Medically reviewed by Dr. John Rosdeutscher – Written by Sine Thieme
Liposuction is one of the most common plastic surgeries in the United States. It is used to break up and remove fatty cells from under the skin. The fat is permanently removed or “suctioned” from the body in a one-time procedure.
In recent years the term liposuction has been expanded to include new technologies that don’t technically suction off fat but nonetheless do destroy fat cells – such as laser, ultrasound, and radio frequency assisted liposuction. The correct term for all these procedures is actually “lipectomy,” meaning fat removal of any type.
The term “lipolysis” is used to differentiate laser and radio frequency based methods from traditional suction-powered liposuction. But in common lingo people simply use the term liposuction, or lipo for short.
Without going into too much detail, it helps to look at the history of the liposuction procedure. It was first developed in its initial form in the late 1960s in Italy, where a gynecologist invented a hollow surgical instrument to “vacuum” fatty acid from a patient’s body without the risk of damaging blood vessels. The game changer came when a pair of French physicians added the injection of saline fluid to the procedure. This “wetting” technique substantially decreased the common adverse effect of bleeding and bruising, reduced the risk of injury, and made suctioning off the fat much easier.
This traditional or common liposuction is sometimes referred to as “suction-assisted liposuction” or “suction-assisted lipectomy” to differentiate it from other, non-suction forms of liposuction that we will get to in a minute.
Dry liposuction is seldom used today as there is a higher risk of complications, bruising, and bleeding during and post-operation. No fluid is injected prior to fat removal. (NuBody Concepts does not utilize dry liposuction for fat removal.)
- Body Jet
If you add lidocaine (local anesthesia) and epinephrine (a vessel-constrictor) to the above mentioned saline solution to relieve discomfort and better constrict the blood vessels, you have the “tumescent” liposuction practiced by most plastic surgeons today. Tumescent is one of the most popular liposuction techniques.
Some other improvements were made along the way, such as more sophisticated cannulas and suction equipment. And multiple tiny surgical incisions replaced the original larger incisions to make fat cells easier to remove and to provide a better, smoother body contour. But essentially, the type of liposuction surgery practiced today has not changed all that much over the last 50 years.
Water-Jet or Water-Assisted Liposuction
This is essentially another name for tumescent lipo. In reality, the liquid injected to break up the fat cells is not water but a saline solution containing the aforementioned drugs. “Wetting” the area prior to breaking up the fat has so many benefits that it doesn’t make sense to perform liposuction without it.
Equipment manufacturers often create brand names that sometimes make their way into common language. For a while, Body-Jet Lipo was much talked about. It is just another form of tumescent liposuction.
Aqualipo is also a form of water-based liposuction, but was combined with laser lipo (SmartLipo) to aid in skin contraction. It was introduced by NuBody Concepts in the early 2010s, but with the emergence of better skin contraction technologies the combo of water and laser lipo is no longer the most effective method.
Power-Assisted Liposuction (PAS)
Think of this as the power steering upgrade to traditional liposuction. A power-assisted liposuction device includes a cannula that vibrates throughout the procedure. To remove the fat, the surgeon moves the cannula back and forth under the skin to reach all the fat cells evenly. This is simply made easier with a vibrating cannula. It is particularly helpful when harvesting a larger volume of fat.
Whether or not a cosmetic surgeon uses a power-assisted or plain device is often his or her preference and does not necessarily affect the outcome.
Next we will discuss liposuction types that do not necessarily suction off the fat the traditional way, but are still grouped with the liposuction family.
The following types of lipectomy are essentially only useful when combined with “traditional” tumescent liposuction. Rather than using physical force and suction, they generate energy to apply heat that can destroy fat cells. There are three types of energy that can be used in this way: Laser, ultrasound, and radio frequency.
Laser-Assisted Liposuction (LAL)
Variously known as laser assisted lipolysis, laser lipo, or under the brand names SlimLipo and SmartLipo, laser liposuction uses targeted and controlled heat generated by laser energy to reach and destroy fat cells under the skin. AirSculpt and TriSculpt are brand names for the combination of power-assisted liposuction with laser-assisted liposuction.
But laser lipo has its limitations. Large amounts of fat are often better eliminated with more powerful means, meaning traditional or tumescent liposuction. This is why laser liposuction works best when paired with these other methods. The first round of liposuction targets the bulk of the fat, breaking it down and flushing it out of the body. The next round of laser liposuction can then be used to reach smaller pockets of fat, or fat in areas that might otherwise bruise too much, and to tighten the skin in all treated areas.
Laser liposuction is an outdated technology. Radio frequency assisted lipolysis is far more effective to achieve skin contraction in liposuction patients.
Ultrasound-Assisted Liposuction (UAL)
Ultrasound or ultrasonic liposuction uses ultrasound energy to attack fat cells. Pulses of this energy are delivered through a thin wand or cannula that is inserted under the skin. The vibrations delivered through the wand break down the walls of the fat cells and emulsify the fat, which makes it easier to suction it out.
This method is great for fibrous areas (such as the back, or male breast) or areas that have been treated with lipo before. As with laser liposuction, a surgeon will typically combine ultrasound technology with tumescent liposuction for additional skin tightening benefits he or she can’t achieve with fat removal alone.
Radio Frequency Assisted Liposuction (RFAL)
Radio frequency assisted lipolysis is the latest and most powerful non-suction lipectomy method. RFAL applies radio frequency energy through a thin cannula that is inserted under the skin. This energy generates bursts of targeted heat that contracts or “coagulates” the underlying tissues while stimulating collagen production, making it one of the best skin tightening techniques available today.
BodyTite and Renuvion are two FDA-approved radiofrequency skin tightening technologies that have shown great promise with skin contraction. They can contract the skin from 35% to 60%, which is significantly higher than older laser or ultrasound technologies are able to achieve.
When combined with tumescent or power-assisted liposuction, BodyTite (including its variant, FaceTite) and Renuvion are great radio frequency skin tightening alternatives to tummy tucks, thigh lifts, arm lifts, and facelifts. See our Skin Tightening page for more detailed information.
Liposuction with Fat Transfer (aka Liposculpture)
This is a variation of liposuction that preserves the harvested fat so that it can be injected into other areas of the body. A surgeon can thereby contour and sculpt (hence “liposculpture”) the body even better by accentuating its curves.
Fat transfer basically combines liposuction with an injectable filler, except that the filler in this case is your own natural fat. The fat is a safe alternative to artificial fillers for face and hands.
However, fat transfers to the buttocks (aka Brazilian Butt Lifts) have come under increased scrutiny in recent years for their elevated risks compared to other cosmetic surgery, which is generally very safe.
Lipo 360 is not really a separate liposuction technique but rather a marketing term. It refers to using liposuction in a way that treats your midsection all the way around from front to back, i.e. 360 degrees around your abdomen.
Most plastic surgeons offer liposuction for several areas at once, and it is just a matter of pricing how these areas are combined. You typically pay a certain amount for the first area and can add on several more areas at heavily discounted prices. Lipo 360 simply refers to a combination of areas into one single procedure for evenly toned results around the abdomen.
Which Liposuction Type is Best?
Now that you’ve learned about all these liposuction types, you might ask which of them you should pick. Is there a clear winner?
We believe that the best liposuction outcomes can be achieved by combining tumescent/power-assisted liposuction with skin tightening such as BodyTite or Renuvion.
But you should also know that a surgeon’s skill and experience play a major role in your results. Picking an experienced, board-certified cosmetic surgeon you are comfortable with is a major first step in getting the type of liposuction that is right for you. You should also know that most plastic surgeons will use two or more of the different techniques in the same session. How you can customize your procedure to best meet your needs is something you’ll discuss with your surgeon in a personal consultation.
Does Liposuction Work?
No matter which type of liposuction you end up getting, you can rest assured that you are likely to see excellent results. Liposuction has been around for many decades, and there is a reason for this: It works extremely well! It’s less invasive than a tummy tuck (full surgery), and it’s more effective than non-invasive fat removal treatments like CoolSculpting.
We hope that we’ve given you a better understanding of the types of liposuction available to you. Please don’t hesitate to contact us if you have any other questions.
If you are ready to get started, use the pink button to schedule a consultation with our board-certified plastic surgeon in Nashville or Memphis.
- Wikipedia: Liposuction