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Liposuction

By Brian Kobienia, MD, FACS on June 01, 2011


Laser liposuction, ultrasonic liposuction, power-assisted liposuction, water jet liposuction, tumescent liposuction, and cryoliposuction are all currently available options to remove fat from those love handles and other nagging bulges.  Which one is right for you? Is one better than another?

Best Candidate

Liposuction involves removing fat from an isolated problem area.  Not everyone is a candidate for liposuction.  The best candidate for liposuction is one that is near their ideal weight and possesses good skin tone in the area where the work will be done.  If the skin elasticity is poor and liposuction is performed a bulging area will likely be morphed into an empty skin sack.  Additionally, liposuction is not designed to correct obesity.  It is not a weight loss operation.  It works best for an isolated area of fat (lipodystrophy) that just won’t go away even though the patient is not overweight.

Techniques

Early liposuction techniques involved using a small straw (cannula) to evacuate fat. This worked well, but patients had significant bleeding.  Because of this, tumescent liposuction was born.  In this technique, fluid containing numbing medication and adrenaline, which causes the blood vessels to contract, and thus signicantly limits bleeding.  This allows the surgeon to work longer and treat more areas without worries of excessive blood loss.  This is the single most important refinement to the technique of liposuction.  Most other refinements pale in comparison.  In fact, Medical News Today recently reported on a survey conducted by the American Society of Aesthetic Plastic Surgery revealing that traditional (tumescent) liposuction is by far and away the most popular technique among plastic surgeons polled.  Most plastic surgeons felt this technique to be the safest. Ultrasonic and power-assisted liposuction were also popular, but laser liposuction and noninvasive procedures such as external ultrasound and laser techniques were least popular.

Ultrasonic liposuction uses a cannula that vibrates at a tuned frequency specifically designed to melt fat.  It works. It really works well.  The problem is it creates heat which can lead to burns and it melts fat, all fat, including the fat insulating the nerve fibers.  This can lead to chronic nerve pain.  This technique remains useful for treatment of areas that have fibrous fat or for revisional or repeat liposuction treatment.

Another technique designed to make the operation easier for the surgeon is power-assisted liposuction.  Using this instrument, the cannula is mechanically vacillating to and fro in an effort to break down the fat and thus make it less labor intensive for the surgeon.  Benefit to the surgeon, no much added benefit to the patient.  I use this for revisional liposuction or treatment in areas where the fat is very fibrous – such as the upper abdomen or chest in the male patient.

Laser liposuction, water jet liposuction and cryoliposuction (freezing) are all techniques that are relatively new and don’t have the history to prove their efficacy and safety.  The cost of these devices put profits in the laser companies but does not add significant benefits to the patient.

Gold Standard

The field of plastic surgery is known for reinventing the wheel.  Every year or two someone develops a new operative technique that is ‘better’ and requires less recovery time than last year’s operations.  Unfortunately, most of this is smoke and mirrors marketing.  Do you really want to be the first person to receive an operation?  Probably not.  The gold standard is the gold standard for good reason.  Usually because it has proven itself in terms of safety and results.
 

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