Episode 37: What are the Different Kinds of Liposuction?
What are the different kinds of liposuction? So let's dive right in and start off by saying that as far as modern techniques go, there really is only one kind of liposuction and all the fancy terms refer to add-on procedures that have pluses and minuses, and might be right for some people and not right for others and we'll go through that here. So when we talk about liposuction in today's modern plastic surgery practices, we are describing a procedure during which tiny three to four millimeter incisions are made, numbing medicine is injected into the treatment area through those incisions. And then a long thin instrument called a cannula is used to suction away excess fat and achieve an improved body contour.
Liposuction, as we've just described, can usually be performed either as a procedure under general anesthesia so you're completely asleep and you have a machine helping you breathe. It can sometimes, for limited cases, be performed under local anesthesia so that you are numb in the treatment area, but you are completely awake and breathing on your own. And then there are also the cases, and these are actually quite common, that are performed in something of a middle ground between these two extremes. And this is called Twilight anesthesia or sedation. So that while you have numbing medicine in place, you are also given IV sedation by a board certified anesthesiologist to make you feel a little bit loopy, and you are dissociated from the goings on and you are not as concerned with what's happening so the liposuction is still a very comfortable process.
What is tumescent liposuction?
I mentioned that as part of the liposuction procedure, numbing medicine is injected into the treatment area through these small incisions. The numbing medicine is called tumescent solution, and tumescent solution gets its name from the fact that the solution is injected until the treatment areas are firm or tumesced. So again, the numbing medicine is called tumescent solution, and that's why some people refer to liposuction as it's usually performed today in modern plastic surgery practices, as tumescent liposuction. That's all there is to it.
What is power-assisted liposuction (PAL)?
The next term that often comes up in describing liposuction procedures is power assisted liposuction. And what this refers to, is the fact that the liposuction device, the cannula, has a small motor attached to it that makes it vibrate back and forth, in and out, very quickly. And this essentially helps the surgeon suction out the excess fat more rapidly and with less effort. So while power assisted liposuction makes the surgeon's job easier, it also helps us achieve better results because instead of enduring a pretty physically grueling process of suctioning large volumes of fat, the power assisted liposuction kind of does a lot of the hard work for us so we can focus more on the fine details of the procedure and achieve a truly excellent result.
So those are the major pieces of vocabulary people use to describe standard liposuction. There's liposuction and tumescent liposuction, which are the same thing. And power assisted liposuction, which is just liposuction with the addition of a motorized cannula to reduce the physical workload on the surgeon so that the surgeon can concentrate on achieving a really great contour.
More Liposuction Vocabulary
So now let's move into some of the other terms people apply to liposuction. And the ones that we're going to focus on here are SmartLipo, Vaser liposuction, BodyTite and J-Plasma. So all of these technologies have one thing in common, their end goal is to heat the tissue, to one, make the liposuction process easier for the surgeon to perform. And two, to tighten the skin of the treatment area so there is a reduced risk of skin laxity after performing the liposuction procedure.
So just in terms of a brief rundown of how each of these technologies work, SmartLipo relies on a laser to heat the surrounding tissue and achieve some degree of skin tightening and to improve the surgeon's ability to suction the treatment area. The BodyTite device uses radio frequency energy to heat the treatment area and achieve these goals. Vaser liposuction uses ultrasound energy to heat the tissue in the treatment area. And finally, J-Plasma uses radio frequency energy to heat helium gas and cause tissue contraction and improve the surgeon's ability to get through the tissue with energy from that process. While BodyTite and J Plasma do both use radiofrequency energy, an important distinguishing feature here is that the J Plasma device is unipolar meaning there is only a heat source under the skin, whereas the BodyTite device uses bipolar radio frequency energy so the radio frequency energy is essentially fired between a probe under the skin to one over the skin and vice versa, and temperature is very precisely controlled at both of those points to ensure both safety and efficacy.
So there is a brief overview of how these different technologies work to produce heat that can enhance the results of a liposuction procedure. So let's look at how each of these technologies performs with regard to each of those goals, namely making the liposuction procedure easier to perform, and more importantly, achieving some degree of skin tightening. And full disclosure, this discussion is purely based on my personal experience. It is not based on data because frankly there is not any wonderful data to describe the efficacy of these various technologies with respect to the degree of skin tightening they can achieve. And certainly not with respect to the degree to which they can make performing liposuction a bit easier for the surgeon.
Which technology makes liposuction easiest for the surgeon?
In terms of the goal of making liposuction easier to perform and thereby facilitating a better result, the Vaser system in my experience really wins out here. The Vaser system uses ultrasound or a super fast vibrating wand to induce a state called cavitation, which essentially shakes fat cells free of surrounding connective tissue. And the result is that performing liposuction after the tissue has been treated with Vaser ultrasound, is extremely easy. And while I don't think that Vaser liposuction is indicated or acquired in most liposuction cases, there are two specific instances in which it can come in very handy. And that is in the case of gynecomastia or male breast reduction. The Vaser system really breaks up the tough fat in the male breast very nicely and makes it amenable to suction. And then also in secondary liposuction cases, when we go in and perform liposuction on people that have previously had liposuction, the Vaser system comes in very handy because it really shakes up the fat cells that are attached to existing scar and makes them a lot easier to suction out with our liposuction cannula.
What is the best minimally invasive skin tightening technology?
In terms of the other goal of achieving some degree of skin tightening, the radio frequency that is achieved with BodyTite, the bipolar radio frequency device, does work very well. However, this is really a procedure that is very dependent on two things. One is the skill of the person performing the procedure, and two is patient selection. So this is a technically difficult procedure to perform because like I mentioned, it is bipolar radio frequency energy. So both the internal and external pole need to be kept at fairly precise temperatures for the right amount of time, to achieve the desired result of tissue contraction. And this is something that can be a bit finicky and really requires great expertise with the BodyTite device to truly master.
The next component, patient selection, is so important because while BodyTite radio frequency skin tightening can be a truly great adjunct to liposuction, if someone has skin laxity that is too extreme for the device, they're just not going to achieve a satisfying result. So again, you really need an experienced board certified plastic surgeon here to be able to identify the patients who will see the excellent results from the BodyTite procedure when performed in conjunction with liposuction.
What are J-Plasma and SmartLipo good for?
In terms of the other two technologies, J Plasma and SmartLipo, my experience with J Plasma is really primarily from speaking with colleagues and they have, for the most part, not been terribly impressed with this technology. And as far as SmartLipo goes, this is, I'd say a moderately useful technology for skin tightening, but it would not be my go to choice. I would almost always use either Vaser liposuction or BodyTite in conjunction with liposuction for skin tightening before I would turn to SmartLipo. But if SmartLipo is the only option that's available, or if a patient has previously tried Vaser or BodyTite and wanted to try something new, then SmartLipo might be a reasonable option to check out.
So hopefully this run through of available liposuction technologies will be helpful as you are reading about various options. And we always welcome any questions that might come up. You can reach us at [email protected], and we're looking forward to hearing from you.