Liposuction Techniques

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All About Liposuction Techniques & Guidelines

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.

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Liposuction Techniques FAQ

What are the most common techniques for liposuction?
The most common liposuction technique currently is Tumescent Liposuction. Another technique is Ultrasound-Assisted Liposuction (or UAL). Somewhat newer than tumescent liposuction, this technique involves sending ultrasonic energy through a cannula to liquefy the targeted fat cells, thereby making them easier to suction out. A third common technique is Laser-Assisted Liposuction, otherwise known as SmartLipo. This technique utilizes low-energy waves to liquefy fat cells that are then removed using a small cannula.
What is Tumescent Liposuction?
Often viewed as the “gold standard” of the industry, Tumescent Liposuction involves the injection of a local anaesthetic (lidocaine), epinephrine (to reduce blood flow), and saline solution. The combination of the three causes the fat to swell and harden (otherwise known as becoming tumescent), which allows for easier removal by your surgeon.
What are the benefits of going with Tumescent Liposuction?
The use of the localized anaesthesia lidocaine in tumescent liposuction permits surgeons a window of 10 hours for surgery to safely take place, and includes the benefit of avoiding the post-operative nausea and vomiting associated with general anaesthesia. The tumescent solution also helps mitigate blood loss. This surgery, therefore, marks a large improvement in safety standards compared to older methods, which often caused such excessive blood loss that blood transfusions were urgently necessary. 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 anaesthesia eliminates pain during the surgery. This, in turn, helps avoid the danger of using a general anaesthetic.
What is Ultrasound-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 the targeted subcutaneous fat. The application of the ultrasound uses high-pitched sound waves to liquefy the 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.
What is 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 face, chin, and jowls.
What liposuction technique is right for me?
The liposuction technique chosen by you and your surgeon is dependent on factors including the volume of fat being removed and the targeted body area. For most procedures, Tumescent Liposuction will likely be chosen. However, for more difficult areas such as the chin, neck, cheeks, knees, calves, and ankles, your surgeon may recommend going with Ultrasound-Assisted Liposuction. In turn, for more visible areas such as chin, jowls, and face, Laser-Assisted Liposuction (SmartLipo) may be preferable for its precision.
Are more experienced surgeons more expensive?
Yes, but it is worth the investment. You should also note that surgeons commonly increase their fees after having had more than 5 years experience.
How long will does it take for liposuction incisions to heal?
The incisions are usually closed up within a week or two. They should be fully healed with no scabs 2 to 4 weeks following surgery and become progressively less visible over the subsequent 3 to 12 months, except for patients with darker skin (in which case the incision sites may stay visible for a year or two).
What is the safest technique for liposuction?
Most surgeons would consider Tumescent Liposuction the safest liposuction technique. Because tumescent liposuction uses a large amount of lidocaine, a local anaesthetic, you can typically avoid being put to sleep with a general anaesthetic, which carries substantially more risks of complications. Additionally, the use of epinephrine in tumescent liposuction constricts blood vessels and reduces blood loss, thereby minimizing the risk of bleeding out and the need for intravenous fluid replacement following surgery.
What’s the difference between Ultrasound-Assisted Liposuction and Ultrasound Fat Reduction?
Ultrasound-Assisted Liposuction (UAL) is a surgical procedure that involves inserting a cannula through an incision in the skin and then running ultrasonic energy through said cannula to liquefy undesired fat cells. This process makes the fat easier for your surgeon to suction out. By contrast, Ultrasound Fat Reduction is a noninvasive procedure where a metal paddle is applied to the fat layer of the targeted area. Ultrasonic energy is run through the metal paddle, theoretically causing the breakdown (or lipolysis) of the fat cells in the chosen area. Proponents of the ultrasound fat reduction claim that the impacted fat cells release triglycerides that are subsequently expelled naturally by the body, causing a visible slimming and contouring of the region. It is important to note that UAL and Ultrasound Fat Reduction are not effective means of weight loss.
Does liposuction use local or general anaesthetic?
In most cases, liposuction will only require a local anaesthetic. However, if you have a large targeted area or are removing a higher volume of fat, general anaesthesia (or being asleep) may be required.
Will I have to stay overnight at the hospital?
Typically, no. However, if you are having a large volume of fat taken out, your surgeon may advise you to stay overnight for observation and recovery.
What’s the difference between a cannula and a microcannula?
In liposuction, the cannula is a stainless steel tube inserted through an incision in the skin to reach undesired subcutaneous fat. A regular cannula has a diameter of 3mm to 6mm, whereas microcannulas run between 1mm to 3mm. Larger cannulas require larger incisions that may lead to visible scarring. Microcannulas reduce the risk of post-operative scarring and also allow for a more gradual, controlled removal of fat, thereby leading to overall smoother results. By contrast, larger cannulas may remove fat so quickly that they remove too much. While the aim of liposuction may be to get slimmer, this is still an undesired effect as it can lead to skin irregularities. Most techniques now utilize microcannulas.
Does any liposuction technique permanently remove fat?
Yes and no. Yes, the targeted fat removed with liposuction is taken out forever. However, this does not prevent fat from returning to the area. The only way to keep fat off the area permanently is through an exercise and dieting regime.
Do all liposuction techniques carry the same risks?
Most liposuction techniques carry similar risks of minor scarring along with temporary swelling, bruising, and soreness following surgery. Other risks include permanent colour changes in the skin (more commonly seen in patients with darker skin tones) and uneven skin surface. In the case of Ultrasound-Assisted Liposuction, there is the additional risk of nerve, skin, and tissue damage caused by the heat of the ultrasonic energy. Tumescent Liposuction also carries the risk of lidocaine toxicity, generally seen when more than one area is being treated at the same time. More extreme, potentially fatal risks, such as excessive blood loss, infection, or blood/ fat clots are more prevalent in patients who are removing exceptionally high amounts of fat.
Will my age determine the liposuction technique chosen?
Generally, age isn’t a consideration when determining what technique to go with, although if you are having a larger amount of fat removed, older patients will not have the same kind of elasticity as their younger counterparts.
Can liposuction be combined with other cosmetic procedures?
Absolutely. Many patients aiming for that “perfect body” will combine liposuction with other procedures such as a tummy tuck, breast reduction, or face-lift. The “mommy makeover,” for instance, is a mix of multiple cosmetic procedures—often involving liposuction, tummy tucks, and breast augmentations/lifts—which aims to restore women’s pre-pregnancy bodies.
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