Liposuction techniques - alternatives
The liposuction techniques are divided into dry and wet (fluid is not or is used). According to the device used and cannula type liposuction can be divided into classical, power-assisted, ultrasound-assisted and laser. They all use the same principle where the intruded fat tissue is removed through a narrow tube – cannula. The cannula is inserted under the skin and using the vacuum it removes the excessive fat tissue. The methods of lipo dissolve and anesthesia maybe combined in various ways. The final result depends on how much tissue is removed, how experienced the surgeon performing the procedure is and, of course, on the technique and anesthesia used.
Dry technique: The technique does not use any fluid injection – therefore the name Dry Technique. A higher suction must be used in this method which may lead to higher blood loss or tissue damage resulting in more significant unevenness. The method is considered as obsolete and is seldom used today.
Wet techniques: The fluid is injected under the skin. The wet techniques differ according to the amount of used fluid. The fluid is a mixture of saline solution (solution of sodium chloride), adrenaline (substance contracting blood vessels) and it may also contain an anesthetic. The technique facilitates the removal of fat, reduces blood loss and if an anesthetic is included it also provides anesthesia during and after the surgery. The injected fluid also helps to reduce bruising.
wet technique (simple wet technique)
The volume of injected fluid is lower than the expected volume of removed fat. Usually 200 – 300 ml of the fluid for the treated area.
The volume of injected fluid approximately equals to the expected volume of removed fat. The technique is similar to the tumescent technique, except that a local anesthetic is not usually contained in the fluid or only in small amounts.
If the tumescent liposuction technique is used, large volumes of fluid are injected into the treated area through a 12cm-long needle which is tubed to a bag with the diluted solution. The fluid is infused slowly using a pump operated by a foot, which enables the surgeon to control the flow easily. The tumescent fluid contains a local anesthetic, usually lidocaine, to provide local anesthesia in the treated area. It enables to perform the procedure without the necessity of general anesthesia. The procedure performed under local anesthesia takes more time than liposuction under general anesthesia. It is necessary to wait for the effect of the local anesthetic and thus inject the fluid into each area just before the suction. The amount of the anesthetic and thereby the amount of the fluid is determined by the weight of the patient. The volume of fluid is usually 2-3 times higher than the volume of the sucked fat. It results in a solid swelling – tumescence, the skin in the treated area becomes white and cold. When the tumescent solution has been applied the suction of fat tissue can start. The liposuction is performed through a cannula tubed to a device which uses vacuum to suck. Different types of cannulas may be used with this technique. The biggest advantage is the possibility to position the patient as the procedure is performed under local anesthesia. The patient is conscious he/she can turn as needed, lift limbs or stand up. Some fat may be after a palpative and visual check removed when the patient stands.
Power-assisted liposuction - PAL
Vacuson LP 60
Power assisted liposuction utilizes a so-called vibration cannula that gently vibrates in quick micro-movements within 0,5 – 1 mm back and forth. The cannula is connected to a special device which produces the necessary power. It carefully penetrates fibrous fat tissue – e. g. in buttocks or back. At the end of the procedure it helps to smooth irregularities in the sucked area and its borders to make the transition from sucked to non-sucked area even and smooth. It is used for example in repeated interventions in the tissue. Most clinics use the advanced Vacuson LP 60 equipment which includes the vibration cannula, a device for solution infiltration and a sucking device. Presently, most experts consider the combination of tumescent liposuction, which is due to the contain of an anesthetic in the infiltration solution performed under local anesthesia, and vibration cannula as most advanced as well as most effective and sparing method.
Ultrasound-assisted liposuction uses a special cannula that produces ultrasonic energy. The energy bursts the walls of the fat cells and the fat is then liquefied. Ultrasound liposuction can be an effective tool for removing fat from fibrous body areas, such as the upper half of the back or enlarged male breasts. The advantage of ultrasound liposuction is the ability to penetrate the more fibrous tissues, e. g. fat tissues. It may be used in repeated liposuctions. Another advantage is a lower blood loss. There is a danger of skin burns unless the technique is performed correctly. The fat is removed in the same way as in other liposuction techniques. The combination of the tumescent method with ultrasound cannula is also a suitable however rare method due to the higher costs of the ultrasound device.
Under the term ultrasound liposuction we often encounter a non-invasive fat removal method where ultrasonic energy is applied to the fat tissue from outside the body. The fat cells are broken and purged by the natural metabolism of the body (lipo dissolve). Ultracontour and Ultrashape are devices using this advanced technology. The term non-invasive liposuction or E-UAL – external ultrasound-assisted liposuction may be rather misleading as it is not liposuction in the true sense of the word. No fat is sucked away.
Laser-assisted liposuction known also as ultrasound lipolysis uses a 1-2 mm wide cannula with a laser beam. With the forth and back movement of the cannula the energy is applied directly to fat cell, dissolves lipo and enables its removal. The laser beam also affects hypodermis, contracting collagen fibers. The liquefied fat tissue is not usually sucked in small localities. It is gradually absorbed during natural metabolism. In larger areas it is necessary to suck the fat tissue liquefied by laser. According to the laser type used we know SmartLipo and CoolLipo. Most clinics use a vibration cannula for the suction; it means they combine laser and power-assisted liposuction.
The liposuction cannula diameter is important in all liposuction technique. Wider cannulas suck more fat and save time and effort. However this type of cannulas leaves more empty space behind and therefore creates bigger irregularities on the skin surface. Presently, cannulas with smaller diameters are used more often as they are considered more delicate.
In out-patient liposuction under local anesthesia it is not advised to remove large amount of fat at a time but divide the procedure in several sessions. The suction of larger volume of fat, which also removes water, vitamins and other nutritious substances, can cause a state of collapse (shock). More extensive liposuctions (more than five litres of fat) should be performed by wet technique under general anesthesia. They require careful post-operative care including 1-2 days of hospitalization, replacement of lost liquids by infusions, pain relieving therapy.