Let’s face it. We would all like to be fit and trim as effortlessly as possible. Unfortunately, Americans are not generally known for their stellar dietary habits and exercise regimens. It is therefore no surprise that liposuction remains in the top three most commonly performed cosmetic plastic surgical procedures year after year. In fact, there has been a 65% increase in the number of liposuction cases performed over the past ten years.

The media is always keen on reporting on the latest and supposedly greatest techniques to remove unwanted fat. Sadly, they are frequently involved in promoting techniques that are at best unproven and at worst come with a high complication rate and low patient satisfaction rating. Because we all would prefer a quick fix, we don’t always make the right choices. For example, the media and the public have been fascinated with lasers for a very long time. When laser energy started being promoted for use in liposuction (SmartLipo) procedures, doctors and patients alike were excited. I contained my excitement and waited for the data. Because lasers involve generation of heat, I was concerned that the complication rate may be higher. The claims about skin shrinkage also seemed over-hyped.

It turns out I was wise to avoid the bandwagon. While laser liposuction remains popular to some degree, particularly among non-board certified clinicians, many aesthetic plastic surgeons have already abandoned its use. It seems the skin shrinkage that was so highly touted is minimal and temporary. Additionally, the claim that it is well tolerated without anesthesia seemed to be false, based on my experience observing treatments. Add to that the possibility of skin burns, and I will happily continue to perform the tried-and-true method of standard wet liposuction, as do more than half of the board certified plastic surgeons in a recent survey conducted by the American Society for Aesthetic Plastic Surgery (ASAPS).

Ultrasound-assisted liposuction (UAL) and power-assisted liposuction (PAL) were developed to make fat removal less labor-intensive for surgeons. These modalities also allowed surgeons to remove fat from fibrous areas more thoroughly. The slightly larger incisions and potential for burns with UAL once again do not make the trade-offs worthwhile, in my opinion. Only 20 percent of surveyed surgeons preferred PAL over standard liposuction. Over half of the surgeons that previously favored UAL no longer use this technique. The operative times are longer for both, and I feel shorter anesthesia times lead to quicker recoveries.

The newest technology to hit the fat reduction arena (Zeltiq) uses externally-applied suction devices that cool the skin and fat to levels that result in the fat dissolving over a period of weeks following the treatment. It is done as an outpatient in an office setting. It sounds very appealing, but it is costly and only very small areas can be treated. It generally requires more than one treatment and the reduction in the fat layer is subtle. Most of my patients seek more significant results than are provided by this type of treatment.

Lastly, the injectable fat dissolvers have led to much disappointment and in some patients I have seen, significant harm. Most commonly referred to as Lipodissolve, this treatment is not FDA-approved. A preparation known to dissolve fat is injected into desired areas, and over time, the fat dissolves. Where it goes is still debated. I have seen brown-scarred patches and incomplete results.

Most importantly, before seeking any body contouring surgery, find plastic surgeons that are board certified by the American Board of Plastic Surgery and members of the American Society of Plastic Surgeons (ASPS). By doing so, you can rest assured you will be cared for by a well-trained and qualified doctor.

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