About the Procedure

Liposuction is one of the most commonly performed cosmetic procedures all over the world, and is in fact the commonest performed Cosmetic Surgery procedure in the United States.

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It is a procedure by which fat is removed from the layers under the skin and through small cuts made in inconspicuous areas, using a vacuum suction cannula.  It is aimed at removing local areas of fats which are resistant to dieting or exercise, and is meant to be a body-contouring procedure, and not for weight loss.

 

History of Liposuction


The history of liposuction is a long one, dating back to the 1920s where disastrous results were obtained by the earliest attempts at removing fats from the body.  Over the years, the procedure evolved and improved in both safety and science.  In 1974, Dr. Giorgio Fischer, a gynecologist from Rome, Italy, invented the liposuction procedure.

Subsequent developments in the technique of liposuction involved the use of blunt cannulas instead of sharp cannulas which were safer to use and had fewer complications of accidentally damaging blood vessels and nerves.

In recent times, the addition of different technologies to assist liposuction such as the use of lasers and ultrasound have greatly improved the safety profile of the procedure and driven the procedure further into the mainstream.
Types of Liposuction
Liposuction can be classified by the method of injection and by the method of liposuction.
Different Injection Methods
Dry liposuction
The dry method does not use any fluid injection at all. This method is seldom used today.
Wet liposuction
A small amount of fluid, less in volume than the amount of fat to be removed, is injected into the area. It contains lidocaine as a local anesthetic, epinephrine to contract the blood vessels and thus minimize bleeding, and a salt solution to make it saline, like bodily fluids. This fluid helps to loosen the fat cells and reduce bruising. The fat cells are then suctioned out as in the basic procedure.
Super-wet liposuction
In this method, the infusate volume is in about the same amount as the volume of fat expected to be removed. This is the preferred technique for high-volume liposuction by many plastic surgeons as it better balances homeostasis and potential fluid overload (as with the tumescent technique). It takes one to three hours, depending on the size of the treated area/ areas. It may require either IV sedation as well as the local lidocaine, or complete anesthesia.
Tumescent liposuction
Tumescent liposuction is the precursor of wet liposuction. The surgeon injects a solution containing a local anesthetic and vasoconstrictor (often lidocaine and epinephrine respectively) directly into the subcutaneous fat to be removed. The volume of fluid creates a space between the muscle and the fatty tissue allowing more room for the cannula. Despite a potentially large total volume of local anaesthetic injected into the tissue, absorption by the body is spread over 12–36 hours because of the vasoconstrive effect, and systemic toxicity from lidocaine is rare.
Laser assisted liposuction
Laser assisted liposuction which uses thermal energy to affect lipolysis has involved either of the Erchonia or Nd:YAG powered devices.
Mechanism of liposuction
Suction-assisted liposuction (SAL)
Suction-assisted liposuction is the standard method of liposuction. In this approach, a small cannula (like a straw) is inserted through a small incision. It is attached to a vacuum device. The surgeon pushes and pulls it carefully through the fat layer, breaking up the fat cells and drawing them out of the body by suction.
Ultrasound-assisted liposuction (UAL)
In ultrasound-assisted or ultrasonic liposuction, a specialized cannula is used which transmits ultrasound vibrations within the body. This vibration bursts the walls of the fat cells, emulsifying the fat (i.e. liquefying it) and making it easier to suction out. UAL is a good choice for working on more fibrous areas, like the upper back or male breast area. It takes longer than traditional liposuction, but not longer than tumescent liposuction. There is slightly less blood loss. There appears to be slightly more risk of seromas forming (pockets of fluid) which may have to be drained with a needle.
After ultrasonic liposuction, it is necessary to perform suction-assisted liposuction to remove the liquified fat. Ultrasound-assisted liposuction techniques used in the 1980s and 1990s were associated with cases of tissue damage, usually from excessive exposure to ultrasound energy. The Vaser Lipo system, a third-generation UAL device, prevents this problem by using pulsed energy delivery and a specialized probe that allows physicians to safely remove excess fat.
A 40-year old woman undergoing a combination liposuction and abdominoplasty. Power-assisted liposuction: the cannula is inserted to about 80% of its full length.
Power-assisted liposuction (PAL)
PAL uses a specialized cannula with mechanized movement, so that the surgeon does not need to make as many manual movements. Otherwise it is similar to traditional UAL.
Twin-cannula (assisted) liposuction (TCAL or TCL)
Twin cannula (assisted) liposuction uses a tube-within-a-tube specialized cannula pair, so that the cannula which aspirates fat, the mechanically reciprocated inner cannula, does not impact the patient’s tissue or the surgeon’s joints with each and every forward stroke. The aspirating inner cannula reciprocates within the slotted outer cannula to simulate a surgeon’s stroke of up to 5 cm (2 in) rather than merely vibrating 1–2 mm (1/4 in) as other power assisted devices, removing most of the labor from the procedure. Superficial or subdermal liposuction is facilitated by the spacing effect of the outer cannula and the fact that the cannulas do not get hot, eliminating the potential for friction burns.
External ultrasound-assisted liposuction (XUAL or EUAL)
XUAL is a type of UAL where the ultrasonic energy is applied from outside the body, through the skin, making the specialized cannula of the UAL procedure unnecessary. It was developed because surgeons found that in some cases, the UAL method caused skin necrosis (death) and seromas, which are pockets of a pale yellowish fluid from the body, analogous to hematomas (pockets of red blood cells).
XUAL is a possible way to avoid such complications by having the ultrasound applied externally. It can also potentially cause less discomfort for the patient, both during the procedure and afterwards; decrease blood loss; allow better access through scar tissue; and treat larger areas. At this time however, it is not widely used and studies are not conclusive as to its effectiveness.
Water-assisted liposuction (WAL)
WAL uses a thin fan-shaped water beam, which loosens the structure of the fat tissue, so that it can be removed by a special cannula. During the liposuction the water is continually added and almost immediately aspirated via the same cannula. WAL requires less infiltration solution and produces less edema from the tumescent fluid. The utility of this technology is under study and is currently not widely used.

Subsequent developments in the technique of liposuction involved the use of blunt cannulas instead of sharp cannulas which were safer to use and had fewer complications of accidentally damaging blood vessels and nerves.

In recent times, the addition of different technologies to assist liposuction such as the use of lasers and ultrasound have greatly improved the safety profile of the procedure and driven the procedure further into the mainstream.

Types of Liposuction

Liposuction can be classified by the method of injection and by the method of liposuction.

Different Injection Methods

Dry liposuction

The dry method does not use any fluid injection at all. This method is seldom used today.

Wet liposuction

A small amount of fluid, less in volume than the amount of fat to be removed, is injected into the area. It contains lidocaine as a local anesthetic, epinephrine to contract the blood vessels and thus minimize bleeding, and a salt solution to make it saline, like bodily fluids. This fluid helps to loosen the fat cells and reduce bruising. The fat cells are then suctioned out as in the basic procedure.

Super-wet liposuction

In this method, the infusate volume is in about the same amount as the volume of fat expected to be removed. This is the preferred technique for high-volume liposuction by many surgeons as it better balances homeostasis and potential fluid overload (as with the tumescent technique). It takes one to three hours, depending on the size of the treated area/ areas. It may require either IV sedation as well as the local lidocaine, or complete anesthesia.

Tumescent liposuction

Tumescent liposuction is the precursor of wet liposuction. The surgeon injects a solution containing a local anesthetic and vasoconstrictor (often lidocaine and epinephrine respectively) directly into the subcutaneous fat to be removed. The volume of fluid creates a space between the muscle and the fatty tissue allowing more room for the cannula. Despite a potentially large total volume of local anaesthetic injected into the tissue, absorption by the body is spread over 12–36 hours because of the vasoconstrive effect, and systemic toxicity from lidocaine is rare.

Laser assisted liposuction

Laser assisted liposuction which uses thermal energy to affect lipolysis has involved either of the Erchonia or Nd:YAG powered devices.

Mechanism of liposuction

Suction-assisted liposuction (SAL)

Suction-assisted liposuction is the standard method of liposuction. In this approach, a small cannula (like a straw) is inserted through a small incision. It is attached to a vacuum device. The surgeon pushes and pulls it carefully through the fat layer, breaking up the fat cells and drawing them out of the body by suction.

Ultrasound-assisted liposuction (UAL)

In ultrasound-assisted or ultrasonic liposuction, a specialized cannula is used which transmits ultrasound vibrations within the body. This vibration bursts the walls of the fat cells, emulsifying the fat (i.e. liquefying it) and making it easier to suction out. UAL is a good choice for working on more fibrous areas, like the upper back or male breast area. It takes longer than traditional liposuction, but not longer than tumescent liposuction. There is slightly less blood loss. There appears to be slightly more risk of seromas forming (pockets of fluid) which may have to be drained with a needle.

After ultrasonic liposuction, it is necessary to perform suction-assisted liposuction to remove the liquified fat. Ultrasound-assisted liposuction techniques used in the 1980s and 1990s were associated with cases of tissue damage, usually from excessive exposure to ultrasound energy. The Vaser Lipo system, a third-generation UAL device, prevents this problem by using pulsed energy delivery and a specialized probe that allows physicians to safely remove excess fat.

Power-assisted liposuction (PAL)

PAL uses a specialized cannula with mechanized movement, so that the surgeon does not need to make as many manual movements. Otherwise it is similar to traditional UAL.

Twin-cannula (assisted) liposuction (TCAL or TCL)

Twin cannula (assisted) liposuction uses a tube-within-a-tube specialized cannula pair, so that the cannula which aspirates fat, the mechanically reciprocated inner cannula, does not impact the patient’s tissue or the surgeon’s joints with each and every forward stroke. The aspirating inner cannula reciprocates within the slotted outer cannula to simulate a surgeon’s stroke of up to 5 cm (2 in) rather than merely vibrating 1–2 mm (1/4 in) as other power assisted devices, removing most of the labor from the procedure. Superficial or subdermal liposuction is facilitated by the spacing effect of the outer cannula and the fact that the cannulas do not get hot, eliminating the potential for friction burns.

External ultrasound-assisted liposuction (XUAL or EUAL)

XUAL is a type of UAL where the ultrasonic energy is applied from outside the body, through the skin, making the specialized cannula of the UAL procedure unnecessary. It was developed because surgeons found that in some cases, the UAL method caused skin necrosis (death) and seromas, which are pockets of a pale yellowish fluid from the body, analogous to hematomas (pockets of red blood cells).

XUAL is a possible way to avoid such complications by having the ultrasound applied externally. It can also potentially cause less discomfort for the patient, both during the procedure and afterwards; decrease blood loss; allow better access through scar tissue; and treat larger areas. At this time however, it is not widely used and studies are not conclusive as to its effectiveness.

Water-assisted liposuction (WAL)

WAL uses a thin fan-shaped water beam, which loosens the structure of the fat tissue, so that it can be removed by a special cannula. During the liposuction the water is continually added and almost immediately aspirated via the same cannula. WAL requires less infiltration solution and produces less edema from the tumescent fluid. The utility of this technology is under study and is currently not widely used.

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Cosmetic Surgeon,
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