrasound-Assisted Liposuction carries a high risk of full-thickness skin burns and scarring compared to other liposuction techniques because of the heat generated by the ultrasonic energy.
Ultrasonic Assisted Liposuction should not be confused with Ultrasound Fat Reduction, which is a nonsurgical technique involving the application of a metal paddle to deliver ultrasonic energy to the fat layer below the skin, causing the breakdown (or lipolysis) of the targeted fat cells. In the latter procedure, fat cells release triglycerides that are expelled naturally by the body, causing a visible reduction of fat in the treated area.
Laser-Assisted Liposuction (SmartLipo)
Laser-Assisted Liposuction was introduced as an alternative to the manual methods of Tumescent liposuction. This technique employs a thin laser fiber that enters through an incision in the skin and applies bursts of low-energy waves to liquefy fat. Among the most noted advantages of the laser-assisted technique over traditional methods is its ability to target specific areas, a precision afforded by a smaller cannula (the metal instrument that houses the laser itself). Due to the specificity and control provided by laser-assisted liposuction, many plastic surgeons choose it for especially visible areas of the body, such as the chin, jowls or face. Another advantage of the cannula’s smaller diameter is that practitioners are able to make smaller incisions and in doing so decrease the size and frequency of scars.
Similar to other liposuction techniques, laser-assisted liposuction begins with the application of a tumescent solution (consisting of anesthesia, saline, and epinephrine), followed by the breakdown of fat, a process referred to as “laser lipolysis.” The surgeon will typically move onto standard liposuction in order to vacuum up or “aspirate” the liquefied fat, although suction is not employed in all surgical cases.
Proponents of laser-assisted liposuction claim that it involves less bruising and a quicker recovery time compared to other liposuction techniques. Surgeons will often apply lasers engineered to coagulate small blood vessels; this strategy has been proven to help bruising. Lasers may also stimulate the production of collagen and elastin, tissues that help firm and tighten skin. Further advancements in laser-assisted liposuction are emerging as a wider range of wavelengths are becoming available.
It is important to note, however, that while the laser energy of this procedure is designed to exclusively target fat cells, it may also apply heat to the surrounding tissues. This exposure may cause side effects such as swelling, bruising, burns, numbness, and minimal bleeding.