- 1 Introduction
- 1.1 What Is Fat?
- 1.2 Layers Of Fat
- 1.3 Liposuction Candidate Myth
- 1.4 What Type of Liposuction Is Right For Me?
- 2 Preparation
- 3 The Liposuction Procedure
- 4 Variations Of Liposuction Depend On:
- 5 Before & After Photos
- 6 Types
- 7 The Four Types / Technologies Of Liposuction
- 8 “Millard” Atraumatic Fat Removal Cannula
- 9 Lesser Known / Used Types Of Liposuction
- 10 3 Tumescent fluid ingredients
Patients are often confused by the many technologies and techniques offered for fat removal.
Lets demystify all of this liposuction confusion!
First Things First: Liposuction is not a weight-loss technique. It’s a sculpting technique best suited for normal-weight individuals.
Liposuction has evolved from work in the late 60’s by surgeons in Europe who were using primitive techniques until modern liposuction was invented by two Italian gynecologists.
We know liposuction helps create a sleeker look by removing fat from the body, but how does it work?
What Is Fat?
Fat (also known as adipose tissue or lipocytes) are cells that insulate your body and store energy.
There are three primary types of adipose tissue:
1. White adipose tissue (WAT)
2. Brown adipose tissue (BAT)
3. Pink adipose tissue (-being studied for inclusion in the mammillary duct development in female breasts).
White Fat Cells (unilocular cells / single chambered)
White adipose tissue composes as much as 20% of a males body weight and 25% of a females body weight in the average person. Wikipedia notes that “the average adult has 30 billion fat cells with a weight of 30lbs or 13.5kg.” When you gain weight, your fat cells increase in size (4x their regular size) then divide to increase their overall number within your body.
White fat cells produce many proteins within your body such as resistin, adiponectin, Apelin and leptin. The hormone ‘leptin’ is produced primarily from the adipocytes in white adipose tissue.
Brown Fat Cells (multiocular cells / many cells or compartments)
Brown are polygonal in shape (a plane figure that is bound by a finite chain of straight line segments) as opposed to White Fat Cells more sphere shape.
The brown color arises from the large amounts of mitochondria.
Brown fat has also been referred to as “baby fat” due to it’s ability to generate heat.
Layers Of Fat
From a morphological standpoint there are two layers of fat for any given body part. The deep or larger globule, looser packed fat, and the superficial or smaller globule, more tightly packed fat.
From a functional standpoint there are really three layers of fat. The first again being the deep layer, as previously described. The second and third layers subdivide the superficial layers of fat into two types:
1. Sub-dermal fat layer, being the immediate superficial layer of fat underneath the skin’s dermis.
2. Superficial fat layer, not including the sub-dermal layer.
The solid yellow is representative of the Deep Fat Compartment. It is important to note that the deep fat compartments are not located everywhere in the body. They stop and start and are responsible for many of the bulges in the body. The Transparent Yellow is the Superficial Fat Compartment. It is important to note that the superficial fat compartment is everywhere, even where deep fat compartment is not.
The Superficial Fat Compartment is functionally divided into two “Functional” Fat Compartments:
The “Sub-Dermal Fat Compartment” — It is the fat immediately underneath the skin and is tightly glued to the skin. It’s main function is to give skin support and “Tautness.”
The “Superficial Fat Compartment” — It is the fat underneath the Sub-Dermal Fat Compartment, but not including the fat immediately glued to to the skin. This fat is more dense and compact than than the deep fat compartment.
The Connective Tissue Matrix is the rich network of connective tissue, small blood vessels, nerves and lymphatic vessels. It’s function is to nourish and heal the tissues as well as shape and give the fat form, shape and structure. Historically, this part of the fat (or adipose) anatomy has been ignored when designing tools for liposuction. This all changed with the invention of the VASER, and was improved upon with Dr. Millard’s innovations such as the 5-Ring VASER probe, Taut Tumescence, Compression Coupling, and Dr. Millard’s specialized, atraumatic cannula design.
What Happens To Your Fat Cells When You Lose Weight?
Your body will never lose adipocytes. In fact, when you lose weight, your adipocytes will simply shrink and lose some of their fat content.
What Happens To Fat Cells When You Gain Weight?
Once your adipocytes attain their maximum capacity of fat (that they can hold – 4x their regular size), they will divide into additional adipocytes allowing for additional fat storage.
Interestingly, adults who become obese, rather than adolescents will have no more adipocytes than before. Their fat cells just become larger.
Overweight adolescents might have a harder time losing weight and keeping it off because they have developed an increase in overall fat cells.
Fat’s Hormone Production
Fat cells produce estrogens from androgens, which is another reason why we see so many people who are struggling with hormone imbalances are also overweight.
Due to estrogens being essential in fertility, some individuals who are underweight or overweight may struggle with fertility.
Fun Fact:Fat’s Leptin production regulates appetite.
Fat’s Location In Your Body
Fat is mostly subcutaneous (underneath the skin) and its distribution is different for everyone. In men, fat will group in areas around their chest, abdomen and buttocks. Women will generally have larger fat storages in their breasts, hips, upper arms, buttocks and waist.
Two Layers Of Subcutaneous Fat:
Liposuction Candidate Myth
One of the biggest myths about liposuction candidates is that they’re overweight / obese individuals. This is not the case at all. In fact, to obtain optimum results candidates should be normal-weight with firm, elastic skin who struggle with localized fat areas. These individuals are more likely to obtain their healthy weight post-liposuction and their skin is more apt to retain tightness around the liposuctioned areas.
Skin that has lost elasticity from weight gain, weight loss, pregnancy or aging many not be suitable for liposuction.
In short: The best candidates for liposuction are normal-weight people with realistic results and good skin elasticity.
What Type of Liposuction Is Right For Me?
No matter how much of a healthy lifestyle, healthy diet and exercise you do, you may still experience stubborn fatty deposits and loose skin.
Unique types of liposuction can help target nearly any body imperfections that bother you; such as the abdomen, hips, thighs, buttocks, and chin, where we perform a variety of body sculpting techniques.
It’s imperative that you know that liposuction is not its own medical speciality (as it should be). This means that any licensed physician, including dermatologists can perform it. The FDA recommends that you ask your doctor whether they have had special training to perform liposuction.
Questions You Should Ask Your Doctor
- Are you Board Certified?
- Can I see your before and after photos?
- Do you remove deep fat and do I have enough deep fat for removal?
- Do you remove superficial fat and do I need or have superficial fat for you to removal?
- Can you remove the sub-dermal fat to accomplish the “Skin Tightening” technique?
- Do you offer a muscle shaping procedure such as VASER Hi Def, which requires the ability to remove fat from the deep fatty layer, removal of fat from the superficial fatty layer, and requires fat removal from the sub-dermal fatty layer?
- Do you offer fat transfer / 4D VASER Hi Def?
- Do you use technologies such as Ultrasound Image-Guided Fat Augmentation Technique (UIGFAT) to improve the safety and accuracy of fat grafting?
- How many times have you performed this procedure?
- What are the risks?
The Liposuction Procedure
Areas Of The Body
- Bra Roll
- Flanks (love handles)
- Gynecomastia (excess male breast tissue / man boobs )
- Inner Knees
- Inner Thighs
- Outer Thighs (Saddlebags)
- Submental (chin / gullet)
- Upper Arms
How Does Liposuction Work?
Liposuction removes fat by utilizing two primary instruments:
1. Cannula – A hollow tube
2. Aspirator – A suction device
Variations Of Liposuction Depend On:
- The amount of fluid injection
- Technology / Mechanism in which the cannula works
- Your doctor’s sculpting skills / expertise and experience
Techniques of Liposuction
Techniques — Now that we’ve gone over the “Technology” aspect, let’s discuss the “Six” basic techniques used in liposuction/body contouring:
- Deep Fat Compartment Liposuction
- Superficial Fat Compartment Liposuction
- Subdermal Fat Liposuction
- VASER Hi Def Liposuction/Liposculpting
- 4D VASER Hi Def Liposuction/Liposculpting (VASER Hi Def Liposculpting with Fat Grafting)
- Liposuction/Liposculpting (Can include or not include Hi Def or 4D Hi Def) with skin removal (Example: Lipo-Abdominoplasty — which is a Tummy Tuck with Liposuction of the abdomen included)
6 Levels Of Liposuction
We’ve developed a Six-Level Scale of Liposuction to help you determine what liposuction techniques might be best for you.
VASER Hi Def Liposuction – Level 1
Developed to address only deep fat pockets that concern patients.
These areas include the central abdomen, flanks, buttock, underarms and inner and outer thighs.
VASER Hi Def Liposuction – Level 2
Developed for patients who desire more aggressive fat removal and body shaping than Level 1.
To accomplish this, fat is removed from both the deep fat pockets and superficial fat pockets.
Typically this level is circumferential in it’s approach, resulting in a more three-dimensional reshaping technique.
VASER Hi Def Liposuction – Level 3
Liposuction Level 3 is very similar to Level 2 with one unique addition; the inclusion of skin tightening.
The skin tightening technique requires a seperate level of liposculpting immediately underneath the skin to accomplish the sought after ‘shrink wrapping’.
VASER Liposuction – Level 4
Liposuction Level 4 includes everything in Level 3 with the addition of enhanced body contouring.
Superficial fat is reshaped to enhance your muscle shape and definition.
VASER Hi Def Liposuction – Level 5
Liposuction Level 5 includes everything in Level 4 with the addition of fat grafting.
4D VASER Hi Def Liposuction safely and effectively re-deposits sterilized fat back into your muscular areas through ultrasound guidance.
This further enhances the precise size, shape and definition of your muscles.
VASER Liposuction – Level 6
Liposuction Level 6 incorporates techniques used in Level 1 through Level 5 with the addition of skin excision.
- Lipo-Body Lift (Lipo-Transverse Buttock & Lateral Thigh Lift)
- Lipo-Inner Thigh Lift (Lipo-Medial Thigh Lift)
Before & After Photos
It’s important that you have an understanding of the different types of liposuction techniques so you can make an informed decision that’s right for you. Your doctor can help answer any questions and might suggest one technique over the other.
The Four Types / Technologies Of Liposuction
- Suction-Assisted Liposuction (SAL) or what most patients know as “Liposuction”.
- Power-Assisted Liposuction (PAL).
- Ultrasound-Assisted Liposuction (UAL) with the most popular being VASER Hi Def.
- Laser-Assisted Liposuction (LAL) with the most popular being Smartlipo.
Suction-Assisted Liposuction (SAL)
Originally introduced in 1974, and perfected in 1977, this technology has remained unchanged.
Suction-Assisted Liposuction uses a small blunt-tipped tube called a cannula (with holes on the side) to remove fat. These cannulas suck / rip out fat when the suction pressure is turned on.
SAL Benefits: Inexpensive technology, allowing physicians to pass that savings onto there patients.
SAL Disadvantages: The cannulas are “non-specificity” for tissues that surround fat cells. Therefore damaging connective tissue (which aids in healing and skin tightening), small blood vessels and lymphatics.
Many of these tissues are also ‘sucked’ and ‘ripped’ during SAL. For this reason, many surgeons limit their technique to the deep fat layer, avoiding the superficial and sub-dermal fat layers.
Power-Assisted Liposuction (PAL)
Power Assisted Liposuction is essentially ‘Powered’ Suction Assisted Liposuction (SAL). Utilizing a power device to rapidly vibrate the SAL cannula with the same advantages and disadvantages as SAL.
Very similar to suction-assisted liposuction, this technique utilizes a mechanical cannula so the surgeon doesn’t need to make as many manual back and forth movements.
Ultrasound-Assisted Liposuction (UAL)
Originally introduced in 1992, required three generations of evolution to become the state-of-the-art device utilized today in liposuction, liposculpting and fat graft harvesting. Ultrasonic liposuction utilizes a cannula that transmits ultrasound vibrations. These vibrations burst fat cells thereby liquefying it for easy removal. This method is a great option for more fibrous areas like the male breast area or upper back.
After ultrasound-assisted liposuction it is necessary to utilize suction-assisted liposuction technique to remove the liquefied fat.
VASER Hi Def Liposuction
VASER Hi Def Liposuction is the first significant breakthrough in liposuction technology in nearly 30 years after the invention of traditional liposuction. VASER represents the third generation ultrasound-assisted “Liposelective” device.
What makes the VASER system unique is that it’s the first technology that’s “Lipo-Selective,” meaning the combination of the one-, two-, or three-ring ultrasound probes (combined with the Vent-X aspiration technology) to significantly limit damage to surrounding connective tissue, blood vessels, and lymphatic structures (which SAL damages).
This revolutionary technology allowed surgeons for the first time, to safely and reliably remove and shape fat in the upper, superficial fatty layer, along with the deep fatty layer.
Because of this innovation surgeons can remove more fat per unit area and body part, shape fat around and between muscle groups (VASER Hi Def) and at the same time promote significant skin tightening, by removing the subnormal fat (fat immediately underneath the skin), effectively “Shrink-Wrapping” the skin around the smaller volume of fat left behind during a liposculpting procedure.
Other than traditional liposuction technology, VASER is the first approved technology for the harvesting of the patient’s own fat for transplantation. Several significant and recent publications have proven this out. This development is important, as many of the more recent body sculpting techniques, such ass 4D VASER Hi Def incorporate the patient’s own fat into the liposuction procedure, much as a sculptor would move clay around in their sculpting work.
VASER 5-Ring Probe Atraumatic Fat Removal Technology
Revolutionary Fat Extraction Cannulas and V5 VASER (5-Ring) Probe Design: Built on the idea of VentX, these high tech fat removal cannulas are designed to be the most “Atraumatic”. They can safely navigate connective tissues, blood vessels and lymphatics, while removing fat.
The 5 Ring Probe was invented and designed by Dr. Millard.
Instrument Innovation Benefits:
- Less pain and bruising
- Less blood loss
- Faster recovery
“Millard” Atraumatic Fat Removal Cannula
- Less risk of bumps and lumps
- More aggressive results (in a safer manner)
4D VASER Hi Def Liposuction
4D VASER Hi Def Liposuction is essentially VASER Hi Def Liposuction with the addition of one thing; fat grafting. Similar to how a sculpter uses a medium (like clay) to sculpt, a trained surgeon can utilize your purified harvested fat for precise sculpting definition that you’ve always wanted.
Autologous Fat Transfer (AFT) is done under strategic ultrasound guidance for precise placement, resulting in optimum results that were never possible before.
Laser Assisted Liposuction (LAL)
Originally introduced in 1992, and like UAL, required several generations of evolution to become safe and effective. The SmartLipo Triplex, with it’s three wavelengths, that offers the best in Laser Assisted Liposuction technology.
Laser Assisted Liposuction liquefies fat in the targeted area allowing for easier fat removal.
The heating of fibrous tissue enhances tissue tightness post liposuction. The heat from the laser can also improve homeostasis, reduce bleeding and shorten recovery time.
The SmartLipo Triplex, with it’s three wavelengths, that offers the best in LASER-Assisted Liposuction technology. It’s advantages include some liposelectivity and the ability to coagulate blood vessels for less bleeding and bruising. It’s disadvantages include it’s limited ability to remove large volumes of fat, though it is capable in both the superficial and sub-dermal layers, unlike most SAL devices.
SAFELipo involves three distinct steps to help ensure optimum results.
1. Separation: An ‘exploded’ tip cannula is used with power-assisted liposuction (PAL) to separate targeted fat globules from one another and their surrounding tissues without damaging any nerves or blood vessels. This process allows the fat cells to become loose without the generation of heat. Which eliminates the potentially damaging effects of thermal probes.
2. Aspiration: Once the fat cells are loosened, a very thin cannula is able to aspirate the targeted fat.
3. Fat Equalization: An equal distribution of fat cells under your skin is essential for enhanced long-term results. This final step allows for the fat to be evened out without the use of suction.
Lesser Known / Used Types Of Liposuction
Twin-Cannula (assisted) Liposuction (TCAL or TCL)
Twin cannula (assisted) liposuction utilizes a tube within a tube cannula. This variation of power-assisted liposuction allows for a larger mechanical stroke than other power devices. Thus, removing most of the labor from the procedure. The outer tube also protects the surrounding tissue from friction burns.
This cannula works both to break down the fat and suction out the fat.
External Ultrasound-Assisted Liposuction (XUAL or EUAL)
This method involves the use of ultrasonic energy outside the body during liposuction. This technique is not widely used and there are no studies concluding it’s effectiveness.
Tumescent Liposuction is simply the injection of a tumescent fluid (a fluid that eases fat removal) into the area getting liposuction. This fluid causes the fatty tissue to swell up and become ‘tumescent’ (to harden).
This is almost always administered right before liposuction.
This is sometimes referred to as a “wet” or “super-wet” technique (depending upon the amount of solution that’s administered). A large volume of anesthetic-containing fluid (up to 5 times the amount of tissue that is removed) will be injected into the areas that is going to have liposuction.
3 Tumescent fluid ingredients
- Lidocaine – Local anesthetic to help numb the area
- Epinephrine – Constricts blood vessels to reduce blood loss
- Saline solution – Salt water helps to remove fat
This usually takes longer than other techniques, but is more effective.
It’s also possible to utilize this technique with only local anesthesia.
Fun Fact: When liposuction was first invented, blood transfusions were required due to a patients significant blood loss. The new-age tumescent technique eliminates the need for any intravenous narcotics, sedatives or general anesthesia while also minimizing blood loss.
This tumescent liposuction method became popular in the 1980s and was considered safer than other methods because of it’s ability to limit blood loss.
Water-Assisted Liposuction (WAL)
Water-assisted liposuction utilizes a thin fan-shaped water jet to loosen fat tissue and then gently removes it.
This technique allows the fat to be removed without destroying or liquefying the fat, making it a great option for fat transfers.