Guidelines for Choosing a Liposuction Procedure
There are many liposuction technologies, and this page provides a brief description of each one. Links are provided to pages with additional in-depth information.
Traditional Liposuction: Suction Assisted Lipolysis (SAL)
Suction Assisted Liposuction (lipoplasty, liposculpture suction lipectomy, or simply lipo) refers commonly to the method when fat is mechanically dislodged by manual or power assisted means and aspirated. The fat is removed through a hollow cannula inserted under the skin. A powerful, high-pressure vacuum is applied to the cannula and fat removed.
Ultimately all surgical body sculpting methods aim aspirating fat to change body contours and liposuction in its traditional term is a part of all body sculpting procedures.
Technology-based body sculpting methods largely supersedes traditional SAL. As traditional SAL targets mainly intermediate layer of fat newer methods allow to work closer to skin and muscles for more defined contours.
History of liposuction treatment
The roots of liposuction date back to the 1920s. Dr. Dujarier, a French surgeon performed a fat removal procedure on a model in 1926, results were disastrous and new attempts were not contemplated till 1960s. Liposuction as treatment term was invented in 1974 by two Italian-American surgeons - Doctors Giorgio and Arpad Fischer.
What we know as 'modern liposuction' started in 1982 by Dr. Yves-Gerard Illouz, a French surgeon. He started what became known as the 'Illouz Method" - a technique of suction-assisted lipolysis (SAL) after infusing fluid into tissues using blunt cannula and a high-vacuum suction.
In 1985 the tumescent technique was described by Drs. Jeffrey Alan Klein and Patrick Lillis (USA). This refers to infiltration of fat layer with volumes of liquid containing a local anesthetic, allowing the technique to be carried out in an office setting under intravenous sedation, rather than general anesthesia.
- Tumescent liposuction - several liters of so called Klein’s saline solution with a local anesthetic lidocaine, vessel-constrictor epinephrine (adrenaline), sodium bicarbonate (to reduce stinging) and sometimes small dose of steroid is pumped subcutaneously (below the skin) in the area that is to be suctioned. This is the most popular form of liposuction. The amount of liquid pumped into the area may be up to three times the amount of fat to be removed. This volume of fluids creates vast expansion of the fatty tissue, allowing more maneuverability for the suction cannula.
- Depending on the volume of Klein’s solution used.
- When less volume of Klein’s solution used often general anaesthetic is preferable to IV sedation.
- Wet liposuction - a small amount of fluid with less volume than the amount of fat to be removed is injected into the target area.
- Super-wet liposuction - this technique uses less liquid that tumescent liposuction; about the same amount of liquid as fat to be removed.
- Dry liposuction - no fluid is injected before fat is removed. This method is seldom used today. There is a higher risk of bruising and bleeding.
- Depending on how fat cells are dislodged SAL can be :
- Manual liposuction –connection between fat cells in layer of fat is simply broken by manual force moving cannula back and forth and rotating it.
- Power assisted liposuction –cannula is rotated, vibrated and its movements in fatty layer is aided by a power device.
Ultrasound Assisted Liposuction (UAL)
This refers to methods when fat cells are dislodged by ultrasound wave energy before fat can be aspirated.
History of UAL.
Liposuction techniques using ultrasound waves were developed in the 1980s. Initial mixed results with UAL led to development of second generation of ultrasound liposuction technologies. Later on in 1990s researchers began developing even newer UAL technologies particularly VASER.
Vaser was developed by Dr. William W. Cimino in 1998 the founder of Sound Surgical Technologies LLC (USA).
Vaser stands for Vibration Amplification of Sound Energy at Resonance, is a third-generation ultrasound-assisted liposuction tool that delivers energy in pulses through a specially designed probe those helping to prevent overexposure to ultrasonic waves and the side effects experienced in previous generations of UAL technologies. The Vaser device is capable of selectively delivering ultrasound energy to liquefy the fat in the body without damaging other types of tissues. This allows doctors to target full thickness of fat layer including parts close to skin and muscle. Mainly the middle portion of fat layer aimed at by other methods, especially conventional SAL.
The Vaser high-definition liposculpture procedure completely revolutionized surgical body sculpting as it really helps to reshape and sculpt the body. This method involves liposuction using ultrasound around different muscles groups. The Vaser instrument used during surgery liquefies the fat and allows the doctor to target specific fat layers which helps to create the sculpted appearance of the muscles by working in multidimensional planes.
Radio Frequency Assisted Liposuction (RFAL)
This method utilised radio-frequency energy to melt and liquefy fat before aspiration. The only surgical grade RF based technology for body sculpting is currently Body Tite.
History of Body Tite
Radio frequency devices in cosmetic medicine and surgery have been used for decades. Body Tite was developed in 2009 and is a registered trademark of cosmetic equipment manufacturer Invasix Ltd , Yokneam Ilit, Israel. The technology quickly gained popularity amongst body sculpting doctors around the World.
It utilises RFAL – Radio Frequency Assisted Liposuction. It involves creating bipolar RF current which flows from the internal to the external electrode placed on the skin above the internal electrode/cannula .
RF energy emission current from an internal electrode towards its external counterpart melts fat on its pathway while simultaneously aspirating it and it coagulates tissues, resulting in coagulation of adipose, vascular and fibrous tissue as well as heating the entire soft-tissue matrix. The coagulated and liquefied fat is aspirated while heating of the soft tissue matrix and sub-dermal tissue results in body tightening and re-contouring. Safety of tissue heating is monitored continuously via special software.
Body Tite is specifically useful for body sculpting in areas with lax skin due to its unique property to retract dermis.
Water Assisted Liposuction (WAL)
This method uses high pressure liquid jet to dislodge fat cells before they can be aspirated.
History of WAL
This method of liposuction, developed in 2001-2003 by German surgeons (Traufig, Meyer) is based on the water jet technique - a technique that has long been known in the industry for cutting various materials and which has been used in the medical field for years, for example in liver surgery. With water jet assisted liposuction, a fan-shaped water jet gently removes the fat cells from the tissue. As part of the same action, the fluid and the removed fat particles area suctioned off.
Body Jet or Aqua Lipo is a technology for WAL and it was produced and launched in 2003 by Human Med AG of Germany, a leading manufacturer of medical and aesthetic devices.
Body Jet (Aqua Lipo)
Using Body-Jet, a pressure system directs the infiltration solution through a closed tubing system into a very thin application cannula. The flow of infiltrate may be customized for each case and can be selected from several different levels through a software guidance system. Highly dispersed infiltrated solution gives immediate anaesthesia. The infiltration cannula is swapped for the suction cannula and the aspiration process begins immediately.
As a general rule, the fluid leads the way dislodging fat; the cannula simply follows and penetrates soft areas. The functional structures are displaced by the jet and thereby protected from mechanical trauma. A gentle, force-free method of working is always a sure sign of a safe and atraumatic procedure.
One of the most unique aspects of the Body-Jet is its AquaShapeFTTM LipoCollector which is suitable for the collection of fat intended for re-injection or laboratory purpose.
Body-Jet offers a superior harvesting opportunity for fat transfer using its closed system of Aqua Shape FT LipoCollector. Harvested this way and immediately filtered, fat does not require the lengthy centrifuge process usually necessary to reduce water volume before a fat transfer. Viability of fat cells collected with Body Jet shown to be far superior to other harvesting methods. It also allows larger volumes of aspirated fat to be undamaged and suitable for re-implantation and reshaping larger areas.
Light/Laser Assisted Liposuction (LAL)
Fat cells are burst by laser light beam and their fat content is then aspirated. Tissue coagulation is observed in this type of liposuction. Most commonly used technology for body sculpting using laser is Smart Lipo.
History of Smart Lipo.
In 2006, Cynosure, Inc., a light-based aesthetic and medical treatment equipment manufacturer from the United States, developed the first laser for tumescent liposculpture named SmartLipo. In November 2009 SmartLipo got the approval from the United States Food and Drug Administration for use in treatments and intended for the surgical incision, excision, vaporization, ablation, and coagulation of soft tissue.
SmartLipo is a type of laser-assisted liposuction treatment.
Particularly useful for dense areas of fatty deposits. Smart Lipo produces effective tissue coagulation and tightening and this is useful for areas with lax skin.