There is a lot of trickery and marketing in liposuction. I have had people ask me, “Do you do liposculpting?” Liposelection, liposculpture, laser liposuction, UAL, Vaser, ultrasonic liposuction- what do these all mean? Please see my liposuction page on my website. Much of this terminology doesn’t mean anything. We all sculpt (or should) when we do liposuction. Ultrasonic, UAL, Vaser are all ultrasonic energy used to break up fibrous fat. Smart lipo, laser liposuction are lasers which are a smaller caliber than ultrasonic, but the purpose is the same: to break up fibrous fat. My favorite marketing gimmick is “We use the new tumnescent procedure.” Perhaps tumnescent is new to that doctor, but it is not a new technique. Everyone uses tumnescent, and it has been around for 20 years. (Tumnescent is infusing the fat with a mixture of anesthetic, epinephrine, and saline prior to fat removal which significantly cuts down on blood loss.)
The laser liposuction while effective, has a small caliber. It is great for a small area like the chin, but not good for more broad fat removal. It is like painting a room with a small paintbrush instead of a big roller. Key to fat removal is smooth. Many of the laser machines say: no anesthesia, no downtime, no need for traditional liposuction. What they don’t tell you is this is only true for small areas. When doing a normal person I will typically get 2-5 liters of fat (4-10 pounds, and no, these are not fat people. We all have more fat than you’d think). When I oriented for the laser liposuction machine, they admitted their photos of 2+ liters of fat involved liposuction with ultrasonic energy. The laser was used as a finishing tool. For those of us adept with ultrasonic, we see no advantage to using another machine. The instructor told me his laser liposuction patients who only used laser had an average BMI of 19. For a 5’6″ woman, this means you weigh 120 pounds. Most of my Palo Alto patients who weigh 120 pounds aren’t in my office looking for liposuction.
I see patients for redo liposuction all the time. The two major factors are 1. not enough fat was removed. 2. uneven fat removal. Revisions are tougher: you now have scar under the skin. I find you need ultrasonic energy to break up this scar to help achieve a smooth result. If you are irregular but still have a lot of fat, the fix is easier. If you are too thin in an area, the only fix is fat grafting, which is difficult.
So. My biases:
- Board Certified Plastic Surgeon. We operate and train as general surgeons before plastic surgery. We do tummy tucks and other abdominal procedures. We know the anatomy better.
- Board Certified Anesthesia Doctor. Many horror stories are from anesthesia and fluid issues. This is elective surgery. You need to be safe.
- Don’t spot treat. No one has fat just in their outer thighs or lower belly. Treat it all or have a funny body shape down the road. (Unfortunately we all fall off our good eating and exercise wagon at some point.)
- This should be done in an accredited OR. Outpatient ORs should be “Quad A” certified. True board certified plastic surgeons can operate in a hospital. Hospitals do not grant operating privileges for liposuction to nonsurgeons: dermatologists, family practice, internal medicine. Hence many of these doctors will do surgery under local anesthesia in their office.
- Ultrasonic or laser energy is good to help break up fat. For anything above a small area like the chin, ultrasonic is better. With both you need to use traditional liposuction (SAL) to remove the liquefied fat, or you will get a seroma (a collection of fluid under the skin).
- If your skin is loose, you are older, or you have a lot of fat, you will get some skin irregularity.
- Stable weight. If you yo-yo or gain weight, you will create new fat cells and ruin your result.