Your Choices In
Your choices in liposuction are numerous, however
not all surgeons will offer each method. Good plastic surgeons will only
offer the methods they feel produce the best results for their patients, not
because they spent the money on a machine they now can't get rid of.
Although surgeons may try new techniques and machines, they will normally use
what they feel most comfortable with and what they feel produce consistent,
- Tumescent Liposuction
Tumescent liposuction is the most common method used in
liposuction. It incorporates the injection of the combination saline, lidocaine (for pain relief),
epinephrine (to constrict the blood vessels, called vasoconstriction,
which lessens blood loss and lidocaine uptake), saline (as a carrier and
to help swell, the tissues), and sodium bicarbonate (which lessens the
stinging of the solution). The tumescent fluid has also been shown
to have antibacterial properties which is the reason why there are less
infections with tumescent than other procedures, when the surgeon adheres
to standard sterile protocols. This method also allows a surgeon to
perform liposuction without the use of additional anesthesia, although an
oral sedative may be given in conjunction to ease any anxiety.
However, liposuction is often performed under Twilight sedation.
General anesthesia is unnecessary with Tumescent Liposuction only.
-sonic) Assisted Liposuction (UAL):
This method uses high energy
ultrasonic energy to melt the fat before it is suctioned out.
With internal UAL, large amounts of tumescent fluid is injected and
then a rod is inserted into the subcutaneous fatty areas to melt the
fat. With external UAL, tumescent fluids are also
injected, but a metal paddle is passed over the skin to melt the fat
before suctioning. With UAL there is the risk of burns both
inside and outside the body. Although some surgeons still use
UAL, others are reluctant due to the high risks of burns.
Surgeons are tending to veer away from this type of UAL.
Liposuction (PAL or MicroAire Technique):
uses a high-speed "linear reciprocating"
(it goes back and forth like a surgeon would be moving it) suction cannula.
The idea is that the cannula moves more easily through the fibrous
fatty areas, can be more precise, and also grants the surgeon less
exertion while performing the procedure. PAL is also used with
tumescent fluid. It is reported that with PAL there is less
bruising and swelling. However, I have had PAL and had bruising
and swelling that didn't seem insignificant to me. Tumescent fluid is
also used with laser-assisted liposuction.
Twin Cannula Assisted Liposuction, or
TCAL: This method uses a cannula which also houses
another cannula. It is actually a variation of PAL (above).
The inner cannula performs the suction while the outer cannula has the
linear reciprocating motion . Since the suction cannula is
housed within the outer cannula, this reduces tissue damage caused by
the high pressure suctioning. The device is designed to not only
assist in les damage, but to decrease the effort needed by the surgeon
to move through the fat.
LASER-assisted Liposuction (i.e. SmartLipo):
Laser liposuction uses a cannula which houses a laser to melt fat.
Tumescent fluid is also used with
laser-assisted liposuction. The
cannula is inserted into incisions
to break down the fat and either laser cannula with suction is used
simultaneously, or in some methods, suction is performed after the fat
Bruising and swelling is
reported to be less than with standard tumescent liposuction because
ot he laser heat's ability to cauterize the broken blood vessels..
The heat from the laser also causes a
thermal wound response which causes tissue contraction and thus
tightens the skin.
VASER LipoSelection® (or Wide
Awake Liposuction): VASER is considered a fourth generation UAL
method. VASER also uses ultrasonic energy but this method gently
breaks up and liquefies the fat. VASER can actually be performed
under local anesthesia only, hence the coined term, "Wide Awake Lipo".
Standard UAL required General anesthesia or very heavy Sedation.
VASER is very precise and the energy is significantly less than
standard UAL (50% less applied power), but still effective, which
leaves the surrounding tissue undamaged. VASER also uses a
specifically designed grooved cannula tip and lower level suction and
massage to further reduce tissue damage. Tumescent fluid is also used
with VASER. Bruising and swelling is reported to be less than with
standard tumescent liposuction.
The heat generated by the ultrasonic
energy also causes a thermal wound response which causes tissue
contraction and thus tightens the skin.
Body-Jet Liposuction: Body-Jet, is a Water Jet Assisted
Liposuction method and uses s low pressure stream of tumescent fluid
to gently break away fat cells. For the most part it doesn't
actually destroy the fat ells, but just separates them from their
connective tissue. Simultaneous suction removes the tumescent
fluid and fat cells at the same time and causes very little, if any
tissue, damage. The recovery is faster than traditional and
other forms of liposuction, and is reported to have little discomfort
and bruising. Another bonus is that since the fat cells are not
destroyed during removal they can be treated and injected for fat
grafting to other areas of your body. Since the fat cells are
whole, if new vessel formation is introduced and they receive a blood
supply, they are far more likely to last than traditional fat cell
removal (liposuction) procedures. In removal procedures that use
suction for fat transfer, usually the fat cell is destroyed and only
the broken cell and fragmented lipids are transferred. The body
usually absorbs most of this and creates scar tissue around the rest
of the injected fat cells which is why you may see augmentation and
lumpiness, although some fat cells do survive.
- Tickle Liposuction
(Nutational Infrasonic Liposculpture (N.I.L), or Custom Acoustical
Liposuction): This method uses a cannula that uses a
patented "nutational" movement which includes vibrations, infrasound
and a "whirling" movement loosen the fat cells from its surrounding
connective tissue. There is no heat used in the procedure so the
fat cells generally stay intact and there is obviously no risk of
burns. The vibration causes a tickling feeling, hence the
recovery is faster than traditional and other forms of liposuction,
and is reported to have little discomfort and bruising.
As with Body-Jet Liposuction the fat cells are usually removed whole
and can be grafted into other areas of the body with much success.