With so many different liposuction techniques now available it’s no wonder so many potential candidates are confused about which method to chose. First, it is important to start with the basic concepts of liposuction. Liposuction is a form of body contouring where fat is removed from various problem areas a patient may have via small, thin hollow “cannulas” that aspirate the fat from the body. The best candidate for liposuction contouring is near his/her ideal body weight and has good elastic skin quality such that when the fatty tissue is removed the skin can essentially shrink wrap and create a nice smooth contour. Liposuction is a contouring technique, not a weight loss method. Those patients who are significantly overweight, have large fluctuations in their weight, or who have poor skin quality are not candidates. Liposuction is not a remedy for cellulite, which by the way has no permanent remedy. And remember, despite tiny incisions, liposuction is real surgery, with real blood loss, with potentially serious, complications. So chose your surgeon carefully and insist they be board certified Plastic Surgeons.
As for the technique, every form of liposuction involves infiltration of a tumescent solution into the fatty tissues as the first step. This fluid often contains lidocaine for anesthesia and epinephrine to constrict the tiny blood vessels in the fatty tissue thereby minimizing blood loss and postoperative bruising. Once the fluid is infiltrated, small- caliber hollow cannulas ( 2mm-4mm in diameter) are used to suction out the fat. In traditional liposuction (SAL or suction-assisted lipectomy) the fat extraction is purely mechanical yielding a chunky, yellow fat slurry. It’s a time consuming procedure, physically demanding on the surgeon and is as much science as artistry. Now comes the confusion.
The next technique on the complexity ladder is PAL or power-assisted lipectomy. In this method, the cannula is now power assisted either with an electric or air driven motor. So instead of the surgeon doing all the mechanical work, the cannula vibrates back and forth (about 90 cycles/minute) making it easier on the surgeon. Kind of like an electric knife as compared to a traditional one.
UAL or ultrasonic-assisted lipectomy is the next method. With this technique, the cannula is now part of a more sophisticated device that generates ultrasonic vibrations at the tip of the cannula. This energy does two things, it essentially liquefies the fat but also creates heat. The tumescent fluid does help absorb the heat but care must be taken because burns can occur. In the early days of UAL,it was thought that the heat that is generated beneath the skin surface could help stimulate the skin to tighten or shrink wrap, but that is only the theory and in practice ,the skin tightening effects are unimpressive at best. Two UAL devices exist,the Lysonics device which I use can deliver both continuous or pulsed energy or the VASER device which is only pulsed. So when UAL is used, the mechanical effort is minimal, surgeon fatigue is minimal, because the fat is essentially being melted. These devices however, do not extract the fat out efficiently, so traditional cannulas still need to be used to remove the fat slurry,which is now frothy yellow like melted fat rather the the chunky fat with more traditional techniques.
So finally there is the newest technique, known as “SmartLipo”. This device uses a laser, specifically an Nd:Yag laser to melt the fat and also coagulate tiny blood vessels in the fat. The cannula is only 1mm so the access incisions are small. Heat is generated and the claim is that this device can also significantly tightened the skin .So well in fact is the skin tightening effect, that physicians who offer SmartLipo say patients with even very lose skin can achieve remarkable results. Well, the reality is that this device albeit using a smaller cannula than the other methods is no more efficient at fat extraction than UAL. The skin tightening is completely unproven and claims of skin tightening are not FDA approved and there is no clinical evidence of this effect. And lastly, the fat still needs to be extracted by traditional cannulas. So while the claims by Cynosure, the company who sells the SmartLipo device are lofty, there is little science to back up these claims. For my money, I’d rather have a Smart Surgeon and good old fashioned DumbLipo!