Liposuction now has a U.S. history of close to 30 years of widespread clinical use. Over the years, many innovations and technologic advancements have come forth for this popular fat removal method. The vast majority of these have been in the past ten to fifteen years and much has centered on the methods of the first half of the liposuction procedure, the initial fat breakdown phase. Whether it be by mechanical disruption, ultrasonic emulsification, laser melting, or water particulation, many liposuction practitioners market and differentiate themselves based on the purported merits of the technologies that they use.
Patients understandably are enamored with new technologies and the visions of fat disappearing like a war game on an iPhone app is alluring. Ads with trim models situated in attractive locations adds to the potential merits of a liposuction operation. Fat removal that may not need for one to be put to sleep with a ‘minimized’ recovery has become the contemporary hook that is now attached to many of these liposuction technologies.
All of these newer methods of fat removal has merit and if one can get a good result for a patient under any operative location or circumstance, I am all for it. Much of what is mentioned here I either has been tried or is currently used in my own Indianapolis plastic surgery practice. But the caution I would extend to patients is that the tool used is just one part of the final result and it may not be the most important part.
Despite what we as plastic surgeons like to tout, liposuction is not really as refined an operation as patients would like to believe. It is, in my opinion, one of the crudest and least controlled of all the cosmetic plastic surgery operations. It is a procedure which is done blindly through a small skin hole, with the patient (and fat deposits) often laying in unnatural horizontal positions, and no real way of knowing with any degree of precision as to exactly what is being removed or left behind. This is no way means it is not a good operation, and often it produces near spectacular results, it simply means that liposuction is still more of an art form as opposed to a completely reproducible surgical operation.
The results of liposuction are determined far more by the hands that hold the tool than by any of the newest technologies that can be put in that hand. Patient selection, experience in knowing how much fat to remove and left behind, operative persistence and attention to detail (its an operation the plastic surgeon wants to end before you are actually done!), and expectation counseling all go in to creating a satisfied patient. The best liposuction technology (if one is truly the best) will not work well if all these other non-technologic issues are not executed well.
The most important component of liposuction, as well as in all surgery, is the plastic surgeon’s experience and training in performing it. A well experienced plastic surgeon can get good liposuction results with any of the technologies and methods that currently exist. Unfortunately, the issue of a surgeon’s experience is the one single assessment that is the hardest, and sometimes virtually impossible, for most patient’s to discern. All I can say is to be careful to not let the wonder of a new liposuction technology bedazzle you to overlook this very important liposuction ‘non-technology’.
Barry L. Eppley, M.D., D.M.D.
Indianapolis, Indiana