Modern liposuction techniques did not develop until the early 1980s. Earlier efforts at liposuction were a failure, with the earliest reported attempt to rasp fat from under the skin beginning in the 1920s. The Fishers, cosmetic surgeons in Italy, introduced new machines for performing liposuction but again, their methods were associated with significant complications. It was not until Paris gynecologist Illouz introduced the concept of a wetting solution and the use of uterine curettes, this method proved more practical. In the early 1980s American surgeons traveled to Paris to learn this technique. Two distinct groups of cosmetic surgeons return to disseminate these methods in the United States. One consisted of general plastic surgeons and the other group was composed of dermatologic surgeons.
These two groups represent the standards of care for liposuction that can still be found in practice today. General plastic surgeons distinguished their technique from the dermatologists by favoring low-volume wetting solution and general anesthesia. This approach is associated with significant blood loss; hospitalization; extended recovery periods; and a death rate as high as one in 5,000 cases. Alternatively dermatologists prefer local anesthesia. In 1985, Jeff Klein, a dermatologist, developed the method of tumescent liposuction, which uses relatively large volumes of dilute local anesthesia to numb the fat being removed. This method had significant advantages over other methods and patients undergoing this form of liposuction did not require blood transfusions, hospitalization, and a very low death rate estimated to be one death in every 300,000 cases.
What began as a failed experiment has since evolved into a relatively safe procedure called tumescent liposuction. Tumescent liposuction is performed under local anesthesia and has very little down-time during recovery. For this technique, the doctor inserts a small cannula into a small incision that heals quickly. Laser liposuction, a recently-introduced technique, is a variation on tumescent liposuction in that it also uses a cannula and is invasive. The significant difference between traditional tumescent liposuction and laser liposuction is that the cannula used in laser liposuction has a small laser attached to the end.
Laser Liposuction vs. No Laser
Laser-based liposuction systems are touted in marketing as the newest and most effective form of fat removal and body sculpting. Although lasers sound sexy and precise, like something out of a science fiction movie, they have not always lived up to the marketing hype. Carbon dioxide laser resurfacing, for example, has left thousands of women with scarred or depigmented skin. In contrast, Zerona® laser treatment, which has never been independently peer-reviewed or scientifically proven to be effective, is unlikely to cause any harm. So why do doctors continue to push laser-based procedures? The answer is based on money; once doctors sign a 6-year lease or buy these very expensive machines, they feel obligated to earn their money’s worth by pushing their patients into the service whether it is right for them or not.
The hype surrounding laser-based liposuction machines with unrealistic before and after pictures are equally misleading. Typically these before and after pictures show a flabby stomach next to a rock-hard etched stomach. These pictures could show the same person, but it is unlikely the differences were the result of laser liposuction. The chiseled stomach is most likely the result of laser liposuction in combination with a carbohydrate free diet, hundreds of hours in the gym, and photoshop. There is no evidence that the device is better than tumescent liposuction or any other form of liposuction. The incisions required to insert these devices under the skin are larger than those needed for the microcannulas.
Invasive vs non-invasive procedures
Smartlipo™, or laser liposuction, is more effective than non-invasive body-sculpting methods such as Zerona Laser Treatment. Although the web is awash with testimonials from allegedly satisfied customers of Zerona, there are no valid peer-reviewed studies showing that this method of shining a low-intensity laser on the skin has an effect on the fat cells targeted by this type of treatment. Changes in body fat associated with this treatment may have more to do with the recommended diet and exercise advised when having this treatment.
Tumescent Liposuction under local anesthesia with mild oral sedation is the safest technique to eliminate those stubborn fat cells. Tumescent liposuction causes minimal tissue trauma, nearly no blood loss, and a fast recovery. Dr. Steinsapir uses a dilute local anesthetic, which is infiltrated gradually into the fatty areas, and removes the fat with a microcannulas, or very small cannulas. A microcannula takes out smaller amounts of fat with each pass offering a highly refined method to control how fat is sculpted. Using microcannulas reduces the size of the incisions required and the amount of trauma to the surrounding tissue.
About Dr. Steinsapir
Dr. Steinsapir is an expert cosmetic plastic surgeon who has skillfully handled liposuction procedures in Los Angeles and Beverly Hills for over 20 years. He only performs tumescent liposuction under local anesthesia because of its superior results and fast, comfortable recovery time. He is a board certified surgeon and fellowship trained in oculoplastic surgery and cosmetic surgery in Southern California where he specializes in balanced facial cosmetic surgery for natural results, with an emphasis on minimally invasive techniques, fast recovery time, and leadership in medical technology. Dr. Steinsapir has a private practice and also serves as an Associate Clinical Professor of Ophthalmology at the Jules Stein Eye Institute, at the David Geffen School of Medicine at UCLA. Contact us today to learn how Dr. Steinsapir’s experience and training make him an expert provider of liposuction.
Services described may be “off-label” and lack FDA approval. This article is informational and does not constitute an advertisement for off-label treatment. No services should be provided without a good faith examination by a licensed physician and an informed consent with a discussion of risks, benefits, alternatives, and the likelihood of treatment success. Only you and your treating physician or surgeon can determine if a treatment is right for you.
