What types of liposuction and liposculpture are there?

by Akshat Narwal · Published 10/05/2023 · Updated 30/05/2023

What types of liposuction and liposculpture are there?

Liposuction

It is the extraction of excess body fat by means of suction using special surgical equipment. Normally, the surgery is performed by a plastic surgeon.

Description

Liposuction is a type of cosmetic surgery. This surgery removes excess fat to improve body appearance and smooth out irregular body contours. This procedure is sometimes called body contouring.

Liposuction can be used to reshape the areas under the chin, neck, cheekbones, upper arms, breasts, abdomen, buttocks, hips, thighs, knees, calves, and ankles.

This is a surgical procedure that has risks and can involve a painful recovery. Liposuction can have serious complications or in rare cases fatal. So you should think carefully about the decision to have this surgery.

What are the types of liposculpture and liposuction?

Many times the patients in the consultation ask us

How many types of liposuction are there?

Currently, there are four different types of liposculpture and liposuction possible:

tumescent liposuction and its variants, such as Aqualipo or Body-Jet,
the super-wet technique in which the volume of local anesthesia is half that used in the tumescent,
Ultrasound-assisted or Vaser liposuction,
and laser-assisted liposuction.

Cannulas used in liposuction-liposculpture

What types of liposuction and liposculpture are there?

dry liposuction

Cosmetic surgery that extracts fat by dry liposuction was the first of the different techniques.

Although dry liposuction is the oldest technique, introducing the cannula through small incisions in the area to extract the fat has stayed the same.

It began to be developed in Paris in the 1970s and marked the start of the technique and the discovery of its possibilities for body contouring surgery.

But it presented many problems since, at that time, the cannulas devised were of a large caliber, measuring a centimeter more or less thick, which caused holes and skin depressions in the postoperative results.

Nor were the tissues infiltrated with vasoconstrictor fluid as now. Shortly after starting liposuction, the bleeding distorted the tissues so much that it was tough to calculate the fat to be removed.

This blood loss also greatly limited the liposuction that could be performed by not exsanguinating the patient.

tumescent liposuction

It is the formula we use today; It consists of the infiltration before liposuction in all tissues of an anesthetic and vasoconstrictive mixture.

We use the Klein solution that is formed by:

Aspiration of fat through the cannula

Klein’s solution:

1000cc of Lactated Ringers.
Lidocaine 10 cc at 2%.
Adrenaline 1 ml.
75cc of Bicarbonate 1/6 molar.

This solution is infiltrated at a lower room temperature, ensuring that the cold helps in vasoconstriction.

One must be very careful not to induce hypothermia in the patient, even if it is mild since they later have some discomfort due to the sensation of cold and chills.

With this solution, we infiltrate at a ratio of 1:1 in the areas of the body that we wish to liposuction.

If we have calculated an excess of about 400 ccs of fat in an area, we must use more or less the same amount of anesthetic liquid to extract it.

This is sometimes not easy and varies greatly depending on the surgeon’s experience.

Once the infiltration is done, we proceed through cannulas to remove the fat from the area we want.

This process must be carried out following a particular order to create a three-dimensional lattice that allows fat extraction to be carried out uniformly.

We will start with moderate caliber cannulas, 4 mm in diameter in the deep layer, through no less than two entry points whose trajectories intersect at approximately 90 degrees.
As we get closer to the skin, we will use finer cannulas, 3 mm in diameter and even 2 mm. The latter is in more delicate parts of the body, or we seek more significant scar retraction, such as the chin, neck, and other body areas.
Throughout the process, placing the opposite hand flat on the area to be liposuctioned, we carefully control the trajectory and depth of the tip of the same.
Periodically we must interrupt the aspiration to perform what we know by its term in English as a “pinch test ” that consists of pinching to see the thickness of the layer of fat we are leaving.
Once the desired result is obtained, we suture the entry points with five-zero monofilament to get an optimal scar (most of the time invisible), and we place the girdle or liposuction garment that we have designed.

Body-Jet liposuction: water jet or hydroliposuction

Dr. Moltó is a specialist in Body-Jet liposuction surgery, which we perform using a device that emits a jet of pressurized water at the end of a cannula.

This jet would break down the fatty tissue, and in a subsequent maneuver, a suction device would eliminate water and fat cells.

This method, which the medical community has yet to accept widely, has the possible advantage that extracting excess localized fat would be less traumatic for the extracted cells. In addition, this allows later use to graft them as filler material, for example, to perform a buttock augmentation with its fat.

It also presents additional advantages of less bleeding and less recovery time for the patient.

Liposuction and laser liposculpture

Photo: http://aestheticmt.com/cannulas.htm Laser liposuction: the lipo laser

With modern fiber optic techniques, it is possible to make a laser circulate inside a fine fiber optic cannula, which can remove fat when inserted into the body.

How do we know that we burn fat and not everything else inside our bodies?

The laser has a very particular way of acting; depending on the frequency of its wavelength, it goes through some molecules as if they were transparent and heats others, which are the specific “target” of each laser.

Thus, the CO2 (carbon dioxide) laser pulverizes the epidermal cells without differences; there are other lasers with different wavelengths that target skin spots or tattoos; others only heat, and therefore destroy the molecules of hemoglobin, which will be helpful to eliminate highly vascularized structures such as angiomas… and so on.

The lipo laser is a laser that has a wavelength that destroys substances that have the same refractoriness as fat.

In other words, although it may seem like a miracle, it can heat and destroy only fat, leaving intact blood vessels, nerves, or other structures inside us.

Is this exactly the case?

Well, if you pay attention to commercial houses, yes.

The reality is that it must be handled with great caution because many structures, such as nerves, also have fat on their walls, as it is part of their natural composition, and therefore this type of laser can damage them.
In addition, due to proximity, the heat that radiates inside causes the neighboring structures to heat up in the same way so that, due to proximity, we can damage them.
Therefore, using these lasers requires a lot of experience and total control of the energy that we program in each quadrant, together with a meticulous technique of uniform and well-programmed passes.
Once we have made the laser pass inside the area, we have to treat it, and we must remove the amount of liquefied fat using conventional liposuction.

What benefits does the laser provide in the liposuction technique?

Not as many as the commercial houses would have us believe.

No study corroborates that the recovery of these patients is better than that of tumescent liposuction with the fine cannula.
Not even the earliest recovery. What’s more, in some circumstances, the damage we can cause to valuable structures, such as superficial sensory nerves, should contraindicate its use.

Thus, we are firm defenders of laser liposuction in areas such as the abdomen in postpartum women with some flaccidity who do not want another type of plastic surgery.

At the same time, we can see a specific contour modification in the jowls, although the thin skin can cause burns that end up externalizing. Although it has never happened to us, they are in the scientific literature.

What is the foundation on which lipo lasers are based?

It is thought that heating close to the deep dermis would generate an inflammatory reaction that would create the synthesis of collagen in the form of a scar, in the same way, that skin burns cause wide spots that are very rich in collagen.

Defenders of conventional liposuction argue that the fine cannulas they use, by perforating the dermis in all directions, generate an even more significant amount of collagen and, more practically, the order in space in the direction the surgeon wishes. So it offers superior anti-sagging traction to the uncontrolled scar from the laser.

We have obtained good results with both techniques, so we use them interchangeably depending on the area to be treated or the patient’s wishes, as reported.

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VASER or high-definition ultrasonic liposuction

Another technique is ultrasonic liposuction, the first to appear associated with a device that implemented the destructive power of the cannula.

It has a mechanism of action very similar to lipo laser; only here, ultrasound is the energy source that destroys tissue at the cannula’s tip.

Ultrasound-assisted liposuction uses a much higher frequency than the human ear can perceive and has such energy that it destroys tissue.

adipocytes

In the same way that a high-pitched sound can cause a glass object to explode, ultrasound can generate a fat cell to burst.

Like laser liposuction, the technique involves introducing the cannula that emits an ultrasound beam at its end to break the fat globules and makes multiple passes through the area while we destroy the adipocytes.
After that, as in laser liposuction, it is necessary to perform conventional liposuction to remove all cell debris and adipocytes that have been half destroyed.
It is usually associated with a more remarkable ability to sculpt body contours, one of the most used techniques for abdominal marking.

What is the mechanism of action argued by those who defend this technique?

The mechanism of action is that cell damage to fibroblasts in the deep layer of the dermis causes it to react with collagen synthesis that will act like lipo laser as a skin tightener, preventing an increase in the sagging.

Why isn’t it one of our favorite techniques?

Like the lipo laser, a severe study has yet to be achieved, apart from those provided and made by commercial houses, which accredits a superior objective result.

In addition, ultrasound liposuction no longer has a mechanism of action as selective as the laser, which only burns fat; the ultrasound damages all the tissues it touches; therefore, in the hands of an inexperienced surgeon, or an oversight, they can be damaged vital organs, fascias, nerves or other structures.

What type of liposuction is best?

Vaser liposuction, which uses ultrasonic energy to break up adipocytes, or fat cells, is often said to remain the most advanced and effective liposuction. This type of liposuction attacks fat cells without touching the surrounding tissue.

In our clinic, we do not use ultrasound liposuction because no serious study has been achieved, apart from those provided to you and made by the commercial houses themselves, accrediting a superior objective result.

What is the most effective form of liposuction?

The most effective form of liposuction and the most common in Spain is tumescent liposuction, Aqualipo, or Body-Jet, which is more effective, safer, and less painful than traditional liposuction and has a much easier recovery in less time.

What are the differences between “classic liposuction” and laser liposculpture?

“classic” liposuction involves more trauma and bleeding as the removed fat deposits are treated through a cannula. The laser lipo procedure coagulates small blood vessels (reducing bleeding and bruising), causing less mechanical trauma.

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What types of liposuction and liposculpture are there?