Liposuction: Then and Now

Liposuction is a very popular plastic surgery – among top 3 worldwide. Liposuction involves removing localized fat from the body , with the help of hollow metal cannula( pipe). Technique of liposuction has changed a lot since liposuction was first started 30 years ago.

Liposuction was initially done for removing localized small fat deposits( like bulges on outer thigh) A hollow metal cannula was introduced close to the fatty bulge, through small incision less than a centimeter in size. Tumescent fluid was not injected into the fat prior to liposuction( dry liposuction). Cannula was attached to suction machine. Back and forth vigorous movement of sharp cannula by the surgeon broke down the fat, which was sucked out into the suction machine. Results were good but there was significant blood loss . Therefore only small amount of fat could be removed safely. Those days fat removal was limited to 1000 ml or less.

Tumescent liposuction and usage of blunt cannula were the next major step forward for liposuction. Tumescent or wet liposuction involved injecting special tumescent fluid into the fat 10-20 minutes prior to liposuction. This fluid helped shrink the blood vessels and made fat softer. Usage of blunt cannulas with holes on side reduced the trauma to blood vessels. As a result the proportion of blood to fat aspirated came to less than 100 ml for 1 liter of fat removal. This enabled surgeons to remove larger amounts of fat , upto 5-8 percent of body weight . For example in a person weighing 100 kilograms 5-7 liters of fat could be removed safely without transfusing blood. Addition of local anaesthetic to the tumescent fluid made the fat deposit numb and liposuction could be done under local anaesthesia.

Ultrasound assisted liposuction (UAL) was the next breakthrough in late seventies. Here a special solid liposuction cannula was used which emitted Ultrasound waves at the tip. When the cannula was introduced into the fat through one or more small cuts( about 1 cm), ultrasound waves broke down the fat into liquid. Liquid fat was then was sucked out into the machine. More fat removal was thus possible even from tough areas like back, with minimal blood loss for the patient. UAL went out of vogue after a decade because of increased rates of complications like skin burn and altered sensation of liposuctioned part .

Power assisted Liposuction( PAL) was the next big thing introduced in nineties. PAL or vibroliposuction cannula was designed to vibrate at the tip. This helped in reducing physical strain to the surgeon. Vibrating cannula broke down the fat in tougher areas with a lot more ease.

Many more liposuction techniques are available now like syringe liposuction, laser lipo and vaser liposuction. In syringe liposuction negative suction pressure is created by large 60 ml syringes and fat is collected in syringes. This is the gentlest liposuction technique and suited for small fatty deposits. Fat collected in syringes can be used for injecting into fat deficient areas like hollow cheeks, buttocks or into breasts . This technique of fat redistribution is called liposculpturing.

Laser liposuction cannula has Nd YAG laser beams coming out of the tip. Cannulas are finer and laser seals blood vessels, resulting in less trauma and bruising. Surgeon exertion is understandably less.

Vaser liposuction is 3rd generation ultrasound assisted liposuction . It is safer than original US assisted liposuction, because vaser delivers less ultrasound energy at the tip.

Tumescent liposuction is a misunderstood term. Originally tumescent liposuction was used to enable small liposuction under local anaesthesia . Nowadays tumescent solution injection is an integral part of all types of liposuction. No one does dry liposuction anymore.

Despite so many different technologies available for liposuction, standard( wet/tumescent) liposuction using hollow cannulas and suction machine remains gold standard . Worldwide majority of surgeons use this technique to deliver safe and consistent results. Other techniques like UAL, PAL, Vaser and laser liposuction have not proved to give better results , although they have some advantages for surgeon like less physical effort. Other claims like less pain, less blood loss , faster recovery are not always true. The surgeon behind the machine is more important in delivering better results with more safety, than the machine itself.