When it Comes to Advancements in Liposuction, the Latest Hasn’t Always Been the Greatest
Since Dr. Illouz and Dr. Fournier first brought liposuction to the United States in 1982 – when I was beginning my residency in plastic surgery – there have been only two truly game-changing developments in how board certified surgeons approach/perform liposuction:
- Tumescent Liposuction – First introduced in 1985, the tumescent technique involves injecting a special ‘tumescent’ solution directly into the subcutaneous fatty layer (which builds up between the skin and muscle layers) that not only makes the entire treatment zone numb, but also acts to constrict surrounding blood vessels so that very little blood loss and trauma to the surrounding tissue, vessels and nerves occurs during the procedure. In surgery, less trauma means less post-operative swelling. Less post-op swelling means less post-op discomfort and a quicker recovery. In most of my liposuction cases, patients are back on their feet the very next day and pain free soon-there-after. The use of local anesthesia in combination with very light general (re: light complete sedation) not only provides a very comfortable experience for my patients but also enables me to be fairly aggressive and precise while addressing multiple locations which contain large amounts of fatty tissue.
- Power-Assisted liposuction (PAL) – Approved for general use by the FDA in 1998, power-assisted liposuction differs from un-powered suction-assisted liposuction (SAL) through the use of a special canula that vibrates rapidly (like an electronic tooth brush) while being moved through the fatty tissue by the surgeon. Without power, pushing and pulling the canula in the standard forwards and backwards motion through the fatty tissue requires quite a bit more effort and force. With power, the canula becomes like a hot knife through butter as it gently breaks up the fat before suctioning it out. The benefits to the PAL approach have been well documented and include less time under anesthesia, less bruising and swelling, a faster recovery and most importantly, smoother, more precise results.
All other ‘advancements’ in liposuction, SmartLipo™ included, have had, at best, an incremental effect on the quality and consistency of result and at worst, done more harm than good (especially when used outside of their very-specific use-cases). As with most new products, after the initial hype and marketing settles down, the indications for use diminish. When laser liposuction (Coollipo™, Smartlipo™, Slimlipo™) first came on the scene, it was touted as a stand alone procedure. But after it became clear that the initial results were less than ideal, traditional liposuction got added to the procedure in order to achieve satisfactory results. Perhaps, in very limited use-cases (e.g. under the chin) there can be some added skin tightening, but as I have seen over the years, if properly performed on a properly chosen patient, there’s really no better option than power assisted tumescent liposuction.
Ultimately however, it remains the skill and talent of the sculptor rather than the make or model of their chisel that determines whether or not one ends up with a superlatively sculpted thigh, hip, neck, buttocks, arm, or abdomen. When I first began performing liposuctions some 28 years ago (during my 8 years of formal residency/training) a professor told me that nothing can substitute the skill and technique of a master plastic surgeon who has, through years of training and experience, refined his technique to the point where such procedures becomes less about suctioning and more about sculpting. I remember thinking that this was easy enough for him to say given that he had already attained master-level status. But when I reached equivalent status, it became clear that he was right. For a young, wet behind the ears surgeon, so much of one’s success depends upon how much pure natural talent, spacial intelligence and aesthetic ‘taste’ one has. Over time however, most first-rate plastic surgeons become much more intuitive and feel-driven in their approach to procedures like liposuction. And while the difference in CCs of fatty tissue suctioned out may not be much, the smoothness of shape and consistency of silhouette between the treatment area and surrounding tissue is more often than not, dramatic.
- Experts warn about ‘awake’ plastic surgery (msnbc.msn.com) – a worthwhile read for anyone considering liposuction from anyone other than a board certified plastic surgeon.
I recently started answering questions on the plastic surgery Q&A website 
