Liposuction is a procedure in which localized deposits of fat are removed to recontour one or more areas of the body. Through a tiny incision, a narrow tube or cannula is inserted and used to vacuum the fat layer that lies deep beneath the skin.
Today, liposuction techniques have been refined and there are several variations available to enhance the cosmetic outcome.
The classic technique of performing liposuction involves the use of stainless steel tube (Cannula) which is inserted into the body through a very small skin incision.
The cannula is pushed back and forth into the fat layer. The other end of the stainless steel tube is either connected to a powerful suction or a large aspirating syringe. When multiple areas of fat need to be removed, multiple small incisions may be required.
This basic technique is used in all patients undergoing liposuction. However, there are some small refinements based on the above technique.
Suction-assisted liposuction (SAL)
Attaching suction to the end of the cannula is a commonly used method for liposuction. The suction is initiated by a vacuum device and the amount of suction is regulated by the amount of fat to be removed and area. As the fat layers are broken up by the cannula, the broken down fat is suctioned off.
When liposuction was first developed, it only involved the insertion of a cannula into the fat and suctioning off the fat. This is known as dry liposuction. Today, dry liposuction is very rarely used. The majority of liposuction techniques involve injection of some fluid prior to suction. Dry suction is usually associated with significant bruising and bleeding.
In wet liposuction, a small amount of fluid, which is always less in volume than the amount of fat to be removed, is injected into the area. The injected fluid contains a local anesthetic and epinephrine (this chemical narrows the blood vessels and minimizes bleeding). The mixture is made up in a salt solution. The major aim of the fluid is to help make the fatty tissue loose and easy to suction out
The local anesthetic also prevents the pain during and after surgery. The narrowing of the blood vessels helps decrease the bruising after surgery.
In this technique .the volume of fluids injected is about the same as the volume of fat expected to be suctioned out. This technique is often used by most surgeons as it avoids major bleeding and prevents the imbalance of fluid as the fat is removed. The procedure is slightly prolonged and may be done under either local or general anesthesia
Tumescent technique (super wet technique): In this technique large amounts of fluid are injected. The amount of fluid injected is nearly 2-3 times the volume of fat needed to be removed. The fluid is generally consisting of a local anesthetic and the procedure is always prolonged. The local anesthetic numbs the area and most individuals do not require any extra anesthesia. When the fluid is injected into the fat tissues, the entire area becomes swollen and firm.
The high volumes of fluid and local anesthetic required for this technique can not be applied in all individuals and the technique is usually limited to larger individuals.
Ultrasound-Assisted Lipoplasty (UAL). Today liposuction can also be done with a special cannula which has the ability to generate ultrasonic waves. The energy generated passes through the fat areas and causes breakdown of the fat, resulting in easier removal.
UAL has been shown to remove fat from difficult areas of the body such as the back, male breast and chin. It can also be combined with any of the above wet methods when accuracy and precision is necessary. In general, UAL takes longer to perform than traditional liposuction. The procedure is also associated with less bleeding but there has been a higher chance of collection of fluid pockets which may require drainage later.
Because of the technical difficulties of ultrasound cannulas, ultrasound can also be applied from an external source. External ultrasound guided liposuction is preferred in some cases because it was observed 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)
Ultrasound guided liposuction has been observed to:
- Cause less discomfort for the patient
- Decrease blood loss
- Allow better access through scar tissue
- Treat larger areas
A point of note is that a though evaluation of ultrasound guided liposuction is still not done and the technique is still considered experimental
Laser assisted liposuction
Today advances in technology have helped create cannulas which have a laser emitter. The laser emitter breaks down the fat which is then removed with suction. The procedure is still in infancy and being evaluated in clinical trials
Unlike the olden days where there large cannulas, today, cannulas of various sizes are available., these small or Microcannula are good fro removing fat from the chin, neck or arm pits through very small incisions
Water-assisted liposuction (WAL)
In some cases, a thin water beam under pressure is first applied to the fat. This spray of water is known to loosen the fat which is then aspirated with a special cannula. During the procedure, water is continuously irrigated and aspirated at the same time. WAL requires less infiltration solution and causes less intraoperative swelling. This allows the surgeon to better realize the target result. The cannula movements are very subtle, helped by the water beam. This is a new technique and not currently approved for use in the USA.
As techniques have been refined, many ideas have emerged that have brought liposuction closer to being safe, easy, painless, and effective.