Liposuction is a cosmetic surgical procedure that is used when people don’t want fat on one or more parts of their body. The basis is removal of small amounts of fatty tissue using suction, typically from areas that don’t readily respond to exercise and healthy eating. These include the buttocks, the abdomen, thighs and hips.
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The procedure is aimed at improving the appearance of the body. The results are both quick and reasonably durable, if the patient maintains good eating and exercise patterns to keep the body weight stable. However, those who are more than a little overweight may not benefit. Moreover, if the skin is flabby, removal of subcutaneous fat is not likely to alter the appearance of the overlying skin.
There are several liposuction techniques available, which are categorized according to the amount of fluid that is injected and how the tube (cannula) used to remove fat deposits is used.
There is no technique which can be claimed to be the best, since the choice depends on the patient’s health, weight, fat distribution, number of sites to be treated, the volume of fat expected to be removed as well as the need for any other procedure, which could be combined with it.
Examples of some commonly used liposuction techniques are given below.
Suction-assisted liposuction
Also called the dry technique, this is the standard liposuction technique and involves a cannula that is attached to a vacuum device being inserted into the treatment area where it is moved back and forth to break up fat deposits and remove them from the body via suction.
It is best avoided unless only 100 mL or less of fat/fluid in total is to be removed, because it can entail significant blood loss (25% to 40% of the volume of fluid removed) if larger volumes are to be sucked out this way.
Wet liposuction
Here isotonic fluid, with or without local anesthetic, is injected into the operative field in order to break up and loosen the fat deposits so they can be removed by a special cannula. The blood loss may be about 10% to 30% of the removed volume, unless epinephrine is used; epinephrine decreases blood loss to about 15% of the volume removed.
Tumescent liposuction
For this technique, a surgeon uses a solution containing a local anesthetic and vasoconstrictor (epinephrine), which is injected directly into the subcutaneous fat in the ratio of 3-4 mL per planned mL of aspirate, to make the treated area tense with fluid.
The inclusion of the anesthetic allows the procedure to be done without pain, while the epinephrine constricts the blood vessels in the area and so limits the bleeding to 1% or less of the volume removed. This in turn also reduces the chances of a blood clot or collection forming in the aspirated area. The fluid in the solution eases the fat removal. About 50% to 70% of the fluid infused remains in the body after the completion of the procedure.
Superwet technique
Here the same technique is used but with a 1:1 ratio of infiltrated solution to removed fat. It is quicker but may require additional sedation or general anesthesia. Only about 1% to 4% of the removed fluid is blood.
Ultrasound-assisted liposuction (UAL)
For this procedure, a special type of cannula that emits ultrasound vibrations is used to burst and liquefy fat cells, making it easier to remove them by suction.
External ultrasound-assisted liposuction (XUAL or EUAL) is a second form of UAL where ultrasonic energy is applied externally through the skin paddle. This avoids the need for an ultrasonic internal probe. The technique was based on the need to minimize necrosis, serous fluid collections and hematomas under the skin after internal UAL.
UAL is often used along with tumescent liposuction to achieve greater precision of body contouring. It takes longer than either tumescent or super-wet technique. However, it is often preferable for secondary procedures and in fibrotic areas such as in the male breast or the upper back. It should never be performed along with dry liposuction.
A still newer development is the VASER- (Vibration Amplification of Sound Energy at Resonance) assisted liposuction technique which stimulates the fat cells using pulsed ultrasound waves applied by a grooved narrow probe. This reduced the power applied to the skin by almost two-thirds, while keeping the efficiency of liposuction almost constant. The excited cells break open at their membranes, and the fat is thus broken down. This reduces the chances of skin injuries while improving the cosmetic result.
Power-assisted liposuction (PAL)
The only difference between this and the first technique is that the cannula’s movement is mechanized, reducing the strain on the surgeon and improving the speed and accuracy of fat removal. This is sometimes preferred if there is a large volume of fat to be removed or if the patient has already had one liposuction procedure previously.
Water-assisted liposuction (WAL)
For this procedure, a thin, fan-shaped water jet is injected to loosen the fat cells from their anchors without destroying adjacent tissue. While gentle and suited for the removal of larger volumes, it has not been used extensively in the US.
Twin-cannula (assisted) liposuction (TCAL or TCL)
Here, a tube-within-a-tube is used to remove the fat cells. The first cannula is used to disrupt the fat cells and prepare it for easier suctioning. The inner cannula is used to aspirate the fat. This technique is then less likely to cause unnecessary damage to the patient’s tissue when the cannula is moved back and forth.
Laser-assisted liposuction
Here, a fiber threaded through a microcannula emits laser energy which is used to selectively break up fat deposits, so they are easier to remove through suction. The laser leaves neighboring structures intact. The laser energy also closes off the small blood vessels and releases fat-digesting enzymes, which enhance liquefaction.
The more thorough liquefaction of the fat cells allows a smaller cannula or drainage tube to be used, which makes it suitable for areas with restricted access. Moreover, the laser energy may produce contraction of skin collagen, stimulate regeneration of collagen in the treated area which enhances the skin tone after the procedure. The 1064 nm Nd:YAG, the 980 nm diode, and the 1064/1,320 nm Nd:YAG lasers are commonly used for this purpose. Disadvantages include the risk of burns, the high cost, and the longer time required.
Newer methods
Radiofrequency (RF)-assisted liposuction is being developed, where fat cells are dissolved by thermal energy produced by high-frequency oscillating current at one million cycles/second. Its benefits include simultaneous contraction of skin collagen to avoid skin sagging after fat removal, remodeling of the subdermal tissue and stimulation of neocollagen formation.
Cryolipolysis is being developed where fat tissue is killed as a result of the local inflammatory reaction following cold exposure. It has a low complication rate and is suitable for the removal of small fat deposits.
High-frequency focused ultrasound is also being used to destroy fat deposits using high ultrasound intensity. It also stimulates collagen contraction to tighten the skin.
If you are considering liposuction, first consult with a physician who is trained in providing this service to discuss which option is most appropriate for you.
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Further Reading