Does liposuction method matter for a BBL?

Question

Hi! Does it matter what kind of liposuction equipment you use for a BBL? I see a lot of surgeons use VASER but I've heard good and bad things about it. Is PAL ok for BBL?

Finny George, MD · Answer

Hi, thank you for sharing your question. Vaser is excellent for breaking up fibrous fat and helping to remove that fat but it is not mandatory for liposuction or for BBL.

Ajaya Kashyap, MD · Answer

Thank-you for your question! Liposuction methods do matter when harvesting fat for BBl. The fat cells need to be intact  and viable to survive after being injected in the buttocks. The methods that  best preserve the cells are syringe liposuction and  Waterjet liposuction, which are the  methods that  I routinely use for BBL. When carefully performed, however , PAl is okay for BBl. Please discuss your concerns with your board certified Plastic surgeon who can help you with all your concerns. All the best!

George Marosan, MD · Answer

Thank you for your question. So lets clear up some misinformation first. The VASER technique, which I've been using for over 20 years, has been extensively studied and there is no fat melting or death from it's use. It is very advantageous for extracting fat from very fibrous areas such as males, gynecomastia, blacks (tend to be more fibrous in the fat compartments), previous liposuction or Coolsculpting patients. The VASER does not remove fat! It breaks up the fat in the deep and superficial fat layers to allow for better fat extraction and more uniform result. It is excellent for body sculpting. The fat is extracted via liposuction using the traditional method or the PAL method. I prefer the PAL, it is faster and it can be used to reinject the fat for a BBL. Laser liposuction does kill fat and that fat should not be reinjected. Often, people confuse the VASER with the LASER (i.e. Smartlipo)
See a board certified plastic surgeon experienced in advanced body sculpting techniques for an in person consultation/evaluation. Good luck.

Darryl J. Blinski, MD · Answer

Great question. In my personal opinion the traditional lipo offers better fat survival. But that is an issue each surgeon choses to deal with. Results are the end game here. Seek ONLY private practice, boarded PSs. NOT clinic based!

Kenneth R. Francis, MD, FACS · Answer

Dear Original,
There are several techniques that are applicable for liposuction for BBL.  The concerns about VASER for BBL are that the ultrasonic energy may irreparably damage the fat cells.  The science on that is not completely in yet.  Probably the most accepted technique now is PAL, as the PAL device is also used to reinject the fat into the buttocks using the EVL technique.

Mats Hagstrom, MD (license on probation) · Answer

The simple straight up answer to your question is no.
There is in fact very little difference among various forms of liposuction. All forms of liposuction still use the same thin stainless steel cannula connected to a vacuum pump.
In that way nothing has changed in the last 40 years.
Various brand-name equipment typically focus on the secondary procedure which claims to make the experience better. laser liposuction most notably smart Lipo which is a term trademarked by the cynosure laser company uses a laser fiber to pre-treat the fat immediately before or potentially after the liposuction. Most providers who have experience using this equipment do not believe it has any significant impact over liposuction alone. 
VASER are uses an ultrasound probe to pre-treat the fat before using traditional Liposuction.
This can potentially remove fat a little faster and a little more aggressively. That does not make it a better procedure.
Take the analogy of a car.
Is a sports car with 800 hp that can go over 200 miles an hour better and getting you to work every morning? The answer is no not really.
A car like that would however potentially be a detriment for a 15-year-old learning how to drive because it could easily cause a fatal accident.
Talented plastic surgeons can deliver the same result regardless of what equipment they use.
Another way to look at this is that plastic surgeons generally have the equipment they need to get their work done.
Do you choose a mechanic based on the brand tools they use?
Do you go to a bakery because they use a certain type of steam oven?
In the end there are only two variables that matter and they are patient candidacy combined with skill and experience of the provider.
Individual patients are generally somewhat limited in what they can do regarding their own candidacy.
For example, women who have pregnancy related changes aren’t going to be able to get rid of their skin laxity for a BBL unless they undergo a tummy tuck. The exception is individuals who are obese who may become better candidates if they lose some weight first.
What patients do you have control over is selecting the provider and that is probably equally as important as candidacy if not more. 
BBL patients should recognize that this is two operations done at the same time. it is liposuction in combination with fat transfer.
To determine candidate the patient should be evaluated for both Liposuction and fat transfer since it’s possible to be a good candidate for Liposuction but not a good candidate for fat transfer, a good candidate for fat transfer but not a good candidate for Liposuction, a good candidate for both or not a good candidate for either.
Delivering consistent quality liposuction and fat transfer result is more difficult than most people believe.
There’s more variation in outcomes of these procedures based only on who does the operation than any other plastic surgery procedure.
Being board-certified in plastic surgery with years of experience and an overall good reputation is insufficient to confirm any plastic surgeon has mastered both Liposuction and fat transfer.
There are also major differences in how plastic surgeons perceive what is attractive or how the procedure should be performed.
This varies greatly among different providers.
The BBL especially the liposuction aspect of it is a permanent and irreversible operation that cannot be improved upon if someone chooses a provider lacking sufficient skill and experience.
When it comes to skill it is not only the technical ability to perform the procedure but also the ability to accurately make assessments and consistently be able to predict what results will look like and have sufficient numbers before and after pictures of patients with similar body characteristics to accurately describe what each individual patient results will look like so there are no questions regarding overall outcome during the final post op visit. 
I recommend patience avoid choosing providers based on what brand equipment they use. This can eliminate good providers because of equipment which you may think is a favorable brand. By selection. Surgeons based on equipment you probably don’t comprehend you could potentially be eliminating the best surgeon.
Personally I’ve been doing liposuction for 22 years and began specializing exclusively in only liposuction and fat transfer about 10 years ago. i’ve done just over 8000 liposuction procedures. 
There’s no particular device that I need but the device I prefer working with his power assistant Liposuction because it makes my job a little easier. I have many different brands of Liposuction Equipment but typically prefer to use is my powers assistant Liposuction equipment made by microaire. There are other brands that are excellent as well.
I also have a strong preference for avoiding general anesthesia for body contouring procedures. I find keeping my patients awake using local anesthesia with mild sedation and having the ability for my patients to move and hold a different anatomic position throughout the procedure and a big advantage.To maximize the chance of getting a high quality outcome with a good understanding of what can and cannot be achieved and minimizing the disappointment I suggest any patient considering this procedure starts by first getting a good understanding of their own candidacy or in other words get a quality assessment.
Just like in other fields of medicine we usually start by confirming the diagnosis then recommend treatments accordingly.
Body shape and contour is caused by numerous different tissue variables and subcutaneous fat it’s only one single variable.
For example the front of the abdomen can also be highly influenced by skin laxity, thickness of subcutaneous fat, muscle separation from previous pregnancies or weight loss and excess visceral or intra-abdominal fat. of those four variables Liposuction only addresses one.
To get a quality assessment and at the same time vett plastic surgeons I suggest you start by getting proper pictures of your body taken the same way plastic surgeons take before and after pictures. pictures should be taken by someone else or using the timer on your camera from about 8 feet away wearing revealing undergarments. Stand in a neutral position and take pictures of your front, side and back side. you can crop the pictures at your neck and just below your knees. 
Bring printed copies of those pictures with you during any consultation.
When you’re reviewing before and after pictures whether it’s at home or during a consultation only focus on the results of patients who had similar body characteristics to your own in the before pictures. Use printed pictures of your own body as a reference when selecting appropriate before and after pictures to look at. there’s no point at looking at the results of patients who are far better candidates for the procedure if you want to get an accurate understanding of what your results can look like.
I recommend patient focus exclusively on in person consultations avoiding virtual consultations and I especially recommend people avoid traveling long distances for elective surgical procedures.
Schedule at least five in person consultations with local board-certified plastic surgeons in your community who seem to have experience with the BBL procedure.
During each consultation take notes throughout the consultation. After getting an assessment and recommendation by the surgeon ask them to open up their portfolio and show you their entire collection of before and after pictures of the procedure of choice. In your case the BBL. Ask providers to only show you results of patients who have similar body characteristics to your own. Again bring printed pictures of your body to use for reference to make sure that they are showing you pictures consistent with your candidacy.
Look very carefully both at liposuction results and fat transfer results. for liposuction review all areas treated and make sure there are no skin contour irregularities anywhere. Ask the provider to review the pictures with you and ask them to point out what areas were treated and what areas were not treated. look very carefully a transition zone between treated and untreated areas. Quality Liposuction should not show of transition zones from treated to untreated areas.
For fat transfer results confirm when the after pictures were taken in relationship to the surgery. Early fat transfer results can look very impressive but do not at all represent final results. after pictures should not be taken any sooner than three months at minimum and preferably six months or longer.
Did the results look balanced feminine proportionate and desirable. Personally I look very closely at the S-curve the ideal female body has along the side and backside. that S curve should be smooth and continuous from the armpit to the knee. 
Create a rating order rating system for quality results based on a previous patient with similar body characteristics such as one through five or one through 10. Take notes during each consultation and give rates or grades to the quantity and quality of before and after pictures each provider shows you. It’s difficult to remember all the information presented during a consultation so taking notes will help refresher your memory regarding what each provider presented.
For reference and experienced provider should have no difficulty showing you at least 50 sets of before and after pictures of commonly performed procedures like the BBL. Highly experienced surgeons will have hundreds or even thousands of before and after pictures of commonly performed procedures.
You should also make notes about how thorough the surgeon was regarding other aspects of the consultation like the physical examination, reviewing medical history, preparation for surgery, recovery, risks and benefits, alternative procedures, revision rate and revision policy etc. 
There’s no correct number of consultations patient should have to find the right provider but the more consultations you have the better you’ll get at consulting especially the ability to vet plastic surgeons.
Some plastic surgeons may be apprehensive of showing you anything other than their “show and tell” best of their career results. Let those providers know that your decision of who you choose as your provider is dependent on seeing the greatest number of before and after pictures including seen a large variety of different outcomes pacifically a patient with candidacies similar to your own.
You are paying for this procedure and you are totally entitled to get all the confirmatory you need to make an informed decision. 
I recommend patient start with at least five consultations and consider scheduling more if needed. 
Once done it is very difficult to make improvements on the outcome of this procedure.
People often do not understand why they are either a good, average or not such a good candidate for the procedure and without understanding your candidacy it is highly likely you will not have a correct set of expectations for tje potential outcome.
You’ll be reminded of the results every day for the rest of your life so make the decision carefully and when in doubt slow down and schedule more consultations.
If you lose sight of what’s important and focus on things like what brand equipment the surgeon uses you may not find the ideal provider for your needs.
Remember there are only two variables that matter.
Your candidacy and the skill and experience of the provider.
Best,
Mats Hagstrom, MD

Does liposuction method matter for a BBL?

Answers (6)

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