Liposuction Explained: Scientific Weight Loss Methods from Tumescent to Ultrasonic Technology

Liposuction:

Excess fat in obese patients mainly accumulates in the abdomen, waist, buttocks, inner and outer thighs, breasts, inner upper arms, calves, chin, and neck. This fat accumulation causes localized bulging, which in mild cases affects physical appearance, and in severe cases, excessive fat accumulation can lead to sagging, such as an "apron-like" deformity of the abdomen. This not only affects aesthetics but also causes inconvenience in work and daily life. Liposuction can be used to treat localized fat accumulation and bulging.

Liposuction is a new cosmetic surgery technique developed in the 1980s. It uses negative pressure liposuction or ultrasonic liposuction to remove excess subcutaneous fat tissue, thereby improving and beautifying the body shape.

French physician Illiouz first successfully used liposuction for weight loss in 1977. Liposuction, initially based on Kesselring's "sharp" cannula and n-liouz's "blunt" cannula, was divided into "sharp method" and "blunt method." The difference lies in the side holes of the cannula tip; the former is as sharp as a blade. The "sharp" cannula has a lower suction negative pressure, which can "cut" fat but can easily damage blood vessels; the "blunt" cannula has a higher suction negative pressure, "pulling" fat out from around blood vessels. Currently, "blunt" cannulas are mainly used in my country. Later, liposuction was further divided into "dry method" and "wet method" depending on whether medication was injected into the suction site. The "dry method" involves directly aspirating fat from the treatment site under general or epidural anesthesia. Its advantages are that the treatment effect can be judged more accurately and the amount of fat removed can be easily controlled. However, this method results in more blood loss, with blood accounting for about 40% to 50% of the aspirated volume, and it is difficult to perform in outpatient settings, so its application is less common. The "wet liposuction method" involves injecting a local anesthetic containing adrenaline (lidocaine or novocaine) into the treatment area before liposuction, with or without general or epidural anesthesia. This reduces postoperative pain and intraoperative bleeding, with blood loss accounting for approximately 20%–25% of the amount of fat removed. It can be performed on an outpatient basis and has become widely used and developed.

In 1987, Klein proposed the "tumescent liposuction method" based on the "wet method." The "tumescent method" involves injecting a large amount of low-concentration local anesthetic (0.05%–0.1% lidocaine), a 1:1000 adrenaline solution, sodium bicarbonate, and physiological saline locally before liposuction. It has advantages such as less blood loss, safety, rapid removal of large amounts of fat, and longer anesthesia time. It is currently the most widely used liposuction procedure.

In 1992, Italian physician Michele Zocchi pioneered ultrasonic liposuction. This procedure combines ultrasound with tumescent manipulation. Ultrasound waves are applied to loose, swollen fat, causing it to emulsify, which is then suctioned away. This method has the advantages of minimal blood loss and few complications, but it has low liposuction efficiency and a long operation time.