LIPOSUCTION THE HIGH DEFINITION WAY

Tumescent Liposuction describes using a specialized solution called tumescent fluid that Dr. Jeffrey Klein found. This solution has revolutionized the safety of Liposuction throughout the world. The traditional tumescent solution calls for 1 Liter of Lactated Ringers infused with 50 ml of 1% lidocaine with epinephrine and 20 ml of 8.4% bicarbonate. Lidocaine provides for anesthetic pain control. The effects of Lidocaine are appreciated within one minute of administration and last approximately 3 hours. The epinephrine allows for constriction of micro-vessels, which minimizes blood loss that is quintessential for patient safety.
Finally, the bicarbonate solution is mixed in to make the solution slightly basic and more physiological. The addition of a bicarbonate solution has two effects. The first is to improve the lidocaine entry into the nerve cells by changing it from a polar to a neutral molecule. The second is to make the solution more cell friendly, which is critical to fat cell viability in patients desiring fat transfer to the buttock region, termed Brazilian Butt Lift. Tumescent solution volumes are limited to 2 Liters in patients without an intravenous (IV) line and 5 Liters in patients treated in an outpatient surgical facility.

Traditional tumescent Liposuction describes the solution used universally by liposuction surgeons around the world. This solution contains 1 Liter of Lactated Ringers, mixed with 50 ml of Lidocaine with 1 % epinephrine, and 20 ml of 8.4% Bicarbonate solution. Our high definition surgeons pioneered modifying the traditional tumescent solution to achieve several advantages for high definition liposuction cases performed under general anesthesia.

The first involves the reduction of 50 ml of Lidocaine with epinephrine to 25ml only, thereby halving the amount of Lidocaine. By halving the volume of Lidocaine injected, concerns of lidocaine toxicity are minimized. The subsequent modification involves adding one amp or epi to increase the epinephrine dose to constrict the microvessels and minimize blood loss. The following modification includes the use of 2mg of Dexamethasone. This addition minimizes the risk of hyperinflammatory reactions that can occur during Liposuction. Hyperinflammation is caused by the influx of white blood cells that then excrete pro-inflammatory products, which can induce undesirable hyperpigmentation and scar tissue deposition.

The white blood cells are suppressed over the first few days by adding a safe level of the steroid derivative above, thus avoiding this side effect. The final product that is added is Transanamic acid which provides additional protection against unnecessary blood loss. Controlling blood loss is especially important during 360 lipo, where more extensive tumescent solutions achieve exceptional high definition body contouring results.

The wet liposuction technique describes traditional Liposuction where a tumescent solution is used to infiltrate the fatty tissue layers and subsequently removed at a ratio of 1:1. This technique is very effective and universally advocated throughout the world. In general, equal volumes of solution are injected and removed ensures that fluid volume shifts are kept to a minimum, making maintenance of fluid dynamics in the body straightforward. The tumescent solution contains Lidocaine, which provides anesthetic comfort postoperatively, and epinephrine, which constricts the microvessels in the soft tissues, thereby minimizing blood loss.
The disadvantage of the wet liposuction technique is that general anesthesia is required due to the limited tumescent solution infiltration compared to the super wet (look below) technique. In addition, the wet liposuction technique or traditional Liposuction is limited to deep fat tissue removal only.

The super-wet technique describes the more generous use of a tumescent solution that utilizes infiltration of 100 cc to every 1cc of aspiration as described by a ratio of 100:1. In essence, 100 times more fluid is injected than removed. The reason for this infusion of fluid is so that Liposuction can be performed while patients are awake. This advantage is unique to patients who do not want to be put under general anesthesia.
However, the disadvantage remains that due to increased infusion to aspiration differential, large volumes of Liposuction must be avoided to avoid fluid volume shifts that can affect a patient’s well-being. The other disadvantage is that Liposuction under local anesthesia is not conducive to comprehensive fat removal as achieved in high-definition Liposuction.
The white blood cells are suppressed over the first few days by adding a safe level of the steroid derivative above, thus avoiding this side effect. The final product that is added is Transanamic acid which provides additional protection against unnecessary blood loss. Controlling blood loss is especially important during 360 lipo, where more extensive tumescent solutions achieve exceptional high definition body contouring results.

Laser lipo utilizes a laser beam to pierce, heat, and melt fat cells into a liquid state. This process does allow for a more accessible and more comprehensive removal of fat. Laser liposuction is a two-step process involving laser probes to deliver the laser energy to the fat cells, followed by the use of hollow bore cannulas to remove the fat. By melting the fat, Laser lipo also claims to cause minor injury to blood vessels and nerves, thus removing fat with thinner cannulas.
Unfortunately, laser lipo does kill the fat cells making them unusable for fat transfers. This inability to fat grafting thereby eliminates the ability to perform Brazilian Butt Lifts, which involves the fat transfer to the buttock, and Natural Breast Augmentation, which involves the fat transfer to the breasts. Finally, we have found that the ability to remove fat comprehensively, although superior to traditional Liposuction, is inferior to ultrasound-assisted Liposuction.

SmartLipo, is the branding name of laser lipo, a form of Liposuction that uses laser technology to melt fat cells. The energy from the laser liquefies the fat cells, thereby making it easier to remove the fat cells.  This technology has the disadvantage of killing the fat cells so that they cannot be used in fat transfers such as BBL, i.e., fat grafting to the buttock.

ProLipo PLUS by Sciton is a groundbreaking liposuction technique. Like many other revolutionary liposuction methods, ProLipo PLUS uses a laser to melt fat to be removed. In addition, the laser tightens and firms the surrounding tissue to create a tight, natural aesthetic. This liposuction technique is minimally invasive, which makes it best for treating concentrated areas of fat. These fat pockets are often challenging to get rid of by diet and exercise.

Areas such as the chin, bra roll, back roll, arms, abdomen, flanks, thighs, and knees are popular areas to treat with ProLipo PLUS. This method causes minimal bruising, bleeding, and swelling, which means a shorter and less complete recovery for the patient. Since ProLipo PLUS can be used under a local anesthetic, the procedure is typically cheaper, less risk for the patient, and can be done in the surgeon’s office. Most importantly, results are immediately visible and continue to improve the weeks after the procedure.

CoolLipo is a modification of the Laser liposuction technique that utilizes a laser wavelength of 1320 nm to break up and liquefy fat. Cool lipo has a topical cooling element to reduce discomfort so that the procedure can be made more tolerable under local anesthetic only. Unfortunately, this modification does not improve the effectiveness of fat removal.

Patients are often concerned with the invasive nature of traditional Liposuction. Fortunately, liposuction technology and liposuction techniques are constantly improving. LipoLite is a perfect example of next-generation Liposuction, which uses laser technology to melt fat so it can be gently removed. Not only does LipoLite remove fat, but the surrounding skin is also tightened as a result of renewed collagen in the treatment area.

All of these results are achieved using a minimally invasive technique. This way, the treatment is more comfortable for the patient, recovery is more accessible, and there is little to no scarring! LipoLite is best for treating stubborn pockets of fat like the flanks, abdomen, neck, face, thighs, and hips, which are difficult to remove by diet and exercise. For many patients, results are visible right after the procedure and continue to improve weeks after. Patients can typically return to work one or two days after their procedure.

The Tumescent Liposuction Technique improves traditional Liposuction because it offers improved results and a decreased risk for the patient. Water Jet Assisted Liposuction further improves on the Tumescent liposuction technique. Commonly referred to as Body-Jet, Water Jet Assisted Liposuction uses a powerful, precise stream of water to break apart fat pockets.

First, a saline solution is injected into the treatment area to loosen fatty tissue. The key to Body-Jet is using a stream of water rather than laser technology to dissociate the fat. Laser liposuction tends to melt fat, so it can’t be grafted. Water Jet Assisted Liposuction gently dislodges the fatty tissue, so the fat is more viable when harvested and more fat can be removed. This method allows the plastic surgeon to carefully remove stubborn fat pockets and contour the patient’s body with precision and accuracy.

Safe lipo is an acronym that stands for Separation, Aspiration, and Fat Equalization. The Separation phase utilizes power-assisted Liposuction (PALS) to separate fat globules, making them easier to remove fat. PALS does refer to a machine that can remove fat more efficiently by a high-frequency oscillating cannula. Safe lipo alleges that its ability to avoid any heat production makes it an ideal tool for Liposuction by avoiding injury to biologic cells. The aspiration phase alleges that since fat cells are separated as above, safer, thinner caliber, cannulas can be removed. Finally, the fat equalization claims to leave a thinner layer of superficial fat that protects the skin from irregularities.
However, safe lipo does have its critics. The first is that PALS lipo does not allow the removal of fat cells from the superficial layer. Although less heat is indeed created, thus potentially avoiding unnecessary thermal injury, this does not translate to more comprehensive fat removal. The second assumption includes the statement that thinner caliber cannulas are safer than larger bore cannulas. We prefer to use larger bore cannulas universally as they are safer and less likely to cause penetrating injuries of blood vessels, nerves, and other tissues.
Finally, one of the premises of achieving superior high definition liposuction outcomes is that selective removal of the superficial fat lining is employed to achieve muscle highlights; this is contradictory to the safe lipo fat equalization process.

CoolSculpting is a non-invasive technique used to eliminate areas of fat accumulation using a topical cooling element. Pads that cool the underlying skin result in the freezing and subsequent death of fat cells underneath the skin. The body then reabsorbs fat cells that have died, thus decreasing areas of undesired prominence. The advantage of this treatment is that surgery that requires anesthesia is not required.
Furthermore, no recovery is required such that patients may return to work immediately. However, the disadvantages are several and include the inability to treat all areas at once. Fat loss is localized only to areas of pad placement. This can create contour issues along the junction of treated and non-treated areas. Additionally, the fat eliminated is the superficial fat instead of the deeper fat layer, typically the preferred fat for the removal layer.
Because the superficial rather than the deep fat is removed, they will preferentially gain girth in the areas treated if patients gain weight. This is because the deep fat, not the superficial fat, is dynamic and fluctuates most during weight change. When the superficial fat is removed and moderate weight gain occurs, patients will see an unforeseen growth of treated areas! This deformity has been characterized as paradoxical adipose hyperplasia (PAH).t selective removal of the superficial fat lining is employed to achieve muscle highlights; this is contradictory to the safe lipo fat equalization process.