Which is the best liposuction technique?

Candidate patient:

With so many methods of lipo I am really confused and also scheduled for traditional lipo. What is the best way? laser/smart lipo?

I'm sure there are many opinions but am afraid maybe

I made a mistake in choosing the standard way, that it will be to painfull or bad end results.

Julio Garcia, MD, Las Vegas Plastic Surgeon

The vast majority of liposuction cases done today are performed with traditional liposuction.

The newer techniques offer small advantages, if any at all. In my practice, I use ultrasonic-assisted liposuction as I feel it makes it easier for me to remove the fat, especially in fibrous areas, such as the love handles, but it is really a matter of the surgeon.

I could remove the same amount of fat out with traditional liposuction; it’s just that I would work a little harder.

As to the claims of better skin contraction with the newer techniques, I think in clinical practice, there are no visual differences in the end result.

Jonathan Berman, MD, Palm Beach Plastic Surgeon

The best liposuction technique is the one chosen by your trusted plastic surgeon.

There are at least 5 different techniques to perform safe liposuction. Whatever works the best in the hands of your surgeon is the type that needs to be performed for you.

Tiger Woods is one of the finest golfers in the world. He can choose the latest and greatest golf clubs yet he uses many clubs that are several years old. Why? They work for him!

Most of us read the latest literature and question representatives of the latest and greatest devices. We choose what works the best in our hands. The bottom line is what kind of results the surgeon can provide for you. Viewing photographs of patients before and after, as well as speaking to them will give you the best insight.

I personally use tumsescent liposuction techniques with ultrasonic and suction assisted liposuction techniques, removing no more than 5 liters of aspirate per procedure.

Otto Joseph Placik, MD, Chicago Plastic Surgeon,

There is no one best liposuction, at least not yet.

Different techniques may have different applications and benefits, depending on the patient and surgeon.

This may vary with the location of the liposuction site. In some instances, I have used laser, ultrasound, power assisted, nutational, syringe suction assisted lipectomy/lipoplasty.

Stanley Okoro, MD, Atlanta Plastic Surgeon,

I always compare liposuction and surgeon to car and driver.

In a car race such as NASCAR, the car does not win the race. What matters is who is driving the car.

Similarly, in liposuction, the surgical outcome is not based on the method, but on the surgeon doing the liposuction. Essentially, the best result in liposuction depends on the training and experience of the surgeon.

Your surgeon should be certified by the American Board of Plastic Surgery. There are many technologies available to assist the Plastic surgeon.

The most common ones are ultrasonic (Vaser & Lysonix) and laser (multiple brands). Each technology carries its own inherent risk and benefits. No matter which technologies used as an adjunct to liposuction, it is the training, experience, and judgment of the Plastic surgeon that makes the most difference in outcome.

The surgeon should select the method that will deliver the best result for the patient. As an expert in all the methods of liposuction, I select which method to deliver the best result.

William P. Coleman III, MD, Metairie Dermatologic Surgeon,

There are now at least 14 different tools for performing liposuction.

Experienced capable doctors can get good results with any of them.

The key is to find the best liposuction expert in your community and let him/her choose the instrument.

Miguel Delgado, Jr. , MD, San Francisco Plastic Surgeon,

There isn't one right answer as to which type of liposuction is better.

Each surgeon has his/her own technique that works best for them. Sometimes it depends on the area and the patient, that can determine the method, as some surgeons use a combination.

But the most important thing to consider is the experience of your surgeon, check to be sure of Board Certification in Plastic Surgery and ask to see lots of before and after pictures.

Some surgeons can arrange for you to speak to one or two of their patients that have been through the procedure

Jon F. Harrell, DO, Miami Plastic Surgeon,

As a surgeon who has performed a large number of liposuction surgeries I find that even I am confused and overwhelmed by the number of technologies out there that claim to offer better results, less down time and less discomfort.

If I'm having trouble sorting out the truth patients must really be confused. I have used ultrasonic and laser assisted liposuction as well as the pneumatic liposuction handle and I can state categorically that the artistic and technical ability of the surgeon is 98% of the equation when it comes to getting superb results.

As with any other cosmetic surgical procedure research out your surgeon with great care. Look at the photos he/she should have in the office.

Feel confident that your surgeon understands your concerns, appears interested in your concerns and is proposing a surgical plan that seems reasonable. Don't stress too much about the technology, but rather about the technique.

Ronald Shelton, MD, Manhattan Dermatologist,

One method is not any more or less painful than another in liposuction although for some patients, the vibration felt with power liposuction may distract the nerve endings and make it feel less bothersome, but after the anesthetic solution is injected liposuction is comfortable for most patients.

The end result may be the same regardless of using conventional tumescent liposuction, ultrasonic liposuction, water jet liposuction or laser-assisted smart liposuction. The good result you obtain from the liposuction is dependent on the surgeon's experience and talent.

Steven Wallach, MD, Manhattan Plastic Surgeon,

I always say that it is not the wand but the magician holding the wand that creates the magic.

Find a good surgeon do not worry so much about the technique used.

Robert T. Buchanan, MD, Highlands Plastic Surgeon,

Dr. Baxter has said it very well. It is not the method of surgery or anesthesia or the machine to assist with the surgery, but it is the surgeon and his/her experience.

Traditional liposuction still works very well. I was one of the first surgeons trained in this country by the Europeans at the beginning of liposuction.

I am still using traditional liposuction and find it very effective, and with far fewer problems than the other methods. It is applicable to very small or very large problems. Post operative pain is the same in all methods. Although all the methods are acceptable, you should inquire about experience.

Many of the Laser or other types of liposuction machines are being sold to physicians with no surgical experience that learn all their technique at a 1 or 2 day course. As Dr. Baxter said, this is real surgery with real risks, including death. You need someone who can reduce these risks to an absolute minimum.

Darryl J. Blinski, MD, Miami Plastic Surgeon,

All of them. I have available the many differing types of liposuction in my office. From traditional, Vaser, ultrasonic, Body Jet.

So I can mix and match the types of lipo to the area to be treated. Just a good idea- don't you think?

George J. Beraka, MD, Manhattan Plastic Surgeon,

The exact technique is not important. I personally use tumescent liposuction.

Many others, like SmartLipo, are just marketing concepts.You want a board certified plastic surgeon with a lot of experience and a good eye. Ask to see a lot of before and after pictures.

George Marosan, MD, Bellevue Plastic Surgeon,

Liposuction has been around for about 30 years. Obviously, there was an evolution and refinement of the technique over the years.

What you call "traditional" lipo is the basic standard technique that is done by every surgeon. This involves injecting the targeted fat compartment with a dilute lidocaine solution (numbing agent) and epinephrine (vasoconstrictor).
This causes local anesthesia for the region infiltrated. Most surgeons as opposed to dermatologists, will use some additional anesthetic from IV sedation to general anesthesia.

The proponents of strictly local anesthesia are not telling the whole truth. Most will supplement the patient with oral pain pills and anxiolytics prior to the procedure or use intramuscular Demerol injection when "the awake" method becomes just too painful. Different tools were also developed that can give more efficient fat removal.

Ultrasound technology, power assisted liposuction, water jet liposuction and laser liposuction. None of these give better results than traditional liposuction except in certain conditions.

Patients, especially males who are more fibrous, gynecomastia, previous liposuction where there's more scarring can benefit from these machines. In my practice I've been using ultrasounds for over 8 years with excellent results.

Remember, it is not the machine, but the surgeon that makes the difference.

Richard Baxter, MD, Seattle Plastic Surgeon,

You are not alone in being confused by all of the options for liposuction, and marketing hype makes it even more difficult to decide.
The first thing to keep in mind is that liposuction is surgery, not a spa treatment.

Next, it is helpful to know what all lipo procedures have in common: a dilute local anesthesia mixture is injected into the fat to help numb the area and reduce post-op bruising. If the only anesthesia is this local injection, it is called 'tumescent" technique and this is an anesthetic method, not a liposuction technique.

Many patients prefer to have some intravenous sedation for comfort, and others might decide on general anesthesia to go completely under. So there are 3 anesthesia techniques commonly employed, although it is often described as local vs. general.

Finally, there are technologies that are added on, such as ultrasonic (VASER), or laser (multiple brands) and others. The thing to be wary of here is that they all add additional risk, for example skin burns with the laser.
The marketing pitch is often additional skin tightening, which is very minor according to published studies. Ultimately it is the training, experience, and judgment of the surgeon that makes the difference and your recovery should be smooth regardless of the technique.

Watch Mara’s experience following her liposuction performed by Dr. Nodas Kapositas, M.D.




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