Liposuction – a brief overview of methods and procedures

Methods of liposuction

Liposuction, also known as liposuction, is one of the most frequently performed cosmetic surgeries worldwide, ahead of breast augmentation and eyelid correction. In Germany alone, numerous physicians perform 250.000 procedures per year from – mostly for cosmetic reasons.

Although the basic principle remains the same in this relatively new treatment method, there are different technical procedures and variations in the treatment depending on the area of application on the body. Here is a brief overview of them, which can give you a first orientation.

The basic principle remains the same

Liposuction is based on the same principle, regardless of the method used: fat cells are suctioned out from under the skin at the desired treatment sites with the help of cannulas.

Surgical liposuction can effectively help against stubborn fat deposits on the hips, abdomen, thighs or under the chin that are difficult to counteract with diet and exercise. Both men and women pursue the goal of a slimmer body image with more harmonious proportions and more defined contours.

But a note beforehand: liposuction is not an alternative for weight reduction, a balanced diet or physical exercise. In addition, the commonly used methods of liposuction are not suitable for the treatment of lipedema, as lymphatic vessels can be damaged in the process. However, there are also lymph vessel-sparing techniques to minimize the risk of lipo-lymphedema.

The Basic Method – the cornerstone

The oldest form of liposuction was already used in the 1970s. Many other methods have developed from it. During the procedure, the areas to be suctioned are marked on the body with a pen beforehand to ensure even and precise body contouring later on.

The cannulas are inserted through incisions in the skin, which loosens the tissue and fat cells. Subsequently, the loosened fat cells can be suctioned out with the help of a medical vacuum pump. As a last step, only the small incisions have to be sutured or glued.

Tumescent method (TLA) – swelling the fat

The tumescent technique is the most commonly used method of liposuction in the world, introduced by a dermatologist in 1987. In this technique, large amounts of a special fluid (tumescent solution) are first injected into the subcutaneous fat tissue of the affected body region in order to swell the fat cells to be removed and to stretch the surrounding connective tissue lattice – “tumescere” comes from the Latin and means “to swell”.

The liquid usually contains a local anesthetic in addition to saline solution, so that the procedure can be performed more gently and painlessly. This means that general anesthesia is not necessary, which allows the patient to stand up during the procedure, so that the surgeon can check the result in a standing position during the operation and make any necessary adjustments.

Super wet method – with less liquid

Mostly identical to the tumescent method, but this technique injects less fluid into the subcutaneous fat tissue. Unlike the name suggests, less than tumescent liposuction – at a ratio of 1:1 to the tissue to be suctioned compared with 3:1.

The fully aspirated and loosened fat cells are then removed, including fluid, as in the other methods, using special cannulas and a vacuum pump. Since less fluid is introduced into the tissue, the anesthetic effect is less, which is why the Supernass method is generally performed under general anesthesia.

Supernass and tumescent procedures can be used to suction larger amounts of fat, for example on the abdomen or thighs. However, the maximum amount should not exceed five liters so as not to put too much strain on the body. Microcannulas are therefore usually used nowadays to protect the tissue.

Water-jet assisted liposuction (WAL) – ongoing loosening of fat cells

Waterjet-assisted liposuction reduces the exposure to saline and medications, as the fat cells are not sponged up, but are specifically detached from the surrounding area with a fine, fan-shaped waterjet. The fat is removed through a second channel at the same time as the water is introduced.

This method is good for treating small and problematic areas of the body, as the surgeon can correct the procedure at any time and realistically assess the final result. In addition, water jet assisted liposuction is of great importance for breast augmentation with autologous fat and similar fat transfers.

The treatment is gentle on the lymphatic vessels, which is why it is also used to treat lipedema. Since the fat cells are dissolved slowly and in a targeted manner, a “dent-free” end result can be expected.

Vibration assisted liposuction (VAL or PAL) – loosening with vibrations

Vibration assisted liposuction or “Power Assisted Liposuction” (PAL) is often used for sensitive skin types and complicated body areas such as the knee and ankles. After the introduction of the tumescent solution, oscillating cannulas with about 6000 oscillations per minute are also introduced, which causes a faster bursting of the fat cells and allows a gentler treatment.

Ultrasound-assisted liposuction (UAL) – for greater tightening

Instead of vibrating cannulas, UAL liposuction uses ultrasound probes in the treated tissue to accelerate the bursting and liquefaction of fat cells. In addition, the tissue is strongly heated with this technique, which can achieve a stronger tightening effect. In addition to ultrasound, radio frequencies can also be used to make it easier to suck out the unwanted fat cells – this is called lipopulsing.

Laser lipolysis (LAL) – modern technique for firm body regions

Another modern method of liposuction is liposuction with the help of lasers. LAL uses laser probes instead of ultrasound, which liquefy the fat cells with laser pulses in different wavelengths. It is well suited for firm body regions, such as liposuction in the back area.

The methods of liposuction have improved over the years and have become more digestible for the body. Depending on the volume to be suctioned off, the physical conditions, the specific body region and your preferences, different procedures are recommended for the desired result.

In addition to the techniques mentioned above, there are several others as well as minor variations – such as the Tulip system, a modification of the suction process. If you are interested in liposuction and are considering treatment, you should in any case get detailed advice about your options.

With an informed choice of surgeon as well as close consultation about preparation, aftercare, risks and achievable effect, you will surely find the right liposuction method for you.

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