Comparative study highlights pros, cons of liposuction methods

NATIONAL REPORT — Results of a prospective, single-surgeon study comparing three different liposuction methods indicate an ultrasound-assisted technique offers superior efficacy relative to both suction-assisted liposuction (SAL) and waterjet-assisted liposuction (WAL). Ultrasound-assisted liposuction (UAL) was also associated with minimal intra- and postoperative morbidity, but is accompanied by some trade-offs that include longer procedure time and increased expense of the ultrasound equipment, says Robert J. Troell, M.D.

Dr. Troell evaluated the three techniques in consecutive groups of 50 patients each and analyzed multiple intra- and postprocedural endpoints. All of the cases were performed using the manufacturers' specifications and recommendations for equipment use and under local anesthesia with oral sedation (~95 percent) or IV sedation (~5 percent). For all three methods, patients had liposuction at an average of three anatomical sites.

The revision rate was similarly low for all three groups, and there were no serious complications. UAL resulted in the greatest amount of fat removal and highest patient satisfaction, and it ranked favorably relative to WAL and SAL in evaluations of intraoperative and postoperative discomfort and postoperative bruising.

A 30-year-old patient before (left) and nine months after VASER Liposuction and buttock fat grafting. (Photos credit: Robert Troell, M.D.)

"Outcomes were favorable for all three techniques. Importantly, however, the UAL patients were most happy with their results, probably because UAL removed the most fat and has enhanced skin tightening, and also because there is less chance of indentations when performing UAL compared with SAL using standard cannulas," he says.

STUDY METHODS The patients enrolled in the study ranged in age from 18 to 65 years. About 80 percent of the procedures were primary liposuction and the rest were revisions. With a few exceptions, the patients were ASA class 1 or 2.

"Safety is key when performing liposuction, no matter what technique is used. Therefore, the vast majority of my cases are performed with just local anesthesia and oral sedation, and all candidates undergo a comprehensive preoperative evaluation for medical clearance," Dr. Troell says.

SAL (Medco) was performed using a superwet technique (1 cc infiltration fluid per estimated 1 cc of fat removed) with a standard cannula (Medco), not microcannulas. The UAL cases were done using a third-generation 36,000 Hz ultrasound platform (VASER, Sound Surgical Technologies) and a solid probe. WAL (Body-Jet, Human Med) was performed using 2.5 mm and 3.5 mm infiltration cannulas and 3 mm to 5 mm suction cannulas.

Dr. Troell prepares his tumescent solution for SAL and UAL procedures using 75 mL to 100 mL of lidocaine 1 percent, one ampule (1 mg) epinephrine, and 10 cc to 15 cc 8.4 percent sodium bicarbonate. Since twice as much fluid is used for infiltration when performing WAL, the tumescent solution is prepared using 25 to 50 percent less lidocaine. Patients receive a maximum lidocaine dose of 45 mg/kg, although the dose is reduced taking into account potential drug interactions and other risk factors for lidocaine toxicity.

Dr. Troell says he treats all of his liposuction and fat-grafting patients with a seven-day perioperative course of antibiotic prophylaxis using oral cephalexin and clindamycin.

"The need for antibiotic prophylaxis in liposuction is yet to be proven, but I have never had a single infection utilizing this regime," he says.