Technical Advances in Liposuction Surgery
Much has changed since the early years of liposuction. The basic surgical suctioning of fat, now known as the "dry" technique, required hospitalization and general anesthesia for every patient, and blood transfusions were usually needed because of the substantial blood loss. For this reason, the dry technique has since been all but completely abandoned since the early 1990s.
The plastic surgery community has since developed a collection of techniques which are continually evolving. These techniques often allow liposuction to be performed in an out-patient setting under local anesthesia and with little blood loss. Here we will discuss the most popular techniques used today in plastic surgery’s “war on fat.”
- The Wet Technique
A small amount of fluid, which is significantly less in volume than the amount of fat to be removed, is injected into the area. This injected liquid is comprised of a combination of lidocaine (a local anesthetic), epinephrine (contracts blood vessels to minimize bleeding), and saline (a saltwater solution similar to our own body fluids). The fluid helps loosen the fat cells and reduce bruising. The fat cells are then suctioned out via a surgical vacuum device onto which is affixed a cannula (the thin hollow tube used to suction out the excess fat cells).
- The Super-Wet Technique
The same fluid cocktail is generally used as for the wet technique, although the proportion of saline to medications is more diluted. Total fluid volume used with this technique is about the same as the amount of fat to be removed. Many plastic surgeons prefer this technique for high-volume liposuction because it balances fluid levels more effectively.
- The Tumescent Technique
With this technique, a very large amount of liquid (up to 3 or 4 times the volume of the fat to be removed) is injected into the area. The contents of the liquid are the same as in the wet and super-wet techniques, although further diluted. The increased fluid volume creates space between the muscles and fatty tissue, allowing the surgeon more room to perform the movements that loosen the fat cells before they are suctioned out of the body.
This procedure takes longer than basic liposuction surgery because the fluid must be slowly and carefully introduced into the body and allowed to fill the area over a longer period of time, causing the tissue to become swollen and firm (tumescent) before any further work is begun.
- Internal Ultrasound-Assisted Liposuction (UAL)
Also known as ultrasonic liposuction, this is a type of tumescent liposuction surgery. A special cannula is used, which transmits ultrasonic vibrations inside the body. The vibrations effectively implode the walls of the fat cells, liquefying the fat, which makes it easier to remove by suction. Because less aggressive movement is needed by the surgeon, the surgery is thought to be less traumatic for the patient.
UAL's advantages appear to be less bleeding and less trauma to fibrous tissues. Some UAL advocates also claim that the approach yields a smoother result, although most agree that this depends largely on the surgeon's experience and skill. The disadvantages include an increased risk of the formation of seromas (pockets of fluid under the skin which require draining with a needle), as well as a risk of burns, necrosis (tissue death), or severe scarring of the skin.
This method takes longer than the wet or super-wet techniques, but not as long as tumescent liposuction with ultrasound. This type of procedure also usually requires general anesthesia or heavy IV sedation.
- External Ultrasound-Assisted Liposuction (EUAL)
External ultrasonic liposuction also uses ultrasonic energy to liquefy the fat which is to be removed. However, the energy is applied from outside the patient’s body, through the skin, via the use of a special paddle (as opposed to internal ultrasound with the use of a ultrasonic cannula).
External UAL is believed to carry less risk of seromas and necrosis, and to allow easier access through scar tissue. Proponents also believe the procedure causes less patient discomfort and allows the treatment of larger areas while further decreasing blood loss. However, this method is not yet being widely used, as studies regarding the method's effectiveness and safety have as of yet been inconclusive. In fact, while UAL devices are routinely used and approved for other medical uses, they are not yet FDA-approved to be marketed specifically for liposuction.
- Power-Assisted Liposuction (PAL)
Power-assisted liposuction uses a specialized powered cannula which moves mechanically in either a rapid in-and-out fashion or a spinning rotation, reducing the number and velocity of manual movements required of the surgeon. In contrast with other liposuction techniques, the cannula's movement is much more subtle, creating less patient discomfort and less surgeon fatigue.
Objective scientific data on the use of PAL devices is scarce because they are still relatively new on the market. However, many surgeons are enthusiastic about the technique. One reason is that because of the more controlled and predictable movements of the cannula, there appears to be less risk of puncturing internal organs.
Continue Your Research
Learn more about liposuction by exploring Liposuction: What You Need to Know.
Sources:
Liposuction, Consumer Information Sheet, American Society of Plastic Surgeons; http://www.plasticsurgery.org/patients_consumers/procedures/Lipoplasty.cfm Eugene H. Courtiss, M.D., et al., Division of Plastic Surgery, Department of Surgery, Harvard Medical School, Boston, MA; “Large-Volume Suction Lipectomy: An Analysis of 108 Patients”; Journal of Plastic and Reconstructive Surgery, 1992, volume 89, pages 1068-1079. Jeffrey A. Klein, M.D., Capistrano Surgicenter, San Juan Capistrano, CA; “Tumescent Technique for Local Anesthesia Improves Safety in Large-Volume Liposuction”; Journal of Plastic and Reconstructive Surgery, 1993, volume 92, pages 1085-1098. Joseph P. Hunstad MD, FACS, Marguerite E. Aitken MD, MFA; "Liposuction: Techniques and Guidelines"; Clinics in Plastic Surgery, Volume 33, Issue 1, January 2006, Pages 13-25.
