Liposuction Surgery – Lipoplasty

Serving New York City, Manhattan


Liposuction is a great procedure for both men and women in New York City to contour the body and remove unwanted fat. It is ideal for patients who have isolated areas of fat that are not successfully treated by diet or exercise. Commonly, patients desire treatment of the abdomen, flanks, back, arms, thighs, knees, calves, ankles, and neck. Men sometimes request treatment of their chest. (See gynecomastia treatment) Although liposuction can help heavier patients to “slim-down,” it should not be considered a substitute for good diet and exercise. In addition, the skin may actually become looser after liposuction, and procedures to remove excess skin may be the better choice. The surgical procedure usually takes between one and three hours with a recuperation time of two to five days.

Why is Liposuction Performed?

The goal of liposuction is to treat areas of unwanted fatty excess so that better contour of the body can be achieved. Dr. Wallach, a Manhattan New York plastic surgeon, recognizes that liposuction techniques have evolved over the years. Originally, the goal was to flatten areas of excess fatty tissue. More recently, techniques were developed to perform “abdominal etching;” to bring out lines of the abdomen so that a more “cut look” is achieved.  Still, further refinements of these techniques have evolved to promote even better definition in all areas of the body: abdomen, flanks, chest, back, legs and arms. Those individuals that have a relatively low body fat concentration that want more definition are the best candidates to get that sculpted look. This can be achieved by bringing out the differential natural shadowing that well framed physiques display.

The Different Methods of Liposuction

Liposuction has evolved over the years from its original description in the mid 1970’s. Surgeons started out performing this procedure with sharp tipped cannulas (instruments to remove the fat) by using a “dry” technique (no wetting solution to diminish blood loss). The early results were good, with limitations removing large quantities of fat mainly due to blood loss from the procedure. The techniques improved by using blunt tipped cannulas and wetting solutions; thereby, diminishing blood loss and allowing more fat to be removed in each session. This resulted in better and safer results. Since the evolution of performing liposuction using wetting solutions, many variations in the concentration of fluid infusion and fat removal have been created.  This includes techniques described as the wet technique, the “super-wet” technique, and the tumescent technique. Wetting solutions usually have a mixture of a balanced sterile salt solution, lidocaine (an anesthetic), and epinephrine (a blood vessel constrictor). The combination of all three solutions allow relative pain free treatment with narrowing local blood vessels both by tissue expansion using the salt solution and the vasoconstrictor effects of the epinephrine. This provides for a minimum of blood loss during the procedure. The instrumentation has evolved over the years, and there are many different tools that can be used. Dr. Wallach performs liposuction using many different tools using the tumescent technique.  He uses standard cannulas, power-assisted liposuction (PAL), ultrasound-assisted liposuction (UAL) using the VASER® liposuction machine, or laser lipolysis using machines such as Smartlipo™ Dr. Wallach has presented and published papers on body contour procedures.


Traditional Liposuction

This terminology is really a misnomer. It suggests that it is an old technique that is outdated, when in fact it is the most popular liposuction technique used today, incorporating tumescent fluid infusion.  Learn more about traditional liposuction.


Through several small incisions focused near the areas that require treatment, a tumescent fluid is infused.  After waiting several minutes for the vasoconstrictor action of the solution to take effect, the liposuction is performed.  Blunt cannulas with holes near the cannula tip allow for an almost blood-less removal of fat cells without disturbing the majority of sensory nerves or blood vessels in the surrounding tissue.

“I believe true confidence comes from a feeling of self-assuredness from one’s inner self. However, I also believe that it is heavily impacted by a lack of confidence with one’s outside appearance as well. Plastic surgery can help improve confidence in this way.”


Several very small incisions are used.  It is unlikely to get seromas (fluid collections) or hematomas (blood collections). Even less frequent are skin burns, because the cannulas do not generate any heat.


This procedure is somewhat labor intensive for the operating surgeon because of the back and forth motion required to aspirate fat with these cannulas.

Power-assisted liposuction (PAL)

This technique uses cannulas that are on either a gas powered or electric powered hand piece that moves the cannulas back and forth. This allows the surgeon to use less energy to remove the excess fat cells. 


The procedure is similar to that described for “traditional liposuction.”  The only different between power assisted and traditional is that this type involves less manual labor for the surgeon.


Incision size is the same as “traditional liposuction.”  There is less manual exertion by the surgeon, because the oscillating hand piece does most of the work. It is suggested to be easier to treat more fibro-fatty regions such as the hips, back and male chest.


There may be a slightly increased risk of seroma formation than “traditional” liposuction.


Ultrasonic liposuction (UAL)


This technique uses ultrasonic technology to loosen and emulsify fat.  Now more surgeons are using the Vaser® machine.  Vaser® stands for Vibration Amplification of Sound Energy at Resonance.  Vaser® is different from earlier UAL devices because the ultrasonic energy is emitted from the rings on the side of the cannula as opposed to the cannula tip. The heat that is generated from the ultrasonic vibrations is focused on the sides of the cannula. This helps minimize some of the potential complications using this technology.


Incisions for access for UAL procedures require a slightly larger incision than with either “traditional” or PAL techniques.  Access protectors are secured at the incision sites while the ultrasonic energy is used.  The ultrasonic probe is inserted after tumescing the fatty layers, and the energy from the ultrasonic probe both loosens and emulsifies (liquefies) the fat.  Once this step is complete, standard liposuction cannulas are inserted to remove the fatty tissue.


There is less manual work than performing “traditional” liposuction or PAL.  May work better on fibro-fatty regions such as the hips, back, and male chest.  May be able to give better contour definition.  May provide better skin contraction.


Ultrasonic techniques have a higher seroma rate than other techniques.  Ultrasonic techniques also have a higher rate of skin burns due to the heat generated during the procedure.  Power assisted methods also have prolonged numbness over the skin as compared to the other techniques. The procedure takes longer than the  “traditional” or PAL techniques.

Laser lipolysis (Smartlipo™)

This technique uses laser light to emulsify fat.  The heat generated from the laser light may also cause some skin contraction. This added technology allows for more delicate or intricate treatment.


Small incisions are made for tumescent access.  The treatment area is tumesced using a cannula and then laser light might be inserted at the beginning of the procedure to emulsify or break up the fat or used at the end of the procedure to heat the skin in an attempt to cause skin retraction. Once this is performed, a traditional cannula is inserted to remove the emulsified fat.  This procedure is better for treating small areas.


Small incisions are used to complete this procedure. May cause some skin retraction.


Laser lipolysis may have an increase seroma rate as compared to “traditional” and PAL techniques.  Laser lipolysis has a higher rate of skin burns due to the heat generated during the procedure as compared to “traditional” and PAL techniques.  It may produce prolonged numbness over the skin as compared to the other techniques. The procedure takes much longer than with “traditional” or PAL techniques.  There may be very little to no skin contraction after the procedure.  For more information on the pros and cons of Laser Lipolysis, visit our blog.

If you would like more information about Dr. Wallach and his success with New York City Liposuction procedures, we invite you to contact our Manhattan NY office at (212) 257-3263 or by mail at 1049 5th Avenue, Suite 2D in New York, NY 10028; or using our contact form to request additional details.


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