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Liposuction has gone through several growing stages since it’s infancy in the early ‘80s. The initial idea came out of France, but the early days were far from perfect.

What is Liposuction

Liposuction is a procedure that removes excess fat from areas of your body, such as the abdomen, flanks, hips, and thighs. This procedure utilizes a long, hollow metal tube (cannula) with one or more holes near the end and a blunt tip. The cannula is attached to a suction device that pulls fat into the hole(s) and out of the body. The motion of moving the metal tube back and forth cuts goblets of fat free. The blunt tip keeps the surgeon from pushing through the skin, and also helps push nerves and vessels to the side, so they aren’t easily damaged.

The Evolution of Liposuction

Tools for this procedure had not been refined in the early ‘80s, and the best ways to numb tissues and decrease bleeding and bruising had to be sorted out. This first stage of development led to many sizes and shapes of cannulas to harvest the fat, as well as many scientific studies of suction pressures and better designs of suction machines to remove the fat from the body. Soon, studies were also being done to assess how much fat could be suctioned without too much blood loss or too much fluid or local anesthesia being given to patients.


As we got better at understanding the broader uses of this procedure, we advanced from more volume suctioning to true liposculpting of the body. It’s very important for patients to understand that it’s not so much what you take as much as it is what you leave behind. Anyone can over-suction fat from a body area, which will give the patient very uneven, rippled, or scarred-up tissues. That is not what we want; we are always trying to achieve a beautiful shape and silhouette. It is all a balance; the right amount of fat must be left behind, and the right amount of fat must be removed.

Liposuction for Fat Filler

Of course, as we learned to suction fat better, we were simultaneously learning how to carefully handle fat for reinjection as a volume filler. The science of liposuction kept marching forward at a rapid pace, for it has proven such a reliable procedure.

Ultrasonic Liposuction

The next phase of liposuction was ultrasonic liposuction, which used rapidly vibrating cannulas to blast apart fat cells that then were suctioned out. While ultrasonic was a big craze in the early 90′s it proved to have many down sides and added risks, without adding much to results. Ultrasonic has been dying a slow death over the last 20 years.

However, ultrasonic liposuction can still be beneficial in tough fat zones, such as gynecomastia or areas that have scar tissue from past liposuction, but it still has added concerns and technical difficulties, as well as significant expense that makes it a relatively uncommon way to do liposuction today.

The experience with ultrasonic liposuction is one good reason every Plastic Surgeon doesn’t jump all over the latest technology that comes out claiming to be the “end all” and “be all” in body contouring. It’s not the machine; it’s the skills of the person driving the machine, and aesthetic judgement is key when deciding how much to take versus how much to leave behind.

Power Assisted Liposuction (PAL)

The evolution of liposuction equipment has led to using syringes to create the suction, various generations of variable suction machines, and also auto-oscillating hand units that move the cannula back and forth rapidly to help remove the fat. These hand pieces are called PAL, or power assisted liposuction.

The PAL handles use electricity or air pressure to vibrate the cannula back and forth at the hand piece, so the surgeon doesn’t have to work his arm quite as much. Dr. Nelson is not a big fan of these units because they are a bit bulkier than a standard cannula and as vibrate too much in his hand. Still, power assisted liposuction is a reasonable premise, and some surgeons really like them.

Laser Assisted Devices

The most recent craze in liposuction is the laser assisted devices. Several companies have integrated lasers with cannulas, so the surgeon can laser blast the fat cells from the inside and then suction the material out or occasionally leave it in the body for the patient’s natural mechanisms to clear out the cellular and fat debris over time. Each company has it’s own laser wavelength(s) that they feel is better than the next company and market their device from that standpoint.

Although the concepts are excellent, after being around for many years now, these devices have not been universally adopted because many surgeons find their results to be just as good without the laser. Liposuction with the internal lasers takes more time and have more expense involved, so the surgeons want to feel confident that they deliver truly better results by adding that equipment expense to the patient’s care. Although the promise of these evolving technologies is great, it is being tweaked a great deal each year.

Know Your Surgeon’s Results!

The key for patients is to see many different results from a surgeon’s office and to love their aesthetic judgement on the result. It’s not so critical whether they go there with a PAL device, an Ultrasonic device, a Smartlipo device, or syringe liposuction. You want to focus on the results demonstrated.

The technological options are going to keep marching forward. One upside is that Dr. Nelson has been present from the infancy of liposuction (the first case he performed using liposuction was during his residency in 1985), and he has been involved with each step of the different techniques and technologies.

Dr. Nelson truly enjoys performing body contouring because he gets to sculpt and see the results right in front of him as he does the procedure. Liposuction can be as small as a few milliliters of fat to even out a rough spot, or as large as 20 liters (close to 4 1/2 gallons) in morbidly obese patients, which was done as a research project when he was a University staff surgeon in San Diego.

Obviously a little liposuction has negligible risks or recovery, and massive liposuction requires hospitalization. Most patients get between one to three liters of fat removed. These typical patients undergo liposuction as outpatient surgery.


During your recovery, you will wear a compression garment for 10 days to two weeks, and you will be back in the swing of things five to seven days after surgery.

This is not a complete coverage of every option in body contouring; whole books are written on that topic. But, hopefully, you now have a better understanding of where liposuction started and where we are currently. Let us know how else we can help you in your information quest.

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