Liposuction is a surgical procedure (also referred to as an invasive procedure) that treats fat by surgical removal. Any subcutaneous (below the skin) fat deposit can be reduced or removed. The areas targeted are typically those that are resistant to diet and exercise (tummy, flanks). However, almost any area can be targeted (i.e. chin, arms, ankles etc). The procedure is performed by placing tubes (also known as cannulas) under the skin and into the fat. Next, different types of energy (traditional, power, laser, ultrasound) can then be utilized to break up and remove the fat. While the type of liposuction (traditional, power, laser, ultrasound) is very important it is not the most important factor. The single most important factor is the surgeon performing the liposuction. Why? Because liposuction is as much an art & sculpting as it is surgery. How is that hour glass figure created? How is muscle definition sculpted? By artistically visualizing what needs to be done and then artistically executing and sculpting the result. This ability is solely based on the surgeon performing the liposuction. Experience absolutely matters!
The technique of liposuction (as discussed above) was introduced in 1974. Since that time liposuction has significantly changed and evolved for the better. Traditional liposuction involves hooking tubes up to a suction vacuum. This suction vacuum then places your fat cells under suction and removes the fat. Let’s look at each Type of Liposuction and discuss them:
Traditional liposuction was introduced in 1974 and became increasingly popular in 1982 when surgeons began adopting the technique. The procedure consists of placing a hollow metal tube under the skin and into the fat. The hollow metal tube is hooked up to a vacuum machine. The machine then creates suction and this cause the fat to be forcibly ripped or torn from the surrounding fat cells. In addition, the cannula is then moved back and forth by the surgeon in order to help further tear and dislodge the fat. In many respects, this can be likened to a cheese grater grating the fat and then the fat being sucked away. It isn’t hard to imagine why the recovery from traditional liposuction was significant. And also why traditional liposuction recovery was viewed as a negative experience. In addition, the surgeon would also get tired from physically having to move the liposuction cannula. As the surgeon becomes physically fatigued there is less ability to focus on the artistic result. For these reasons, it is rare that traditional liposuction is performed today.
Power liposuction involves a motor that moves the hollow metal tube (also known as a cannula) at speeds that are barely visible to eye. The motor causes the cannula to move 3mm 4,000 cycles per minute! That is extremely fast! The powered liposuction cannula significantly reduces the fatigue of the surgeon. Overall, this allows for increased surgical precision in artistically sculpting and contouring the body via liposuction.1 The powered nature also allows for the fat to be removed in a less traumatic (less injury to the body) fashion. Think of it like grapes on a grape vine: Power Liposuction allows for grapes to be plucked while maintaining the grape vines and not injuring the plants. Conversely, traditional liposuction would be similar to simply tearing the grapes with the vines/plants or taking everything in one swoop and ultimately injuring the plant. This is way when Power liposuction is compared to traditional liposuction power liposuction has significantly better patient comfort.2
The next evolution in Liposuction was to help break up the fat before suction even begins! Prior to placing a hollow tube under the skin, a different round tube is place under the skin and into the fat. In this specific case, the end of this tube has a LASER. The laser emits different light wavelengths (i.e. 1064nm, 1320nm, 1440nm). Ultimately, these specific wavelengths are absorbed and create heat. Thing of it like butter: what happens when you take a stick of butter out of the refrigerator and place it on a pan? What if you put that pan on the stove and turned the stove on? In effect, these wavelengths break up and partially “melt” the fat. This makes the suction removal easier. In addition, the other laser wavelength help to coagulate (or burn) blood vessels to decrease blood loss and decrease bruising. In addition, the coagulation (or burning) causes the tissue (skin) to tighten.
Unfortunately, despite the great marketing name (SmartLipo®) and the ability to say, “LASER”, there are significant concerns with burns (skin burns) that can cause significant injury and ultimately cause major cosmetic issues (i.e a tummy with burns over it). Further, the packed in or difficult to treat fat areas have a limit of how aggressive they can be treated because the risk for burns also increase.
The newest evolution step in energy assisted liposuction then turned toward SOUND! In this case Ultra-Sound. UltraSound is sounds waves that have a frequency above normal hearing (above roughy 20KHz for the physics buffs). The tube that is first inserted vibrates and creates ultrasound (similar to a SonicCare® Toothbrush…except this is Ultra-Sonic!) these reverberations creates microscopic bubbles that surround fat cells and microscopically dislodge the fat cells. This process is also known as Acoustic Streaming. Overall, the fat is separated not by Avulsion but by Emulsion and this has a significant impact on post-operative recovery and the viability of the fat cells harvested. The process of Acoustic Streaming allows for the precision in the areas of packed-in stubborn fat (flanks/love handles/lower belly); and by the efficient and effective removal of the fat the skin significantly retracts.
Further (and potentially more important), newer ultrasound devices are able to be placed closer to the skin. This causes tightening and firming of the skin; and in some cases this reduces or replaces the need for surgical skin removal.
The main advantages of UltraSonic Liposuction ease of fat removal which reduces surgeon fatigue and increases the precision in body contouring and body sculpting, ease of recovery due to the less traumatic fat separation, decreased pain, decreased bruising, less swelling, and significant skin retraction.
UltraSound and Fat Transfer:
Finally, studies have begun to show that fat transfer with the fat harvested by Ultra-Sound have better fat transfer rates!3 I think this is extremely important to stress. If you are thinking about a fat transfer with the liposuction, studies have shown that UltraSound Fat Harvest produces better results (also known as take-rates) of the transferred fat.
I believe the most important factor is the surgeon performing the liposuction. The surgeon is essentially the body artists or sculptor that is sculpting your body. In my spare time I paint. Even if I had Michelangelo’s art supplies, and I went head-to-head with Michelangelo… I am going to lose. I think the same can be thought of with the different devices. The devices could be the absolute best…but the surgeon holding and using it also needs to be the best!
OK so let us assume all Liposuction Cosmetic Plastic Surgeons are equal (not the case but we will assume it), then I think a combination of Powered Liposuction (to remove the fat) and an Energy Based (to break up the fat) should be removed. Why? Because the combination creates a very effective and great result by first breaking up the fat (with the Energy Source) and then removing the Fat (with the Powered LIposuction). In my hands, I think UltraSound produces the best results and with the least negatives (i.e. risks of burns or thermal injury that can be seen with LASER). Therefore, I utilize a Combination of Vaser Liposuction and then I perform a second treatment with Power Liposuction (two forms of treatment in 1 surgery). It is this combination that allows me to create some amazing results!
No. Liposuction may be performed with you completely awake (local only), sedated or sleepy (think multiple margaritas!), or completed asleep or general anesthesia. The number of areas and the amount of liposuction can determine what type anesthesia you can get. For example, there is a limit, based on your weight, of how much local anesthesia (awake lipo) you can receive. Therefore, if you want to do a number of areas (Tummy, Waist, Back, Arms) AND do it awake, then either we need to split the surgeries up into separated days (could be the following day) or utilize a different form of anesthesia that will allow you to get all the areas done at once.
Personally, I think it is a more comfortable experience for you to simply go to sleep and then wake up with it being completed. However, it is completely up to you!
No. Just like liposuction, liposuction and fat transfer (Brazilian Butt Lift or BBL) can be performed with you awake, sedated, or completely asleep. However, in order for me to get the BEST results with the fat transfer, I need to place the fat in areas that you may feel during awake liposuction. So this leaves us with a couple options: 1) Accept that you will not get the best results under awake liposuction & fat transfer or 2) Have you go to sleep for the fat transfer (my preference because in my opinion it provides the best results). Again, it is up to you but I truly believe you will get a better result when you are asleep (general anesthesia).
Firmness is also completely normal and completely expected after liposuction. The firmness is because the fat and surrounding tissues are swollen and inflamed (think angry) from the liposuction. Think about it like when you sprain an ankle, it gets bruised, swollen, and firm. It also take at least 6 weeks to 3 months for the ankle to soften. For some people it takes less time and for others it takes more time. How do we treat it? We elevate the ankle, apply warmth, and wrap the ankle. Therefore, in order to help shorten the firmness and overall recovery time, massage is started at 1 week after surgery (unless a breast surgery has been done at the same time then I wait until at least 2 weeks) to the liposuction areas. The massage softens the skin and tissue. In my opinion, massage is a KEY step to faster recovery and overall better results.
Another important factor when thinking about recovery: as we discussed above, different forms of liposuction technology can either increase or decrease your recovery time and in my opinion the UltraSound Liposuction produces the quickest/fastest recovery and the least amount of bruising/swelling/firmness.
For all of my patients, I recommend switching to Spanx® or a similar department store compressive garment 2-3 weeks after surgery. Typically, around that time the original compressive garment is loose bc a significant amount of swelling has gone down. Continually, downsizing your compressive garment improves both your healing time (recovery time) and overall results.
Frequently, if you are getting a tummy tuck, I will perform liposuction at the same time. Why? Because almost all tummy tucks benefit from some liposuction. Conversely, with the new Ultrasound Liposuction, all tummy liposuction does not need a tummy tuck.
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