Tumescent liposuction uses a specialized solution called tumescent fluid, which Dr. Jeffrey Klein introduced. This solution changed the safety of liposuction throughout the world. The traditional solution is 1 liter of lactated Ringer's infused with 50 ml of 1% lidocaine with epinephrine and 20 ml of 8.4% bicarbonate. Lidocaine provides anesthetic pain control. Its effect begins within about one minute and lasts approximately three hours. Epinephrine constricts the micro-vessels, which minimizes blood loss and is essential for patient safety.

Bicarbonate makes the solution slightly basic and more physiological. It helps lidocaine enter the nerve cells, and it makes the solution more compatible with cells, which matters when harvested fat will be transferred to the buttocks in a Brazilian butt lift. Volumes are limited to 2 liters without an intravenous line and to 5 liters in an outpatient surgical facility. Mid-definition and high-definition body contouring both depend on this fluid.

The wet technique infiltrates the fatty layers with tumescent solution and then removes a similar volume, at a ratio of about 1 to 1. Equal volumes injected and removed keep fluid shifts small, so the body's fluid balance stays straightforward. Lidocaine provides comfort after surgery, and epinephrine constricts the micro-vessels and limits blood loss.

General anesthesia is required, because less fluid is infiltrated than in the super-wet technique. The wet technique, which is traditional liposuction, is also limited to the deep fat.

Laser liposuction uses a laser beam to heat and melt fat cells into a liquid. Light probes deliver the wavelength, and hollow cannulas then remove the fat. Melting the fat is said to limit injury to blood vessels and nerves, so thinner cannulas can be used.

The energy kills the fat cells, so the fat cannot be transferred. That rules out a Brazilian butt lift and natural breast augmentation. Removal can be more thorough than traditional liposuction, and it remains less thorough than ultrasound-assisted liposuction.

ProLipo PLUS, by Sciton, uses a laser to melt fat before it is removed. The light is also intended to tighten and firm the surrounding tissue. It is used for concentrated pockets that are hard to change with diet and exercise, including the chin, bra roll, back roll, arms, abdomen, flanks, thighs, and knees.

It is described as causing little bruising, bleeding, and swelling, and it can be performed under local anesthetic in the office. Results are described as visible immediately and continuing to improve over the following weeks.

LipoLite uses a laser to melt fat so it can be removed gently, and it is described as tightening the surrounding skin through new collagen. It treats stubborn pockets such as the flanks, abdomen, neck, face, thighs, and hips.

The treatment is minimally invasive, with little scarring. For many patients, results are visible right after the procedure and continue to improve over the following weeks. Patients can typically return to work one or two days later.

Power-assisted liposuction uses specialized cannulas that speed fat removal with a reciprocating, oscillating motion.

CoolSculpting cools the skin with a pad so the fat cells underneath freeze and die. The body then reabsorbs those cells. No anesthesia and no surgical recovery are required, and patients may return to work immediately.

The treatment cannot cover every area at once. Fat loss is limited to where the pad sits, which can leave a step between treated and untreated skin. It removes superficial fat rather than the deeper layer that usually changes with weight. If weight is later gained, the treated areas can enlarge. That change is described as paradoxical adipose hyperplasia.

The super-wet technique infiltrates much more tumescent fluid than it removes, described as about 100 cc injected for every 1 cc aspirated. That volume of fluid is what allows liposuction while the patient is awake.

Because so much more fluid is injected than removed, large-volume liposuction has to be avoided so the fluid shift does not affect the patient. Liposuction under local anesthesia also does not allow the comprehensive removal achieved in high-definition liposuction. Much of what is suctioned is the fluid that was infiltrated, rather than fat.

SmartLipo is the brand name for a form of laser liposuction. Focused light liquefies the fat cells so they are easier to remove. The same energy kills the cells, so they cannot be used for fat transfer, including grafting to the buttocks.

CoolLipo is a laser liposuction method that uses a 1320 nm wavelength to break up and liquefy fat. A cooling element reduces discomfort so the procedure can be tolerated under local anesthetic alone. That cooling does not improve how effectively fat is removed.

Water jet-assisted liposuction, commonly called Body-Jet, uses a stream of water to separate fat. Saline is injected first to loosen the tissue. Because the fat is dislodged with water rather than melted by a laser, more of it can remain viable for transfer, and more fat can be removed.

SafeLipo stands for separation, aspiration, and fat equalization. Separation uses power-assisted liposuction to separate fat globules with an oscillating cannula, without producing heat. Aspiration then uses thinner cannulas. Fat equalization is meant to leave a thin layer of superficial fat so the skin is protected from irregularities.

Power-assisted liposuction does not remove the superficial layer, so avoiding heat does not make the removal more complete. Thinner cannulas are not necessarily safer. Larger cannulas are less likely to penetrate blood vessels, nerves, and other tissue. High-definition liposuction selectively removes superficial fat to reveal muscle highlights, which is the opposite of leaving that layer in place.