09 January 2009

Suction Assisted Liposuction (SAL)
Suction-assisted liposuction is the standard method of liposuction. A small cannula is inserted through a small incision. It is attached to a vacuum device. The surgeon pushes and pulls it carefully through the fat layer, Laser Assisted Liposuctionbreaking up the fat cells and drawing them out of the body by suction.

Laser Assisted Liposuction (LAL)
Laser assisted liposuction which uses thermal energy to affect lipolysis has involved either of the Erchonia or Nd:YAG powered devices.

Ultrasound Assisted Liposuction (UAL)
Ultrasound Assisted LiposuctionAlso referred to as ultrasonic liposuction. A specialized cannula is used which transmits ultrasound vibrations and heat into subcutaneous fat. This vibration bursts the walls of the fat cells, emulsifying the fat (i.e. liquefying it) and making it easier to suction out.
  • UAL is a good choice for working on more fibrous areas, like the upper back, or male breast area
  • It takes longer to do than traditional liposuction, but not longer than tumescent liposuction
  • There is slightly less blood loss
  • So far, there appears to be slightly more risk of seromas forming (pockets of fluid) which may have to be drained with a needle
Internal UAL is the term used to describe the technique where a long metal probe, which may be solid or hollow, is inserted into fat through a large incision. Among those surgeons who do internal UAL, most rely on the use of general anesthesia or heavy IV sedation. Internal UAL has largely been abandoned because of the risk of full-thickness skin burns and severe scaring. The initial reports of internal UAL were unrealistically enthusiastic. After ultrasonic liposuction, it is necessary to perform suction-assisted liposuction to remove the liquified fat.

Power Assisted Liposuction (PAL)
Power Assisted LiposuctionPower Assisted LiposuctionPAL devices use power supplied by an electric motor or compressed air to produce either a rapid in-and-out movement or a spinning rotation of an attached liposuction cannula (specialized cannula with mechanized movement), so that the surgeon does not need to make as many manual movements. Otherwise it is similar to traditional UAL.

Twin-cannula (assisted) Liposuction (TCAL or TCL)
Twin-cannula Assisted LiposuctionTwin cannula (assisted) liposuction uses a tube-within-a-tube specialized cannula pair, so that the cannula which aspirates fat, the mechanically reciprocated inner cannula, does not impact the patient's tissue or the surgeon's joints with each and every forward stroke. In doing so it is gentler on both patient and surgeon by nature of design.

It allows decreased bleeding and bruising, faster recovery and reduced blood loss. The aspirating inner cannula reciprocates within the slotted outer cannula to simulate a surgeon's stroke of up to 5 cm. (2") rather than merely vibrates 1-2 mm (1/4") as other power assisted devices, removing most of the labor from the procedure.

Superficial or subdermal liposuction is facilitated by the spacing effect of the outer cannula and the fact that the cannulas do not get hot, eliminating the opportunity for burns.

External ultrasound-assisted liposuction (XUAL or EUAL)
XUAL is a type of UAL where the ultrasonic energy is applied from outside the body, through the skin, making the specialized cannula of the UAL procedure unnecessary.
It was developed because surgeons found that in some cases, the UAL method caused skin necrosis (death) and seromas, which are pockets of a pale yellowish fluid from the body, analogous to hematomas (pockets of red blood cells).
XUAL is a possible way to avoid such complications by having the ultrasound applied externally. It can also potentially :
  • Cause less discomfort for the patient, both during the procedure and afterwards
  • Decrease blood loss
  • Allow better access through scar tissue
  • Treat larger areas
At this time however, it is not widely used and studies are not conclusive as to its effectiveness.

Water-assisted liposuction (WAL)
Water Assisted LiposuctionWAL uses a thin fan-shaped water beam, which loosens the structure of the fat tissue, so that it can be removed by a special cannula. During the liposuction the water is continually added and almost immediately aspirated via the same cannula. WAL requires less infiltration solution and produces less edema from the tumescent fluid. The utility of this technology is under study and is currently not widely used.

Sutures
SuturesSince the incisions are small, and since the amount of fluid that must drain out is large :
  • Some surgeons opt to leave the incisions open, the better to clear the patient's body of excess fluid. They find that the unimpeded departure of that fluid allows the incisions to heal more quickly.
  • SuturesOthers suture them only partially, leaving space for the fluid to drain out. Others delay suturing until most of the fluid has drained out, about 1 or 2 days.
In either case, while the fluid is draining, dressings need to be changed often. After one to three days, small self-adhesive bandages are sufficient.

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