By Brook Flagg © 2008-2009
PlasticSurgery.com Staff Writer
Considering your interest in cosmetic surgery, you are probably already aware that a basic definition of liposuction ("lipoplasty" or "suction-assisted lipectomy") is: a procedure which utilizes a suction device ("cannula") to remove unwanted, excess fat in localized body areas. However, with so many new surgical methods being utilized, how can one make an informed selection when choosing a certain liposuction technique?
No matter the plastic surgeon’s specialty method, a prospective patient should understand what is being suggested to them. Therefore, a breakdown of commonly used liposuction terminology follows.
"…dry liposuction has essentially phased out of modern cosmetic surgery practices."
Dry liposuction: Once known as "traditional" liposuction, dry liposuction refers to the earliest of all methods, which involves administering only general anesthesia prior to suctioning. Due to the increase in potential complications it poses to the patient, such as severe pain, significant blood loss, and temporary immobility (which increases the risk of pulmonary embolism), dry liposuction has essentially phased out of modern cosmetic surgery practices.
Tumescent liposuction: Originating nearly two decades ago, tumescent liposuction is the most commonly performed liposuction method today, and has generally assumed the title of "traditional" liposuction. Here, suction is performed after administering a tumescent injection (which contains a local anesthetic, epinephrine, and a saline solution) at a volume that exceeds that of the targeted fat. As a result, the risks of general anesthesia are eliminated, the blood vessels are temporarily minimized for reduced bleeding, and post-operative pain is noticeably reduced.
According to Robert Schwartz, M.D., a board certified Dallas plastic surgeon, "Every surgeon I know of performs some variation of tumescent."
Two of the most common types of liposuction are:
- The same injection fluid is administered, but is lower in volume than the amount of targeted fat.
- Super wet:
- The same injection fluid is administered, but is equal in volume to the amount of targeted fat. It is generally preferred in cases of large volume liposuction.
"Typically referred to as ‘Vaser,’ Dr. Schwartz describes this procedure as, ‘The third generation of UAL.’"
These techniques are often performed after the administering of a tumescent injection:
Ultrasound-assisted or Ultrasonic-assisted (UAL): A specially-designed cannula is used to send ultrasonic waves into the targeted fat cells, causing them to rupture and emulsify, or "melt," before suction. Since its inception, UAL has acquired several incarnations, the newest of which is marketed under the name Vaser LipoSelection.
Typically referred to as "Vaser," Dr. Schwartz describes this procedure as, "The third generation of UAL." He finds Vaser preferable over other UAL techniques because, "Originally, it was too powerful, and much less precise. When it became apparent to me that the results between the two were like night and day, I began using Vaser for all of my liposuction patients." Like Dr. Schwartz, many surgeons are partial to the ease that the Vaser instrument allows when passing through fat cells, including harder, more fibrous areas. "While it may take up to 30 percent longer than traditional liposuction, people hurt a lot less post-operatively, and experience a much better recovery. And, their results are more refined."
However, patients should note that there are a select number of surgeons nationwide who offer Vaser. Many surgeons still safely and effectively utilize the original UAL method, as well as similar variations, such as power-assisted liposuction (PAL).
Laser Liposuction ("laser lipolysis"): Currently, there are two technologies available to surgeons who perform the laser liposuction technique. Marketed as SmartLipo and CoolLipo respectively, these procedures share similarities such as fat emulsification, gradual skin tightening, and the preservation of delicate tissues. However, according to William Boss, M.D., a plastic surgeon who frequently uses CoolLipo, there is one notable distinction. "The Cool Touch laser (used in the CoolLipo procedure) was one of the first lasers to tighten the skin without burning it," he says. And, while he has never used SmartLipo at his practice, Dr. Boss says that after using CoolLipo for the past year, "I can really start to see skin toning and tightening."
One surgeon who offers SmartLipo is Constantino Mendieta, M.D., a Florida plastic surgeon. Dr. Mendieta prefers to include SmartLipo as a complement to a three-fold procedure, beginning with Vaser, then followed by UAL (or PAL). Finally, the procedure is completed with SmartLipo to provide the patient with a skin retraction benefit. He believes that this can also be helpful if the patient requires fat removal in both deep and superficial layers, saying, "We combine these technologies to optimize their results." He believes that for patients who wish to achieve truly dramatic results, this can be an ideal option.
"…the terms "liposuction" and "liposculpture" are used interchangeably at times, and for good reason…"
Liposculpture: As you view liposuction before and after pictures and research cosmetic surgery procedures, you may notice that the terms "liposuction" and "liposculpture" are used interchangeably at times, and for good reason: There is little, if any, difference between the two. Most of the time, liposculpture refers to the refinement with which liposuction is performed today. Small, modern cannulas and other advancements allow for more precise fat removal on the part of surgeons. The deliberate, targeted contouring that surgeons are capable of today resembles sculpting; hence, it is sometimes marketed as "liposculpture."
If you are considering liposuction as a means of eliminating localized body fat, remember: Most surgeons advise that the best long-term results are achieved when a healthy diet and exercise plan is implemented as well. A skilled plastic surgeon may be able to remove fat in your body’s resistant areas, but gaining and maintaining a permanent outcome is each patient’s responsibility.