The State of Liposuction

Miles Graivier, MD, FACS is Director of the Graivier Center in Atlanta, Georgia.

Given the advances we've seen in the liposculpting/ fat reduction arena in the last several years, can you offer insight into the state of liposuction? Is it still a viable procedure?

Dr. Graivier: The answer is a definite and unequivocal “yes.” Liposuction performed with tumescent infiltration is still the gold standard for body contouring. Liposculpting with large or small volume fat reduction as well as fat grafting when necessary has continued to evolve. Precision in techniques has improved as well as technical advances in liposuction assisted devices (Laser, Ultrasound, Waterjet, Power, Vibratory) have improved results with safer, often higher volume fat reduction with increased skin contraction, and less downtime. Improved cannula design and a better understanding of body proportions that sometimes need addition as well as subtraction has led to improved results. Liposuction with body sculpting offers a much greater volumetric reduction than non-invasive fat reducers, usually with a one-time treatment.

Have there been any advancements that have altered or expanded the scope of liposuction?

Dr. Graivier: There is a variety of liposuction assisting technologies currently on the market that have a variety of powered, peer-reviewed level 2 studies showing good efficacy. Some of these studies show improved skin contraction and faster recovery and more preservation of the fatty layer architecture than tumescent liposuction alone, but the studies usually have a relatively low number of participants. These include laser-assisted liposuction, water Jet-assisted lipo, ultrasound-assisted lipo, power and vibratory-assisted lipo, and others on the horizon. Improved cannula design as well as mechanical breaking up of isolated fat with different cannulas prior to area specific liposuction can also be performed. Additionally, tumescent infiltration of varying volumes has improved safety by lessening bleeding and allowing better anesthesia with less lidocaine toxicity. All of these techniques as well as the precise addition of fat in selected areas has made liposculpting a much safer and more effective treatment.

What are your feelings on fat reduction devices that offer more targeted liposuction with less invasiveness?

Dr. Graivier: Most of the current non-invasive fat reduction devices target smaller areas such as the central abdomen and hip area. Most of the unipolar or multipolar RF-based technologie,s even with the addition of electromagnetic fields, are designed to target the deeper fat and require four to eight treatments to show results. LED-based technologies also require multiple treatments and have not demonstrated apoptosis of the adipocytes. Some devices (Coolsculpting, Focused ultrasound, and fixed arm focused field RF) have demonstrated apoptosis. Coolsculpting and focused ultrasound are usually recommended as single treatment regimens, but have a percentage of lower responders. Focused field RF usually takes four treatments, as well.

In addition, most of the non-invasive fat reduction devices show varying decrease in mid-section circumference in the 4-15cm range. The average in most of these studies is 7cm circumferential reduction. Based on these results, the results are less striking and variable as compared to the more invasive liposuction techniques. The trade-off instead is the lack of downtime, pain, and recovery associated with liposuction.

Can you offer a brief rundown of how you counsel patients regarding liposuction?

Dr. Graivier: While liposuction is an excellent answer for body contouring, it is only one piece of the puzzle. When I talk with patients, I emphasize that a holistic approach is necessary. Good nutrition as well as maintenance of a healthy lifestyle with exercise and a healthy diet is the only way that we, as a team, can be successful. A common statement from patients is: “I have heard that after liposuction when you gain weight, that you gain it in other areas.” My response is, “You said when you gain weight. If you maintain your diet, exercise, and healthy lifestyle, then you will not gain weight anywhere. I will do my part. I just need you to do yours.”

What's your take-home message about the utility of liposuction and newer liposculpting procedures and their future in aesthetic medicine?

Dr. Graivier: Newer liposculpting techniques and technologies are continuing to evolve. These offer more and more precision and deliver safer and better results. We now have better contour with addition as well as subtraction, better methods to achieve skin tightening, and methods to successfully address cellulite.