Liposuction methods compared: tumescent, VASER, laser and other techniques

Every modern liposuction follows the same basic steps. The surgeon makes a few small incisions, introduces a thin hollow tube called a cannula and removes fat by suction. The differences lie in what happens before and during suction: how much fluid is injected into the tissue and whether energy such as vibration, ultrasound, laser light or a water jet is used to loosen the fat.

No single method is best for everyone. The result depends far more on the surgeon's skill, the amount of fat, skin quality and good aftercare than on the name of the device.

In the earliest form of liposuction, known as dry liposuction, fat was removed without injecting any fluid first. Bleeding and bruising were considerable, and the technique has been largely abandoned.

The wet and super-wet techniques that followed introduced a smaller amount of fluid containing a local anaesthetic and a medicine that narrows blood vessels. This reduced blood loss and made the operation more comfortable. These ideas led directly to the tumescent method, which today forms the basis of most procedures.

In tumescent liposuction the surgeon first fills the treatment area with a large volume of sterile saline solution containing a local anaesthetic and a vessel-narrowing medicine. The tissue becomes swollen and firm, which is where the name comes from: tumescent means swollen.

The fluid has several effects:

• it numbs the area, so smaller procedures can be done under local anaesthesia;
• it narrows small blood vessels, reducing bleeding and bruising;
• it separates fat cells, so they can be removed more evenly through a thinner cannula.

Power-assisted liposuction uses a cannula that moves back and forth very quickly, a few millimetres at a time. The vibration helps the cannula pass through fat, especially dense, fibrous fat such as on the back or in the male chest, and reduces the physical effort required from the surgeon.

It is usually combined with tumescent fluid. Some studies suggest it can shorten operating time when larger volumes are removed. Recovery is broadly similar to that after tumescent liposuction.

In ultrasound-assisted liposuction a thin probe delivers ultrasound energy into the fat after the tumescent fluid has been injected. The energy breaks fat cells apart and turns them into an emulsion, which is then removed by suction. VASER is a widely known system of this kind that works in short pulses.

Because the fat is loosened first, the method works well in fibrous areas and for detailed contouring, for example to bring out the outline of the abdominal muscles. Ultrasound also produces heat, so the surgeon protects the skin and keeps the probe moving to avoid burns. Some surgeons believe the heat helps the skin contract a little, but results vary, and skin with poor elasticity will not become firm through liposuction alone.

Laser-assisted liposuction

A fine laser fibre is passed under the skin to melt fat and heat the surrounding tissue before suction. It is typically used for small areas such as the chin, knees or arms. Claims of significant skin tightening should be treated with caution: the effect, if any, is usually modest, and heat carries a risk of burns if the technique is not precise.

At the consultation the surgeon considers several factors:

• the areas to be treated and the amount of fat in each;
• how dense or fibrous the fat is, for example after a previous liposuction;
• skin quality: firm, elastic skin adapts well, while loose skin may need a tummy tuck or another lift instead;
• your goal: a smoother contour or more pronounced definition;
• your health, weight stability and the type of anaesthesia that suits you.

City Medical Centre uses two methods. Tumescent liposuction is the main technique: a special saline-based solution is injected first to loosen the fat and narrow the vessels, and the fat is then gently removed through a thin cannula. VASER ultrasound liposuction is used when fat needs to be broken down before suction, for example for athletic contouring of the abdomen or for delicate areas. Several areas can be treated in one operation, under local or general anaesthesia depending on the scope.

• ASPS — Liposuction: what to expect
• NHS — Liposuction
• MedlinePlus — Liposuction