Techniques

Conventional Liposuction, also called Suction-Assisted Lipectomy (SAL).

In SAL a narrow tube (cannula) is inserted into the superficial fat through a small incision in the skin. A vacuum pump is then used to apply suction, causing the fat to adhere to the end of the tube. The surgeon moves the tube back and forth, removing small pieces of fat, which are pulled into the tube and vacuumed away.

Conventional liposuction is simple and effective. It is relatively atraumatic and non-destructive of surrounding tissue. Conventional liposuction capitalizes on a unique characteristic of fat; i.e., fat is the weakest tissue in the body and most easily removed by suction. Blood vessels and nerves running through the fat and nourishing the overlying skin are encased in fibrous tissue which is much stronger than fat. Hence, most blood vessels and nerves and other surrounding tissue are relatively undisturbed and remain intact when the fat is vacuumed away with conventional liposuction. This protection and preservation of nerves and blood vessels is enhanced by use of the tumescent technique for local anesthesia.

Multiple surgical devices have been developed to improve liposuction.

Click here to view before and after photos.

Power-assisted liposuction (PAL)

In PAL, the suction cannula is attached to an electric hand-piece, which causes the cannula to vibrate back and forth along the long axis (reciprocation). This reciprocating motion imparts enough energy to the tip of the cannula so that it passes easily through the fat with almost no physical effort on the part of the surgeon and minimal impact on surrounding tissue. The reciprocating motion helps to pull out the fat and suction it away. The PAL device allows the surgeon to remove fat more efficiently and sculpt the tissues with more finesse. The depth and power of the vibrations are sufficient to ease passage through the fat but not so strong as to injure normal tissue.

PAL offers other advantages:

  • The duration of the operation is shorter because the fat is suctioned more quickly by the powered cannula.
  • Vibrations at the tip of the cannula loosen the fat and permit more facile extraction.
  • The surgeon can focus more on the sculptural aspects of the procedure and less on having to extract the fat.

Internal ultrasound (Vaser™)

In UAL, a probe is inserted beneath the skin prior to liposuction. Ultra high-frequency vibration produces a powerful energy field at the tip of the probe, which causes the fatty tissue to liquefy. The ultrasound energy also breaks up fibrous tissue and scar. After the fat is liquefied, the surgeon places a cannula into the tissues and vacuums out a mixture of liquid and semi-liquid fat. By reducing the surgeon’s work effort, UAL permits more concentration on smoothness of contour and finesse in results. Theoretically, the high energy causes increased scarring which may cause increased tissue tightening. Vaser™ is the proprietary name for an ultrasound device manufactured by Sound Surgical Technologies.

Vaser™ and other UAL devices have some disadvantages.

  • Use of Vaser™ or ultrasound introduces an additional step in the operation and increases the duration of the procedure by 25% or more.
  • Since ultrasound uses high energy to melt the fat, it is possible to cause a burn of the skin or elsewhere.
  • Since ultrasound is a more destructive modality than conventional liposuction, it is likely to injure or destroy more blood vessels and nerves than conventional liposuction. In fact, some surgeons report increased pain post-operatively in some patients following UAL and Vaser™ treatments. Theoretically, destruction of blood vessels will permanently reduce blood supply to the skin.
  • The access incisions and surrounding skin have to be protected from the high energy of ultrasound by inserting protective rings into the incisions. These rings necessarily enlarge the incision.
  • Patients undergoing UAL may have a higher incidence of post-operative seromas (temporary collections of fluid in the treated areas, usually the abdomen).

Lasers (Smartlipo™, Slimlipo™ and other devices)

Smartlipo™ and Slimlipo™ are the proprietary names of laser devices which, like ultrasound, melt the fat before it is vacuumed away. The laser energy is delivered via a small fiberoptic cable (0.9 mm in diameter) which is passed under the surface of the skin through a small incision. The laser energy liquefies the fatty tissue which is then vacuumed away using a conventional liposuction cannula.

The laser is also used to heat the fat and the undersurface of the skin. The goal of tissue heating is to cause contraction and tightening of the skin and its underlying tissues. Recent presentations at medical meetings have claimed tissue tightening as a result of laser liposuction. Publication in medical journals is pending as is confirmation by additional investigators.

Laser-assisted liposuction has the following advantages:

  • Since the laser is less than 1 mm in diameter, it can be introduced through a very small incision; but this advantage is more theoretical than real as the incision has to be enlarged to admit a suction cannula to remove the melted fat.
  • The laser melts the fat and can dissolve scar tissue, easing passage of the suction cannula through the fat and permitting more facile fat extraction in patients with heavy scarring or fibrous tissue.
  • The laser creates scarring under the skin with the goal of producing additional skin tightening. Evidence for smooth and predictable skin tightening is suggestive and remains to be confirmed in controlled clinical trials.
  • Laser-assisted liposuction has some disadvantages.
  • Use of the laser introduces an additional step in the operation and increases the duration of the procedure by 25% or more.
  • Since laser uses high energy to melt the fat, it is possible to cause a burn of the skin or elsewhere.
  • Like ultrasound, the laser is a more destructive modality than conventional liposuction. The laser seals blood vessels by heat, potentially reducing blood supply to the skin.

Water-assisted liposuction (Body-Jet™)

Body-Jet™ is the proprietary name for a new device which delivers a high pressure mist of local anesthesia to the fat prior to liposuction. The same device also suctions out the fat while continuing to irrigate with small amounts of fluid to increase efficiency of fat extraction by a flushing mechanism. Because the local anesthesia is delivered as a high-pressure mist, it penetrates the fat more efficiently. Anesthesia is achieved quickly with relatively small amounts of fluid and medication. Irrigation during liposuction is theoretically more efficient at removing loose particles of fat and should further reduce postoperative swelling.

Body Tite™ (Radio-frequency assisted liposuction)

Body Tite™ is the name of a new device which simultaneously melts fat, suctions fat, and heats the skin and its supporting tissues using radio frequency energy. The device is very efficient since it uses a one-stage procedure with heating and suctioning occurring simultaneously. The heating is controlled with real-time monitoring of tissue temperatures. The goal is to remove fat and tighten skin.

Similar to Vaser™  and laser devices, efficacy of skin tightening with Body Tite™  is a desired goal but as yet unproven. Dr. Pitman’s personal experience with the device to date is that it is efficient at removing fat. He has not seen any complications with the device, but it theoretically shares the same disadvantages as the other high-energy devices mentioned above.

Body Tite™  has been granted Institutional Review Board approval in the United States for an ongoing clinical study seeking FDA approval. Dr. Pitman is a clinical investigator in the study.

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