Liposuction, Liposelection, Liposculpture - What's the Difference?!

What is the difference between all of these types of lipo: Liposuction, Liposelection, Liposculpture? What type works the best?

Doctor Answers 22

Technology vs. Marketing

While there have been both medical and technolgical changes in liposuction, not all of them are such huge advances as marketing campaigns would suggest.

From a medical standpoint, the procedure has changed with the use of a wetting solution, both with constituents and quantity. The very first liposuction techniques were performed Dry, where fat was directly removed through a suction cannula. No wetting solution was used, and there was a significant amount of bleeding and bruising associated with the procedure. A major medical jump forward was the addition of epinephrine (a vasoconstrictor – it causes blood vessels to temporarily shrink), and lidocaine (local anesthetic that makes the area numb). These two additions significantly decreased blood loss and bruising, and addressed discomfort associated with the procedure. Depending on how much fluid is used in relation to how much fat is removed, the technique is descriptively called “Wet” (minimal), “Superwet” (1:1), or “Tumescent” (2-3:1). Typically, most surgeons performing the procedure under anesthesia will use the Superwet technique, as this amount of wetting solution is enough to reduce bruising, and not too much to cause distortion of the anatomy. The Superwet technique is generally not enough to provide complete pain relief. If the procedure is performed without assistance of an anesthesiologist, the Tumescent technique is often used, as the increased amount of wetting solution is enough to provide full pain relief.

From a technology standpoint, there have been some improvements to the cannulas, most of which make the procedure easier for the surgeon to perform. With classical liposuction, the surgeon personally moves the cannula back and forth under the skin to remove the fat. To make the removal even and smooth, small cannulas are used, and the back and forth motion can occur several hundred to a few thousand times. As you expect, fatigue can occur, and this can affect the outcome. All of the newer technologies assist the surgeon by delivering energy under the skin surface, which makes it easier to pass the cannula (they reduce resistance). At the low end of the energy spectrum, Power Assisted Liposuction, or PAL, the cannula reciprocates back and forth in the several hundred hertz range. Moving up the energy spectrum, in Ultrasonic liposuction the cannulas vibrate in the ultrasound range. A good technological refinement in this class was VASER, where the cannula was re-designed to spread the direction of energy (to decrease the chance of end-hit skin burns), and pulsing the energy to reduce the amount delivered below the skin surface. The most recent energy addition is in the visible wavelength, with laser liposuction or SmartLipo. All of these do make it easier for the surgeon to move the cannula through the fat, and in certain instances (revisional surgery, male chest region), they are really necessary. However, this increased surgical ease comes at a price, as all of them deliver heat below the skin surface as a side effect. There can be advantages and disadvantages to this heat. A small amount of heat can have the beneficial effect of causing more contraction of tissues. Heat also increases the chance that the body may respond by making more fluid (called a seroma, which may need to be drained). And finally, if too much heat is delivered, a burn may result. As always, it is good to balance the risks and benefits for each individual patient, as there is no one “best” method for performing liposuction.

The last thing to review is some terminology that is now associated with liposuction, that is truly marketing. Terms such as Liposelection and Liposculpture are marketing methods of branding liposuction performed using a particular device. In recent years, catchy names for new devices have been used, as some of them suggest superior results. Having a good marketing campaign does not necessarily mean the device is better at what it is supposed to do, rather, only that the marketing is doing a good job. Have a frank discussion with several surgeons regarding your goals, and listen to what they tell you. Every procedure and technique has issues, and the more informed you are about these risks and benefits, the more comfortable you will feel about your decisions.

Dallas Plastic Surgeon
4.9 out of 5 stars 67 reviews

Liposuction options between conventional liposuction, ultrasound assisted liposuction, and laser

Liposuction is formally referred to as Suction Assisted Lipectomy, whereby fat cells are removed using a small cannula and a vacuum assisted device. The technique is well recognized, safe, and commonly used by most plastic surgeons.

Recent advances have changed the scope of liposuction to include an added benefit of not only removing the fat through suction, but also dissolving the fat with energy. The energy types are ultrasound energy (VASER) or laser.

The process of ultrasound assisted liposuction is well documented and involves a process of cavitation, whereby sound waves are used to break open and kill fat cells prior to the liposuction. This results in improvement in contour for patients.

The type of liposuction you are recommended is usually dependent on your particular body profile and the experience of the surgeon. Patients will do well with conventional liposuction and more advanced techniques equally well if the surgeon utilizes appropriate technique.

Raffy Karamanoukian, MD, FACS
Los Angeles Plastic Surgeon
4.8 out of 5 stars 94 reviews

There are some equipment differences between the various...

There are some equipment differences between the various "types" of liposuction but really all are about the same, just fancy names for the same thing trying to sound different, better, or more elegant.

Basically the result you will get depends far more on the nature of your skin and its ability to shrink and the sculpting eye and skills of the surgeon than anything else. No technical developments or advances have occurred in liposuction that exceed these two factors or can cover up poor skin quality or mediocre surgical technique.

Richard P. Rand, MD, FACS
Seattle Plastic Surgeon
4.8 out of 5 stars 67 reviews


Liposuction is the basic technique. in small areas, where you are doing small volumes, i sometimes use the word liposculpture, because we are focusing on shape more than on volume (we always focus on both). I find that patients spend too much time online (that's you, if you are reading this), and not in offices speaking to surgeons. Most surgeons will offer free consultations. Go talk to them. At the end of the day, your results will depend on the person performing the procedure.

Marwan R. Khalifeh, MD
Chevy Chase Plastic Surgeon
4.7 out of 5 stars 106 reviews

There is no difference between them

Many different terms have been created to help brand a practice or make the advertised procedure appear special.

Any liposuction procedure involves the removal of fat in such a manner as to leave a desired shape. Sculpting is therefore part of the process. Aggressive sculpting to reveal underlying musculature may involve excessive removal of fat which may not support the overlying skin, thereby resulting in complications. Indentations may occur as a result of liposuction when performed in the most expert hands! That is why It is so important to consider having surgery by a knowledgeable and experienced plastic or dermasurgeon.

Ronald Shelton, MD
Manhattan Dermatologic Surgeon
4.9 out of 5 stars 38 reviews


#LipoSuclptureAndLiposuction are often used interchangeable so ask your plastic surgeon for their defiinition. In my mind, liposculpture often is used to create a specific image by leaving or removing fat in a non homogeneous manner for example giving the illusion of an abdominal "six pack" by leaving small amounts of fat behind to mimic muscle fullness.

Larry S. Nichter, MD, MS, FACS
Orange County Plastic Surgeon
4.9 out of 5 stars 157 reviews

Liposuction, Liposelection, Liposculpture

irrespective of the technique it is the skill and mastery which comes out ofexperience of thesurgeon that counts,ofcourse the technology is more helpful in easing the labour of the surgeon and the pockets of the patient and ofcourse you have to give what the public demands ,you must have the vaser,laser and nutationalinfrasonic and what ever,besides the skill and expertise,these are great marketing tools that helps you stay ahead of the competition.Its not just the apple that matters,but also how you eat them!

Thangavel Ayyappan, MBBS, MS, MCh, DNB
India Plastic Surgeon
5.0 out of 5 stars 3 reviews

Liposuction, Liposelection, Liposculpture - What's the Difference?!

Liposuction is the original name for the removal of fat by suctioning it from underneath the skin. This was originally done without infusion of a wetting solution with epinephrine. After the introduction of liposuction with a wetting solution, the differences were in how much solution to use. With general anesthesia, only a 1:1 ratio of  infiltrated fluid to fat is needed. With local anesthesia, the ratio goes up to 3:1.

Then in the 90's, ultrasonic liposuction was introduced from Europe with the idea of breaking down the fat first and then removing it. This was thought to be less traumatic to other tissues like blood vessels and fibrous supporting tissue. Early ultrasonic machines concentrated too much heat at the tip of the probe and made it difficult to control side effects like fluid/seroma collections or even skin burns.

Liposelection is a name coined by the makers of one current generation of ultrasonic-assisted liposuction machines. This is Sound Surgical Corportion and they make the Vaser. They call it vaser ultrasonic liposelection.  The reason for the name is that the way the ultrasonic energy is generated both at the tip and along the shaft of the probe makes the fat cells split apart from each other. The risk of overheating or burns is very low, so side effects from the heat are much less likely.  Of course the cosmetic outcome is still very much in the hands of the surgeon. The vaser is a tool.  It is very helpful in breaking down fibrous areas or for secondary liposuction procedures. It is good for gynecomastia. When used for a lipo-abdominoplasty, it is great because it allows "lipo-sculpting" of the abdomen and torso at the same time. Regular liposuction is more traumatic to blood vessels and could impair the healing of the abdominal flap. One can do a comprehensive job of "sculpting" the body first by removing all the excessive fat of the upper abdomen and around the waist before proceeding on to the tummy tuck itself. 

"Liposculpture" is just a usage that connotes an artistic approach to contouring. You might say it means that what is most important is what is left behind, the final shape. Since the underlying body is obscured by excessive fat, the removal of that fat to reveal the body shape can be called lipo-sculpting.

You can also have laser-assisted liposuction,  such as the SmartLipo Triplex which I currently use for office procedures.  I use vaser "liposelection" for cases in the hospital which may have larger or more widespread areas because it is more efficient. I rarely use liposuction alone anymore because I like the way vaser liposelection allows gentle and incremental breakdown of the fat.  I find it less likely to lead to contour abnormalities from over removal, as compared to regular liposuction which depends on the cannula design and a vacuum to grab and pull out the fat.

Don't forget that before there was liposelection (vaser), or laser, or "liposculpture", we delivered great results.  The best procedure is what works best in the hands of your board-certified plastic surgeon. 

Robert M. Lowen, MD
Mountain View Plastic Surgeon
5.0 out of 5 stars 49 reviews

Help! I don't understand all of the liposuction machines and techniques???

Tumescent liposuction, VASER Lipo, Smart Lipo, Cool lipo, Pro Lipo, Slim Lipo, Water Jet lipo...

What does this all mean? If I don't get Smart lipo does that mean I'm dumb? If my surgeon recommends Slim Lipo does that mean he/she isn't a "Pro"? It truly is a ridiculous situation we have come to with regard to liposuction and the number of people trying to cash in on America's desire to be rid of its collective fat.

In well motivated patients, body contour improvement can be a very healthy endeavor, but how is an otherwise intelligent and well-adjusted person to know the difference between a responsible provider of aesthetic services offering them safe options for help with their body contour and a poorly trained and inexperienced provider more interested in their wallet than in your outcome and safety?

It is first important to realize that all of these devices will require you to undergo a liposuction procedure. The only difference is the approach to the treatment of the fat prior to its removal.

Because they all involve liposuction, and this is in fact a surgical procedure, it is very important that you "do your homework" and find a surgeon certified by The American Board of Plastic Surgery who has the years of training in liposuction necessary to give you the safe experience and superior outcome you deserve and desire. Behind the amazing number of machines now available to remove your fat, there has followed an army of their sales representatives and an equally impressive number of providers marketing themselves as "liposuction experts".

What has made them "liposuction experts"? In almost all cases, a few days or weekends training with the salesman for the device or with someone more experienced in the procedure. It is their promise that if you have the device in their possession brought to bear on your behalf, your fat will be gone, your skin will miraculously shrink away, you won't need any anesthesia because the device allows painless removal of the fat, and it can be done on your lunch hour. The only thing I am surprised by at this point is that they don't promise you'll get rich and be more sexually alluring after the procedure too.

Selling the particular device to patients is not unlike someone saying to you that because they will give you access to Tony Stewart's racing car that you will be able to win this weekend's race and make a million dollars. Tony Stewart wins races because he is a great racing car driver AND he has a great car...This is no different.

Getting the best outcome from a body contouring procedure depends most on finding a well-qualified and experienced surgeon, and much less on the device used.

Most of these people are so aggressive in their marketing of these questionable devices because they are, in fact, not trained plastic surgeons but rather are either not physicians at all, or they are doctors with core training which would not have prepared them to do liposuction. Many have read recently about a death in my home state of Florida after a healthy 40ish year old mother had liposuction performed be a rehabilitation medicine doctor. Amazingly, I know of eye doctors (!!) doing liposuction as well- and yes, they market themselves as "liposuction experts".

The particular device used can affect the overall experience, however.

Despite the claims of the manufacturer and the practitioners who plunked down the large sum the device costs, Smartlipo has never been proven to shrink skin better than tumescent liposuction. SmartLipo, SlimLipo, Prolipo, and Coolipo all use a laser to destroy the fat cells, allowing them to be removed by liposuction. My problem with these is that, first of all, as a scientist and doctor I am offended when false claims of benefit are made, and that because the lasers will burn whatever you point them at, I worry that your nerves, blood vessels, muscles, and skin may be injured by the laser.

Bottom line (and in my opinion) -- there is no benefit to these devices, they are expensive (meaning that the cost to you, the patient, will be higher as well), and the risks are higher.

Tumescent liposuction is the gold standard to which all other techniques must be compared. It has been proven to be safe and effective over many years (provided that it is performed by a well-trained surgeon). It involves the injection of a fluid into the fatty tissue layer that causes blood vessels to shrink and the fat to expand, making it easier to remove and lowering the risk of a complication.

VASER lipo involves an additional step, in which the fat (after injection of fluid but before suction is applied) is treated with ultrasound energy. Unlike the laser filaments used in SmartLipo and the other devices mentioned above, the VASER probe is blunt and the ultrasound energy it uses is much more specific for fat, so that the risk of injury to the blood vessels and nerves, as well as the muscles and skin are much lower. This is seen in the patient experience of reduced swelling and bruising.

Each time a new (revolutionary!) liposuction machine comes out, I think the most important questions to ask are not "Does it work?", but rather, "Does it work better than what is already available, is it less expensive (not more), and is it safer than what is already available?"

The VASER (in my opinion) passes this test, while the laser based devices do not.

Having said all of that, I would emphasize that it is the education, training, experience, and skill of the surgeon at the end of the liposuction device that will make the greatest difference in your outcome and safety. There is not substitute for the years of training Board Certified Plastic Surgeons receive in liposuction, directly supervised by other Board Certified Plastic Surgeons. A well trained and Board Certified Plastic Surgeon would be more than capable of achieving a better outcome through tumescent liposuction than any eye doctor with a Water Jet. As in the analogy of Tony Stewart above- a great professional with a great tool (like the VASER) would only make those results and their safety even greater.

Please know that I have no financial relationship with any of these companies and have personally tried each of the discussed technologies myself on patients.

Armando Soto, MD, FACS
Orlando Plastic Surgeon
4.8 out of 5 stars 159 reviews

Liposuction, Liposelection, etc.

The first was suction-assisted liposuction, then Ultrsound liposuction and Tumescent liposuction. All these are different techniques of suction-assisted liposuction. Ultrasound liposuction uses ultrasound to disolve fat the suction the disolved fat

Tumescent liposuction infuses large volume of fluid with other medications then perform any other method of liposuction.

The new comers: Smart Lipo and Water Jet Lipo. There is no significant experience with these methods. There is no scientific peer reviewed articles about their safety and effectiveness, therefore, they are marketing gimimcks.

Samir Shureih, MD
Baltimore Plastic Surgeon
4.2 out of 5 stars 7 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.