Techniques for liposuction

Techniques

Power-assisted liposuction Cannula.

In general, fat is removed via a cannula (a hollow tube) and aspirator (a suction device). Liposuction techniques can be categorized by the amount of fluid injection and by the mechanism in which the cannula works.

Amount of fluid injection

Dry liposuction

Mechanism of liposuction

Suction-assisted liposuction (SAL)

Suction-assisted liposuction is the standard method of liposuction. In this approach, a small cannula (like a straw) is inserted through a small incision. It is attached to a vacuum device. The surgeon pushes and pulls it in a forwards and backwards motion, carefully through the fat layer, breaking up the fat cells and drawing them out of the body by suction.

Ultrasound-assisted liposuction (UAL)

In ultrasound-assisted or ultrasonic liposuction, a specialized cannula is used which transmits ultrasound vibrations within the body. This vibration bursts the walls of the fat cells, emulsifying the fat (i.e. liquefying it) and making it easier to suction out. UAL is a good choice for working on more fibrous areas, like the upper back or male breast area. It takes longer than traditional liposuction, but not longer than tumescent liposuction. There is slightly less blood loss. There appears to be slightly more risk of seromas forming (pockets of fluid) which may have to be drained with a needle.

After ultrasonic liposuction, it is necessary to perform suction-assisted liposuction to remove the liquified fat. Ultrasound-assisted liposuction techniques used in the 1980s and 1990s were associated with cases of tissue damage, usually from excessive exposure to ultrasound energy.[2] Third-generation UAL devices address this problem by using pulsed energy delivery and a specialized probe that allows physicians to safely remove excess fat.[3]

A 40-year old woman undergoing a combination liposuction and abdominoplasty. Power-assisted liposuction: the cannula is inserted to about 80% of its full length.

Power-assisted liposuction (PAL)

PAL uses a specialized cannula with mechanized movement, so that the surgeon does not need to make as many manual movements. Otherwise it is similar to traditional SAL.

Twin-cannula (assisted) liposuction (TCAL or TCL)

Twin cannula (assisted) liposuction uses a tube-within-a-tube specialized cannula pair, so that the cannula which aspirates fat, the mechanically reciprocated inner cannula, does not impact the patient's tissue or the surgeon's joints with each and every forward stroke. The aspirating inner cannula reciprocates within the slotted outer cannula to simulate a surgeon's stroke of up to 5 cm (2 in) rather than merely vibrating 1–2 mm (1/4 in) as other power assisted devices, removing most of the labor from the procedure. Superficial or subdermal liposuction is facilitated by the spacing effect of the outer cannula and the fact that the cannulas do not get hot, eliminating the potential for friction burns.

External ultrasound-assisted liposuction (XUAL or EUAL)

XUAL is a type of UAL where the ultrasonic energy is applied from outside the body, through the skin, making the specialized cannula of the UAL procedure unnecessary. It was developed because surgeons found that in some cases, the UAL method caused skin necrosis (death) and seromas, which are pockets of a pale yellowish fluid from the body, analogous to hematomas (pockets of red blood cells).

XUAL is a possible way to avoid such complications by having the ultrasound applied externally. It can also potentially cause less discomfort for the patient, both during the procedure and afterwards; decrease blood loss; allow better access through scar tissue; and treat larger areas. At this time however, it is not widely used and studies are not conclusive as to its effectiveness .

Water-assisted liposuction (WAL)

WAL uses a thin fan-shaped water beam, which loosens the structure of the fat tissue, so that it can be removed by a special cannula. During the liposuction the water is continually added and almost immediately aspirated via the same cannula. WAL requires less infiltration solution and produces less immediate edema from the tumescent fluid.