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Liposuction (Lipoplasty)

Jan 24, 2024 | Body Aesthetics

Liposuction, also called lipoplasty, suction lipectomy, suction-assisted liposuction or just lipo, is a fat-removal procedure used in plastic surgery. In general, fat is removed via a cannula, a hollow stainless steel tube inserted under the skin’s surface. A powerful, high-pressure suction device, called an aspirator, then breaks up and “sucks” fat, called adipose tissue, from the body.

Liposuction slims and reshapes specific body areas and improves body contours and proportion by eliminating any undesirable deposits of body fat resistant to diet and exercise. It helps sculpt the body, which is why the technique is also referred to as “liposculpture.”

People who undergo liposuction usually have stable body weight and should be within 20 pounds of their ideal weight. Liposuction is not an overall weight-loss method and is not a treatment for obesity. The procedure also does not remove cellulite, dimples, or stretch marks.

The concept of liposuction was first pursued by Dr. Charles Dujarier, a fully qualified French surgeon. In February 1926, Dujarier operated on a young model and ballerina, Mademoiselle Geoffre, who wished to improve the looks of her unbecoming ankles and knees.

To remove her subcutaneous fat, or “adipose tissue,” Dujarrier made a long skin incision and broad subcutaneous dissection, and removed a large part of skin and adipose tissue with a uterine curette, a spoon-shaped instrument.

The result was tragic. Due to excessive tissue removal and too-tight sutures, Dujarrier’s procedure caused necrosis (gangrene), which required the amputation of her leg. Geoffre successfully sued Dujarrier, who was required to pay 200,000 francs, $200,000 in 1920s dollars or millions today. Shortly after his sentence was confirmed two years later, Dujarier died.

This surgical disaster set liposuction back 50 years because it wasn’t until 1975 that two Italian doctors, father and son team Arpad and Giorgio Fischer, developed the first blunt hollow cannula attached to a suction source. A cannula is a hollow stainless steel tube that is used to suck out the fat using a suction device called an aspirator.

Liposuction is the second-most commonly performed cosmetic procedure in the U.S., after breast enhancement, including breast augmentation and breast lifts. According to the American Society of Plastic Surgeons, 211,067 liposuction procedures were performed in 2020, down 20% from the 265,209 procedures performed in 2019, the year preceding the pandemic.

Fat Classification

Subcutaneous fat is the jiggly, pinchable fat located just underneath the skin. It’s harmless but aesthetically undesirable. The abdominal wall, made up of muscle and tissue, separates subcutaneous fat from visceral fat inside the abdominal cavity. Visceral fat is firm and hard, typically associated with a beer belly. People with a lot of visceral fat are sometimes called skinny fat. Because visceral fat is stored next to your organs, it may impact your overall health.

All fat cells release hormones visceral fat, however, is more likely to interfere with organ functions, which can lead to greater insulin resistance (type 2 diabetes), higher blood pressure, higher bad cholesterol (LDL) levels in your bloodstream, and increased risk for heart disease and stroke. The moral of this story: exercise and diet to help reduce your visceral fat before and after liposuction.

Procedure Types

Four different procedures can be used for liposuction. In addition to traditional liposuction, patients can consider the use of either laser-, ultrasound- or water jet-assisted liposuction:

  • Tumescent liposuction or suction-assisted lipectomy (SAL) – Invented by Californian dermatologist Jeffrey Klein in 1987, tumescent liposuction is the most common type of liposuction. It involves injecting a large amount of medicated solution, a mixture of saline solution and adrenaline, before the fat removal process. This procedure allows liposuction in larger volumes under local anesthesia without requiring sedation or general anesthesia. Klein invented a formula consisting of 0.05% lidocaine (local anesthetic), 1:1,000,000 epinephrine (contracts blood vessels and helps reduce blood loss, bruising, and swelling), and 10 mL sodium bicarbonate per liter of saline (intravenous salt solution), which is infused into body tissue before liposuction. Lidocaine helps numb the area during and after surgery. The IV solution helps remove fat more easily. It is suctioned out along with the fat using a microcannula. This small cannula forms a tunnel in the subcutaneous (under skin) tissue and allows for more effective and less traumatic fat removal than a large cannula.
  • Laser-assisted liposuction (LAL) or laser lipo (e.g. Smartlipo) – Laser liposuction uses low-level laser energy waves emitted through a thin laser fiber inserted through a small incision. Energy is focused on parts of the body where fat deposits (adipose tissue) are to be eliminated. Once the fat is liquefied, removing it with a cannula from the under-skin (subcutaneous) space is easier. Lasers may also stimulate the production of collagen and elastin, which results in firmer, tighter, and smoother skin, according to WebMD.
  • Radio-frequency-assisted liposuction (e.g. BodyTite) – Radiofrequency-assisted liposuction (RFAL) uses radio waves, low-frequency electromagnetic waves that reside below the range of human vision, to deliver a controlled amount of energy to treated tissue resulting in fat liquefaction. Like laser liposuction, RFAL offers skin tightening benefits.
  • Ultrasound-assisted liposuction (UAL) or ultrasonic lipo (e.g. VASER Lipo) – An ultrasonic liposuction uses low-frequency ultrasound waves to dissolve excess fat in the patient’s target area before it is suctioned out using a microcannula, or a small hollow tube, and a medical vacuum (aspirator). Ultrasonic waves are high-frequency sound waves above the range of human hearing. Ultrasound-assisted liposuction procedure, like other liposuction procedures, is typically used for stubborn areas within the patient, such as the knees, neck, chin, feet, and ankles.
  • Water-assisted liposuction (WAL) or water jet-assisted lipo (e.g. body-jet) – Water-assisted liposuction uses a fan-shaped jet of water, which includes an anesthetic. Unlike tumescent liposuction, where an anesthetic solution is injected separately beforehand, the water-jet wand injects the solution and suctions body fat.

Keep in mind that all the above procedures are derived from traditional tumescent liposuction. The different approaches to improve the breakup or dissolution of body fat include heat (laser), mechanical agitation (ultrasound and water jet), or vibration (radio frequency).

Liposuction Devices

Getting a liposuction procedure is already stressful. Then you have to deal with a practitioner, either a dermatologist, plastic surgeon, or medical doctor who dabbles in aesthetic procedures; and who tries to push you into a procedure they either like, own equipment for, or, heaven forbid, have some vested stake in, due to a manufacturer’s incentive or “spiff” that skews their judgment.

We will try to steer you toward the best procedures here, including listing the top procedures based on our research. However, keep in mind that some practices may own older models of the equipment listed here, including problematic first-generation units. It may be stressful, but better to ask your provider to be safe rather than sorry.

As mentioned before, liposuction is not a weight-loss remedy. It’s meant to body contour by removing stubborn fat pockets. Also, this is as good as any point to mention one study, which suggests that liposuction is a very temporary solution. The study, entitled “ Short- and Long-Term Effects of Abdominal Lipectomy on Weight and Fat Mass in Females: a Systematic Review,” was published in July 2015 in Obesity Surgery, a trade publication.

This study is known in the medical circles as a meta-analysis — a research study of other studies. The authors, all Greek physicians, led by Konstantinos Seretis, affiliated with the Department of Plastic Surgery, Medical School, Aristotle University of Thessaloniki, Greece, systematically reviewed 10 studies out of a total of 231. Their first observation was, “A significant weight loss and BMI improvement were reported in 4 out of 5 studies with a mean follow-up of 1–2 months but in none of the 5 studies with a longer follow-up (3–20 months).”

The report continues, “This systematic review revealed only a transient effect of abdominal lipectomy in body fat and weight in women, which fades a few months after the operation. These results corroborate the evidence from experimental and clinical studies, which support fat redistribution and compensatory fat growth as a result of feedback mechanisms triggered by fat removal.”

In other words, the body adapts to the changes brought about by liposuction procedures and compensates by introducing new body fat.

You have to balance this study with the 8,528 RealSelf community member reviews that rate liposuction as “worth it” 88% of the time.

Also, an entire cottage industry of liposuction procedures worth more than $1.5 billion annually suggests that there may be more than meets the skeptical eye.

Our research shows that these are the top liposuction procedures today:

  1. Smartlipo – Approved by the FDA in 2006, Smartlipo uses laser energy to liquefy tissue before being suctioned out. Smartlipo also stimulates collagen production to tighten the skin and boost elasticity. Westford, Mass.-based Cynosure, manufactures Smartlipo. The company’s latest device is the Smartlipo Triplex.
  2. body-jet – Approved by the FDA in August 2008, body-jet is a water-assisted liposuction device manufactured by Germany-based Human Med.
  3. VASERlipo – Approved by the FDA in 2002, VASERlipo uses ultrasound energy for minimally invasive aesthetic body contouring that yields dramatic results with less pain and downtime than traditional liposuction. Manufactured by Solta Medical, a division of Bausch Health Companies Inc.

Popular liposuction devicesThese are the most popular liposuction devices you will see in practitioner’s offices. Keep in mind that some medical practices may own older models of the equipment shown here, including problematic first-generation units.

Michael Tchong

Michael Tchong

Founder, Author, Adjunct Professor, Futurist

Michael is the founder of Toolhacker LLC, an innovation speaker and adjunct professor at the University of San Francisco, futurist, and author of “Ubertrends — How Trends And Innovation Are Transforming Our Future.” He is also the founder of four ahead-of-the-wave startups, including MacWEEK, Atelier Systems, CyberAtlas, and ICONOCAST.