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Here’s How Liposuction Totally Changed While No One Was Paying Attention

Liposuction hit the U.S. in the early 1980s, but some advances have been truly game changers. Here's what you need to know.


It's safer and doesn't always require general anesthesia

The numbers are in, and liposuction once again ranks as the most popular cosmetic surgery procedure of the year, according to the American Society for Aesthetic Plastic Surgery (ASAPS). In 2016, 414,335 people had liposuction to suck unwanted fat out of their arms, legs, necks, stomachs, thighs, and more. Some liposuction advances, namely tumescent liposuction, don't sound all that sexy, but have likely saved many lives and dramatically cut back on blood loss and the need for fine-tuning. In the past, surgeons went in dry, and the result was bleeding and bruising. Sometimes a transfusion was needed due to blood loss. Enter tumescent liposuction. In a nutshell, this technique delivers fluid containing the numbing agent lidocaine, saline (salt water), and epinephrine to the treatment area, where it hardens fat, making it easier to remove. "The tumescent technique has made the biggest impact on liposuction," says Lara Devgan, MD, a plastic surgeon in New York City and an attending plastic surgeon at Lenox Hill Hospital. The epinephrine in the cocktail basically eliminates bleeding as it narrows blood vessels. "This has been a great improvement in safety." In many cases, this technique means no more general anesthesia and its accompanying risks. "You can turn over and stand so we can see how the results look when gravity is working, and do any touching up before you leave the operating room," adds Bruce Katz, MD, clinical professor of dermatology at the Icahn School of Medicine at Mt. Sinai, Director of the Cosmetic Surgery & Laser Clinic at Mount Sinai Hospital and Director of the JUVA Skin & Laser Center in New York. All types of liposuction can be done via the tumescent technique. "This is now the gold standard," Dr. Katz says.


It's gentler on your body

In its early years, liposuction was very taxing on surgeons as each motion involved serious effort, but power-assisted lipo has made things easier on surgeons and improved results. "With power-assisted liposuction, the tip of the cannula vibrates rapidly so the liposuction is gentler on the body," says Dr. Devgan, comparing this liposuction advance to a power-assisted lawn mower or blender. "Instead of just relying on our hand, we get some added vibration and power for a smoother procedure." Here's how to lose belly fat without exercising.

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Treatment is tailored to individual locations on your body

Cannulas are the thin, hollow tubes that, when attached to the vacuum pump, suck out fat. They now come in all different shapes and sizes: sharp, angled, blunt-tipped, you name it. "We can now choose the right cannula for the right procedure," Dr. Devgan says. "For example, I may choose an angled cannula for neck lipo, but for ab-etching, where a man wants a more defined six-pack, I would choose another type." Find out how to flatten your belly without doing a single crunch.

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Your skin looks better post-procedure

SAFE—which in this case stands for Separation, Aspirate, Fat Equalization—changed everything, says Simeon Wall, Jr., MD, a board-certified plastic surgeon at The Wall Center for Plastic Surgery in Shreveport, Louisiana. "In the past, the more fat we suctioned out, the worse the skin looked," says Dr. Wall, who invented the SAFE technique. "Now, with SAFE, you can take out as much fat as you want and it never increases risk of contour deformity." In lay terms, the S, separation, involves loosening the fat. Once the fat is loosened, it is easier to remove (or Aspirate). The third step—Fat Equalization—involves smoothing out the layer of fat that is left behind. "We go back in and make a smoothie out of the remaining fat so fills in contours like a smooth blanket," he says. "The SAFE technique has revolutionized liposuction, and has been adopted by many plastic surgeons to help them achieve predictably aesthetic results," agrees Gary D. Breslow, MD, FACS, medical director of The Breslow Center For Plastic Surgery in Paramus, New Jersey.


Your skin is tightened

"All assisted liposuction techniques break up the fat so it dislodges easier and there is less trauma and bleeding," says Miles Graivier, MD, plastic surgeon in Atlanta. For example, radiofrequency-assisted liposuction uses radiofrequency energy to break up the fat before it is removed. "This elevates the temperature of the skin to stimulate the production of collagen and produce a better skin tightening effect," he explains. Collagen is the main structural protein found in skin, and it is responsible for our skin's supple, elastic and youthful qualities. Ultrasound-assisted liposuction emulsifies the fat with sound waves, making it easier to remove, but it can burn skin if it gets too hot. One type of ultrasound-assisted liposuction, VASER, may stand apart from the fray. (VASER stands for Vibration Amplification of Sound Energy at Resonance.) "Other types use energy that is too high, VASER selectively heats the fat," explains past ASAPS President Peter Bela Fodor, MD, a plastic surgeon in Los Angeles who developed the VASER technique with a physicist. "Fat cells are fragile so there is no reason to use higher amounts of ultrasound," he says. "VASER breaks up the tissue much better and there is no collateral damage to blood vessels, nerves. and connective tissue." Laser liposuction removes fat and tightens skin, says Dr. Katz. "With unassisted liposuction, you take out fat but it produces a deflated balloon-like effect on the skin," he says. The heat from laser, however, seals tiny blood vessels in the treatment area, so there's less blood, bruising, swelling, and downtime. The heat also softens fat so it is easier to suck out. There's more: Laser energy boosts the production of collagen, eliminating that deflated balloon look.

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You can use the fat to your benefit

Water-assisted liposuction removes unwanted fat with less trauma and bruising. This means that the fat can be salvaged and used to plump up areas of the body where volume is lacking–such as the breasts, butt, or face. "Water loosens fat cells from connective tissue, and the fat is removed," explains Dr. Graivier. Tickle lipo offers the same perk. It breaks up fat with acoustic waves and leaves connective tissues untouched. (Its more scientific name is Notational Infrasonic Liposuction.) "I would use these two gentler methods if I needed a large volume of fat to use for a fat grafting procedures such as for breast enhancement or butt enhancement," he says. These procedures are spiking so this is a pretty big plus. (Fat injections to the face increased by 13 percent, buttock augmentation using fat grafting increased by 26 percent and breast augmentation using fat grafting increased by 72 percent from 2015 to 2016, according the American Society of Plastic Surgeons (ASPS).) Find out how to lose weight without diet or exercise.


You may not have to have surgery at all to remove fat

Liposuction works, but it is a surgery and all surgeries involve downtime and risk. In recent years, there has been an explosion of non-surgical fat reduction technologies. Some promise to chill and kill fat. Others melt it away gradually with laser ultrasound or radiofrequency energy, and some dissolve it via injections. Some are aimed at smaller pockets of fat (double chins) while others target larger areas like the stomach. "With liposuction the fat is sucked out through small cannulas. At the end of the procedure, you can see canisters of your fat, which has been physically removed. You can also see an immediate result," says David Shafer, MD, a New York City plastic surgeon. "While the non-invasive methods have minimal to no recovery, the results and can not even be compared to true liposuction." Still, he says, liposuction does involve a recovery and time off from work, unlike these non-invasive procedures. Find out how to lose your love handles without exercise.