Orange County Register

Fat removal via liposuction is one of cosmetic medicine’s most popular procedures, but doctors don’t agree on what’s the best technique to use.

To reduce the confusion, plastic surgeon Dr. Warren Lent of Beverly Hills compiled the following explanation of the various types of liposuction, including his opinions about which ones are useless or of unproven merit.

These include categories associated with two widely marketed, yet medically disputed, forms of lipo — ultrasound-assisted Vaser lipo (pictured at right) and laser-assisted Smartlipo (pictured below).

Including all types of lipo, cosmetic doctors in the United States performed 341,000 liposuction operations last year, according to a survey by the American Society for Aesthetic Plastic Surgery. That put it at No. 2 on the list of most popular cosmetic surgical procedures, just behind breast augmentations, with 355,700 operations.

Even the benefits of the best types of lipo are subject to debate. Bariatric surgeon Dr. Brian Quebbemann of Newport Beach says that, in the end, lipo just moves fat around and doesn’t remove it. That’s because lipo patients put the weight back on if they don’t change their eating habits after the operation, Quebbemann says.

Here are Lent’s descriptions of liposuction and the various techniques for performing the operation. The comments in italics are from me, not from him.

Lent writes:

Liposuction, also known as Suction Assisted Lipectomy (SAL), is the term used to describe the basic surgical procedure of removing fat cells from the space under the skin. It is done with a hollow metal tube, called a cannula, which is attached to a suction machine.

OUTDATED

The Dry Technique is the original method of conducting liposuction. A small incision is made into the skin and the hollow tube is inserted into the area where excess fat will be removed. No other fluid or medicine is placed into the area and this technique is associated with a higher degree of blood loss, which leads to more swelling, bruising and overall risk. In general, except in rare special circumstances, this type of liposuction is no longer performed.

GOLD STANDARD

Tumescent Liposuction is the most preferred technique today. The plastic surgeon first places a large volume of saline, usually mixed with a pain killer (Lidocain, which is sometimes inaccurately referred to by the public as Novocain) and a medication that decreases bleeding (dilute Epinephrine) to the area where the procedure is being performed.

Several advantages to this technique include diminished postoperative pain, decreased bleeding and bruising and a better aesthetic result. It is believed that the improved cosmetic results are due to the firmness created by the added fluid, which allows the surgeon to actually sculpt the area to the desired shape. This method is still considered the gold standard for liposuction.

Tumescent lipo was invented by dermatologic surgeon Dr. Jeffrey Klein (pictured) of San Juan Capistrano. For more information, see the post, “O.C.’s liposuction inventor wins lifetime honor.”

SOME PROBLEMS

Ultrasound-Assisted Liposuction (UAL) is liposuction that adds an ultrasound wave-producing device into the fat. The theory is that the sound waves will dislodge fat cells from their attachment to thicker collagen fibers. This technique may be useful in areas of the body where there are many of these thick fibers, such as the upper abdomen, back and where scar tissue exists.

The downside of UAL is that the device has been known to cause skin burns, leave increased wavy irregularities of the skin and may be associated with additional blood loss.

One prominently marketed type of ultrasound-assisted lipo is Vaser, which has many devotees who are seeking to establish its medical credentials. For an example of that, see the American Health and Beauty article headlined, “Liposuction remains a popular procedure but it may need to move over for Vaser, a new technology using ultrasound.” The article cites a clinical study that found Vaser produced less blood loss and more skin-tightening than traditional lipo. It did not state whether the comparison was to dry lipo or tumescent lipo.

NO PROVEN BENEFITS

Laser-Assisted Liposuction adds laser technology to the standard liposuction procedure. It is a two-step method, where, first a thin glass fiber is inserted into the area and the fat is melted in small volumes by the laser energy. The second step requires a standard form of liposuction to remove the liquefied fat and any additional fat cells. This technique is still relatively new, and it is unclear whether the laser truly adds any benefit to the final results. Thus far, reputable studies have shown no major clinical benefit.

Smartlipo (pictured at right) is a prominently marketed type of laser-assisted lipo. It also has many devotees who are seeking to establish its medical credentials.

Klein, the inventor of tumescent liposuction, says Smartlipo is medically unproven. William Coleman, editor of the journal of the American Society for Dermatologic Surgery, agrees with Klein and adds, “Smart Lipo is a marketing gimmick to get people through the door.”

NO EXTRA BENEFIT TO PATIENT

Power-Assisted Liposuction is when a small motor is attached to the cannula to move it in and out. The major advantage to this technique is to the surgeon, who experiences less fatigue, and not to the patient. This technique offers no improvement to the final results.

ALLEGED ALTERNATIVES

External devices such as external ultrasound and skin vacuum rollers or cellulite massage devices have not been shown to have any benefit in eliminating fat from under the skin. Despite various claims to the contrary, they are not alternatives to liposuction.

Injection techniques such as Mesotherapy, injection lipolysis or Lipodissolve claim to be non-surgical alternatives to liposuction. These techniques involve the injection of fat-dissolving chemicals that are supposed to dissolve fat cells. This technique has many unknowns and the results are uncertain, difficult to control and unpredictable. Allergic reaction, skin ulcers, scarring and infections have been known to occur.

FUTURE

The future holds many possibilities for advances in liposuction techniques. Power Water-Assisted Liposuction and improved laser technology may offer viable future improvements in the current methodology. Only with critical scientific analysis will we know if they offer true clinical advantages.

Photos: Top, Vaser liposuction operation (Photo courtesy of Innogyn.com) Second photo: Dr. Jeffrey Klein. Third photo, Smartlipo operation (Photo courtesy of LaserMDMB.com)

Related links:

• O.C. inventor of lipo technique challenges laser lipo
• Lipo just moves fat around, doesn’t remove it?
• Liposuction debate — Fat will return?
• O.C.’s liposuction inventor wins lifetime honor
• ‘SmartLipo is a marketing gimmick,’ says dermatology expert
• Cellulite is target of new Thermage devices

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