Review of Liposuction Methods - Is Invasive or Non-invasive Liposuction the Best Choice

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     It is best to differentiate between true liposuction and non-invasive "liposuction" such as Zeltiq / Coolsculpting, Suresculpt and Vanquish.  These companies have huge marketing dollars for the non-invasive "liposuction" target audience - those people not wanting surgery and a desire for minimal to no downtime.  However, there is no comparison between what true surgical liposuction can achieve in terms of overall result.  I often tell patients that if you have lots of money, lots of time and low expectations then go ahead and try the non-invasive methods, but most come back and say, "Hey Doc, now its time to do the real thing because I want real results. 

     With Coolsculpting (freezing the fat), Suresculpt (Light based energy treatment of the fat) and Vanquish (radio-frequency treatment of the fat) the fat is treated externally and the body is then supposed to absorb the fat over the next several months.  With Vanquish the machine does not even touch the body - it just kind of hovers over the body and transmits focused radio-frequency through the skin.  

     With true or surgical liposuction, the fat is sucked out through small cannulas.  At the end of the procedure, you can see canisters of your fat which has been physically removed.  You can also see an immediate result.  

     While the non-invasive methods have minimal to no "recovery," the results are lacking and can not even be compared to true liposuction because the non-invasive results are so minimal.  There are also some side effects such as lingering numbness or tingling which can occur after the procedures.

     Surgical liposuction is not without a recovery.  There is a direct relationship between the number of areas treated and the aggressiveness of fat removal with the amount of swelling and possible bruising.  Patients have to wear compression garments to help shape the empty skin (fat now gone) to tighten against the underlying muscle and also to reduce swelling.  Most patients need to take several days off of work.

     Cost is also an issue.  While the cost per treatment with the non-invasive procedures may be less (average around a $1000 per treatment) the number of areas required and number of repeat treatments can quickly add up.  Surgical liposuction has a higher up front cost, but in the end gives better value in terms of result and total cost.

     One must then differentiate the different types of surgical liposuction.  Traditional liposuction is almost never used anymore because of the side effects of bleeding, bruising and massive swelling.  Now, tumescent liposuction is the standard of care.  In this version of the procedure, the fat is pre-treated with injections of saline mixed with lidocaine (for pain control) and epinephrine (to reduce bleeding).  There are many technologies which can be used in combination with tumescent liposuction.  Power-assisted liposuction is a vibrating cannula system which helps break up the fat and remove it with a smoother contour.  The fat can also be pretreated with Smartlipo Triplex (laser technology).  The pre-treatment with the laser under the skin can help melt the fat and stimulate the collagen cells to help tighten the skin.  Other technologies include ultrasound (VASER) which breaks up the fat prior to removing it.  No study has shown any of the invasive methods to be better than others but they are all better than non-invasive methods.  

     If patients want a BBL - Brazilian Butt Lift or other fat grafting, then tumescent liposuction is performed, but the fat cannot be treated with the Smartlipo or Vaser first because these technologies kill the fat cells.  After the fat is harvested, the surgeon can go back and perform the laser treatment if desired.  

The best advice for patients is to consult with a board certified plastic surgeon with extensive training in liposuction and body contouring.  During the consultation, the surgeon can help discuss with the patient the best options for their body to help meet their expectations in terms of results, recovery and cost. 

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New York Plastic Surgeon