Suction-assisted lipoplasty, also known as liposuction, is a body contouring technique that was unknown in the United States until the meeting of the American Society of Plastic and Reconstructive surgeons in 1982. A French surgeon named Yves-Gerard Ilouz, working independently from a Swiss colleague named Kesselring who was trying for the same idea, arrived at the method most widely used in the world through the 1980s and most of the 1990s.

Since the beginning of plastic surgery, surgeons had held the idea that if subcutaneous fat were removed without removing any of the skin, the skin would be loose and sag in a disfiguring way. What Ilouz and Kesselring discovered was that if fat were removed through a series of tunnels, and the skin were held tightly against the underlying muscles by an elastic bandage or pressure garment, the skin would adhere by the scar tissue to the muscle surface without sagging! The two techniques of Ilouz and Kesselring differed in that Ilouz used a blunt instrument, (known as a cannula) while Kesselring used a sharp one. Surgeons have discovered that the blunt one is safer, and not as likely to damage vital structures.

Common to both surgeons’ technique was the suction pump, basically a very strong vacuum machine with pulls the fat out through the probe by its attachment with a strong vinyl tube. Originally the pump was the same one used by gynecologists to carry out the dilation and curettage (D&C) procedure, although the machines now are custom-designed for lipoplasty.

The outpatient procedure consists of one or two puncture wounds for each treated area, each about 1/8 inch long, and requiring only one or two stitches to close. This allows the cannula to be introduced into the fat between the skin and superficial muscle.

By moving the cannula back and forth, much like vacuuming a carpet, the fat flows out through the tubing into a collection bottle on the machine. The amount removed from any one area varies from a few spoonfuls (such as beneath the chin) to a pint or more (such as from the abdomen or saddlebag area.)

Once an area has been treated, it is important to hold pressure on the site to minimize swelling and bruising. For this we commonly use a compression garment, like a special girdle or binder. Even with proper garment wear, patients swell enough that an early determination of the final result is not possible in the early period after surgery.

In fact, I call this the operation of “3’s” since for the first three weeks most people feel that we must have put in fat, instead of removing it. At three weeks, most of the surgical swelling is gone, and the real improvement begins. For the next three months, about 90% of the improvement takes place. For three months after that the other 10% occurs.

Body contouring by suction lipoplasty is becoming the most common plastic procedure in the United States, since both men and women are candidates. The main thing to remember is that the operation is NOT for weight loss, but just for localized fat deposits. The amount of weight actually lost is not great, even in cases where several pints of fat are removed. But because we see these fat deposits as associated with obesity, the person looks like they have lost weight – a lot more than they actually have.

The complications associated with the procedure are those common to a lot of surgical procedures: bleeding, infection, etc. A few things unique to suction lipoplasty are dimpling, waving or wrinkling of the skin, staining of the skin because of the bruises settling in the skin, and temporary numbness of the skin. All except the last can be causes of additional surgery.

Since the procedure is designed to improve the appearance, it is considered aesthetic, or cosmetic, and not covered by insurance. It does not prolong or save a life, but it can improve quality of life. The improvement in appearance frequently encourages a person to adopt a healthier lifestyle and perhaps a personal fitness program, since they now have something to be proud of and maintain.

Perhaps the most frequently asked question by patients is, “Can the fat come back?” The answer to this is that the fat cells removed by the operation do not come back, but it is possible to gain weight and fill up fat cells in other locations, even those which are left behind in the treated area. Causing the area to become lumpy and uneven, since the fat is no longer distributed the same way it once was. So our recommendation is to maintain body weight approximately where it was on the day of surgery, or even reduce it slightly. Don’t take the operation as an excuse to overeat! Surgery does not make you immune to the rules of metabolism!

Therefore, the best candidates for body contouring are those who have adopted a reasonable program of exercise and sensible eating, and who have developed localized fat deposits in areas resistant to fat loss (abdomen, love-handles, saddlebags, buttocks, double chin and the male breast.) Most of these people can be benefited by removal of excess fat by suction lipoplasty.

Ultrasound-assisted Lipoplasty

Ultrasound-assisted lipoplasty, abbreviated UAL, is a newer version of suction-assisted lipoplasty (SAL.) The procedure, like the original, was invented in Europe. An Italian plastic surgeon with a degree in acoustical physics –the study of sound energy—Dr Michele Zocchi invented a technique whereby a sound wave generator is attached to a sterile handpiece with a titanium rod which is caused to vibrate at a very high, but slightly audible pitch. This sound wave delivers energy to the fat tissue just beyond the end of the probe so that fat is liquefied, making it easier to remove.

In fact the fat is so liquefied that only low-pressure suction is required to remove it. Whereas the traditional lipoplasty machine removed the fat quite roughly and traumatized the fat and adjacent tissue rather severely, UAL is a gentler procedure, for the surgeon and patient. Because the machine breaks up the fat, areas which had been poorly responsive to the older technique are now more effectively treated. Some examples are the “love-handles” and abnormally large breasts on men, and the back area around the shoulder blades on both sexes.

Another advantage of UAL is that the less-traumatic technique allows removal of larger volumes of fat with a lower percentage of blood in the material removed. We have been commonly removing twice the total volumes we were previously able to do. Recovery times seem to be slightly shorter, though individual results will vary. Bruising and swelling appear to be less severe, possibly relating to the less traumatic nature of the technique.

Other aspects of the two procedures are essentially the same, with regard to necessity to wear compression garments postoperatively, etc. The complications associated with the procedure are likewise comparable.

Liposelection™ by VASER®

The newest ultrasound technology involves using pulses of sound energy to more effectively break up fat deposits, while sparing critical structures such as vessels, nerves, etc. The VASER® company was granted a service mark for the technique, calling it liposelection,™ referring to the specificity of the machine for emulsifying fat.

There are three steps in the process carried out in the operating room. First we instill fluid into the tissue to firm it up and stabilize the fat for further work. This is not the commonly referred to tumescent technique, which involves much larger volumes of fluid placed in the tissue and has led to complications such as fluid overload, pulmonary edema (fluid buildup in the lungs) and other complications. The second step is the application of the pulsed sound energy to the fat to break it up and make it easier to remove. Finally, low-power suction is used to evacuate the fat from the space.

Because of the more effective liquefaction of dense fat with the pulses of energy, we have been able to extend the procedure to areas not previously treated with traditional suction: lower legs, lower back, etc. Additionally, more complete removal of fat from the male breast, hip rolls, posterior shoulder and other areas is possible.

While ultrasound-assisted suction has traditionally been less traumatic and resulted in fewer bruises, the more aggressive use of the new machine and treatment of more areas at the single surgical procedure have worked somewhat against this rapid recovery. Because we lose less blood with this machine, we no longer “stage” the procedure by planning multiple trips to the operating room for treating additional areas.

Complications remain the same as for traditional lipoplasty, with minor touchups which can usually be done in the office at little expense being the most commonly occurring. General anesthesia is necessary because of the heat generated by the probes, and there are certain risks attendant with this, which the anesthesiologist will discuss with you in detail.

The expense of the procedure is slightly higher because of the cost of the machine, but our opinion is that the benefits are absolutely worth this additional money. Where your health is concerned, cost-cutting is not the primary concern; your health and the final aesthetic appearance are uppermost.

In summary, we now have tools that will help the conscientious patient who is trying to achieve a better appearance through diet and exercise to reach his or her goals. No surgery is a substitute for a healthy lifestyle, but those who seek the best possible appearance, and are unable to achieve this with diet and exercise alone, now have 21st century assistance.