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Notes on Liposuction: Traditional ‘Cold’ Liposuction vs. Other Techniques

Today, I want to talk about traditional liposuction techniques versus the new and fancy laser and ultrasonic methods that are heavily marketed to patients.  I’m going to break this into a few more blogposts that discuss the critical aspects for successful liposuction using the traditional methods, as well as  why you should not always be impressed by the lure of fancy liposuction equipment to help make the decisions on what you want done with your body . This will help you develop a critical eye, which will help you in the long run to achieve the result you want.

  • Technique and skill always trump technology and marketing

In short, traditional liposuction involves  3 important things: a proper facility, the proper liposuction equipment and technique, and a well trained surgeon.

Let’s begin with talking about the proper facility.

I believe that to get the best results, results that you want, requires the proper facility. This means primarily a facility that can safely offer sedation/anesthesia. Why? The simple fact of the matter is that when people are relaxed, the surgeon is able to work more meticulously to achieve superior results. In many ways, the surgeon has to be as comfortable as you are as relaxed as you are to get to the areas that need the most attention.  It’s that simple.

If you are comfortable, and not squirming around because you’re in pain because the area that your surgeon is working in is not adequately anesthetized, then you will generally have a better result because the surgeon will be able to work more meticulously and thoroughly, since your pain and discomfort will not be issues.

The problem for most patients is that doing liposuction in a facility like a surgicenter costs more. Many surgeons will offer ‘outpatient’ procedure  is in their office that are done under local anesthesia. Sometimes this works, if the irregularity is small. But in my experience as a plastic surgeon, to get the best results possible you need a proper facility so the proper amount of liposuction (or if an abdominoplasty is required) can be performed.

  • Liposuction is an invasive procedure. Make no mistake. It IS surgery, and to get the best results, you need to be relaxed. Although liposuction can be done in an office with little or no anesthesia, there is a limit to how much and you probably will not get the results that you want. 

Section 2: Equipment and Technique

Unsightly fat that people have difficulty removing through traditional methods of diet and exercise has been a problem since time immemorial.  Unfortunately, definitive methods, like surgical excision of this fat, as I have stated, have not.  Prior to the advent of surgical techniques that were safe and reproducible, people used things like corsets and other body shaping garments to help them create an elegant bodily contour, but of course, wearing a corset is not a definitive or permanent solution by any means to the vexing problem of unsightly body fat.

However, once methods became available to make surgery more safe, thus allowing the possibility of elective surgery, removal of unsightly fat or surgical excision became a reality. Unfortunately, this reality was almost not realized at all because one of the first attempts at liposuction resulted in a horrible complication which set back the pursuit of liposuction and similar body contouring procedures for many decades. Here is a summary of the specific case, taken from  Ann Chir Plast Esthet. 1989;34(3):290-2.

On February 17th, 1926, Charles Dujarier, a fully qualified French surgeon, operated a young model, Mademoiselle Geoffre, who wished to improve the looks of her unbecoming legs. The operation was a disaster. Suture tension was responsible for gangrene that required amputation of the operated leg. The outcome of the lawsuit was severe for Dujarier who was required to pay 200,000 francs compensation, but even more so for plastic surgery that was practically outlawed. Two years later, Dujarier’s sentence was confirmed, but plastic surgery was cleared and considered licit on condition that the patient’s informed consent be obtained. Dujarier died shortly after the second ruling.

It was not until the mid-1970s when liposuction was introduced by French surgeon Dr Yves-Gerard Illouz, in 1982. The actual technique which actually suctions the fat with that aid of a special instrument called a cannula is both safe and effective. And even though has only been around since about the early 1980’s, there have been numerous attempts at refinement of the  technique to make it more effective, thus removing more fat and producing more dramatic results with less surgical downtime. The introduction of things like ultrasound and laser to help break up fat cells more aggressively and allow removal of greater amounts of fat tissue has also been utilized, along with surface techniques that also use things like ultrasound and laser to help tighten the skin and give the appearance of appealing contours – sort of like a permanent courset.

As a plastic surgeon, I get several trade magazines a month which are always trying to sell me new products and devices to help serve my patient’s needs more effectively. In each of these magazines there are several pages of advertisements dedicated to the latest and the greatest machines that are available to help either remove fat surgically or promote more static body contours with surface techniques (ie skin tightening).

I think some of them are of value, and can be very effective adjuncts to surgical procedures like abdominoplasty (ie tummy tuck) and liposuction. But from my perspective, as a plastic surgeon who is practiced for several years and performed hundreds if not thousands of these procedures, traditional liposuction with a cannula, or what is otherwise known as cold liposuction (to differentiate it from ultrasound and laser techniques) is still the gold standard of care, and with the aesthetic judgment of a skilled plastic surgeon produces lasting results which are beautiful.

What is Cold Liposuction anyway?

Cold liposuction refers to a technique that utilizes an infusion fluid called tumescent (which has things like numbing medicine and saline within it) that is injected into the soft tissues where liposuction will be performed. After a the fluid has been infused, then liposuction can proceed.

If only a small volume of fat is removed an office based procedure can be an excellent choice, but when significant amounts of fat need to be removed, such as in the case of the abdomen and thighs, cold liposuction can be not only effective, but can be coupled with other procedures such as thigh lift or tummy tuck to provide outstanding aesthetic results.

One of the reasons why I like the cold liposuction technique is because it really affords me the opportunity to couple procedures in a way to achieve outstanding results for my patients, in a way that liposuction alone can not achieve. Likewise, cold liposuction techniques are associated with less tissue injury, which can result in wound complications and infections which can compromise the final result.

Section 3: A Skilled Surgeon

I am a board certified Plastic Surgeon who practices in the suburbs of Chicago (Glenview, IL), and I have the requisite training necessary to provide patients the result that they desire both safely and effectively. I have great respect for the technique of liposuction, and I consider it real surgery that requires training and skill. I also have great respect for my patients, and I feel they deserve to have treatments performed by doctors who are skilled at providing the result that they really want, both safely and effectively.

2 Responses to Notes on Liposuction: Traditional ‘Cold’ Liposuction vs. Other Techniques

  1. Liposuction – the surgical removal of fat – is a nontrivial procedure that may involve a painful recovery and serious complications. (1) including but not limited to: an increase in toxic visceral fat, long-term fat mobilization, metabolic syndrome, increased insulin resistance, disturbing fat distribution patterns, painful over-resection, and death. The studies are out there. No more bodies need to be disfigured. Short term visual results are not indicative of what the long-term issues will be. There are studies with laboratory rodents that had fat surgically removed. The fat always came back. And, like the women in the study, the rodents got their fat back in places other than the place where it was removed. (2) It can take a year, but it all returns. (3) Certainly there are negligent surgeons, but the problem with liposuction does not depend on the surgeon. It depends on the biology of fat. (4) Vacuuming fat out of the body is not physiologically sound. Fit people need fat in order for their bodies to function well.

  2. Hmm… I wonder what the doctor has to say.. I had liposuction on my abdomen.I had a “muffin top” because I was restricted from my normal active life due to a work injury. After a year I notice this “unsightly fat” area. I had lipo performed and was very happy~ at first! But at about a year out, I noticed that my breasts, upper arms, face, neck, thighs etc. had gotten bigger. My weight was the same! But I had to throw out most of my wardrobe. I learned then that fat redistributed after liposuction. My problems continue. I have bulges of skin on my abdomen and sides as well as under my breasts towards my back. I consulted a plastic surgeon (paid $100 fee) and she said it was all empty loose skin. The only remedy to this would be a tummy tuck. For my breasts and all that~ I don’t know a remedy except an extremely limited diet (calories) and an amount of exercise that is unnatural.
    There is no way for me to get recompense from the doctor; I signed the consent form. BUT I did not know this would happen and even though studies show these effects, the form did not mention them.
    It has greatly affected my life, and caused me much emotional pain. (Just to be clear~ I am the SAME weight as pre-lipo)

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