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Liposuction Techniques

 

The basic surgical challenge of any liposuction procedure is to:

  • Remove the right amount of fat
  • Cause the least disturbance of neighboring tissue
  • To leave the person’s fluid balance undisturbed
  • To cause the least discomfort to both patient and surgeon

As techniques have been refined, many ideas have emerged that have brought liposuction closer to being safe, easy, painless, and effective.Liposuction surgery

Modern techniques have allowed the procedure to be applied to more varied sections of the body, including:

Abdomen

  • Hips
  • Outer thighs (saddlebags)
  • Flanks (love handles)
  • Back
  • Inner thighs
  • Inner knees
  • Upper arms
  • Submental (chin)
  • Gynecomastia (male breast tissue )

It is worth pointing out that not everyone is a good candidate for the liposuction procedure. It should not be seen as an alternative to dieting or exercising.

Contraindications for liposuction include Diabetes, Infection and Heart & Circulation problems. As an individual gets older their skin becomes less elastic, which limits the ability of the skin to readily tighten around the new shape, so appearances might not live up to expectations in the more elderly patient.

Despite this, Liposuction was the most common plastic “cosmetic” procedure performed in 2006 with over 400,000 patients treated in America alone, and this has continued to rise year after year in both America and the rest of the world.

Mechanism of liposuction

During Liposcution, the fat is generally removed via a cannula and a suction device (aspirator), and the procedure can be classified either by the mechanism in which the cannulas works or by the amount of fluid injected:

  • Suction-assisted liposuction (SAL)

This is the standard method of liposuction and is performed by a small cannulas being inserted through a small incision and this is attached to a vacuum device. The surgeon then pushes and pulls it carefully through the fat layer which breaks up the fat cells and allows them to be drawn out of the body by suction

  • Ultrasound-assisted liposuction (UAL)

This uses a specializes cannulas that transmits ultrasound vibrations within the body that bursts the walls of the fat cells making it easier for suction. This is a good choice of procedure for more fibrous areas such as the upper back. It generally takes longer than traditional liposuction but there is slightly less blood loss but more risk of a seroma which have to be drained with a needle.

After this procedure is performed it is then necessary to perform suction assisted liposuction to removal the liquefied fat.

  • Power-assisted liposuction (PAL)

This is a very similar procedure to the above mentioned UAL but uses specialized cannulas with mechanized movement so the surgeon does not need to make as many movements so reduces bruising, pain and blood loss

  • Twin-cannulas (assisted) liposuction (TCAL or TCL)

Twin cannulas (assisted) liposuction uses a tube-within-a-tube specialized cannulas pair, so that the cannulas which aspirates fat, the mechanically reciprocated inner cannulas, does not impact the patient's tissue or the surgeon's joints with each and every forward stroke. The aspirating inner cannulas reciprocates within the slotted outer cannulas to simulate a surgeon's stroke of up to 5 cm (2 in) rather than merely vibrating 1–2 mm (1/4 in) as other power assisted devices, removing most of the labor from the procedure. Superficial or sub dermal liposuction is facilitated by the spacing effect of the outer cannulas and the fact that the cannulas do not get hot, eliminating the potential for friction burns.

  • External ultrasound-assisted liposuction (XUAL or EUAL)

This is a type of UAL but the ultrasound energy is applied from outside the body and through the skin. It was developed because surgeons found that in some cases, the UAL method caused skin necrosis (death) and seromas, which are pockets of a pale yellowish fluid from the body, analogous to hematomas (pockets of red blood cells).

The other advantages of XUAL are less discomfort both during and post procedure, less blood loss which means larger areas can be treated although is not yet widely used as its effectiveness is still in question.

  • Water-assisted liposuction (WAL)

This procedure uses a thin fan-shaped water beam, which loosens the structure of the fat tissue, so that it can be removed by special cannulas. During the liposuction the water is continually added and almost immediately aspirated via the same cannulas. WAL requires less infiltration solution and produces less edema from the tumescent fluid. The utility of this technology is under study and is currently not widely used.
 
 
 
 
  • Dry liposuction

This is seldom used today and involves no fluid injection at all

  • Wet liposuction

This involves a small amount of fluid that is less in volume than the amount of fat that is to be removed. The fluid contains lidocain as a local anesthetic and adrenalin to contract the blood vessels and limit the amount of bleeding. The solutions also contain salt to make it saline like a bodily fluid which helps to looses the fat cells and reduce the bruising. The fat cells are then sucked by suction as in the basic procedure

  • Tumescent liposuction

This procedure involves the surgeon injecting a solution of local anesthetic and vasoconstrictor directly into the fat to be removed. The volume of fluid will then create a space between the muscle and the fatty tissue which allows more room for the cannulas. This procedure involves a potentially large volume of local anesthetic but the absorption by the body is spread over 12-36 hours because of the vasoconstrictor effect so systemic toxicity is rare.

  • Super-wet liposuction

This involves the amount of fluid injected to be the same as the amount of fat that is to be removed. This technique is the preferred choice for high volume liposuction as it better balances homeostasis and potential fluid overload. The procedure can take between one and three hours depending on the size of area to be treated and may require so sedation as well as the local anesthetic. In some cases a general anesthetic is also used when performing this procedure

  • Laser assisted liposuction (LAL)

Laser assisted liposuction, also known as Laser Lipolysis, uses thermal energy to affect lipolysis and has involved either of the Erchonia or Nd:YAG powered devices. One of the market leaders of this type of Laser is the 'Fotona XP-2 Focus'.
The procedure was first FDA approved for "smartlipo" in 2006  but in fact approval of the Nd:YAG system dates back as early as 1994. Recent studies of laser assisted liposuction show it is ideal for treating localized fat deposits and skin laxity on various areas of the body and the face. The other benefits of laser liposuction is the skin tightening effect through tissue coagulation  and is also a highly efficacious and less traumatic solution for permanently eliminating fat cells.

 

The following pages looks at Laser Lipolysis in greater detail.