These days, thanks to the growth of the internet, people living amid a flood of information seem to find it even harder to judge and decide. Liposuction techniques, too, come in so many varieties, and everyone claims theirs is the best. Isn't it dizzying?
Some time ago, on the Venus Clinic online consultation board, I received a question: "Don't you offer **** liposuction? I hear it's the big trend these days." I remember being startled by a term I had never heard before and searching the internet eagerly to find out which hospital had come up with that name.
Every one of them claims less bruising and swelling, better skin-tightening effects, and less pain. Yet I cannot find any academic evidence at all. If a method truly works, I believe its results should be objectively demonstrated and academically recognized by other physicians.
Of course, I understand the desire to adopt a newly developed machine, differentiate it as a new and special method, and advertise its superior effects, but....
To get straight to the conclusion: each liposuction method has its own advantages and disadvantages, and no one method can be said to be better than the others. What matters is knowing whether the device being used has been clinically tested enough for its effects and complications to be proven, and what you should choose is not the machine but the surgeon's experience and skill.
You can stop reading here. Reading further might give you a headache. Haha
Oh, wait a moment. Before reading this article, it may help to first read about the history of liposuction; if you haven't yet, I recommend taking a look.
VAL Vaser assisted liposuction
Updates and advances in liposuction.
Liposuction is a procedure in which tumescent solution is infiltrated into the fat layer to anesthetize the area, constrict blood vessels, and swell the fat cells; the surgeon then inserts a cannula and moves it back and forth by hand to suction out and remove fat cells without bleeding. Whatever device is used, every surgical technique shares this common process. This is called the SAL technique.
The name of the procedure changes depending on which device is used as an adjunct. Devices are used for assistance according to each patient's individual situation, such as fibrous fatty tissue, large-volume liposuction, revision liposuction, or areas where maximal skin contraction is desired.
From here on, I will describe the various modern liposuction methods currently in use, centering on the paper by Phillip J. Stephan et al. published in 2010 in Aesthetic Surgery Journal, the journal of the American Society for Aesthetic Plastic Surgery (ASAPS) (Updates and advances in liposuction. Stephan PJ, Kenkel JM. Aesthet Surg J. 2010 Jan;30(1):83-97).
For reference, this is a CME (Continuing medical education) article, meaning it is academically recognized content that American plastic surgeons are expected to study
- SAL (suction assisted liposuction)
- PAL (power assisted liposuction)
- UAL (ultrasound assisted liposuction)
- VAL (Vaser assisted liposuction)
- LAL(laser assisted liposuction)
1. SAL (suction assisted liposuction)
SAL stands for suction-assisted liposuction. It is the most basic surgical method, so much so that it is also called traditional liposuction. It is also the method we mainly use at Venus Clinic today.
I once got the impression from a certain physician who interpreted this as the "classic" liposuction technique that it was already outdated. However, most modern liposuction is performed with this method. There are even renowned foreign surgeons who insist on liposuction using only the negative pressure of a syringe, without borrowing the power of an aspirator (Pierre F. Fournier, Luiz Toledo).
Syringe liposuction has its own advantage of causing less tissue damage, and I too sometimes operate using only the negative pressure of a syringe.
2. PAL (power assisted liposuction)
PAL is called power-assisted liposuction, and most of the machines currently available are products from Lipomatic or MicroAire. By mechanical power, the cannula, that is, the suction tube, automatically moves back and forth about 2-5 mm at roughly 4,000 cycles per minute. Since the cannula reciprocates on its own even when the surgeon moves it slowly, it takes less effort and the suction speed is faster. So far, there have been no reports of increased complications compared with SAL. Venus Clinic also owns a Lipomatic liposuction device.
3. UAL (ultrasound assisted liposuction)
UAL is ultrasound-assisted liposuction. It is divided into an external method, in which ultrasound is applied from outside the fat layer by massaging the skin, and an internal ultrasound method, in which the cannula itself emits ultrasound while suctioning at the same time. Ultrasound generates heat, but as the intensity of the sound waves alternates between strong and weak, the fat cells repeatedly compress and expand, bubbles form inside the cells, and eventually the fat cells undergo implosion; this is called the cavitation effect.
The cavitation effect has a powerful ability to liquefy fat cells, making liposuction easier, and it is especially effective at weakening and removing fibrous tissue. However, because of frequent postoperative complications such as seroma and dermal injury, it is rarely used these days.
4. VAL (Vaser assisted liposuction)
VAL stands for Vaser-assisted liposuction, and you can think of it as a third-generation internal ultrasound liposuction device. A metal probe with a grooved tip emits pulsed ultrasound; after tumescent solution is infiltrated, the fat layer is treated for about 10-15 minutes to soften the fatty tissue, and then a cannula is inserted to remove the fat.
Technically, it is a method developed to reduce the complications of ultrasound liposuction; it is effective when used for fibrous tissue or revision liposuction, and it is also a method we use at Venus Clinic.
5. LAL(laser assisted liposuction)
LAL is called laser-assisted liposuction. Like VAL, this method infiltrates tumescent solution, then irradiates the fatty tissue with a laser to soften it, and then removes the fatty tissue with a cannula.
In particular, because it uses the heat of a laser, it is claimed to have the advantage of inducing postoperative skin tightening, but this effect has not been academically proven.
In addition, according to a 2006 paper by Prado et al., when the surgical area was divided into two sides, with LAL performed on one side and traditional SAL on the other, there was no difference in surgical results; rather, the operation simply took longer by the amount of time spent on laser irradiation. Because of this report, the usefulness of laser liposuction is currently in doubt. (Prado A, Andrades P, Danilla S, Leniz P, Castillo P, Gaete F. A randomized, double blind, controlled clinical trial comparing laser-assisted liposuction with suction- assisted liposuction. Plast Reconstr Surg 2006;118:1032-1045.)
These are the methods currently in clinical use and recognized by the academic community. The important point is that all of these devices merely help make fat removal easier after tumescent infiltration; ultimately, the fat is removed by the surgeon's hands.
Whatever device is used, the fat must be removed by human hands, so when choosing liposuction, it is wiser to choose the experience and skill of the operating surgeon rather than the machine. A surgeon with extensive experience and skill can produce satisfactory results with any device, and the best results come only from careful, meticulous touches made with devotion to the very end.
Other recently developed methods still under trial are listed below; they have not yet received approval from the U.S. Food and Drug Administration (FDA) and are reportedly still in clinical trials. In Korea, however, in the spirit of the early adopter, I understand that all of these devices except Zeltiq are being used under the name of "**** liposuction."
A. Ultrashape
B. LipoSonix
C. BodyTite
D. Zeltiq
A. Ultrashape is a focused external ultrasound therapy that concentrates external ultrasound to destroy fatty tissue using heat and the cavitation effect. It is said to act selectively on fatty tissue while preserving nerves and blood vessels.
B. LipoSonix uses high-intensity focused ultrasound (HIFU) to generate heat and thereby destroy fat cells. It is currently in clinical testing in the United States and is reportedly in use in Europe.
C. BodyTite is a radiofrequency ablation method of fat destruction that is currently under experimental study. The mechanism is to destroy fatty tissue with electrical heat and then induce skin contraction.
D. Zeltiq is a method that cools fatty tissue to selectively destroy only the fat without damaging the skin; it is currently under study.
This concludes my summary of the content of Dr. Stephan P.J.'s paper, Updates and advances in liposuction. I am not sure how well it has come together for you. If it has only become more complicated, I apologize. ^^;
PostScript
However, there is one liposuction method missing from this paper: WAL (waterjet assisted liposuction). It is called water-jet assisted liposuction. Although it was not introduced in this paper, it is a device that is extensively advertised and in use in Korea. Judging from its absence in this paper, however, it does not seem to be widely used in the United States at present.
The water-jet method was developed in Germany. After tumescent solution is infiltrated for local anesthesia, normal saline is immediately injected under strong pressure to separate the fatty tissue while suctioning at the same time; because it causes less tissue damage, it is said to result in less postoperative bruising and faster recovery.
So far, there is no objective paper proving this, and only one clinical research paper from the time of development exists. Clinically, because saline injection and suction occur at the same time, the cannula is known to be thick, and removing a sufficient amount of fat is known to be difficult.
Testing, researching, and developing newly released devices is important work and forms the foundation of medical progress. However, even if a device is truly clinically outstanding, if its effects and complications have not been proven with scientific published data, then, with apologies, it cannot be called a good method. Surely you would not want to undergo surgery with a method that, regardless of your own will, may make you a test subject for the latest techniques and technologies?
Medicine is a science, and it has no fads that change from moment to moment. In medicine, there are no secret techniques belonging to one clever doctor alone. Among countless new treatments, only those that are objectively recognized by other physicians, then improved and supplemented, and finally standardized are academically recognized as effective. Modern medicine has advanced through the efforts of countless physicians who came before us.
New machines appear, and some quietly disappear from the market. When choosing liposuction, you should not expect a method to be highly effective simply because it is new, without years, or even decades, of academic data.
If you have read this far, I trust you will be able to understand the liposuction methods being performed at each clinic. In closing, I hope this has been of some small help in choosing a good clinic.
The sweltering heat and the tedious monsoon season have already become a thing of the past, and autumn, the season of reflection and harvest, has arrived. The autumn leaves on faraway Seoraksan are probably taking on colors just this clear, don't you think? Though it is only a photograph, I hope you will join me in feeling the vitality of nature's clean air and colors, with gratitude that we, too, as living beings, are alive together with nature. Click the photo and you will find yourself already deep in the mountains. Thank you.
Source : Updates and advances in liposuction. Stephan PJ, Kenkel JM.Aesthet Surg J. 2010 Jan;30(1):83-97; quiz 98-100. Review.
References :
Medicine Has No FadsLiposuction Methods
[Dr. Wonho Jung, Director of Venus Clinic]
