Many of us remember the old days of “dry” liposuction which started in the late 1970s. No fluid was injected into the fat to soften it or make is easier to remove, so excessive blood loss and bruising during the procedure caused serious complications for patients. Thank goodness those days are gone. Is liposuction safe today? Drastic improvements have been made in technology and technique, and liposuction can be done safely today without the need for general anesthesia.
Liposuction was the 4th most popular cosmetic surgical procedure in the U.S. in 2010 according to the American Society of Plastic Surgeons (ASPS). Over 202,000 procedures were performed (an increase of 2% over 2009), and 88% of them were performed on women.
Keep in mind that ALL liposuctions are surgical procedures. Liposuction itself is the process of sucking out or vacuuming the fat and this part of the process is virtually the same from one method to another. However, there are different approaches to treating or preparing the fat before it is removed. These include the assistance of lasers, ultrasound, motorized power, and water. We will examine several of the approaches here.
Is liposuction safe? In general, yes; however, every surgical procedure has a risk of potential complications.
What is liposuction?
Liposuction is also called suction-assisted lipectomy. Pockets of undesirable fat are removed from the face, neck, stomach, thighs, buttocks, and other parts of the body to contour the body and improve the patient’s appearance.
Tumescent liposuction has been the preferred method of liposuction since the 1980s. Today, whenever a physician refers to liposuction, he or she is undoubtedly referring to the tumescent method. Tumescent liposuction is considered “regular” liposuction.
“Tumescent” refers to the local anesthetic solution that is injected into the fat beneath the skin to shrink the arteries and make the fat easier to remove.
It is a saline (or saltwater) solution typically made up of highly diluted lidocaine and epinephrine. The solution has a numbing effect to help with pain reduction and it causes the fat to become puffy, or “tumescent”. The doctor then performs the regular liposuction, using a small cannula (metal tube) to manually loosen and break down the fat, and suctions out the excess.
The tumescent method can be done without general anesthesia. The method helps prevent too much bleeding and bruising. Is liposuction safe using this method? In general, yes; tumescent, or “regular”, liposuction is a very safe procedure when done by a properly trained and board certified plastic surgeon.
Wet and super-wet liposuction
In contrast to the old-fashioned “dry” method, in wet liposuction a small amount of fluid is injected into the fat. The saline solution contains lidocaine to numb the area and adrenaline to constrict the blood vessels. This helps to loosen the fat cells and reduces bleeding. However, about 20% of the tissue removed is blood and the procedure can still be dangerous.
In super-wet liposuction, the same fluid is injected but in a much larger proportion to the volume of fat expected to be removed. In situations where a lot of fat must be removed, the super-wet technique is preferred by plastic surgeons because they have more control over the quantity of injected fluid compared with tumescent liposuction. Injection of too much lidocaine can cause serious complications. Surgical blood loss is greater than the tumescent technique but less than the wet technique. The super-wet technique is more commonly performed than the wet technique.
Is liposuction safe using the wet or super-wet methods? Generally, yes; but wet and super-wet liposuction require the skill and precision of an experienced plastic surgeon. If excess fluid is not thoroughly removed from the body it can migrate to the lungs causing serious illness. Other risks include the deadening of nerves, embolism and scarring.
Laser liposuction (a.k.a. laser lipolysis) is an alternative approach to regular liposuction. The category includes several familiar product names such as SmartLipo, CoolLipo, and LipoLite. A tumescent solution is injected beneath the skin to reduce pain and blood loss. Instead of using a cannula to manually break down the fat tissue, laser (intense light/heat/thermal) energy is delivered in pulses to melt or cook the fat in the target area. The liquefied fat is then either drained through tiny incisions or suctioned away with a cannula. Some methods involve removing the fat and others allow it to be reabsorbed and naturally expelled by the body.
Is liposuction safe using the laser method? Generally, yes; laser liposuction is said to be gentler than regular liposuction and less scarring occurs because only tiny incisions are necessary. There is less pain and little bruising compared to any method involving manual manipulation of the fat. Laser liposuction is frequently used on the face, chin and jowls. Incisions are small, requiring one suture, and healing is significantly faster. An added benefit is that lasers may stimulate the production of collagen and elastin, resulting in tighter and smoother skin. Laser liposuction is more expensive than regular liposuction.
In the early 1990s, surgeons began using ultrasonic liposuction. The high frequency sound waves basically explode the fat cells through a “hot wand”. This wand delivers the sound waves and suctions out the fat. The incisions are rather large because a protective sleeve has to be used to protect the skin from excessive heat.
Is liposuction safe using the ultrasonic-assisted method? Apparently the levels of ultrasonic energy delivered to the skin and fat were too high, causing significant burning, bleeding, swelling and tissue damage. This method fell out of favor until VASER liposuction arrived on the scene.
VASER ultrasonic-assisted liposuction
VASER liposuction (or, more properly, VASER LipoSelection) was approved by the FDA in 2001. This method begins with the injection of the tumescent solution and then applies a low level of ultrasonic energy to break apart the fat cells underneath. Instead of using a cannula and manual movement to break down the fat, or a laser, VASER liposuction uses ultrasound high-frequency vibration. Small suction cannulas are then used to remove the fat.
Many surgeons prefer the VASER method because the ultrasound is very precise and gives them more control. The surgeon can target and liquefy the fat, minimizing risks of injury to the blood vessels, nerves and surrounding tissue. This means less bleeding, bruising and pain. Unlike laser liposuction, a lower amount of heat is delivered to the skin translating to a lower chance of burns. Also, the VASER ultrasound apparently offers more skin-tightening capability than other methods.
Is liposuction safe using the VASER ultrasound-assisted method? Generally, yes, if properly performed. Keep in mind that ultrasound energy is safely used in many medical procedures such as fetal scanning and dental cleaning. VASER liposuction is more expensive than regular liposuction.
Water jet assisted liposuction
Another method of liposuction used by cosmetic surgeons today is water jet assisted liposuction. Instead of using a cannula to manually break down the fat tissue, or a laser, or ultrasound, this method uses a pressurized stream of saline (saltwater) delivered through the cannula to loosen and dislodge the fat cells. The fat can then be simultaneously suctioned through the cannula.
Is liposuction safe using the water jet assisted method? Generally, yes, if properly performed. The procedure is considered very gentle and no force is needed to loosen the fat. This means there is very little bruising and swelling. Because the water does not cause swelling, the surgeon is better able to see the progress during the procedure. Using water as opposed to something hot like a laser or ultrasound reduces trauma to surrounding tissues. Recovery time is also faster. This technology is rather new (2009) and is gaining in popularity.
Introduced as another technique for breaking up fat cells without using laser, ultrasound or water, the power-assisted method involves a cannula with a motorized tip. It is powered by an electric motor or compressed air. The cannula spins or moves rapidly in-and-out to loosen and partially dissolve the fat.
Is liposuction safe using the power-assisted method? Generally, yes, if properly performed. Proponents of this technique believe the device makes it easier on the surgeon by eliminating the need to manually break down and loosen the fat. However, others are skeptical that the technique simply makes it easier on the surgeon but provides no added benefit to the patient.
Is Liposuction Safe?
Is liposuction safe for everyone? Diabetics are at increased risk of infection and wound healing complications but liposuction can be performed with proper care. Is liposuction safe when done in a doctor’s office? If done carefully in very small amounts, it is possible to safely perform liposuction in the office instead of as a hospital outpatient. Large volume liposuction in an office setting, however, is not safe. Is liposuction safe for older patients? Yes, patients through their 70s can undergo liposuction with satisfactory results.
Is liposuction safe no matter who performs it? No; to minimize the risk of disastrous complications from any of these procedures, you should do your homework and choose a board-certified plastic surgeon that has proper training and a significant amount of experience. Do not assume that he or she is properly trained just because your doctor offers some form of liposuction. Any physician can purchase the equipment. It’s not worth subjecting yourself to devastating health problems at the hands of an improperly trained physician.
Is liposuction safe for use as a weight loss method? No, liposuction is designed for small, targeted areas. To improve safety for patients, the American Society of Plastic Surgeons and the American Society for Aesthetic Plastic Surgery recommend that no more than 5 liters of fat (equal to about 10 pounds) be removed in a single outpatient procedure. More fat can safely be removed, but large volume liposuction comes with more risks and complications.
Is liposuction safe? As you can see, these are serious surgical procedures. But yes, liposuction is one of the safest plastic surgery procedures available when done by a well-trained surgeon, particularly if you choose one of the more recent methods such as laser or VASER assisted liposuction.