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
- Power-Assisted Liposuction (PAL)
- Ultrasonic Liposuction (UAL)
- Laser Lipolysis (Smartlipo™)
- Alternative Liposuction Options
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.
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. Ultrasonic techniques may 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™)
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.
Liposuction Frequently Asked Questions
Can I do liposuction instead of going on a diet?
Liposuction is not a substitute for a diet. Good nutrition and exercise are an important factor to staying fit. Liposuction is ideal for those patients who have defined areas of fatty deposit that they can’t seem to lose by diet or exercise. Common sites for treatment include the abdomen, hips, back, thighs, and arms.
Are you taking all the fat out from the areas you suction?
No, liposuction does not remove every single fat cell from a given treatment area. You want to maintain an even layer of the more superficial fat so that contour deformities do not result. In fact, overzealous liposuction can cause severe deformities that sometimes cannot be corrected.
Will the fat come back in those areas that were suctioned?
Liposuction decreases the overall volume of fat cells in a given treatment area. New cells will not grow back in the areas treated, however, if you gain weight, the cells that are present in that area will enlarge. I tell patients that if you gain weight then the weight will probably be more evenly distributed and not accumulate as frequently in the areas previously suctioned.
What are the different types of liposuction techniques that are available today?
There are many different ways to perform liposuction. I like to divide them into those that use heating devices and those that do not. The ones that do not use heat include traditional liposuction and power-assisted liposuction (PAL). Those that use heat include ultrasonic liposuction devices like Vaser and laser lipolysis machines like Smart Lipo. The heating devices in my opinion tend to have a higher risk of fluid collections (seromas), prolonged numbness, and the potential for burns.
What is Vaser Liposuction?
Vaser liposuction is a form of ultrasonic liposuction that can be performed in an office based operating facility. It uses high frequency ultrasound that generates heat to melt the fat that is being treated. Once this is performed, the emulsified fat is then suctioned with more traditional cannulas. Some believe that the heat can cause skin contraction, but it does not appear that it improves skin contraction any better than other techniques, including traditional liposuction.
I have some numbness after liposuction, will this get better?
It is pretty common for patients to develop some numbness, or what is called dysesthesia, after liposuction. This is commonly due to swelling and usually improves over a six to eight week period when the swelling subsides. On the other hand, the heating component devices like Vaser or laser lipolysis machines (i.e. SmartLipo) tend to cause prolonged numbness.
I heard that some patients can get burns from liposuction. Why is that?
Burns are more likely to develop with liposuction devices that generate heat. Maneuvers in using the probes leading to what is called “end hits” tend to cause burns. This is more common with the Vaser machine or the laser lipolysis devices such Smartlipo or Powerlipo. This is almost unheard of with traditional liposuction or power-assisted liposuction
What is PAL?
PAL stands for power-assisted liposuction. This is a liposuction machine that assists the surgeon to perform the liposuction. The handle oscillates the liposuction cannula back and forth. It is still a mechanical process that is thought to decrease surgeon fatigue during the procedure.
Does skin tightening occur with liposuction devices?
In general, liposuction can cause some skin tightening. But I do not think that any one machine will give you “true” skin tightening in the sense that if the skin is loose, it will tighten up significantly. Although this is suggested as a benefit for using the liposuction devices that heat the tissues, the results in my opinion are not any better than more traditional techniques.
How does traditional liposuction differ from power-assisted liposuction (PAL)?
Traditional liposuction uses standard cannulas that are connected to suction. The surgeon uses these cannulas in a manual forward and back motion to mechanically suction the fat. In my opinion, this is one of the least traumatic techniques available for liposuction.
What is tumescent liposuction?
Tumescent liposuction refers to the infusion of fluid into the tissues during a liposuction procedure. It usually consists of a sterile salt water solution, usually Lactated Ringers, along with lidocaine (an anesthetic), and some epinephrine (a blood vessel constrictor). This fluid fills the space (or tumesces) where the fat is. It helps with constricting the blood vessels both by pressure of the infused solution and as a result of the effects of the epinephrine. This in turn decreases the risk of blood loss during the procedure. The lidocaine numbs the area being treated and can help with early post-operative discomfort. The majority of liposuction techniques use variations of the tumescent technique. There are different levels of fluid infiltration referred to as wet, super wet, or the tumescent technique. These three vary by the ratio of infusion solution to fat removal. The true tumescent technique usually uses fluid in a ratio of 3:1 infusion to fat removal. I will most commonly use a wet or super wet technique to limit the amount of fluid infused in any one patient during liposuction.
Should I have Smartlipo done on my abdomen?
Patients always ask me about the specific technique that they have read about in the press and want to know if a specific technique or device is best for them. In general, I do not think a specific device is any better than any other. Quite frankly, I think it is more surgeon-dependent rather than anything else. I always tell my patients that it is not the wand (the machine) but the magician (the surgeon) that creates all the magic!
How much fat can you remove in one operative setting?
This is a question I get asked quite often. In general, I perform most of my surgeries in an out-patient facility. The ASPS or ASAPS recommends that no more than five liters of fat be removed in any one operation in an out-patient facility. Some states like Florida have limited the aspiration to even less fat.
Do I have to wear a garment after liposuction?
I like my patients to wear a compression garment that is especially made for liposuction post-surgical care. I think that the compression helps minimize the risk of fluid collections, and helps to decrease post-operative swelling. In general, I think that patients are more comfortable during the recovery. I like my patients to wear these garments for three to six weeks. I usually have them purchase two so that they can wear one and have a clean one available to change into. Some surgeons do not recommend garments to their patients.
Can I have liposuction of my hips?
Liposuction of the hips, more specifically the flanks or outer thighs, can be performed as part of a liposuction procedure. However, the only way to be properly evaluated is to be seen in person for a proper evaluation.
Can I have liposuction of my chest?
A common request from men is to ask about liposuction of their chest. If the chest does not have a lot of loose skin or feels more fatty than glandular, liposuction alone may be an excellent choice. For those men who might have a glandular component to the chest that would not be amenable to liposuction alone, then they may require a small glandular resection, perhaps through an incision around the border of the areola. In men who have severe skin laxity, they may require a skin excision and glandular excision as well. This can be performed using several different techniques. Most will require a compression garment.
Will I need a drain after chest liposuction?
If liposuction is the only procedure performed, I do not usually place a drain. However, I will commonly place closed suction drains when large amounts of skin and soft tissue are removed surgically.
Submental liposuction, is it a good idea?
Submental liposuction refers to liposuction of the area under the chin. If a person has a significantly fatty neck, liposuction of this region can be quite satisfying. It can usually be done through a small incision underneath the chin or behind the ears. The fat that is superficial to the platysma muscle is the area best treated by liposuction. It is important to try to maintain a thin layer of fat between the skin and muscle if possible to help minimize the risk of overtreatment. However, if there is a lot of loose skin, subplatysmal fat, or plastyma muscle banding, liposuction alone may not be enough, and there are surgical options that may be able to treat these concerns.
Will liposuction be right for me if I have had a few kids and my skin is loose?
If a woman has had multiple pregnancies and now complains of loose skin and a weak protuberant abdomen, then liposuction may not be the right procedure for her. Loose skin will likely become looser after liposuction in these types of patients. A full tummy tuck may be a better treatment option to treat the loose skin and tighten the muscles. Liposuction can sometimes be performed on the abdomen at the same time when limited abdominal flap elevation is performed, or done before or after a tummy tuck.
Can I have liposuction because I want to lose weight?
Liposuction is really not a good idea for someone who is looking to have liposuction to treat obesity. If a person is significantly overweight or obese, then diet and exercise are the best ways to lose the weight. Liposuction is ideal for those patients who are close to their ideal weight but can not get rid of unwanted areas that are recalcitrant to diet and exercise. Liposuction is a great procedure to improve contour. In fact, I have been using it a great deal in combination with fat augmentation in women who want a Brazilian butt lift.