Confused About All the Different Types of Liposuction

We are in an era of intensive marketing, inflated claims, and frankly a lot of misinformation about liposuction so you are not alone in being confused. One thing you will hear consistently from the docs on RealSelf is that it is more important to choose your surgeon than to base your decision on technology or brand-name. That said, here are a few pointers: All forms of liposuction use what is called a "wet" technique, in which the fat to be removed is injected with a dilute numbing solution. If that is the only anesthesia used, it may be called "tumescent" technique, but that is an anesthesia method, not a different lipo method. It has its own risks and potential benefits. Many patients opt for intravenous sedation for more comfort, and another option is general anesthesia. Where it starts to get more complicated is with lasers; these are all the brand name procedures. However, lasers carry the risk of burns and the advantages are not as well proven as the ads would lead you to believe. Finally there is ultrasonic lipo, which is usually VASER. Just keep in mind that liposuction is surgery and should be done in an accredited surgical facility regardless of the technique.

Tumescent liposuction is the gold standard for surgical fat removal and has a long safety record. While the internet is a wonderful source of information, it can also cause a lot of confusion because so many people are trying to call attention to themselves through innovative marketing techniques and rebranding. Liposuction, liposculpture, Vaser 4d – all of these are variations on tumescent liposuction. The important thing when considering liposuction is not what the procedure is called, but who is doing it. Internet searches cannot beat the plain old footwork of meeting several board-certified dermatologists face to face to find the one whose results are beautiful and who inspires you with confidence. Don't worry about the name; find the right doctor and you'll be happy with your liposuction. During your consultation you can also discuss nonsurgical fat removal techniques such as ThermiLift, Vanquish and CoolSculpting.

The liposuction procedure will begin with the anesthesiologist administering sedation. A small incision between .5cm-1cm wide will be made. Through the incision a tumescent solution will be injected into the area being treated. This solution contains sterile salt water, anesthetic and epinephrine. The tumescent solution is used to expand the fat layer. This allows for even suctioning. It also provides anesthesia.  The incisions will be strategically placed. Scars from the incisions will fade over time. A thin hollow wand, called a cannula is then inserted through the incisions to suck out the excess fat.  The length of the procedure varies depending which areas are being suctioned. The procedure generally takes 1-2 hours.

I have been performing liposuction for 25 years. Over the years I have seen different types of liposuction come and go. The most widely used type used is the Tumescent method. The Tumescent method has also been around the longest. It is considered the 'Gold Standard' to which all other forms of liposuction are compared. None of the newer forms have proven as effective. Some of these so called new and improved forms of liposuction have even ended up being dangerous. They have lead to severe complications for the patients. I use the Tumescent procedure in my practice. I have found no form of liposuction that is superior.

A word about safety

In my practice, safety comes first. I am always cautious of new procedures that are being touted as the latest and greatest. Before I incorporate any new procedure into my practice I like make sure that it is best for my patients. This is why I do procedures with a long track record of success. I don't believe patients should be used as guinea pigs to test out new and potentially unsafe procedures.

 It is important to keep in mind that ultimately, what is most important in this and any other cosmetic surgery procedures is the skill and experience of the surgeon.



 

I agree with Dr. Baxter. Don't be misled by marketing--it is the skill and experience of the surgeon that is important.

There are essentially two types of liposuction based on the anesthesia: General anesthesia and local anesthesia.  The basis for this statement has to do with safety.  The death rate for having liposuction, irrespective of the machine used to suck out the fat is approximately one in 40,000 cases but possible more when liposuction is performed under general anesthesia.  However, the death rate for having liposuction under local anesthesia is approximately one in 300,000.  Liposuction under local is also referred to as tumescent liposuction and is typically practiced by dermatologists.

There have been a proliferation of liposuction machines.  The first wave of these were ultrasound based and new machines utilize lasers to help break up the fat.  However, ultimately the fat is still sucked out of the body.  Yet from a marketing stand point there is appears to be nothing better than to be able to advertise laser assisted whatever.  However, there is no evidence that laser based liposuction machines result in better results than the safest form of liposuction, tumescent liposuction.  Be aware that tumescent liposuction was developed by dermatologists and they remain the largest aesthetic subspecialty practicing this form of liposuction.  So don't expect a board certified plastic surgeon to offer this method.

The message here is beyond the decision to have liposuction under general anesthesia or local anesthesia, the most important decision is not what machine the surgeon is using but who the surgeon is and how are they trained, and what are their results like.  Do you like the office and does your potential surgeon spend any time with you?  You should feel like there is an actual connection with the surgeon and that they listen to your concerns rather than treat you like the liposuction in room 3.  

Evaluate your surgeon's credential, their website, look at their resume for any unexplained gaps or training that does not make sense.  Study their website for before and after results.  Just because your girl friend had successful Botox with the doctors nurse does not necessarily mean that they will do a terrific job with your liposuction.  Do spend the time to actually meet several surgeons.  Remember that there is no magic machine that does the liposuction- its the surgeon.

The confusion about types of liposuction comes from companies hyping their machines. So far there is no evidence that one device is better than another. What is clear, however, is that there is a great deal of difference between the results obtained by highly experience liposuction surgeons and those who dabble in this procedure.

Don't go for the hype. FInd a good doctor to perform your liposcution who gets consistently good results.  I have used most of them.  It is not the wand but the magician waving the wand that creates the magic!

Awake liposuction starts with infiltrating tumescent numbing fluid into the area. It may be followed by laser or ultrasound to melt the cells, or water to flush them loose. Next is the actual suctioning. This may be manual or "power assisted".

We do smart Lipo, Body Jet water, and power assist, depending on each individual's goals.

Because of added risk (and expense) - liposuction with general anesthetic should be reserved for unusual situations, and may even involve an overnight stay.

I would agree that more important than the name of the instrument, is the surgeon or dermatologist using it.

95% of what you are reading is marketing and not science.  Tumescent liposuction has an amazing long record of safety and good results.  And I would only go to a board certified plastic surgeon.