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liposuction

Liposuction is a common procedure for men and women. We recommend it for people stable at a normal weight who want to improve their body contour. The ideal patient is one with pockets of fat, such as “love handles” or “inner thighs,” resistant to diet and exercise.

There are many terms with liposuction: Tumescent, SAL, Ultrasonic, UAL, Vaser, liposculpting, liposelection, laser liposuction, smartlipo. Almost all plastic surgeons use the tumescent technique to help with anesthesia and to reduce blood loss. SAL is the term for traditional liposuction. Many physicians use the term liposculpting – all liposuction, when done well, is sculpting the underlying tissue. Vaser is a kind of ultrasonic machine, and their marketing has coined the term “liposelection.” It is ultrasonic liposuction. UAL and ultrasonic are also terms for liposuction using ultrasonic energy to help break up fibrous fat and form smooth contours. I use all of these techniques. Laser liposuction is similar to ultrasonic in its use of energy to help break up fat.  The major difference is it has a small gauge.


Liposuction is effective in many areas:

Liposuction permanently removes fat cells through small incisions. As long as you maintain a stable weight with exercise and nutrition, the fat should not return.

Areas to be suctioned are filled with a fluid called “tumescent.” Tumescent fluid is made of anesthetic (to numb the local area and reduce the amount of general anesthetic), epinephrine (to reduce blood loss and bruising), and saline. For procedures of the trunk and thighs, I use two positions (from the front and back) to have a smooth natural transition in the sculpting from front to back. My bias is to use general anesthesia for patient safety, fluid regulation, and more fat removal.  I perform the tumnescent liposuction procedure in an outpatient surgery center in Palo Alto.  Board certified anesthesia doctors give the anesthesia.

I treat my patients globally, usually addressing multiple areas, to help ensure a smooth, natural contour. This is important to make sure future weight fluctuations don’t create a “funny” body shape. I do all ranges of fat removal, from small touch ups to large volume removal (around 5 liters).

Liposuction may not work well as a stand-alone procedure. If your skin has many stretch marks, fine wrinkling, or drooping, you will likely need skin removal. This may involve abdominoplasty, miniabdominoplasty, medial thigh lift, arm lift, or body lift.

Dr. Greenberg completely resculpted my waistline and gave me curves that were better than when I was 25!
– K.S., Waltham

Ultrasonic liposuction, or UAL, uses ultrasonic energy waves to help break up the fat. I find my Palo Alto patients are very athletic – as most Bay Area people are – and they tend to have firm, fibrous fat. UAL is critical in fibrous areas such as the upper abdomen, back, and thighs, and in secondary liposuction cases. Men in general tend to be fibrous, and should use ultrasonic liposuction. I like to use UAL with most patients, as I feel it helps give a smoother result, larger fat volume removal, and better skin retraction. SAL is traditional liposuction. This uses cannulas hooked up to suction. I always follow use of the ultrasonic liposuction with traditional liposuction. As fat removal progresses, I use smaller and finer cannulas to help sculpt and contour. Laser liposuction uses an energy to break up fat as the ultrasonic does.  Many use a small guage cannula, so it needs to be combined with other fat removal techniques.  Due to the small size of the cannula, the surgery takes more time.  All of these different kinds of liposuction are combined with the tumnescent technique.  All remove fat.  Downtime following surgery is related to the amount of fat removed and areas treated.

It is difficult to redo a liposuction case. I urge you to choose your surgeon wisely, as your first shot is truly your best shot. Liposuction is one of the most common procedures I perform. I have co-authored a chapter on the subject  published in a plastic surgical textbook.  I redo many cases from other doctors due to irregularities, fat remaining, and poor shape.  A disturbing trend is non plastic surgeons doing liposuction.  Many take a weekend course, and some of the laser liposuction companies are targeting non plastic surgeons purposefully.  There is a skill to doing good liposuction. It is not simply getting out as much fat as you can. I see patients who have loose skin, very irregular fat removal, and poor body shape.  These patients were told “if the skin doesn’t look good, go to a plastic surgeon and get a tummy tuck.”  When I meet these patients, I know their first surgeon was not a plastic surgeon.  They did not have the right procedure for their body type. Please be evaluated by a plastic surgeon and get multiple consultations prior to doing the procedure. See my picking a surgeon page.

Noninvasive liposuction techniques are developed.  I was on the advisory board of one company. Coolsculpt is the most commonly used one. It works, and if you have a small amount of fat and good skin tone it may be a good choice for you.  I get why it is so enticing.  No bruising, no recovery.  Sign me up!

But there are a few things you must consider:

With any noninvasive system, fat is absorbed in the bloodstream and a collection of fluid or liquefied fat under the skin could be an issue.

There is also a new injectable Kybella, to liquefy the fat under the chin.

For Bay Area patients to find out what combination of traditional, ultrasonic, and tumescent liposuction provides the right body contouring for your individual body type, contact my Palo Alto plastic surgery practice today.

Liposuction Before and After Photos


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Read testimonials from liposuction patients


*Individual Results May Vary

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