There are two different basic types of liposuction, one is called Tumescent liposuction and the other is called Ultrasonic liposuction. The basic of liposuction is that fat is removed via a cannula which is a hollow tube and an aspirator which is a suction device. Liposuction works well to remove fat from certain parts of the body that are not responding well to weight loss techniques, diet and exercise. The small tube like cannula is inserted through tiny incisions made by the surgeon. The cannula is used to break up and vacuum away the unwanted fat deposits that are beneath the skin. Success of the surgery is associated with a variety of factors including age, skin elasticity, weight, and the overall health of the patient.

Liposuction, as with any plastic surgery, has risks associated with it including injection nerve damage, seizures or reactions to general anesthesia if it is used. Liposuction surgery, in specific, can have adverse outcomes including bruising, scarring, unevenness, or unwanted indentations and irregularities left from over aggressive fat removal. Another complication is that the skin, if it is not elastic enough to bounce back, can drape differently after lipo giving an unwanted dimpled cellulite looking effect. With certain patients that have loose skin (common in older women or those that had rapid weight loss), liposuction will not be a beneficial surgery by itself. In such instances the lipo might have to be done with a bigger plastic surgery that involves removing or tightening the skin along with the removal of fat.

Tumescent liposuction

Tumescent liposuction has been around since the early eighties. Tumescent is also commonly called standard liposuction, suction-assisted lipoplasty, liposculpture, and lipoplasty.

With the tumescent technique, the fat is injected first with tumescent fluid. The fluid is essentially a sterile water/saline solution with local anesthetic added into it. The tumescent solution works to plump up the fat cells making them swell slightly and become firm for easy removal. It also helps the cells separate. After the fluid is injected into the area with the fat, a tiny rod is inserted into a small incision. The rod is attached to a vacuum which sucks the fat out. Removal of the fat involves reinserting the rod as needed into tiny incisions, potentially moving it around under the skin, and sucking the fat out of the body. The resulting scars are relatively small. Bruising happens from the trauma.

The tumescent fluid eliminates pain since it has anesthetic in it, and also reduces blood loss. From the reading that I have done on this topic, my understanding is that the tumescent method offers a somewhat quicker liposuction recovery period than the ultrasonic method.

Wet liposuction

Wet liposuction is similar in nature to tumescent liposuction, except that the anesthetic is not injected directly in to swell the area. Instead, only the sterile saline is used. Since there is no anesthetic, the patient in this case is under a twilight sedation or general anesthesia so that they don’t feel anything. Some surgeons differentiate between dry, wet and super wet, essentially it has to do with how much solution is injected into the area, as well as whether the anesthetic is included in the fluid, and if patient requires IV-sedation, general anesthesia, or only the local tumescent anesthetic.

Is tumescent liposuction safer that wet liposuction?

It is debatable in my mind whether tumescent liposuction with local anesthetic only is better than the so-called wet liposuction done using general anesthesia or IV-sedation. While tumescent can eliminate the risks of having to go under general anesthesia, the procedure does have its drawbacks. For one thing, the surgery can take hours longer. The surgeon has to be careful injecting all that solution into the body and then he has to wait like an hour to let it penetrate the tissue and expand the affected areas.

I realize that tumescent liposuction is the trendy thing, with all the claims about how you save the general anesthesia risks. But as far as I know, many Beverly Hills plastic surgeons just say forget it and ask their patients to go under for the surgery, provided that they are healthy and pass all pre-surgery physicals. That way the surgeon can have at it with the cannula without the patient literally bothering them by being awake. I’m serious that it’s probably easier and faster for the surgeon to have you dead asleep and if I were getting liposuction I am not so sure I’d want to be awake for it anyways. The cannula movements are rather violent as they move it around and suck fat out of you. I saw a liposuction video a few years back on T.V. It’s rather hard core! That’s why women are totally black and blue after they get liposuction! Tumescent would only be practical in my mind, if you are only having something really minor smoothed out.

Ultrasonic liposuction (UAL)

Ultrasonic liposuction, also known as UAL, is similar to tumescent because it also starts out with the tumescent fluid being injected to make the fat stiffened up and removable. At that point, the two liposuction techniques differ from one another. With ultrasonic liposuction, ultrasonic high frequency energy and heat is emitted out from the thin wand called the cannula. The cannula gets inserted under the skin and passed over all of the fat that is going to be removed. The ultrasound high frequency energy waves that are emitted by the wand serves to help liquify, separate and rupture the fat. Then the fat is taken out of the body using the rod like a tiny pipe.

UAL

Ultrasonic liposuction is supposed to be useful in cases where there is very dense fatty tissue that needs to get broken up to come out. Fat in places like the back has these properties and ultrasonic technique can be useful for areas like that. UltraSculpt from Mentor is a common ultrasonic brand of equipment that surgeons use for ultrasonic liposuction surgery. I’ve also heard of surgeons applying the ultrasonic energy outside of the body (on the skin itself) rather than inside with the ultrasonic cannula. Again, the ultrasonic energy is supposed to help break up the fat for easy removal.

I don’t view ultrasound liposuction as particularly better or safer, but that’s just my opinion after reading up about it. I don’t even think the Food and Drug administration has approved an ultrasonic device for the use of ultrasound-assisted liposuction. I seriously doubt the external version of the ultrasound can do much to break up the fat. You probably have a higher chance of getting a bad burn from it than anything else. I personally just wouldn’t bother with ultrasound liposuction. I don’t know about the merits of using ultrasonic waves to emulsify the fat cells. Since I haven’t read anything saying it’s the better way to dissolve the fat, I am not a believer in it at this point.

Power assisted liposuction (PAL)

PAL similar to the other liposuction techniques but it uses a motor-powered cannula which supposedly helps the surgeon make smaller movements when the cannula is under the skin and it can purportedly result in a more comfortable experience for the patient if they are awake during the procedure. Again, I am not sure I would want the power cannula over having the surgeon just moving the cannula around by hand. Maybe it would be less traumatic on the body, not sure. Some of these different versions of liposuction are just tied to equipment being used, and individual preference of the plastic surgeon .

If it were me, I’d want to be asleep! I also might pass on liposuction as an older woman, cuz jiggle can actually be a good anti-ager

If I was going for liposuction, I’d go with the basic cannula and the suction vacuum and I’d pick a surgeon that had done it a million times before using his hands on the cannula and not some power tool or ultrasound tool! I’d want him to have done liposuction the old school cannibalistic way like for years if not for decades before he did it on me. I’d probably want to be asleep for it, even though I know that general anesthesia is a risk. I mean, would you want to be awake for this?

I don’t think liposuction is always the greatest thing for older women either. For one thing, much older women generally need a more serious surgery along with lipo that involves removing and tightening skin. So it becomes not really lipo they are getting. It becomes a major tummy tuck, with some lipo thrown in for good measure. It’s basically not primarily lipo, it’s a tummy tuck for example, where they might do a little lipo but they are also removing excess skin.

Liposuction can really help if you have young elastic skin and stubborn fat areas like thigh saddle bags, or for some women their waistline thickens after having several children and they want to buy their original hourglass body shape back. But at the same time, having some jiggle and fat is a sign of youth! Older women who take all their fat away, and become overly fit and athletic, end up with these straight up and down thin plank figures that don’t look feminine to me, particularly as one gets onward in age. That’s why these body fat transfer surgeries are in. They offer to liposuction the fat out, then reinject it in somewhere else so you still have some shape to you, only shape in the right places. Yet the transfered fat will probably will just absorb after a while and not stay. Like taking from your outer thighs and putting back into your buttocks. That’s another topic, but suffice it to say I don’t think fat transfer works permanently matter how much they tell me about stem cells, moving and re-growing fat cells!

Lastly, if your skin is not elastic enough because you are older, it can drape poorly over the area where fat was removed. It can actually give you a dimple dented appearance similar in nature to cellulite! That’s a real potential complication that I rarely hear mentioned in the liposuction articles. You’ve removed something under the skin and now your skin is in excess. It’s common sense to know that your skin might not drape the same. That’s why they have you stuffed in a compression garment for weeks after liposuction – to help reduce swelling and shrink the skin back. Hopefully you found this article entertaining, informative and filled with some of the considerations you might want to ponder if you are middle aged woman and looking into some lipo. I like some jiggle because I think curves have an anti-aging effect on a woman. You may want to think twice before you get rid of everything.