Like any new technology or surgical technique, liposuction has undergone multiple refinements and improvements in technique over the years, including tumescent lipo, ultrasound lipo and now laser lipo. During my early training, liposuction patients were admitted to hospital one night before surgery. They had already donated blood, which was re-infused during their procedure—such was the amount of blood loss that occurred with surgery! The cannulae (tubes) used to remove fat were as large as my thumb, and an IV of 5% alcohol was given during the surgery to decrease the risk of fat emboli that was real and frequent.

Tumescent liposuction

A “tumescent” technique established in 1990 revolutionized liposuction. A solution was injected under the skin and fat immediately before liposuction was to begin. Epinephrine stopped bleeding and xylocaine numbed the area during and after the procedure, allowing less use of anesthesia and a faster recovery. The procedure was  transformed into an outpatient procedure with little risk of blood loss, and this technique soon became the most commonly used plastic surgical procedure. Cannulae became smaller in size, decreasing the risk of fat emboli and damage to other structures. Tumescent liposuction is now used in all cases of liposuction, irrespective of the manner of  fat removal.

Ultrasound liposuction

In the 1990s, ultrasound energy became a “new” method for performing liposuction. Board-certified plastic surgeons flocked to ultrasound courses. The idea of ultrasonic liposuction was to melt the fat under skin before removing it via a normal cannula. The advantages touted were less bruising and greater skin tightening. Problems started to show up soon thereafter, including burns to the skin from ultrasound wands, seroma (fluid build-up under skin) after the procedure, delayed healing, larger scars, more operating time and greater cost. I use it  judiciously. Results are identical to tumescent liposuction, with standard cannulae in terms of bruising. There may be more skin tightening, but there may not be. The risks and complications are real enough that I only use it in cases of secondary liposuction and in specific areas such as the male chest and back, where tissues are tougher! Currently the ”Vaser” machine is the toast of the town, but I have yet to be convinced of its benefit to my patients given its increased cost (about $300 more per surgery).

Power-assisted liposuction

As the downsides of ultrasonic liposuction became more apparent. The principle of a jackhammer was used for liposuction cannula to remove more fat faster. The power-assisted liposuction drives the cannula back and forth. This allows the cannula to penetrate the fat more easily and thus requires less force from the plastic surgeon. There is no burn as with ultrasound or damage to other structures.

Laser liposuction

This is the latest technology to be used for liposuction. The laser in “laser liposuction” is used to melt the fat before its removal. Again, the touted advantages are less bruising, less pain and more skin tightening. These are excellent goals, but unfortunately the devices on the market today are designed for removal of fat in very small areas, such as under the neck or from the arms in thinner women. They are not designed for the majority of liposuctions (thighs, abdomen or back), as the burn they would cause is too large and would cause major problems. These laser liposuction machines include slim lipo, smart lipo and other disingenuous names. None of the “advantages”  have so far been proven scientifically or otherwise!

Which liposuction technique?

I find no differences in the available techniques. I am convinced that the variations seen by plastic surgeons have more to do with each patient’s own skin elasticity and attributes rather than the technology being used.
Traditional liposuction requires force to push cannulae in and out of  fat. Ultrasound and laser techniques make it easier but are much slower by comparison, with the cannulae being moved slowly. The power-assisted machine likewise makes surgeons’ experiences less of a workout.

An ultrasound machine costs $30,000-$50,000, and laser liposuction machines between $100,000-$ 250,000! I often wonder whether a surgeon’s judgment is affected by an incentive to recoup that financial outlay for such expensive medical equipment.

In late 2008, a study was performed comparing ultrasound liposuction, laser liposuction and power-assisted liposuction. No differences in results were seen. Power-assisted liposuction was the technique that had the least amount of damage to the skin and its structures and was, by extension, the safest. I’ll keep using it until “nuclear liposuction” comes along; we’ll see if that is any better.

2020, and with everyone injecting fat everywhere both laser lipo and ultrasound lipo have fallen off the perch where they were the end all. Too much scarring and uneveness of skin contours put an end to the popularity of these techniques.

Morad Tavallali, M.D., FACS

Cosmetic Plastic Surgeon


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