TYPES OF LIPOSUCTION
Suction-assisted liposuction (SAL)
All liposuction is essentially suction-assisted lipectomy (SAL)—the removal of
fat from the body through the assistance of some form of suction. Fat removal
involves the use of a cannula (a thin hollow tube that is inserted below the skin)
to manually loosen fat. Suction is applied through the cannula to remove the fat
from the body with specialized vacuum-powered equipment. For small localized areas
such as the face, or to harvest fat for transfer, suction may be manual, using a
large syringe attached to the cannula.
Improvements in SAL include the ability to use smaller cannulas, thereby leading
to smaller incisions and more precisely sculpted contours. This is made possible
by accompanying SAL with specialized techniques, mainly tumescence and ultrasound assistance.
Tumescence
Tumescence is a treatment administered just prior to liposuction, during the same surgical
session. Sometimes called the "wet" or "super-wet" technique, it involves infusing the area
to be treated with sterile saline to help plump the fat cells and distinguish the fat layer
from overlying soft tissue and underlying muscle and organs.
Essentially, tumescence magnifies
the fat layer, making it technically easier to remove. The saline is generally combined with
the appropriate balance of lidocaine, or some other local anesthetic, for your comfort during
and immediately after liposuction, and epinephrine, to constrict blood vessels and reduce
bleeding and bruising.
By including tumescence with liposuction, your surgeon is able to make smaller incisions, use only mild sedation
if appropriate and have better control of the area being sculpted. In addition, tumescence
may reduce recovery time, discomfort, swelling, bruising and the risk of post-operative bleeding.
Ultrasound-assisted lipoplasty (UAL)
Ultrasound assistance is a technique used in addition to SAL. Some surgeons
believe it improves your outcome. UAL (ultrasound-assisted lipoplasty) uses high-frequency
energy from ultrasound to literally rupture fat cells and dislodge them prior to suctioning.
The procedure can be either internal or external.
- Internal: Internal UAL can be a one-step process when the ultrasound device
is in the tip of the canulla. More commonly, UAL is performed as a two-step process,
where an ultrasound probe is first inserted to liquefy the fat before the canulla is
inserted into the same incision to extract it.
- External: A device placed outside the body emits energy through the skin and soft
tissue to the fat. External UAL is commonly used as an adjunct to SAL.
Those who perform UAL find it useful for areas of more fibrous or dense fatty
tissue, such as the back, upper abdomen or male breast region. Some plastic surgeons
also find it is helpful in repeat procedures, for treating larger areas of fat,
or in combination with other surgical body-contouring procedures.
Power-assisted liposuction (PAL)
Power-assisted liposuction (PAL) is not an added technique, like tumescence or UAL.
PAL is basically suction-assisted lipectomy (SAL), with an added dimension. It uses
special equipment to give the cannula the power necessary to dislodge fat instead of
using the doctor's physical force and energy. PAL offers the advantage of being less
tiring to your plastic surgeon. It may be a desirable option, but it does not enhance surgical
outcome.