Vancouver, British Columbia — Despite a raft of newer body contouring modalities now available, tumescent liposuction remains the gold standard in this regard, according to one expert.
"In terms of body contouring, if one wants to see permanent, predictable results in a safe and cost-effective manner, tumescent technique liposuction still remains the most effective method," says David M. Zloty, M.D., F.R.C.P., clinical assistant professor of dermatology at the University of British Columbia.
A matter of experience
"The main tenets of tumescent liposuction are, first, one must choose patients very carefully, because safety should always be the prime consideration," he explains. "In our facility, we only operate on American Society of Anesthesiologists (ASA) class 1 patients."
Furthermore, he says that in his practice, "We do not accept any patients who want large volume or weight reductions. We don't choose those patients any longer" in part because the established nature of his practice allows him to be more selective.
In addition to safety, Dr. Zloty says, "We strive for a very smooth, uniform final contour. We achieve that by using very tiny cannulas - averaging 2 to 4 mm outside diameter. And most of our suctioning is now done with 2 and 3 mm cannulas. Because we're not doing the big volume reductions, we don't need larger cannulas."
To perform tumescent liposuction as efficiently and effectively as possible, he says, "One needs to have either a good assistant or oneself who is putting the tumescent mixture into the fat compartment very uniformly. One wants to make sure that the contour change the tumescent mixture causes occurs in a very uniform fashion. That means that one doesn't want a large amount of anesthetic in one area and none in the next. Not only will this lead to patient discomfort, but because one may have changed the overall look of the contour, one might also have a problem with accurate fat extraction."
In terms of assuring an excellent cosmetic result, Dr. Zloty says, "That's mostly in the hands of the physician. How obsessive is he or she in ensuring very even fat removal? That's done by visually inspecting the site constantly, employing careful palpation of the treatment site using the non-dominant hand and accurately estimating the volume one had anticipated removing" when drawing near the desired endpoint.
As for variations on tumescent liposuction, Dr. Zloty notes that powered, ultrasonic and laser-assisted liposuction are now available.
"All those variations, particularly the ultrasonic and powered, have come about either to increase the ease of fat extraction, to increase safety or to improve the final cosmetic result. But none of those modalities increase safety above and beyond the standard tumescent technique. They certainly do not improve on the final cosmetic result. And laser-assisted liposuction is an experimental device, so it doesn't have any practical applications for patients yet," he says.
However, Dr. Zloty says that some newer options may provide benefits in increasing the ease of fat extraction for the physician, especially in areas that are very fibrous, such as male breasts or male flanks, particularly in bodybuilders or in previously treated areas.
Mesotherapy is more controversial, he says.
"Mesotherapy basically refers to the injection of any substance into the fat layer below the skin for either medical or cosmetic purposes. It started in France around 1952, and is actually recognized as a medical specialty there since about 1987. But French doctors are using mesotherapy to treat things like migraine headaches and chronic joint pain. They were not using it for aesthetic purposes initially," Dr. Zloty says.