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Dr. Pastrick's Blog - The Skinny on Liposuction

April 17th, 2012 12:09 pm by Staff Report

By Gregory H. Pastrick

Often our office phone rings and a voice on the other end asks "Do you do SmartLipo?"

Shaun, our patient care coordinator, will say "No, we do ultrasonic liposuction." The person on the other end, not-so-confidently, will usually add something like, "I heard SmartLipo is better." Shaun will politely and succinctly inform them of the truth regarding the various liposuction techniques and have them come in for an evaluation, and to talk more in-depth about it with me.

So this month, I'll save you the phone questions and fill you in on the specifics about the various liposuction techniques. It's more dependent on the person using the machine than on the machine itself. Most people are well aware of the benefits of liposuction in body contouring. Simply put, it removes fat by suctioning it out through small incisions using a cannula hooked up to a suction machine.

There are different types of liposuction including: traditional liposuction, tumescent liposuction, ultrasonic-assisted liposuction, laser liposuction (SmartLipo), power-assisted liposuction, and water jet liposuction.

Traditional liposuction was the first liposuction performed, in the early 1980s in France, and set the whole industry in motion as it was shown to be very effective in body contouring. The problem with it was the large amount of blood loss that accompanied it.

From this, tumescent liposuction evolved - which involves first injecting a "wetting solution" into the fatty tissue which constricts the blood vessels to reduce bleeding. Most liposuctions now use the tumescent technique (also called the "superwet technique") which by itself doesn't actually remove fat.

Ultrasonic liposuction uses internally-applied, high frequency ultrasound waves to break up fat cells and liquify them for more efficient removal of the fat. It also creates heat, which improves collagen reorganization in the skin to help tighten the skin somewhat. This is the same concept behind laser liposuction, or laser lipolysis, except that it uses laser light energy rather than ultrasonic energy.

SmartLipo is the most marketed brand name for the laser technique. Both ultrasonic and laser liposuction have been shown to improve skin tightening after liposuction, compared to traditional liposuction, but no scientific clinical studies have demonstrated that one is superior to the other (ultrasonic vs. laser liposuction) in that regard.

Skin burns have been reported with laser liposuction that aren't associated with the other techniques, and a recent survey of Board Certified Plastic Surgeons that perform a significant amount of liposuction showed that only 10 percent of them use laser liposuction.

Power-assisted liposuction is traditional liposuction with a cannula attached to a hand-piece that moves the cannula in and out to make it easier on the surgeon. Wet jet liposuction, as the name implies, uses a stream of pressurized water to help break up the fat cells. These last two procedures have not been shown to improve outcomes.

I hope this helps clarify the confusing nomenclature of liposuction so that you'll be able to discern the truth from the hype.

Gregory H. Pastrick, M.D. is certified by the American Board of Plastic Surgery. He practices at The Plastic Surgery Center, located at 1 Sheridan Square, Suite 200, Kingsport, Tenn. Check out all of his services at or call 423-392-4884.

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