Tuesday, November 3, 2009


New technologies in suction lipectomy were discussed recently in Seattle at the American Society of Plastic Surgery meeting. The ASPS membership is composed of board certified plastic surgeons from the U.S.A. and around the world. The theme of this meeting was "East meets West", and presentations from China and other far east countries were highlighted. Much of the investigation resolves around the best technique to "break-up" the fat cells before they are suctioned, and what, if any, technology will assist in tightening the overlying skin. One of our problems that we constantly have to deal with is skin redraping. In essence, how well will the skin tighten after the underlying fat is removed. If skin elasticity is not good, the patient will end up with loose and redundant skin. Traditional liposuction is still the "gold standard" when comparing different technologies. This is done with small cannulas in a setting of tumescence (infiltrating saline into the fat prior to suctioning). The technique involves manually breaking up the fat with to and fro movements or using a power assisted device (P.A.L.) in which the cannulas are vibrated through the tissues. Ultra-sonic Assisted Lipoplasty (using internal ultrasonic energy to break up the fat cells) was initially thought to be beneficial in tightening skin but it has not shown to be that much better than traditional liposuction. Although it was a "hot procedure" starting in the late 1990's, it has not shown to give the skin tightening that we originally anticipated, and thus, it has become less popular. Laser Assisted Lipoplasty (using laser energy to lyse the fat cells) is the "buzz word" today. Various laser devices (SmartLipo; SlimLipo and many more) are being marketed to the public and to a wide variety of "cosmetic surgeons"as the device of choice for suction lipectomy. Various laser wavelengths are being investigated to try to find the optimal wavelengths to breakup the fat and also tighten the overlying skin. The most frustrating problem in the moderate to large volume liposuction cases is skin tightening and re-draping. It does not do any good to suction fat if the end result will result in loose and unattractive skin. The verdict is still out on the Laser assisted devices. Water jet liposuction is a new technology that uses a high powered stream of water to break up the fat cells. It is still under clinical trials, and from my initial analysis of the results and the data, I do not see this as being a better alternative. More clinical trials will have to be completed on this device. Radio-Frequency (R.F.) assisted liposuction uses radio-frequency waves to break-up the fat cells. This is still under investigation. Non-invasive techniques for fat reduction such as external ultrasound and injection lipolysis are under clinical trials. The theory with External Ultrasound is that energy placed on the surface of the skin will breakup the underlying fat. Injection Lipolysis uses various solutions injected into the fat to dissolve the fat cells. These are still under investigation and the final word is not yet written. Initial enthusiasm and "hype" is always a problem with any new technology. As a board certified plastic and reconstructive surgeon, my job is to evaluate and to make sure the scientific data shows a benefit and is safe before embarking on a new, expensive technology. I will keep you updated as data accumulates.