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Liposuction Techniques Overview

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John Q. Cook, M.D.

Chicago 312-751-2112
Winnetka 847-446-7562

Learn About the Different Types of Liposuction Techniques

Why We Gain Weight in Different Ways

How we gain fat is determined largely by our genetic makeup, but also in part by patterns of nutrition and exercise. If you are very lucky, the fat you gain will be distributed in a uniform way throughout the body. Much more commonly, the fat will go to specific zones, such as the abdomen in men and the hips and outer thighs in women. This process of excess fat accumulation in one or more specific areas is referred to as lipodystrophy. Zones of lipodystrophy can be enormously frustrating, since they can be very resistant to programs of diet and exercise.

If you have a zone of excess fat, it’s always best to begin with a structured program of diet and exercise. If you are very lucky, this may be all you need to lose the zone of unwanted fat. More commonly, the fat will still be there, but you will have laid a foundation for long terms success if you seek surgical treatment.

Direct Excision of Fat and Skin

If you had zones of excess fat before the 1970’s your only option was surgery that involved long incisions and direct removal of the excess fat. The only areas where this worked half decently were the abdomen (abdominoplasty, tummy tuck) and the breast (breast reduction). In other areas the scars were a bad trade off, and it was hard to remove the fat in a manner that left a pleasing contour.

Classical Liposuction Technique

The person who moved the ball forward was a French surgeon named Dr. Illouz. He figured out that if there was a zone of excess fat you could reach it by making a small incision and passing a long metal tube with one or several holes on the end into the excess fat. If the tube is connected by plastic tubing to a suction pump, when the surgeon moves the tube back and forth it will break off pieces of fat that are sucked out of the body.

This inelegant description is exactly what early liposuction was like. The early instrumentation was crude and made little distinction between fat and other structures, such as nerves and blood vessels, so there was quite a bit of trauma with the procedure. The recovery was often long and painful and bruising could last for months.

Refinements of Classical Liposuction

In my opinion the next great leap forward occurred as a result of two technical developments: the popularization of what is now called tumescent liposuction and the development of better instrumentation. With tumescent liposuction, the surgeon introduces into the zone that is to be treated a solution that is essentially a mixture of salt water, local anesthesia, and an agent that constricts blood vessels. This makes the fat easier to extract and cuts down on bruising quite dramatically. It also makes it easier to work with more sophisticated, smaller diameter cannulas to extract the fat, and this in turn leads to a smoother result, at least in the hands of a skilled surgeon. As results became better and more consistent and recovery became easier, the popularity of liposuction exploded.

Ultrasonic Liposuction and Vaser® Lipoplasty

Just when everything seemed to be standardized with lipoplasty technique, along came an Italian plastic surgeon named Dr. Zocchi. Dr Zocchi was experimenting with the effects of ultrasound on different body structures when he discovered that certain frequencies of ultrasound were very good at breaking apart fat cells but left other structures unharmed. He realized that this might make ultrasound a useful technology for liposuction, and he developed a technique that harnessed ultrasound’s possibilities. As with any potentially disruptive technology, there was a mixed reaction among plastic surgeons when Dr. Zocchi began to present his work at American meetings. It seems that when something new comes along plastic surgeons tend to divide themselves into three groups: the fat and happy, the intellectually curious, and the eager early adapters.

The “fat and happy” surgeons were very busy in their practices with classical liposuction, perhaps to the point where they really didn’t want to be much busier, so they viewed the introduction of a potentially disruptive technology with annoyance and tended to disparage it. The “eager early adapters” were typically young plastic surgeons not far out from the completion of their training, who were looking for a vehicle to distinguish themselves from the established surgeons in their community. They were open- minded as to new possibilities, but perhaps a little eager to jump on the next bandwagon without doing all their homework. Fortunately for the field of plastic surgery, the organized structure of plastic surgery professional organizations at the time had a sufficient number of the third group, the “intellectually curious,” that a concerted effort was made to work with the FDA in order to evaluate this new technology and to introduce it to surgeons with the proper qualifications.

The net effect of this process was that ultrasonic liposuction was introduced in a highly structured way to board-certified plastic surgeons. Some chose to adopt the technology; others did not. There tended to be relatively few complications, because the surgeons who chose to use the new technology of ultrasonic lipoplasty were experienced and properly credentialed. To this day, there are surgeons who prefer classical liposuction because of its simplicity and those (like myself) who feel that, especially in certain zones, various forms of ultrasonic liposuction impart an advantage.

Ultrasonic liposuction has evolved since its introduction and has reached a level of sophistication that makes it a “workhorse” for many busy plastic surgeons. Vaser® lipoplasty is, in my opinion, the most advanced form of ultrasonic liposuction that is widely available in the United States. I have used this technology in over 1000 patients with a very high level of success. The character of the ultrasound can be varied in ways that allow for a very specific approach to different zones of fat. With a highly-experienced surgeon there may be a moderate degree of tightening of the treated area, but not to the degree that can be obtained with laser lipoplasty.

Power Assisted Lipectomy  (PAL)

PAL or power-assisted lipectomy is a technology that some surgeons utilize for speed and comfort. Rather than manually pushing the cannula back and forth to remove fat, the surgeon uses a device that mechanically moves the cannula back and forth. Some surgeons feel this makes them less fatigued for longer surgeries.

Laser Liposuction, SmartLipo® and SlimLipo®

Laser liposuction has a number of similarities to ultrasonic liposuction. The treatment sequence is similar: first the introduction of the tumescent solution to prepare the area that is to be treated, then the application of energy, then the extraction of the melted fat.

The two most important distinguishing characteristics of laser liposuction are the ease of application under local anesthesia and the tightening effect that occurs with this technology. These and other issues are discussed in detail on Laser Liposuction page of this website.

Dr. Cook has worked extensively with both the SmartLipo® and SlimLipo® technologies of laser liposuction. Our patients appreciate the convenience of an office-based procedure under local anesthesia with a limited recovery. They also benefit from the extensive experience and artistic vision of Dr. Cook.

Non-Surgical Fat Reduction and SculpSure®

In the last few years several non-invasive techniques of fat reduction have been introduced to the American market and more are on the way. These devices use heat, cold, radiofrequency, and other forms of energy to reduce fat deposits in the body. Some of these technologies will produce a modest reduction in treated zones, but I have never seen results that equal what can be accomplished with any form of liposuction: classical, ultrasonic, or laser.

Dr. John Q. Cook and the Whole Beauty® Institute are pleased to have been selected as the first practice in the Midwest to offer the SculpSure® technology for non-invasive fat reduction. We believe that this technology represents a significant improvement over existing fat reduction methods. Please visit the SculpSure® page of this website for more information. It is important to remember that this technology, although powerful, will not equal the results of liposuction in a single procedure.

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