Anesthesia: General, Sedation, or Local
Location: Hospital, surgical center or office

Surgery time: 30 minutes-4 hours
Quick Fact: Women have softer, less fibrous fat than men - making it easier to perform liposuction


Which type of liposuction?
There are two basic techniques used in liposuction: tumescent and ultrasonic. Both techniques share core surgical elements. In fact, even if ultrasound is used, it will be followed by tumescent liposuction.


Tumescent liposuction is also called standard liposuction, liposuction, lipoplasty, liposculpture, liposculption, and suction-assisted lipoplasty. This type of liposuction has been performed in the United States since the 1982. First, the surgeon fills the fat with tumescent fluid (a solution containing saline and local anesthetic). Then, the fat is suctioned with long thin rods. The procedure can now be performed through a few small incisions, which can be hidden with natural skin creases. The tumescent technique may reduce blood loss and alleviate pain. The local anesthesia may be supplemented with intravenous sedation or general anesthesia.


Ultrasonic liposuction also starts with filling the fat with tumescent fluid to make the fat stiff. However, the fat is not suctioned, but liquefied with high-frequency ultrasonic energy with a long thin rod that emits ultrasonic waves. The rod is inserted into the fat through a tiny incision and then, the fat is suctioned out.


There are other sub-categories of the two techniques:


Suction-assisted Liposuction (SAL): The traditional method, by which the surgeon removes fat by inserting a small, hollow tube (cannula) connected to a vacuum pressure unit, directing the cannula into areas to be suctioned through tiny incisions.


Ultrasound-assisted Liposuction (UAL): Sound waves are transmitted to the tip of the cannula to liquefy fat before it is removed by suction.


External Ultrasound-assisted Liposuction (E-UAL): External ultrasound waves alter fat cells. The area is injected with fluid containing local anesthetic to transmit ultrasonic energy and liquefied fat is removed by suction.


Power-assisted Liposuction (PAL): A cannula with a back and forth motion of the tip passes through tissue to suction out fat and fibrous or scarred tissue with reduced effort.


VASER®-assisted Liposuction (VAL): Intermittent, or continuous bursts of ultrasonic energy can be used to break up fat cells which are then removed by suction.


Source: The American Society for Aesthetic Plastic Surgery (ASAPS)


There is not a consensus among plastic surgeons as to which technique is superior. There is slightly less blood loss and a greater ability to remove fat in difficult areas with ultrasonic liposuction, but it is also associated with greater complications than tumescent liposuction such as burning and/or tingling, swelling, skin burns and seromas (fluid collecting under the skin). Discuss these technique with your surgeon. Because there are only small differences between the procedures, the technique that your surgeon is most skilled in will cause the least complications.


Liposuction can be performed under general anesthesia (in which you are completely asleep), sedation (very relaxed in a light sleep), or under local anesthesia depending upon your surgeon and your circumstances. It can be performed in the office or hospital. Depending on how many areas are being worked on, surgery lasts from 30 minutes to 5 hours. In addition to fat, the surgeon also removes body fluid in the procedure. Because of this, patients are given fluids intravenously during the operation and there is the possibility that a blood transfusion will be necessary.


After surgery, you will wear a body-compression garment. You must wear this for several weeks. After surgery, you can usually go home. You'll want to make arrangements for a responsible adult to care for you for the first 24-48 hours. If your surgeon performed a large-volume liposuction (over 5 liters) then you should stay in the hospital overnight for observation and safety.


Tummy Tuck vs. Liposuction of the Abdomen
If you have excess abdominal fat, no stretch marks and fairly good skin tone, you are a good candidate for liposuction. If you have stretch marks, loose skin and a loose inner girdle (all more likely after pregnancy), a tummy tuck is probably your best choice.