Wouldn’t you just love it if a new painless, inexpensive, and permanent treatment for unwanted fatty deposits or cellulite was available? Many medical device companies and some unethical practitioners would lead you to believe there are already options such as these available. Unfortunately, they have ignored the old adage that science must come before commerce.

Many of these treatments continue to be discussed in the lay press and popular magazines. Consequently, unsuspecting consumers are duped into believing unrealistic results are available. I hope to dispel the myths regarding many of these newer techniques and provide sound advice regarding which fat reduction procedures are worth your time and money.

Over the past several years, more than one quarter of a million people have undergone liposuction in the United States, and that number has increased by 65 percent in the past decade. It has remained in the top three most commonly performed cosmetic procedures for many years. It is no wonder that patients are confused by the options for treatment, as there are so many available. I will discuss each current type of liposuction treatment below and discuss the benefits and downsides of each.

In 1982, liposuction was introduced to the US. The early techniques were done “dry,” but these days, fluid is infused into the fat prior to the fat being suctioned away. The infused fluid has medicine in it to induce numbness and constrict blood vessels so that minimal blood loss occurs. A metal tube called a cannula is connected through tubing to a vacuum machine. The cannula is inserted into the fat through incisions that are less than one-quarter inch long, and then the cannula is moved in and out of the fat to suction it away.

This form of liposuction is generally referred to as standard liposuction or suction-assisted liposuction (SAL). It is the technique that all other forms of liposuction are compared to. In a recent survey, the American Society for Aesthetic Plastic Surgery (ASAPS) reported that 51 percent of its plastic surgeon members favored this technique.

Power-assisted liposuction (PAL) is a form of standard liposuction that was developed recently. In this type of treatment, the cannula used to remove the fat is powered and creates a reciprocating motion up to 4,000 cycles per minute. This was developed to decrease surgeon fatigue and to treat more fibrous areas. Frankly, I have never found the need for it. Only 45 percent of ASAPS members use it and only 20 percent prefer it over SAL.

With either of these techniques, when multiple areas are treated, general anesthesia is generally employed and is the safest option, in my opinion. Good candidates for liposuction are healthy and not dramatically overweight. This procedure is generally performed as an outpatient. After surgery, you have to wear a compression garment for two to three weeks. Most patients return to work after one week and to sporting activities in three weeks. The benefits of this procedure are that it provides predictably good and significant results.

The downsides are that it is best performed under general anesthesia and results in bruising and swelling that can last up to two to three weeks. Other rarer complications include contouring problems such as rippling or divoting of the skin. This has become much less common as smaller cannulae are now used to remove the fat. This is much less of a problem when patients with reasonably good skin tone are chosen. Blood clots that can occur in the deep veins of the legs and travel to the lungs have also been reported. Higher risk patients for this complication are those who smoke, are obese, or take hormones.

Ultrasonic liposuction was introduced to the US in the late 1990s. This process involves heating the tissues, including the fat to be removed. VASER is a newer type of ultrasonic liposuction that requires less delivery of heat to the tissues. This technology uses solid probes that deliver energy to the fat that emulsifies or liquefies it through cavitation. The probes are larger than standard liposuction probes and require a guard to prevent skin burns, so the incisions used are slightly longer. Fluid is infused first and standard liposuction is frequently performed at the close of the procedure to remove the liquefied fat.

This procedure is also performed under general anesthesia as an outpatient. The purported upsides are that it is easier to remove fat from fibrous areas such as the upper back, and that larger volumes of fat can be removed. Personally, I have never found fat that was so fibrous I could not adequately remove it with standard liposuction, and I do not perform high-volume liposuction, as this has been deemed somewhat risky.

The downsides of this technique are that it takes longer in the operating room, the machine is expensive so fees are generally higher, and it can result in skin burns and subsequent scarring. Any of the other potential complications described above can also occur with this technique. Fifty-five percent of ASAPS members who have experience with this technique reported they no longer use it.

I believe laser-assisted liposuction (LAL) has received more hype than any other form of liposuction developed to date. There are many different types, but SmartLipoSlimLipo and Cool Lipo are popular brands. The public has been fascinated with lasers since Star Wars debuted. A laser is nothing more than highly concentrated energy in the form of light. Lasers generate heat and consequently emulsify or liquefy fat. This technique has been purported to tighten loose skin, but buyer beware! There is extremely little high quality data available to support any of these claims. In the one prospective randomized study available, no differences were noted in outcome between LAL and SAL other than a slight reduction in discomfort in the first two days following the procedure.

The laser-assisted liposuction procedure is also purported to be well-tolerated under local anesthesia with light sedation. I have witnessed this to be untrue in several cases performed while I was present. The heat element can lead to skin burns and scarring. This procedure takes a great deal longer to treat the same areas as SAL. In the one very small study published to support the skin tightening claim, the author was paid by one of the companies that makes the laser machine that was used.

Lastly and of great significance, the companies that make these devices very aggressively market them to non-plastic surgeons, such as obstetricians, dermatologists, and family practitioners. I believe they resort to this because only 12 percent of ASAPS members surveyed reported they have used this technology. Regrettably, I have seen many patients who have been deeply disappointed by their lack of result following these procedures. If it sounds too good to be true, it usually is. Until this technology is further researched and improved, I would avoid it.

Lastly, there are many non-invasive and minimally invasive treatments that have been recently developed or recently resurrected, none of which I am overly impressed with. Zeltiq is a new externally applied device that cools fat to a temperature that results in it dissolving over a period of weeks to months. It is applied for approximately 45 minutes to an area of concern. No anesthesia is required, and it is performed in an office setting. There are very few side effects reported other than temporary numbness of the skin and mild swelling. Only very small areas can be treated at a time.

One of the most well known plastic surgeon international speakers on liposuction stood at the podium at a national meeting last year and admitted he tried it on himself. He was underwhelmed and opted not to offer it to patients. He stated for practitioners that cannot perform surgery, it may be a worthwhile addition to their treatment armamentarium, but he felt that most patients expect a more significant result than what this treatment can provide.

Mesotherapy or Lipo Dissolve treatments have come and gone over the years. Let me say at the beginning that these treatments are not FDA approved. This technique involves injecting a medication through the skin into the fat layer in multiple areas without anesthesia. Over time, the fat in the area dissolves. My experience of seeing patients who have been disappointed by the lack of results has shown me that minimal result is obtained and problems with brown pigmentation of the skin in the treatment areas do occur, as well as contouring deformities. We do not know where the components of the dissolved fat end up either, so there remains a concern about potential damage to other organs. Steer clear for now.

Externally applied rollers, radio frequency devices (Thermage, Velashape, Exilis) and topical agents have all been recently marketed to decrease unwanted fatty deposits, tighten skin, decrease cellulite, or all of the above. There is no doubt that some degree of improvement can be gained from most of these procedures. On the plus side, they are non-invasive and low-risk. On the significant downside, they require multiple treatments over weeks, are several hundred dollars each, and provide only temporary results.

I realize that 90 percent of the female population over 30 has some degree of cellulite and that 100 percent of that majority does not want it, but these treatments truly represent marketing to the desperate. Unless you have unlimited time, financial resources, and dedication to maintenance treatments, there is still no reasonable treatment for cellulite.

Most anything that is worthwhile requires an investment of time and resources. My goal is to provide the most effective, studied, and proven techniques to my patients with the greatest degree of safety. With the currently available technology and treatments, I remain very happy with standard suction-assisted liposuction (SAL) and I have hundreds of very satisfied patients who agree with me.

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