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Date: 07.19.2016 / by DiBello Plastic Surgery

Liposuction: Which Technique Is Right for Me?

Liposuction (or Liposculpting) remains one of the most common cosmetic surgical procedures for both men and women. According to the ASPS procedural statistics for 2015, Liposuction was the second most common surgical cosmetic procedure, behind Breast Augmentation, and showed a 5% increase compared to 2014. Despite this, there remains to be confusion regarding the techniques available, the indications for the procedures, the possible side effects, and the long-term results. It's easy to get lost in the woods of information and hype with terms like” Cool”, “Smart”, “Sonic”, “Strawberry”, “Angel” or “Laser” advertised, versus the Traditional, or Tumescent, Liposuction.

Liposuction is often considered when stubborn areas of fat accumulation are unable to be reduced or improved with diet and/or exercise alone. People who are within 20 to 30 pounds of their ideal weight are typically considered the best candidates for liposuction, since the areas of abnormal fat accumulation will be more apparent and better targeted by the liposuction procedure. Liposuction should not be considered a replacement for a healthy lifestyle and should not be used as a means for dramatic weight loss, but rather an improvement in the contour of an otherwise healthy individual in fairly good physical condition.

 While Traditional, or Tumescent, Liposuction has remained the gold standard and has undergone advances in technique over the years, it is still considered ”vanilla” compared to the many other flavors of liposculpting that have been heavily marketed to consumers over the past several years.  All “Traditional” liposuction procedures are true surgical procedures, and as such, should be performed in an accredited surgical facility, by a Board-Certified Plastic Surgeon, since there are significant risks and potential complications involved.  

Laser- Assisted Liposuction (“SmartLipo” for example) and Ultrasound- Assisted Liposuction are variations of traditional liposuction with the addition of laser or ultrasonic energy delivered to the fat cells to promote destruction. These procedures should not be performed with Fat Transfer Procedures (Brazilian Buttock Lift for example), since the goal there is to preserve the integrity of the fat cells in order to increase their survival after re-injection. In addition to the usual possible risks associated with liposuction, there are potential additional risks with the delivery of energy to the tissues and the release of fatty acids into the body, which should be explained to you in more detail by your provider.

In an effort to cater to people trying to avoid an actual surgical procedure with its associated “downtime” and cost, there have been several procedures that have come to market relying on “Lipolysis”, or an attempt to “dissolve” fat cells by nonsurgical means. Some of the most recent attempts include the use of laser, ultrasound, radio frequency, or cryotherapy. All of these procedures involve the delivery of a form of energy to the treated tissue, and while fat cells are the primary target, there are potential adverse effects to the surrounding tissues.  While these are nonsurgical and can therefore be performed in an office setting by non-surgeons, they are definitely not without risk and potential complications.

Cryolipolysis (“CoolSculpting” for example) is a medical treatment (cryogenics) used to destroy fat cells (lipolysis). The treated tissue is cooled above freezing in an effort to cause destruction of the fat cells. Some reported complications of cryolipolysis include skin damage, prolonged pain, contour irregularities, and paradoxical adipose hyperplasia (unexpected increased fat accumulation in the treated areas).

Low level laser light  (“Strawberry”, “Curve”, and “Smoothshapes” for example)  disrupts the fat cell membranes, allowing cells to release the fatty acids, without damaging the cell.  The fatty acids released into the body are then absorbed and eliminated. The different procedures available that are marketed differ mainly by the wavelength of light used. Since the laser is applied through the skin, there are potential risks of injury.

External ultrasound techniques work by externally delivering focused energy in the form of ultrasound waves to cause destruction of the fat cells. There is “thermal focused ”  (“Liposonix” for example) and “nonthermal focused” (“UltraShape” for example), each promoting their own benefits. While the application is new, the technology is actually quite old. It may not be able to be used on all parts of the body, and there are potential risks to the tissues adjacent to, or surrounding, the treated areas.

Radiofrequency (RF) devices work by delivering an alternating electric field across the tissue which causes an orientation change in the charged particles leading to fat cell death and inflammation at the site of application. This is the same technology employed by the cautery devices used by surgeons in the operating room to control bleeding and burn tissue. Aside from the potential risk of burn, there have been deaths reported from some of the procedures employing RF.

The old saying: “If it’s too good to be true, it probably is” is one to keep in mind when searching for plastic surgery procedures, not just liposuction.  A recent study by the ASPS (American Society of Plastic Surgeons) reported on the low quality of information available online relative to liposuction.  Dr. DiBello offers the most up-to-date, safe and proven procedures.  Dr. DiBello performs almost all of his liposuction procedures utilizing the "super-wet technique" in which a tumescent solution is infiltrated prior to actual suctioning, providing improved safety (through reduced blood loss )and quicker recovery times. The Super-Wet Technique, as opposed to the Wet Technique, uses lower volumes of wetting solution, with the same reduction of blood loss, but with less risk of fluid overload. Dr. DiBello also specializes in Power-Assisted Liposculpture (PAL), using a reciprocating handpiece attached to smaller cannulas, which lets him achieve smoother and more precise results for his patients. A consultation with Dr. DiBello will help you determine if you are a candidate for liposuction. At that time, he will discuss what is involved in your personal surgical experience and the best technique for you to achieve a natural, toned result.

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