How Liposuction Is Performed

Step One: Marking your territory. Using a magic marker, your surgeon will literally mark the areas of your body where he or she will remove unwanted fat. Such markings before surgery help your plastic surgeon plan the liposuction procedure.

Step Two: Anesthesia awareness. Liposuction is typically performed under general anesthesia, but in some cases local anesthesia can be used. Other options include intravenous sedation or epidural block. The decision involves both you and your doctor. It takes into account how much time the surgery will take, as well as where on the body the liposuction will be performed and how much fat will be removed.

Step Three: Wetting solution savvy. Wetting solutions are infused into the area before fat is removed. The fluid contains saline (salt water) and epinephrine (which constricts blood vessels to minimize any blood loss in the aspirate) and a local anesthetic. The reason that surgeons use a wetting solution is simple: they want to minimize blood loss, to increase the safety of liposuction. Various types of wetting solutions are used in liposuction. The main difference among them is the amount of fluid used.

• The "dry" technique. Before wetting solutions came along, surgeons went in dry. This resulted in blood loss and bruising. In fact, about 45 percent of what was suctioned out was blood (not fat!), so it has fallen out of favor.
• The "wet" technique. The surgeon will infuse 100-300 milliliters of fluid (with or without epinephrine) into each treatment site. With the wet technique, about 20-25 percent of what is suctioned out is blood.
• The "super-wet" technique. As its name implies, the super-wet technique involves the infusion of greater amounts of fluid than with the wet technique. It is about a 1:1 or 1:1.5 ratio, meaning that the amount of fluid is approximately equal to the amount of fat to be removed. With the super-wet technique, less than 1 percent of what is suctioned out is blood.
• The tumescent technique. This involves even much more fluid than is used in the super-wet technique. Basically the surgeon will infuse three to six times as much fluid as the volume of the aspirate to be removed. Proponents say the tumescent technique swells the tissues, which aids in fat removal; but detractors say it interferes with the surgeon's ability to sculpt, and it is unsafe because of potential fluid overload and an overdose of anesthetic (which is used in the solution). Learn more about tumescent liposuction.

Step Four: Fat removal. There are many different ways to vacuum out the fat during liposuction.

• Traditional suction-assisted liposuction. This involves inserting a cannula (a long, thin tube) through a tiny incision to vacuum the fat cells. The surgeon moves the cannula back and forth through the fat layer to break it up, and then suction out, the excess fat.
• Ultrasound-assisted liposuction. Here the surgeon inserts a special cannula through small "access" incisions. The cannula emits sound waves to help break up the fat, presumably making it easier to vacuum. Vaser-assisted liposuction is the cutting-edge, third-generation version of ultrasound liposuction technology. In a nutshell, the cannula used for Vaser-assisted liposuction emits gentler sound waves to break up and then remove fat. These do not disturb blood vessels, nerves and connective tissue, resulting in less bruising, swelling and pain than traditional suction-assisted liposuction.
• Power-assisted liposuction. This uses a motorized cannula to break up fatty tissue that will then be vacuumed out. It is inserted through the same tiny incisions.
• Laser-assisted liposuction. This involves a small incision and the insertion of a laser fiber probe that produces a burst of energy to liquefy the fat before it is removed. (Two of the brand names you may see are SmartLipo and CoolLipo.) Proponents say that laser-assisted liposuction is the latest and greatest and may also tighten skin. But detractors say it adds nothing to the results of liposuction except for expense and for making the procedure more cumbersome for both the patient and surgeon. And, they say, it can add many hundreds of dollars to the cost of liposuction without proven extra benefit.
• Body-jet liposuction. Using a thin, fan-shaped jet that pulsates water, your surgeon loosens fat cells from connective tissue, while simultaneously vacuuming them out. It is sometimes called water-jet assisted liposuction or water-assisted liposuction. While other liposuction techniques destroy or break apart the fat cells before suctioning them out of the body, the new water-assisted technique may loosen the fat cells first. As a result, water-assisted liposuction may be less traumatic than traditional liposuction methods. There may also be a shorter recovery time if the technique is proven to be gentler. Body-Jet liposuction does not use as much fluid as tumescent liposuction. What's more, the fluid is infused while the procedure is being performed, not beforehand as it is with other types of liposuction. The water is then immediately sucked back out with the fat; which may make it easier for your surgeon to determine if any areas need additional suctioning. Water-assisted liposuction flushes the fat instead of destroying it, so there may be an opportunity to harvest fat for fat transfer to other parts of the body where it is needed to restore plumpness. Water-assisted liposuction may be performed under local anesthesia, but general anesthesia will likely be needed for larger areas of fat removal. The bottom line is that more research is needed to determine the exact benefits and risks of water-assisted liposuction.