Liposuction in 2010 by Dr. Ronald Schuster, Board Certified Plastic Surgeon in Baltimore, Maryland

Liposuction has come a long way int he past 25 years. Today there are several different ways to get rid of fat so it is not hard to a bit confused. In this blog I will briefly described many of the current methods of fat removal and give you my opinion of them. First, traditional liposuction is still the most popular and commonly used method to remove unwanted areas of fat. Today however it is much more refined. The cannulas (metal tubes) to remove the fat are thinner to give a smoother result. Tumescent anesthetic solution is used fairly uniformly and includes physiologic salt water, epinephrine (to decrease bleeding and bruising) and Lidocaine anesthetic (to reduce pain). While this solution can be used differently between different doctors, the benefit is to be able to remove more fat, with less bleeding/bruising and more comfort. This type of liposuction is still the gold standard and one which everything else must be compared to. A wide range of fat can be removed using this time honored technique and special care must be taken by the doctors when performing large volume liposuction (greater that 4 liters) in order to provide for a safe recovery.

About 15 years ago Ultrasonic Assisted Liposuction (UAL) was introduced, and I was one of the first Plastic Surgeons who was trained during specially arranged training sessions. In short, UAL created a powerful sound wave of ultrasonic energy at the tip of the cannula (or probe). This energy liquifies (technically called cavitation) the fat without disrupting the nearby blood vessels, thus again reducing the amount of bleeding and allowing even more fat to be removed. Another potential benefit of UAL is its ability to cause skin shrinkage. As with any type of liposuction the final result depends in a larger degree on the quality of the skin,]. The better the quality of the skin, the better the shrinkage. In cases where the skin is not in such great shape it would be helpful to have something actively help to shrink the skin. Enter UAL. The energy of the sound wave is very hot and when used correctly can help to heat the undersurface of the skin.Heating of the collagen within the deeper parts of the skin can produce skin shrinkage. The problem comes if it is not used correctly which than can cause burns. Unfortunately this ultimately depends on the experience of the surgeon to use just the right amount. Fortunately, being one of the earliest users I have become very experienced and very comfortable using UAL.

Since those early days there have been additional generations of UAL. The most widely marketed is the VASER. It is really nothing more than a brand of ultrasonic assisted liposuction. After using the VASER I found myself returning to a second generation of UAL for more control and safety. I presently use the Lysonix UAL power generator and continue to be very happy with its results. UAL is particularly useful in removing “tough” fat such as in the back and upper abdomen, as well as for fat removal in men.

Next came Laser Lipolysis. The most notable of these are Smart Lipo, Slim Lipo, and CoolLipo. Using thin fiberoptic lasers the laser light energy targets the fat and melts it. These lasers also produce heat so that they might have a benefit to shrink skin also. These lasers do not by themselves actually remove the fat however. So either it must be absorbed by the body or traditional liposuction must be done afterwards in order to remove the fat. These lasers are heavily marketed because if they really did what they said “no pain, no bruising, etc, etc” it would be great. The truth is that they do work very well for very small areas but most likely do not produce skin tightening as well as UAL. In my experience most patients who only need a small area of fat removed do extremely well with just traditional liposuction and have very little downtime. Patients who need more fat removed would need to go back to have laser lipolysis repeated and ultimately will end up being at least if not more expensive. Also, in inexperienced hands the lasers can definitely cause internal burns. Although I run the risk of being “old school” I do not believe that, aside from marketing, laser lipolysis has anything extra to offer than traditional or UAL.

Most recently two additional methods of fat removal have been introduced. The first is the Zerona device. This is a method that applies laser light energy externally in the hope os reducing fat. This method requires a strict adherence to a special diet and during a critical review I attended at the American Society Of Aesthetic Plastic Surgeons in Washington, D.C. this past Spring, there was fairly uniform disappointment and skepticism in the success of its claims. The second method is the Zeltiq. This is a machine that freezes small areas of fat, most notably around the waist. The freezing kills the fat cells and the fat is gradually absorbed. While this has been shown to actually work, it is difficult to apply to larger areas and is logistically difficult.

Finally, injection lipolysis is a very old method of fat removal which recently became popular when it was marketed under the trade name of Lipodissolve. This method, known as mesotherapy, involves a technique of injecting certain chemical agents beneath the skin that dissolve the fat. The problem is that it is very uncontrolled and it is certainly possible that anything could be injected if performed by unscrupulous “doctors”. Most of the recognized chemicals include bile acids which are well known to assist in the dissolution of fats that you eat. Even when performed well, this technique requires multiple treatments and still may leaves areas of irregularity.

So there you have it. In summary, in my opinion advances in traditional liposuction and UAL are still the most predictable safe methods to remove fat and reshape contours. Today there is a great deal of hype and marketing surrounding every new machine that comes out. Usually not enough true comparison testing is performed before the direct to consumer advertising begins. Just remember, be careful out there. While I constantly search out the best technologies for my patients, I will stick to safety and predictability over flash and hype every time. That’s what my patients want.

Feel free to blog back with questions.

Dr. S