Liposuction Surgery

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In the basic approach, a small cannula is inserted into the body through a small incision. It is attached to a vacuum device. The surgeon pushes and pulls the cannula carefully through the fat layer, breaking up fat cells and drawing them out of the body by suction.

This method is seldom used today. Instead, the surgeon will employ some of the various improvements that have been made since liposuction’s inception.

Basic Liposuction with Fluid Injection

A small amount of fluid, less in volume than the amount of fat to be removed, is injected into the area. This injection consists of:

1. Lidocaine-a local anesthetic

2. Epinephrine-contracts blood vessels and minimized bleeding

3. A salt solution –to make it saline, like our own body fluids

This fluid helps to loosen the fat cells and reduce bruising. The fat cells are then suctioned out as described in the basic procedure.

Tumescent Liposuction

This method is a major improvement to liposuction surgery. Rather than a small amount of liquid, a 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 basic liposuction, but the increased quantity creates space between the muscles and fatty tissue, which creates more room for the suction tube that is used to remove the fat cells. This method allows the surgeon more room to perform the back and forth movements that break up the fat cells and allow them to be suctioned out of the body.

This type of liposuction procedure takes approximately 3 to 4 hours depending on the size of the area to be worked on. This procedure is longer than basic liposuction surgery. This is because the fluid must be carefully introduced into the body over an extended period and then be allowed to percolate and enlarge the area prior to any work is started.

Stitches

Stitches are used at the discretion of the surgeon who is performing the liposuction surgery. Since the incisions are small but the amount of fluid that must drain is large:

1. Some surgeons choose to leave incisions open, to better clear one’s body of excess fluids. Uninhibited departure of these fluids allows for faster healing of the incisions.

2. Other surgeons only stitch partially, which leaves room for fluids to drain.

3. Others delay stitching until a majority of the fluid had drained, which normally takes 1-2 days.

Regardless, while fluid is draining, bandages must be changed often. After 1-3 days, self-adhesive bandages are sufficient.

Super Wet Liposuction

Fluid volume in this method is about the same as the amount of fat expected to be removed. Many plastic surgeons prefer this technique for high-volume liposuction because it better balances hemostasis and fluid overload. It takes 1-3 hours depending on the size of the area to be treated. It may require either:

1. IV sedation as well as a local lidocaine or

2. Complete anesthesia

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 within the body. The vibration bursts the walls of the fat cells, emulsifying the fat, making it easier to suck out.

1. UAL is a good method for working on more fibrous areas of the body such as the upper back or male breast area.

2. This method takes longer than a traditional liposuction procedure, but not as long as a tumescent liposuction procedure.

3. Less blood is involved in this type of procedure.

4. Thus far, there appears to be slightly more risk of seromas forming, which may require draining with a needle.

Power-Assisted Liposuction (PAL)

Power-assisted liposuction uses a specialized cannula with mechanized movement, so as to reduce the number of movements that the surgeon has to make manually. Otherwise, this method is similar to the UAL method.

Unlike other methods of liposuction surgery, cannula movements during this type of procedure are much more subtle, creating less patient discomfort. So far, there appears to be less risk of puncturing internal organs, due to the more controlled and predicable movements of the cannula.

External Ultrasound-Assisted Liposuction (XUAL or EUAL)

External ultrasound-assisted liposuction is a type of UAL where ultrasonic energy is applied from outside the patient’s body, through the skin, making the specialized cannula of the UAL procedure unnecessary.

XUAL was developed when surgeons found that, in some instances, the UAL method caused skin necrosis (death) and seromas (fluid pockets) analogous to hematomas (pockets of red blood cells). XUAL is a possible way of avoiding such undesirable side effects through external application of ultrasonic energy. It also has potential to:

1. Cause less patient discomfort during and after the procedure.

2. Decrease blood loss significantly.

3. Allow easier access through scar tissue.

4. Treat larger areas.

However, this method is not currently popular or widely used and studies regarding the effectiveness of the XUAL method are inconclusive at this point in time.