With all of the new lipo procedures out there - tumescent, laser-assisted, ultrasound-assisted, and even fat-dissolving injections - is there still a place for traditional liposuction?
Is Traditional Liposuction Outdated?
Doctor Answers 14
Liposuction options can be confusing- be careful
Liposuction Devices and Techniques... Is one really better than another?Tumescent liposuction... VASER lipo..... SmartLipo.....Cool lipo... pro lipo....Slim lipo... Body 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 their 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. In fact, I see at least one patient every month with severe contour deformities and injuries after being treated with one of these devices by a local "liposuction expert". 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 (with the exception of the Body Jet, which I don't believe even deserves a try) on patients.
"Traditional" Liposuction = Regular / Tumescent Liposuction
In these tough economic times, like mushrooms after the rain, the ranks of Plastic surgeons are rapidly filling with mass defection of doctors who trained in other fields.
Putting power and tax revenues first and the interests of patients a very distant seconds, in all states in the USA, ANY licensed doctor, regardless of his/her actual training, can PRACTICE any field in Medicine. With declining reimbursements and huge insurance hassles thousands of ER, Family Practice, Gynecologists, General Surgeons and other have become cosmetic surgeons.
As the competition for cosmetic patients has heated up so have the claims of the participants and of the companies supplying them. Now, every cream is the ULTIMATE wrinkle eraser. Every Laser is THE BEST wrinkle tightener with no down time. There is no shame. Every dinky hole in the wall medical office has been magically transformed either into a "CENTER" or an "ADVANCED INSTITUTE" regardless of the preposterous nature of such claims. PT Barnum and other mount-back snake oil salesmen would be truly proud.
In such an atmosphere, the aim by many of these under-qualified physicians is to confuse and make sales. Few fields lend themselves more to confusion than Liposuction.
Few Facts: There is NO "traditional" liposuction. Traditional liposuction IS tumescent liposuction. But -don't tell that to those who try to convince you otherwise.
TUMESCENT Liposuction / Regular / Traditional Liposuction - the areas of fat and infiltrated with a TUMESCENT (swelling) solution of Ringer's lactate, dilute adrenaline and a local anesthetic. After allowing the adrenaline to cause shrinkage of the blood vessels, liposuction is carried out with minimal blood losses EITHER with oral, IV sedation or general anesthesia DEPENDING on the extent of liposuction and the patient and doctor preference.
VASER Liposuction / Liposelection = After tumescent solution is infiltrated the fat is broken up with ultrasound waves providing a more homogeneous fat removal with less bruising. This is especially useful where the fat is encased in a lot of fibers such as backs, men breasts etc. Once the ultrasound treatment is over, the resulting fat is vacuumed just as in regular / traditional / tumescent liposuction.
Power Assisted (PAL) Liposuction - Identical to traditional / Tumescent / regular liposuction except that the back and forth movements of the suction tubes (canulas) are not done only by the surgeon's arm but by a reciprocally powered device (Google MICROAIRE to see).
Laser Assisted (LAL) Liposuction (such as SmartLipo, ProLipo, SlimLipo etc) - After Tumescent solution is infiltrated everything under the skin is heated / cooked with a laser fiber. The resulting fluid is then vacuumed just like regular/traditional / tumescent liposuction. THERE IS NO SCIENTIFIC EVIDENCE WHATSOEVER THAT THIS IS BETTER THAN OTHER METHODS NOR THAT IT SHRINKS SKIN despite all you read out there. Nonetheless, this appears to be THE favorite liposuction bait used by many NON-Plastic surgeons to lure uneducated and unsuspecting patients into their operative suites.
Hope this was helpful.
Dr. P. Aldea
Traditional liposuction still lives!
Traditional liposuction combined with a modified tumescent technique is still the gold standard for liposuction. Do not be deceived by all the cleverly named "newer" techniques promising more than they can deliver.
No "new" technique can beat properly performed traditional liposuction and make a marginal candidate for liposuction have a great result. The key to obtaining a great result is to go to a real plastic surgeon who has excellent artistic sculpting skills and ask for a realistic evaluation of how well your skin will shrink after liposuction. If you don't have good elasticity, they should tell you because you won't get a great result no matter what technique is used.
Just yesterday, I evaluated a patient destroyed by Smart Liposuction done by a general surgeon (the kind of doctor who would remove your appendix or gall bladder). He told her he was a national trainer for Smart Lipo but he had NEVER been trained in plastic surgery himself at all.
"Buyer beware!!" holds true more in liposuction than in almost any other cosmetic surgical arena because so many non-qualified physicians are tempted to do it because it looks simple and often these are the people promoting the "latest and greatest" lipo techniques.
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Traditional liposuction is still the gold standard of...
Traditional liposuction is still the gold standard of treatment.
There are many good scientific studies comparing traditional liposuction with some of the newer techniques. In one study published by Fodor and Watson (Plast Reconstr Surg. 1998 Apr;101(4):1103-16; discussion 1117-9.), ultrasound assisted liposuction and traditional liposuction were used in the same patients. Using several different analysis techniques (including blinded patient and observer analysis) they were unable to find a difference in the two techniques. One study of laser assisted versus conventional liposuction by Prado's group (Plast Reconstr Surg. 2006 Sep 15;118(4):1032-45) showed no significant difference in clinical indicators between the two groups.
To determine the merits of a procedure, visit the link below and search for peer reviewed scientific articles to determine if a procedure is good. Companies will produce studies which only show the best part of a product, not the down side. The best peer reviewed scientific articles will have double blinded controlled studies. This means that the participant and the evaluator will not know what procedure is done. In this way, an unbiased decision can be made as to the results.
The underlying principles of laser and ultrasound assisted liposuction are sound. With advances in technology, differences may become evident. For now, the use of additional technologies is a physician-dependent decision. The key is to find a physician who is comfortable performing liposuction, is trained and experienced in the procedure, and is able to produce reproduceable desired results.
Vaser liposelection is the new mainstay
In my practice Vaser Liposelection is the mainstay. Since discovering Vaser I've not used any other technique as the results are so far superior. The technique incorporates the tumescent process. 3rd generation ultrasound breaks up the fat so the aspiration process is quite gentle. Actually, the entire procedure is very gentle. More fat can safely be removed and, since there is less bruising and swelling, recovery is faster.
Liposuction techniques and terminology
Traditional liposuction is the gold standard for liposuction. Liposuction results have nothing to do with how much fat you remove, it is all about how much fat you leave behind and the elasticity of the skin. It is important to leave a variable amount of contouring fat. If all of the fat is removed it will not look good. Once you have seen a patient who has been overly liposuctioned you will understand the difference. If a large defect is created under atrophic skin it will not only look bad but will be almost impossible to correct.
I have performed the majority of different techniques including Power assisted, traditional, Vaser, etc. To me, traditional is the safest. They all do the trick. I always say to patients it is not the wand but the magician who waves the wand that creates the magic.
Traditional Liposuction is still the best option. Everything else is marketing.
The new alternatives to traditional liposuction, such as SmartLipo, are using very effective aggressive marketing techniques to promote their products.
Usually these procedures are offered by non-plastic surgeons who have done a short course in doing the procedure and then set loose on the public. They are also used by plastic surgeons who wish to promote their practices.
Only small areas can be treated with local anesthesia in the office with safety. But the proponents will claim that they can do large areas under local, in the office, and that it is safer than general anesthesia. This is clearly misleading.
The costs are much higher for these new procedures, without the benefit of anesthesia.
Get an opinion from a Board Certified Plastic Surgeon who has been doing liposuction for years, and compare, before proceding with a new highly marketed procedure.
Each of the techniques you mention have their place, and none are suitable for all patients. Traditional Liposuction works well for significant areas that can not be adequately treated by any other technique.
Liposuction Has Evolved
Traditional liposuction is still being performed and is a staple in most dermatologists' armamentarium to combat stubborn pockets of fat. However, the technique has evolved from the days when large cannulas (straws) were used to suction away the fat under general anesthesia. Now we perform what is called “tumescent liposuction,” in which a special fluid containing lidocaine and adrenalin to prevent pain and excessive bleeding is first injected into the treated area. This fluid also helps to break up the fat, making it easier to suction away with the newer micro-cannulas (very small straws). There are also variations on liposuction, based on the experience of the surgeon. In addition, many doctors have created their own branded names for what are basically the same procedures that everyone performs. Beware of fancy marketing techniques that may detract from less than optimal results. To get the best liposuction, you need to spend time to find an expert with great before-and-after videos, photos and testimonials – not just a fancy new name.
As for all of the nonsurgical fat-removal options you mentioned, such as CoolSculpting, Vanquish, Kybella and ThermiLift, these simply give patients more options. For those averse to surgery, noninvasive options may be the best choice. For those who want faster results, larger amounts of fat removed, and don't mind minimal downtime for recovery, liposuction is still the gold standard. Please be sure to find a board-certified dermatologist with a specialization in liposuction and other body-contouring techniques to help you.