VASER Liposelection Vs Liposuction or Laser Lipo

Anyone who reads a magazine, listens to the radio, and watches TV is being inundated with information about the latest and greatest technique of liposuction. Without knowing much about the different claims, it would seem that each year the technology is being completely reinvented. I thought it might be helpful to give you some background information about the different techniques so you can make an informed decision about what is right for you.

Liposuction has been around for about thirty-five years, in one shape or form. With its inception, plastic surgeons were able to remove large amounts of fat through very small incisions by introducing cannulas that were attached to a suction device. This became known as suction assisted lipectomy (SAL). We now take this pretty much for granted, but it was a real innovation when it was first introduced.

Prior to this, the only way to remove large areas of fat was to surgically cut them out, which left significant scars. And, this time honored technique is basis for all forms of liposuction. All different techniques that I will talk about rely on fat removal by suction.

One of the first innovations, which in used in virtually all liposuctions, is the tumescent technique. This technique introduced fluid into the tissues prior to the liposuction. Usually there is also some local anesthetic mixed in with the fluid to help with pain relief. Additionally, small amounts of epinephrine (adrenaline) are mixed with the tumescent fluid to reduce bruising and blood loss.

Alphabet soup: the different techniques

Several different techniques have been introduced over the years. Some involve different technologies, and some are variations on the basics of the original technique. All use the tumescent technique as the first step of the operation, and basic liposuction as the final step. The difference in many of these techniques is the energy used to remove the fat, or move the cannulas within the tissue during the suctioning. In SAL (suction assisted lipectomy, or traditional liposuction) it is the strength of the surgeon that moves the cannula through the tissue to remove the fat. This is why I go to the gym to lift weights!

In the early 1990’s, an Italian surgeon, Michele Zocchi, began to work with ultrasound as an adjunct to liposuction. This technique became refined, introduced into this country in the mid 1990’s and has become known as Ultrasound Assisted Liposuction (UAL). After the tissues are tumesced, a cannula emitting ultrasonic energy is introduced into the tissues. This energy breaks up, or emulsifies the fat to assist in its removal. This is very effective in most areas, and is of greatest benefit in areas where the fat is very dense, such as in the chest or abdomen. After the fat is emulsified or broken up, it is removed with traditional suction cannulas, SAL.

I had the pleasure of taking several courses taught by Dr. Zocchi and become intrigued with this method. Subsequently, I became the first plastic surgeon in East Tennessee to perform UAL, and have been doing so for about twelve years. I continue to find this to be an excellent method of liposuction, and use it in most of my liposuction cases.

About six years ago, another device for ultrasound assisted liposuction was developed and marketed: VASER liposuction. The technology behind this machine is virtually identical to other UAL machines. I have used this machine and believe it is a good device. However, I prefer the other UAL device that I have been using. Other surgeons prefer the VASER device. A marketing claim associated with VASER has been to use the term “liposelection.” To me, this term is meaningless, as in all liposuction cases the surgeon must be careful to determine which fat is selected for removal, and which fat should be left in place.

Towards the end of the 1990’s, after UAL had come into clinical use, another form of liposuction was developed: power assisted liposuction (PAL). In this, the cannula is moved back and forth in the tissues driven by a small motor. I have also used this machine and have found it to be effective. It’s main advantage is that it takes less strength on the part of the surgeon as opposed to SAL. Like UAL, this is very effective in areas where the fat is dense. In some cases, I continue to use this in combination with UAL and SAL.

The latest addition to the liposuction arena is laser assisted liposuction (LAL). This uses laser energy to disrupt the fat cells to assist in their removal. The laser itself is introduced within a specialized suction cannula. A very good scientific study compared this method, LAL, to traditional SAL. There was no difference seen in the results or the time of recovery. The only real difference seen was that the laser assisted liposuction took a bit more time in the operating room. As you might expect, there has also been some marketing hype with this technology. The proponents of this have termed this “Smart Lipo.” It occurs to me that the machine for this type of liposuction is quite expensive, as all lasers are. Who do you think will end up paying for the cost of this machine?

The bottom line
So what is one to make of all these different technologies? Which is the best, and which of the claims of superior technology should you be listening to? Frankly, you can have a good result from any of these techniques, and you can have less than optimal results with any of these techniques.

What matters most is how well the technique is performed which is ultimately dependent upon the surgeon on the other end of the suction cannula. What you should be looking for, when considering liposuction, is a board certified plastic surgeon with a wealth of experience with liposuction. It is this experience that will guide the surgeon in knowing how much fat to remove from which area(s), which technology to use, and whether or not liposuction is the best treatment for the area of concern.

Hi there-

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. With the amazing number of machines now available to remove your fat, there has also come a equally impressive number of providers marketing themselves as "liposuction experts" (who completed a few days of training by the salesman for the device), promising that because they use one device or another that you will achieve a superior result.

This is not unlike someone saying to you that because they have 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. So please be careful.

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. You may 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.

The 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, 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.

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.

Ultrasound assisted liposuction came out in the 1990's. There were potential problems with the earlier equipment (burns, nerve issues, etc) and many plastic surgeons, myself included, were reluctant to use it. Sound Surgical, a Colorado company, completely redesigned their equipment from the ground up virtually eliminating the problems that existed before. Even the suctioning system to aspirate the emulsified fat is different. They called the system Vaser (Vibration Amplification of Sound Energy at Resonance) and coined the term Liposelection since their ultrasound delivery system specifically targets fat to emulsify it. I started using Vaser shortly after it was introduced and never turned back. It is a much gentler procedure so there is less pain-bruising-swelling. I rarely see any surface irregularities anymore. Bottom line --> Patients are very happy. Sound Surgical has taken ultrasound assisted liposuction into the 21st century.

Vaser is one brand name for ultrasonic-assisted lipoplasty (UAL), just as SmartLipo is one brand name for laser-assisted liposuction (or lipoplasty). Liposuction is a general term that applies to the basic procedure that has been around for over 25 years. Though "liposuction" describes a fat-removal operation understood by the public, the marketing geniuses among liposuction doctors and the companies that sell liposuction machines want you to buy a "BMW, the ultimate driving machine," not just a car. Or "STP, the racer's edge," not just motor oil. So we now have "Vaser Liposelection," "SmartLipo," and "BodyJet water-assisted liposuction."

The thing is, these techniques ARE actually advances over "regular" liposuction, but because they have these clever names (notice the judicious use of capital letters), the natural scientist and cynic in me make me apologetic for the fact that they can't seem to be content to be just be better than the standard or regular old liposuction techniques. The good news is that they are (better than plain old liposuction); the bad news is that any surgeon with one of these machines still needs to be able to sculpt fatty tissues with training, experience, and excellent technical skill.

Thus, as with so many things, selection of surgeon is MUCH MORE IMPORTANT than the machine or process he or she uses. There is no substitute for these factors, as no SmartLipo machine will make a lousy surgeon magically into a good one! Example: Michaelangelo was a superb sculptor with basic hand tools; imagine how much better he might have been had he been able to use power tools. But give power sculpting tools to the sculptor down the street, and there is no magic transformation to Michaelangelo!

Look for a well-trained, experienced, board-certified (American Board of Plastic Surgery) plastic surgeon for advice about liposuction, and don't be suckered-in by "special" techniques or marketing terms. BTW, I have used Vaser since it came out in 2002, and Lysonix ultrasonic liposuction prior to that. SmartLipo works well, but is really best for small areas, Water-assisted lipo is fairly new, but may be promising. I can't say that it will be better than existing state-of-the-art techniques, but time will tell.

Vaser is Ultrasound that is administered before traditional liposuction in order to melt fat and help shrink skin a bit.  Laser Lipo is the use of laser light under the skin to melt fat with heat (laser light) and stimulate the collagen in the skin and under the skin to shrink.  Laser Lipo can be done with or without traditional liposuction.  Traditional Liposuction is performed by infusing Tumescent solution in the area, followed by the suctioning out of fat cells with a long thin cannula, thereby removing the fat cells directly.  Each has it's uses and indications.  No one technique is better all the time for all people.  The right combination of one or more of these various techniques and technologies can used to achieve the optimal result for each patient.

Liposuction is a general term used to describe suction-assisted removal of excessive fat deposits. A number of different devices have been introduced over the years to aid in this suction-assisted removal of fat. These devices have included various different sizes and shapes of cannulas, as well as reciprocating cannulas. More recently, in the late 1990’s, ultrasound-assisted liposuction became very popular. Unfortunately, there were problems associated with this type of liposuction, largely related to burns from the “inside out”. Sound Surgical, Inc. refined the ultrasound delivery system to specifically target and emulsify fat, minimizing the risk of damage to tissue and occurrence of burns. They refer to this specific targeting of fat cells as “liposelection” with their VASER (Vibration Amplification of Sound Energy at Residence) system. Next, laser applications in liposuction surgery entered the market. The earlier long wave-length laser applications such as Irdium were applied externally with the intention of emulsifying fat through the skin. Lasting improvements with this type of laser have not been clearly established. SmartLipo refers to the use of an internal laser for liposuction in a manner similar to that of the VASER technology, with the goal of specifically targeting and emulsifying fat cells. While this technique was very sexy when it first was released, the hopes that laser alone could remove the fat were not realized. In my practice, I use a combination of Tumescent liposuction technique with the assistance of VASER liposelection for the most consistent, even, natural-looking results with minimal post-op pain, bruising or swelling.  

The Vaser system uses ultrasound energy to break up the fat cells. Used with the tumescent technique, the Vaser causes much less blood loss and helps to heat the underlying portion of the skin to help skin shrink better than liposuction alone.

It's great for the "tough" areas of fat, such as the love handles on men and the back on women. It also works great for areas that have previously been suctioned. The fat from Vaser liposuction can be easily re-injected for fat grafting. It is my favorite liposuction technique, and I have used most all techniques.

The following is my personal opinion:

I have used vaser since 2004 when it first became available. It has allowed me to contour areas during procedures that the other 2 methods do not allow. Why? Because Vaser is selective for fat cells and leaves vessels and nerves and lymphatics for the most part undamaged IF the Vaser is used properly!

Simply speaking:

1. Infuse an adrenaline containing solution into the fat

2. Let it sit for a minimum of 10 minutes!

3. Insert titanium probe that vibrates at around 40,000 times a second to create ultrasonic waves that are maximally absorbed by the fat and separate the cells from each other.

4. Use Vaser's Ventex cannulas which do not tear the tissues in order to suck out the emulsified fat liquid created by #3.

5. Place patient in a compression garment.

Other methods can rip and tear vessels and nerves and soft tissues, and in the case of Smart Lipo, burn them as well. The fat from Vaser Lipo Selection is very suitable for Brazilian Butt lift - the injection of the strained fat into the buttock muscles for excellent long term augmentation!