Liposuction – Questions & Answers
In professional liposuction, also known as liposuction, fat deposits are removed with fine microcannulas and thus permanently removed. In this way, problem zones in which fat pads protrude can be adapted to the other body contours.
With a liposculpture, certain lines and contours (e.g. venus dimples, champagne channel) can be specifically emphasized. With the smallest skin incisions, which can be hidden in the wrinkle lines of the skin or under a swimsuit, targeted, lasting and visible contour improvements can be achieved. First, fluid is injected into the subcutaneous tissue to loosen the tissue. The excess fatty tissue is then gently removed with a cannula and a vacuum pump.
Below you will find answers to the most frequently asked questions about liposuction.
How is liposuction performed?
- The duration of the operation is about 1.5 to 3 hours, depending on the findings.
- Small areas can be treated on an outpatient basis under local anaesthesia or in twilight sleep.
- Larger quantities are removed under general anaesthesia. Then inpatient monitoring for 1 to 2 days is recommended.
- The small punctures are sutured with fine skin threads.
What experience with liposuction do CenterPlast specialists have ?
CenterPlast surgeons are highly trained specialists in plastic and aesthetic surgery. Dr. Santos Stahl and Privatdozent Dr. Stahl have passed the German and European specialist examinations. Dr. Santos Stahl completed her specialist training in Brazil. The country is regarded as a pioneer in the field of aesthetic surgery. Privatdozent Dr. Stahl is a former clinic director in a maximum care hospital. The specialists are distinguished by their many years of experience, their commitment to the safety of their patients and the development of innovative techniques. They have experience as senior doctors, train other doctors and are networked with leading plastic surgeons in Europe, the USA and Brazil.
For the best possible result, every single step on the way to the goal is crucial. CenterPlast’s specialists take all necessary precautions to avoid unexpected complications. When unavoidable complications occur, the surgeons know what to do. Thanks to many years of experience with a wide range of techniques (lifting operations, autologous fat treatments, minimally invasive treatment methods, microsurgery), the surgeons can also treat complications after liposuction. CenterPlast is equipped with the latest technology. Modern methods are used to prevent pain. Each procedure is performed according to the strictest hygienic standards.
How much does liposuction cost in Saarbrücken?
With our free price calculator, you can determine the cost of your liposuction online in just a few clicks.
Does health insurance pay for liposuction?
Liposuction of the abdomen is not one of the services covered by health insurance. Only in rare cases where there is a “pathological disfigurement” does a claim for reimbursement make sense. For more details, see the page Liposuction of the abdomen.
Since January 2020, liposuction of the legs in the case of stage III lipedema has been part of the catalogue of services provided by the statutory health insurance. The inclusion is limited until 31 December 2024. Lipedema is a pathological increase in fatty tissue, especially on the legs and arms. CenterPlast surgeons have many years of experience in the treatment of lipedema. CenterPlast specialists are allowed to perform liposuction for stage III lipedema at the expense of the statutory health insurance.
How can you prepare for liposuction?
- Liposuction should be performed when the desired weight has been reached.
- All your questions about possible complications and alternative treatments should be answered in advance.
- Keep nicotine and alcohol consumption to a minimum!
- If necessary, set temporarily stop taking medication containing hormones (the pill).
- Blood-thinning medication (e.g. ASS, Thomapyrin®) must be discontinued at least 10 days before the operation after consultation with your doctor.
- Vitamin preparations (A & E) as well as food supplements (omega-3 fatty acids / St. John’s wort preparations, etc.) must be taken at least once a year. be discontinued 4 weeks before the plastic-aesthetic procedure.
- A follow-up cost insurance should be taken out for the performance of aesthetic operations.
- Operations limit the ability to travel by air. Therefore, do not plan any professional or private air travel during the 6 weeks after the operation.
What is the detailed surgical procedure of liposuction at CenterPlast?
The procedure on the day of the operation will be explained to you step by step during the consultation. On the day of the operation you will be received personally by your surgeon. The body parts to be treated will be precisely marked in consultation with you. The drawing resembles the contour lines of a map. You will be put on compression stockings and taken to the operating room. Here we make sure that you lie as comfortably as possible. For your safety and comfort, the operating table has a special state-of-the-art foam core.
If you wish, you can listen to music to relax. A special warm air flow ensures that you are pleasantly warm. In accordance with the highest safety standards, the entire team discusses the treatment plan on the basis of a checklist. If you wish, you will be given medication to relax. The operating field is then disinfected with an alcohol solution and protected with sterile cloths. The anaesthetic is gently injected into the tissue using small cannulas. After the anaesthetic solution has developed its maximum effect, the fatty tissue is dissolved using the SAFELipo technique. If you do not sleep peacefully anyway, you may notice the surgeon’s hand movements.
The fat pads are specifically thinned out with fine cannulas. During the operation, the surgeon palpates the skin with great sensitivity and care. Each step is precisely documented. The small punctures are finally sutured and connected with fine skin threads. You will then be dressed in compression garments. The procedure takes about 1.5 to three hours, depending on the findings. Afterwards, you can rest while your vital signs are monitored for a few more hours. If you feel like it, you can also drink or eat something. Before you are picked up by your relatives, you will receive a report. The report will explain all the steps of the operation and the post-operation behaviour in a way that you can understand. Appointments will be made to check your well-being and recovery. In the report you will also find the personal mobile phone number of the surgeon, who is always available for you. By the way, before, after and even during the operation you can watch movies or your favourite series with virtual reality glasses. Not only is this entertaining, the distraction has also been shown to decrease sensitivity to pain.
What do you need to keep in mind after liposuction?
- Postoperative medical checks usually begin on postoperative day 3. The next control appointments take place after 1, 2, 6 weeks and after 6 & 12 months.
- The stitches are removed between the 10th and 14th day after the operation.
- Compression girdles that have been previously fitted to your body are to be worn continuously for 6 weeks.
- Scar care in the form of scar massages, sun protection and silicone padding from the 3rd postoperative week onwards support scar healing and help to achieve inconspicuous scars.
- Sports activities, sauna sessions, swimming as well as heavy work & sunbathing are not recommended for min. 6 weeks.
- Consistent sun protection (sun protection factor 50+) for 6 months is recommended.
- More detailed information on follow-up care can be found on the respective sub-page of the specific treatment. Of course, we will explain all points to you in a personal conversation and answer any open questions.
When can I take a shower after liposuction?
It is a fallacy that showering before wound healing is complete is dangerous. Wounds are normally covered with a dressing until the skin sutures are removed, thus protecting them from moisture. A large number of studies also show that showering does not increase the risk of inflammation. Showering with tap water helps clean a wound after surgery. Daily showering is very important for personal hygiene. Based on our long-term experience and scientific findings, we recommend showering with tap water on the 3rd day after the procedure, without soaking or rubbing the wounds. After the shower, dry the wound(s) with a clean towel or cool air from a hair dryer.
Experiences after liposuction in CenterPlast group practice
At the CenterPlast practice in Saarbrücken, the specialists systematically check the success of the treatments. Through seamless documentation, the services are continuously improved. For this purpose, we will also find out how satisfied you are with your appearance before and after the treatment. Strict quality assurance is everyday practice for us. Many patients agree to share their experiences to help you make the right decision for yourself. We are happy to connect with other patients during an individual patient consultation. The satisfaction of our patients is the yardstick for the quality of our work. We are pleased to receive reviews, testimonials and patient opinions about our treatment on the well-known online review portals.
Will I have pain after liposuction?
CenterPlast surgeons prevent possible pain with numerous measures. All steps of the procedure are considered to make the procedure as comfortable as possible. The surgeons, surgical staff and anesthesiologist care about your well-being. Even small details like listening to music will help you relax. You’re on painkillers. These take away your fear at the same time.
The tissue is then gently injected with a long-acting local anaesthetic. This ensures that you do not feel any pain even after the operation. As a preventive measure, you will be given well-tolerated pain medication such as paracetamol or ibuprofen. Throughout the surgery, you can put on virtual reality goggles and watch movies or your favorite shows. In addition to entertainment, distraction has also been shown to help reduce pain sensitivity. We will also provide you with the necessary pain medication to take at home, and after a week at the latest, you will no longer need pain medication.
What are the risks of liposuction?
Liposuction is one of the most frequently performed procedures in plastic surgery, with over two hundred thousand procedures performed every year. The operation is considered one of the safest, provided that specific safety measures are taken into account. Unfortunately, doctors without surgical training also offer liposuction without justification. It is not uncommon for larger amounts of fatty tissue to be suctioned out in the process. As a result, media reports of serious complications are accumulating. Only plastic surgeons learn the technique of liposuction in their advanced training. To avoid complications, the experts at CenterPlast:
- a team of trained specialists in plastic and aesthetic surgery with many years of experience
- A competent consultation and selection of the appropriate treatment,
- an accompaniment and supervision by very experienced anesthesiologists,
- atraumatic surgical procedures in combination with a precise surgical technique.
The most common risk after liposuction is the occurrence of dents. Dents are observed in two to three percent of cases. Differently long legs or an oblique hip are generally widespread. Pre-existing lateral differences are often perceived more consciously after liposuction. Liposuction is not suitable for compensating for incorrect posture. Irregularities can be corrected six months after liposuction with a fat injection. The CenterPlast specialists take the following preventive measures to minimize the risk of irregularities:
- The suction is performed with the SAFELipo technique.
- Fine suction cannulas with a diameter of two to three millimeters are used.
- The thickness of the soft tissue layer of the skin is constantly checked during the operation.
- The deep layers of fatty tissue are thinned out.
- The suction cannulas are carefully guided and the opening of the cannula is aligned with the tissue to be sucked off.
- The movements of the cannula tip are constantly controlled by the subtle palpation of the treated body parts during the operation.
- The tissue is sucked off in a “criss-cross” technique, i.e. crosswise, in order not to create any furrows.
- The suction is switched off when the cannula enters or exits the wound.
The suction of large amounts of fatty tissue, especially in the region of the lower abdomen, can lead to the accumulation of wound water (seromas). This can be treated by puncture under ultrasound control. The risk of this is increased in patients with a high BMI and during ultrasound-assisted liposuction. Wound water can accumulate on the abdomen in the first week or three to four weeks after liposuction.
The CenterPlast specialists prevent the accumulation of wound water through the following measures:
- We recommend a moderate liposuction in the area of the lower abdomen.
- We use the SAFELipo technique.
- We make sure that excess wound water can escape naturally through the wounds.
- We provide you with a special compression wash.
- We encourage you to moderate physical activity immediately after the operation.
Liposuction can cause a dark discoloration of the skin. This may be caused by bleeding into the skin, sunbathing after liposuction or certain medications such as iron or hormone preparations. In rare cases a skin sinking (skin necrosis) may occur. Patients with diseases of the connective tissue and heavy smokers are at risk. Scars on the stomach or blood sugar disease can increase these risks. These complications are unlikely with a careful selection of the treatment method and a gentle surgical technique. A feeling of furryness occasionally occurs after liposuction. In the vast majority of cases, the loss of sensation spontaneously improves or disappears after two to three months.
Every injury to the skin is in principle a gateway for bacteria to enter. Certain circumstances can impair the body’s defences and favour the multiplication of germs. This applies, for example, to long-term cigarette smokers, elderly people and people with chronic illnesses. Inflammation after liposuction requires antibiotic treatment and, in rare cases, surgical removal of infected tissue. The CenterPlast specialists take a number of measures to keep the risk of inflammation as low as possible:
- In the morning of the operation, we recommend that our patients take a shower with a disinfectant soap.
- Before the operation, your skin is carefully disinfected several times over a wide area with an alcohol solution.
- We use local anaesthetics, which also have an antibacterial effect.
- Operations that take more than two hours are performed under a preventive single antibiotic administration.
- We use disposable cannulas for suction.
- We plan close monitoring of wound healing in order to detect and treat a wound healing disorder in time.
When large quantities of fatty tissue are aspirated, a relevant loss of blood cannot always be ruled out. The surgeons at CenterPlast therefore recommend checking for anaemia before liposuction. A gentle surgical procedure, the SAFELipo and the use of the tumescent solution reduce the risk of significant blood loss.
The probability of death during liposuction is about 0.02 percent (source: Mendez, Aesthet Surg J. 2019). This corresponds to the risk of a fatal accident by car after 46,000 kilometres (source: Destatis 2018). The most common causes of death in liposuction are thrombosis, embolism, abdominal injuries, fat embolism and heart-lung failure.
The risk of thrombosis and embolism is greater when large amounts of fat are aspirated and in severely overweight patients. Further risk factors of thromboembolism are smoking (tobacco cigarettes, e-cigarettes), hormone replacement therapy and permanent lying. Plastic surgeons take the following measures to minimise the risk:
- They are examined for their individual risks for thromboses and embolisms (age, smoking, hormonal contraceptives).
- The surgeons will help you to create the best possible conditions for performing liposuction.
- We recommend liposuction in twilight sleep, which is associated with a lower risk of thrombosis.
- Specialists recommend the suction of a moderate amount of fatty tissue per procedure.
- You will receive compression stockings for thrombosis prophylaxis during the first three weeks after liposuction.
- We encourage you to move on the day of the operation. On the first day after the operation you should walk shorter distances several times.
- Depending on your individual risk, you may receive an injection to prevent thrombosis.
- Long flights can promote thrombosis. We therefore advise against air travel in the first four weeks after the operation.
Are scars visible after liposuction?
The very fine cannulas for liposuction are inserted under the skin through 2 to 3 mm incisions. These incisions are made in the wrinkle lines of the skin so that they are barely noticeable. The gentle, attentive and atraumatic treatment of the tissue ensures particularly inconspicuous scar healing. Fine suture material creates a fine and line-shaped scar that is barely noticeable. An additional measure is to make the incisions on the right and left sides of the body in different places so that even the tiniest scar does not give the impression of a planned surgery.
Liposuction – how much is possible?
The amount of liquid sucked off during liposuction consists of the removed body fat and the tumescent solution injected beforehand. The tumescent solution consists mainly of water and adrenaline and helps to keep blood loss to a minimum. With liposuction, up to eight percent of the body weight in fat volume can be removed per procedure (four to eight liters). The American Society of Plastic Surgeons defines five thousand milliliters as large volume liposuction. There is no fact-based information on the maximum amount of fat that can be aspirated. In 2015, plastic surgeons from Chicago examined the relationship between the suction volume and the body mass index. They have found that smaller complications (seromas) occur more frequently from a suction volume of one hundred millilitres per unit of the body mass index. The risks of liposuction are lower in healthy patients. Overweight, diseases of the heart, lungs or metabolism, cigarette smoking and hormonal contraception are health risks. These factors therefore also influence the risk of liposuction. How much fat can be suctioned varies from patient to patient. The exact suction quantity is determined during a personal consultation.
Can liposuction of the abdomen, legs and buttocks be combined?
Liposuction of the abdomen, buttocks and legs is indeed possible in one procedure. However, the total amount of fatty tissue removed should always be moderate so as not to increase the risk of surgery. Of course, this upper limit varies individually from patient to patient. The maximum amount depends on your health condition, body weight and lifestyle habits. In some individual cases, liposuction in several separate procedures is the safer way to achieve optimal results. Whether this is the case will of course be clarified in a personal consultation.
12 measures to prevent the appearance of dents during liposuction.
The CenterPlast uses several methods to prevent the appearance of dents.
- For precise planning, the skin is marked before the operation.
- The deep layers of fatty tissue are given priority.
- The tissue is loosened with a so-called tumescence solution (super wet technique).
- The amount of tumescent solution used per area and side is precisely controlled.
- The tissue is loosened with the SAFELipo technique.
- The vibration liposuction helps to avoid unevenness.
- Fine cannulas are used to create even contours.
- Cannulas are mainly used, the openings of which allow targeted treatment.
- Liposuction is performed in a standardized order.
- The amount of fat tissue removed is constantly monitored per area and side.
- The contours are continuously and subtly scanned during the procedure.
- Immediately after the operation you will be put on a special compression garment.
Can hardening occur after liposuction?
The healing process can be accompanied by a hardening of the tissue. Two to three weeks after liposuction, tissue cells migrate into the treated regions. These cells form new collagen. The collagen is then gradually rebuilt, realigned and cross-linked. During this remodeling phase, the tissue feels harder. If there is a pronounced swelling and bruising after the procedure, the subsequent remodelling phase is correspondingly more intensive. In order to prevent hardening, it is therefore very important to wear compression underwear consistently, especially in the first three weeks. Manual lymph drainage and ultrasound treatments can additionally support the healing process. The operation itself can be ideally successful – the final result is only perfect after the after-treatment.
How long is swelling visible after liposuction?
Swelling is unavoidable in the first days after surgery. The special injected liquid (tumescent solution) is used to prevent bruising. It is largely suctioned out during the procedure. A small proportion is absorbed by the associations. The rest is excreted through the kidneys in the hours following liposuction. At the same time, various messenger substances increase the permeability of the blood vessels in the treated regions. This phase of wound healing includes 1 to 2 weeks. After that, the swelling reduces to a significant extent. The special compression garment also serves to greatly reduce swelling. If swelling is pronounced despite compression garments, early lymphatic drainage is necessary.
5 reasons why compression garments should be worn after liposuction.
The compression wash:
- reduces the inevitable swelling after surgery.
- shortens the duration of the swelling.
- prevents the accumulation of wound water in the suctioned regions.
- promotes the shrinkage of the skin and helps to achieve a more beautiful contour.
- The result is that scars remain as fine and inconspicuous as possible.
High-quality studies prove that compression stockings (antithrombosis stockings) reduce the risk of thrombosis after certain operations. The doctors at CenterPlast recommend wearing compression underwear and compression stockings for three weeks after liposuction.
When can you see the result after liposuction?
The result of liposuction becomes clearer with each passing day. The swelling can always fluctuate during the day. From week to week, the new body contours become more visible. After about 4 weeks, the result is largely visible. The treated areas of the body may still feel somewhat hardened at this time and the skin surface may still be somewhat numb. The hardening and the so-called furry feeling are usually in full remission in the 3rd month after the treatment. Four months after surgery, the actual end result can be seen in about ninety-five percent of patients.
11 reasons to perform liposuction on an outpatient basis.
Outpatient surgery offers many advantages:
- Scientific studies show that outpatient surgery in twilight sleep with experienced plastic and aesthetic surgeons as well as experienced anaesthesiologists are safe.
- The coordination of the date of the operation is uncomplicated.
- The excitement before an outpatient procedure is usually less.
- They are spared the cumbersome formalities and the filling out of long forms before in-patient admission.
- You do not have to do without the comfort of your home.
- You will recover more quickly in your familiar surroundings. The healing process is often better.
- There is no danger of getting infected with germs.
- The foreign and anonymous environment of a clinic can be dispensed with.
- Clinics are often designed to perform operations under general anaesthesia. The experience with less stressful anaesthesia is greater in outpatient centres.
- With outpatient surgery, you can expect all-round care from your familiar and experienced specialist in plastic and aesthetic surgery. Postoperative care is provided by your surgeon. Treatment from a single source improves quality and gives you security.
- Outpatient care strengthens the doctor-patient-confidence relationship. This gives you the feeling of security and contributes to the success of the treatment.
5 reasons for liposuction in twilight sleep.
In general anaesthesia, your consciousness is temporarily switched off. The respiratory drive and protective reflexes are also completely eliminated. A twilight sleep (also called analgosedation) takes away your fear, reduces your sensitivity to pain and makes you sleepy. Twilight sleep offers many advantages:
- By combining different painkillers, the amount of stressful medication can be significantly reduced. You will recover faster.
- Side effects such as nausea are much rarer.
- Severe side effects such as thromboses or embolisms are also less common after twilight sleep than after general anesthesia.
- After a twilight sleep you can return home faster and eat and drink again faster.
- The satisfaction of patients after twilight sleep is very high.
Why is a liquid injected before liposuction?
Tumescent anesthesia is a form of local anesthesia using a highly diluted anesthetic that is administered in large quantities under the skin. The technique was already described by Matas in 1915 and was later used by Klein for liposuction. In 1920 it was recognized that the addition of adrenaline was helpful. Adrenaline is a stress hormone that constricts blood vessels when used locally. This reduces the risk of bleeding. The anaesthetic stays longer in the tissue and the anaesthesia lasts longer. The tumescent solution takes about twenty minutes to take effect. The use of a long-acting anaesthetic ensures that you will not experience any pain after the procedure. The amount of tumescent solution helps to keep blood loss to a minimum. The good tolerability and the low risks as well as the excellent analgesic effect explain why the tumescence technique is also used in other procedures. The tumescence technique is also used in the CenterPlast for tummy tuck, breast lift, breast reduction, breast enlargement and face lift. The advantages of the tumescent technique are:
- You do not need a general anaesthetic.
- A sleeping pill is not absolutely necessary.
- Fewer medications get into the body’s circulation.
- Side effects such as nausea are unlikely.
- They recover faster and are back home faster after the operation.
Before and after pictures of liposuction in Saarbrücken?
During our consultation, you will have the opportunity to view anonymized before-and-after images. Of course, these were recorded with the patients’ consent and are used only for this purpose. It is not allowed to publish such images on the Internet. Please feel free to arrange a personal meeting to get an idea of the results you can expect.
Is drainage required during liposuction?
Drainage is not necessary for liposuction. A combination of abdominal liposuction and abdominoplasty may require short-term drainage in selected cases. In the case of liposuction to correct a male breast in conjunction with the removal of a mammary gland, drainage is also occasionally used. By using the tumescent solution (injection of water with adrenalin) before liposuction, the use of blunt cannulas, careful preparation for the operation, a good follow-up treatment and a certain dexterity, there is no need to worry about bleeding after the operation. Patchy bleeding of the skin is unavoidable. The bruises disappear on their own after five to ten days.
Since when have liposculptures been performed?
As early as 1964, the plastic surgeon Schrudde from Cologne removed fat deposits using a minimally invasive procedure. To plan the operation, Schrudde drew marking lines on the skin and recommended wearing compression garments after the operation. In 1976 Kesselring and Meyer developed precursors of today’s instruments: long hollow needles connected to a vacuum pump. In 1977, Illouz, a surgeon in Paris, injected the tissue with an enzyme and a saline solution to reduce the risk of rebleeding.
In 1987 the Californian physician Klein applied the tumescent anaesthesia technique described by Matas in 1915 to liposuction. The term derives from the Latin and means “swelling”. The dilution of the anaesthetic and the addition of adrenalin mean that only a small amount of anaesthetic gets into the body circulation. This means that a stressful general anaesthetic can be dispensed with. In addition, the patients recover faster after the operation.
Gasperoni also performed liposuction in the superficial fat layers in 1990 in order to correct contours more precisely. In 1997 Matarasso first combined the techniques of liposuction with the technique of abdominoplasty in order to perfect the results.
What are the different methods of liposuction?
The technique of vacuum liposuction, as performed in 1976, is known as “suction-assisted liposuction” (SAL). In this technique, the fatty tissue is removed using a hollow needle. The hollow needle has a blunt tip and lateral openings through which the fatty tissue is sucked off with a negative pressure of 0.8 to 0.9 bar. The following techniques offer a complementary procedure to remove the cells from the tissue:
- Vibration liposuction (power-assisted liposuction, PAL).
- Water jet assisted liposuction (WAL).
- Ultrasonic liposuction (ultrasound-assisted liposuction, UAL).
- Laser-assisted liposuction (LAL).
- Radiofrequency-assisted liposuction (RAL).
What is vibration liposuction?
Vibrational liposuction was first approved by the US Food and Drug Administration (FDA) in 1998. With this method, a motor causes the hollow probe for liposuction to vibrate. The hollow probe moves three millimetres back and forth up to four thousand times a minute. The fat tissue is released by the vibration. The fine vibration allows precise suction of fatty tissue. By aligning the openings in the hollow probe, the fat tissue can be specifically thinned out. The amount of fat tissue extracted can be controlled by the vibration frequency. Unlike laser or ultrasound-assisted liposuction, there is no risk of burning. The risk of an accumulation of wound water is also lower than with ultrasound or laser-assisted liposuction. Skin shrinkage is observed in the treatment of the superficial fat layer, similar to ultrasound or laser liposuction.
What is the SAFELipo?
The SAFELipo technique is a special procedure of vibration liposuction described by the American plastic surgeon Wall 2010. The technique is performed in three steps and reduces the risk of bruising and irregular contours. The acronym SAFE is composed of the English terms “Separation”, “Aspiration” and “Fat Equalization”. After the injection, the fat tissue is loosened with the device for vibration-assisted liposuction and a special cannula. The fat tissue is then aspirated with three to four millimeter-thin cannulas using vibration liposuction. Finally, the contours are levelled with a special cannula. The SAFELipo technique is also used for autologous fat treatment. The technique offers many advantages and is therefore frequently used in the USA:
- Special cannulas stretch the tissue and allow an even suction of the patient’s own fat.
- The vibration loosens the fat tissue. Dents and irregularities are thus avoided.
- The shape of the cannulas protects the vessels and reduces the risk of bruising.
- The cannulas are easy to guide, allowing precise and targeted correction of the contours.
- Specially shaped cannulas increase the safety of the treatment.
What is ultrasound-assisted liposuction (VASER®)?
The use of ultrasound for liposuction was first described by Scuderi in 1987. Ultrasound is a mechanical vibration with a wave frequency above 16 kilo-hertz. During liposuction with ultrasound, the tip of the hollow probe vibrates 19 to 27 thousand times per second. The vibrations cause changes in pressure and an increase in temperature. Both lead to a liquefaction of the fatty tissue. Ultrasonic-assisted liposuction is particularly effective for fibrous tissue. The superficial application of ultrasound waves and the rise in temperature leads to a slight shrinkage of the skin. There are indications that ultrasound-assisted liposuction is more gentle on the skin vessels than conventional suction-assisted liposuction (SAL). However, this method has a major disadvantage compared to the conventional method. The ultrasound waves can lead to burns and scarring. Newer third-generation ultrasound-assisted devices such as VASER® (Solta Medical, Hayward, CA, USA) therefore use pulsed ultrasound waves.
What is water jet assisted liposuction (Body-Jet®)?
The use of water jet assisted liposuction was first described in 2009. In this method, the liquid is injected over a wide area at an estimated pressure of 20 bar. The fat tissue is then aspirated as with the conventional vacuum method (“suction-assisted liposuction”, SAL). The device Body-Jet® (Human Med, Schwerin) required for this is mainly used in Germany. Due to the fan-shaped injection with high pressure, less tumescence solution is required.
What is laser-assisted liposuction (SlimLipo®)?
Apfelberg applied laser-assisted liposuction for the first time in a study in 1991. The laser beam is emitted into the fat tissue either before or during liposuction. Laser-assisted liposuction leads to a targeted temperature increase in the fat tissue. This destroys the fat cells, the smallest vessels become desolate and the structure of the collagen fibre bundles is changed. Similar to ultrasound-assisted liposuction, the rise in temperature leads to a slight shrinkage of the skin. Laser-assisted liposuction therefore also involves a risk of burns. The combination of different wavelengths between 900 and 2800 nanometers should improve the shrinkage of the skin and reduce the risk of burns.
Several companies offer such devices as a supplement to liposuction:
- SlimLipo® (Palomar Medical Technologies GmbH, Hamburg) 924 and 975 nanometers.
- SmartLipo® (Cynosure Inc., Westford, MA, USA) 1064 and 1320 nanometers.
- ProLipo Plus® (Sciton, Palo Alto, CA, USA) 1064 and 1319 nanometers.
What is Radio Frequency Assisted Liposuction (BodyTite®)?
Radiofrequency surgery is a widely used surgical procedure. The terms high frequency surgery, electrosurgery, and diathermy are used synonymously. In this procedure, high-frequency electrical energy is generated between two electrodes. The technology works with frequencies of one megahertz and powers of twenty-five to seventy-five watts. The electrical energy generates an increase in temperature. In radiofrequency-assisted liposuction, an electrode is inserted into the tissue. The other electrode is placed on the skin. The inner electrode is a hollow probe with a diameter of three millimetres. This hollow probe is isolated up to the tip. The electrode on the skin surface is wider and absorbs the high-frequency current. Both electrodes are connected with a handpiece. One centimeter around the tip of the hollow probe the highest temperature is reached and the fat liquefies. The vacuum in the hollow probe sucks off the liquefied fat, just like with the usual liposuction. The external probe measures the temperature on the skin surface to prevent burns. At the skin surface, a temperature of 40°C to 42°C leads to the desired skin shrinkage and the formation of new collagen. The tissue is then further thinned using the conventional negative pressure method or vibration liposuction. A device approved for radio frequency assisted liposuction is called BodyTite® (Invasix Ltd, Yokneam Ilit, Israel). BodyTite® received US Food and Drug Administration (FDA) approval in 2016.
Abdominal liposuction without surgery
In the meantime, there are many alternatives to surgery:
- Cryolipolysis (CoolSculpting®)
- Ultrasound (Liposonix®)
- electromagnetic impulses (Emsculpt®)
- Radio frequency (Thermage®)
- Laser lipolysis (SculpSure®)
- apical syringe
The effectiveness of these techniques cannot be compared to the effectiveness with liposuction. It is limited to the fatty tissue immediately below the skin. In the following sections, these methods are examined in a little more detail.
Liposuction versus cryolipolysis (CoolSculpting®)
The effect of cryolipolysis cannot be compared to liposuction. The effect of cryolipolysis unfolds mainly in the superficial fat tissue. In order to achieve a satisfactory result, several cryolipolysis treatments at two-month intervals are necessary. During liposuction, both the deep and the superficial fat tissue can be reduced. Liposuction can reduce the fat tissue considerably more than cryolipolysis.
Liposuction versus ultrasound (Liposonix®)
Ultrasound can be used to reduce fat (twenty kilohertz to several gigahertz). Both the heat generated by 56 degrees Celsius and the cavitation mainly damage the fat cells. Cavitation refers to strong pressure fluctuations that cause the fat cells to burst. Ultrasound technology makes it possible to reduce the circumference of the hip by two to four centimetres. The penetration depth is one to three centimetres. The effect is therefore much less than the effect of liposuction. As a rule, at least three treatments are required every four weeks. For example, treatment of the abdomen lasts about thirty minutes. The result can be seen after two to six months.
Liposuction versus electromagnetic pulses (Emsculpt®)
Electromagnetic impulses cannot be compared to liposuction in their effect. Electrical and electromagnetic impulses cause muscle tension. The electromagnetic impulses penetrate deeper into the tissue and cause no pain. In addition, electromagnetic impulses release higher muscle forces than electrical impulses. The electromagnetic impulses cause intensive muscle training and fat burning. Rapidly changing magnetic fields generate an electrical impulse in the underlying tissue. The nerves thus trigger muscle tension. A high frequency of the muscle tension leads to an increase in muscle size and muscle strength as well as to fat reduction. A reduction of a muscle gap between the straight abdominal muscles (rectus diastasis) has also been proven. One treatment lasts thirty minutes. Twenty thousand impulses are generated during one treatment. Four treatments at two-day intervals are recommended. The results are visible after four weeks. Subsequently, one treatment is repeated every three to six months to obtain the results. This technology (High-intensity focused electromagnetic, HIFEM) was approved in 2018 by the US Food and Drug Administration (FDA) for the treatment of the buttocks and abdomen. The strength of the muscle tension can be adjusted from 0 to 100% with the Emsculpt® (BTL Industries, Inc., New York, NY, USA). The stronger the muscle contraction, the clearer the result. Most patients describe the treatment as pleasant. The only known complication is a temporary, slight muscle soreness. Electromagnetic pulses should not be used during pregnancy or in patients with metal implants or pacemakers.
Liposuction versus radiofrequency (Thermage®)
Radio frequency devices primarily cause a slight tightening of the skin. In addition, radiofrequency devices can degrade fatty tissue to a low degree. The radiofrequency waves are emitted to the skin by electrodes and generate heat between 43 and 45 degrees Celsius. The increase in temperature leads to a shrinkage of the tissue. The cells of the connective tissue (fibroblasts) are stimulated to form collagen and elastic fibres. The heating of the tissue leads to a degradation of the fat cells. In order to prevent burns, certain devices simultaneously cool the skin and continuously measure the temperature of the skin surface. A radiofrequency treatment lasts twenty to thirty minutes. The heat development can lead to slight pain. The redness and swelling of the treated areas improve after one day. Occasional side effects include hypersensitivity, a temporary sensation of pain, fat loss and nodulation. Several treatments are necessary to achieve an improvement. The result can be observed after two to six months.
One of the most common radio frequency devices is the radio:
- Thermage® (Solta Medical, Pleasanton, California, USA). The device received approval from the US Food and Drug Administration (FDA) in 2002. The approved applications are skin tightening and fat loss on the face, abdomen, thighs and buttocks.
- Vanquish® (BTL Industries, Boston, Massachusetts, USA). The device is suitable for low fat loss on the abdomen, back and flanks.
- truSculpt® (Cutera, Brisbane, California, USA).
- Venus Legacy® (Venus Concept, Toronto, Ontario, Canada). The device uses radio frequency and electromagnetic impulses.
Liposuction versus laser lipolysis (SculpSure®)
Laser lipolysis is a technique for reducing fat deposits on the abdomen, back, flanks and neck (double chin). There are two different methods of laser treatment. Low level laser therapy (LLLT) with wavelengths from 532 to 635 nanometers. Low-level laser therapy makes the cell wall of fat cells permeable. The fat cells thus release their fat reserves. The treatment lasts about thirty minutes and is repeated twice a week for six weeks. The hyperthermal laser treatment (hyperthermic laser lipolysis, HTLL) applies wavelengths of at least 1060 nanometers. The laser causes the temperature of the fatty tissue to rise to 42 to 47 degrees Celsius. The effect unfolds 0.5 to 2.5 centimetres below the skin. The fat cells die off and are broken down by phagocytes. Two to twelve treatments of twenty minutes each at intervals of six weeks are required. The laser devices cool the skin surface to prevent burns. Laser lipolysis can cause slight pain. Swelling and tissue hardening will disappear after one week. The treatment areas should be free of scars and tattoos. The following devices are used for laser lipolysis.
- SmartLipo® (Manufactured by Deka, Italy, marketed by Cynosure, Westford, Massachusetts, USA). SmartLipo® uses a Neodymium:Yttrium-Aluminum-Garnet (Nd:YAG) laser (1064 nanometer, 1320 nanometer and 1440 nanometer wavelength). The device has been approved in the USA since 2006.
- SculpSure® (Cynosure, Westford, Massachusetts, USA). The device uses a wavelength of 1060 nanometers and has been approved by the US Food and Drug Administration (FDA).
- Erchonia Zerona® v2.0 (Erchonia1 LipoLaser; Erchonia Medical, Inc., McKinney, Texas, USA). The green laser has a wavelength of 532 nanometers.
- Fotona TightSculpting® (Fotona, LLC, Dallas, Texas, USA). The device is approved in the USA for the reduction of fat and tightening of the skin. Two lasers are used (1064 nanometers Nd:YAG and 2940 nanometers Er:YAG).
Liposuction versus fat way injection
A fat-away syringe cannot replace liposuction. Repeated treatment with a fat removal injection reduces small surrounding fat deposits, such as a double chin, to a mild to moderate degree. However, liposuction can remove an estimated 50 times the amount of fat tissue per treatment. You can learn more about the syringe on the Fat Away Syringe page.
“We provide you with extensive expert knowledge so that we can work with you to select the best possible treatment path.”
Dr. med. Stéphane steel is the former director of the Clinic for Plastic, Reconstructive and Aesthetic Surgery / Hand Surgery at the Lüdenscheid Clinic. Dr. Stahl studied medicine at the Universities of Freiburg and Berlin. In 2011 he passed the European and 2012 the German specialist examination for plastic and aesthetic surgery. Further specialist qualifications and additional qualifications followed (including quality management, medical didactics, physical therapy, emergency medicine, laser protection officers, hand surgery) as well as prizes and awards. In 2015 he completed his habilitation in plastic and aesthetic surgery in Tübingen. He is an experienced microsurgeon, a sought-after expert and a regular speaker at specialist congresses. After a multi-stage selection process, Stéphane Stahl became a member of the American Society for Aesthetic Plastic Surgery (ASAPS), one of the world’s largest and most influential specialist societies for aesthetic surgery. His authorship includes numerous articles in respected peer review journals and standard surgical textbooks.