Liposuction is a body contouring surgery that requires not only an artist's eye, but also the insight to determine which patients are likely to benefit from the procedure, and which specific areas of a patient's body are appropriate for liposuction. When artfully and appropriately applied, liposuction can produce dramatic contour improvements. As with all plastic surgery, the goal should be to produce a natural contour.
Some liposuction patients that I treat seek a 'total body makeover', and undergo circumferential liposuction of the trunk, thighs and lower legs. The soft tissue contraction and resulting contour enhancement that is achieved by circumferential liposuction of a given area can be truly amazing. At the same time, I am increasingly seeing patients who come in for what I refer to as 'finesse' or 'refinement' liposuction, where very fit individuals seek refinement of specific areas that they feel are resistant to further improvement with diet and exercise.
To achieve ideal results, the skin tone overlying the area to be suctioned must have adequate tone in order to 'snap back' and redrape in a manner that is aesthetically pleasing. Areas with significant skin excess or redundancy generally require some manner of skin excision in addition to the reduction in the volume of subcutaneous fat by means of liposuction.
It is important to understand that liposuction is not designed to be a weight loss surgery, but rather a body contouring procedure. Patients undergoing liposuction ideally need to be at or near their goal for their long-term weight, and their weight needs to have been stable for several months.
Aren’t there different kinds of liposuction?
Liposuction is traditionally performed using vacuum suction. Recently, new technologies have become available in an attempt to improve the efficiency of fat removal. The liposuction technology that I have been using for the past several years is called 'power-assisted' liposuction (MicroAire Corporation). This device consists of an electric handpiece that pistons the tip of the attached liposuction cannula (the hollow tube that extracts fat) a few millimeters, several thousand times per minute, which greatly enhances the efficiency of fat removal.
One great advantage of power-assisted liposuction is that much less physical effort is required on the part of the surgeon to complete the surgery. While a conventional liposuction apparatus requires a firm grip and forceful arm motion to accomplish fat removal, the power-assisted liposuction device allows one to pass the cannula with great ease. Liposuction surgery using this technology becomes a finesse operation instead of a 'workout', and more energy may be spent on artistic sculpting instead of on just getting the surgery done.
'Ultrasonic' liposuction first appeared in the 1990s, and after gaining some popularity, gradually faded in prominence. It is a technology in which ultrasonic energy is emitted at the tip of the liposuction apparatus to emulsify (liquefy) fat and thereby enhance its removal. A consequence of ultrasonic energy emission is the local heating of tissues, which can lead to burns and other complications if a number of precautions are not carefully followed. This has led some plastic surgeons to not adopt or to abandon ultrasonic liposuction.
In my experience, ultrasonic liposuction does not allow me to produce results that are superior to that which I obtain with power-assisted liposuction. Given the complications that can be associated with the use of ultrasonic energy, I no longer use ultrasonic technology. While I formerly found an ultrasonic device to be of use in fibrous areas that have greater resistance to the passage of a liposuction cannula, such as the back and the buttocks, I now rely on the power-assist device to obtain beautiful results in these more 'stubborn' areas.
Is ‘tumescent’ liposuction better?
Well, yes, but tumescent technique is used for almost all liposuction, and has been for a quite some time. 'Tumescent technique' essentially means that a saline solution containing epinephrine (and usually a local anesthetic such as lidocaine) is injected into the areas to be suctioned, so that the blood vessels in the fat constrict prior to the passage of the liposuction cannula. The vasoconstriction produced by the epinephrine solution minimizes bleeding during fat removal, and liposuction of a large volume of fat can be performed without significant blood loss.
Occasionally I see advertisements for 'tumescent liposuction', which always seems rather odd. Advertising that one performs 'tumescent liposuction' (as opposed to some other, unnamed kind of liposuction, I guess) is a little like bragging that you drive a car with wheels.
Choose your surgeon carefully
Liposuction, as you may have heard in the popular media, is the most commonly performed surgical procedure each year in the United States. Here's a statistic that you may not have heard: the majority of physicians performing liposuction in the United States are not plastic surgeons; in fact, many do not have any formal surgical training whatsoever. It seems hard to believe, but many physicians performing liposuction have had no more training in liposuction than a 'weekend course'. One way to determine whether or not a physician has had appropriate training in a particular surgery is to confirm that they have hospital privileges for that procedure.
I fear that some practitioners view liposuction as a 'simple' surgery, since it does not involve making large incisions, and it requires little, if any, suturing. Nothing could be further from the truth. Liposuction, in my mind, is a very challenging operation that requires careful planning and preparation, and a great deal of care and finesse when it is actually performed. It requires a three-dimensional understanding of the layers of human anatomy, an understanding that is second nature to a surgeon alone. I think that it is often an inadequate understanding of anatomy (and, perhaps, of the body's response to surgery) which leads to the poor results in liposuction and body contouring that unfortunately are so often seen.