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.
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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:
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.
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:
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™ 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.
CoolSculpting™ by Zeltiq™ is a new, non-surgical procedure which reduces superficial fat by cooling fat tissue. Intense cold is applied through the skin to the underlying fat in selected areas. Fat is more sensitive to cold than other tissues, and the controlled, targeted cooling of the fat results in cold injury and gradual dying off of the microscopic fat cells (adipocytes). The dead adipocytes are slowly eliminated from the body by the body’s natural mechanisms for removing non-functioning tissue. This slow elimination of fat causes a decrease in size of the treated area. Results are seen in 2-4 months.
CoolSculpting™ is done entirely through the intact skin surface and requires no surgery, no needles, and no anesthesia of any kind. Treatment usually takes one hour, and patients return to daily activities the same day. The CoolSculpting™ device is FDA approved.
One treatment with CoolSculpting™ removes about 20% of the fatty tissue, less than can be removed with PAL. Multiple treatments with CoolSculpting™ may be necessary to achieve the same results obtainable in one liposuction treatment with PAL. As of November 2010, CoolSculpting™ is available for treatment of tummy and hips.