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Micro-liposuction is the 'spot cleaner' of cosmetic surgery

Article-Micro-liposuction is the 'spot cleaner' of cosmetic surgery

Key iconKey Points

  • The goal of micro-liposuction is to remove ounces rather than liters of fat from ankles, knees, chins, necks, backs and upper arms.
  • The evolution of medical devices has enabled the advent of micro-liposuction and liposculpting.

Dr. Toledo
NATIONAL REPORT What do computers, cars, cell phones, and hearing aids all have in common? Answer: they're all getting smaller, and consumers are all the happier for the shrinkage. Cosmetic surgeons are responding to another growing trend in patients who want less – micro-liposuction. Improved technology, including smaller cannulae, ultrasound to help break up fat, and evolving technique have all enabled treatment of areas that previously were difficult, such as kneecaps, ankles, "back fat," and other "spot touch-ups."

PRECISION PROCEDURE "In the last two to three years, liposuction, once used predominantly to remove excess fat from overweight patients, has become a tool to enhance the near-perfect body parts of the already-fit patient," says Luiz Toledo, M.D., a plastic surgeon at the International Modern Hospital in Dubai, United Arab Emirates. According to Dr. Toledo, "The goal of micro-liposuction is to remove ounces rather than liters of fat from ankles, knees, chins, necks, backs and upper arms. By employing a disposable syringe instead of an aspirator, surgeons can be less aggressive and more precise. In some cases, that fat may [then] be injected into other areas of the body via liposculpting."

Dr. Toledo says that, with such precise technique enabling the treatment of very small, focal areas, "even skinny people who have localized fat deposits — the kind that do not disappear with diet or exercise — can finally have the bodies they desire."

The evolution of medical devices has also enabled the advent of micro-liposuction and liposculpting, says Angelo Cuzalina, M.D., Tulsa Surgical Arts in Tulsa, Okla. For these precision procedures, he says, "With laser devices, 'micro-liposuction' may not involve a 'cannula' but still involves use of very small instruments [1-mm diameter] to perform fat removal. Some would also describe it as removal of small areas of fat for very specific contouring of areas where the excess fatty deposits are minimal. Definitely, the opposite of 'high volume' liposuction in the heavier patient."

Beyond providing the benefit of increased precision for the surgeon-sculptor, adds Dr. Toledo, these "micro" procedures can be considerably easier on the patient: "Minimal trauma...means little or no pain, a quicker recuperation, less swelling and bruises."

Dr. Cuzalina agrees, noting, "micro-liposuction is for the patient who wants minor changes with less downtime. The smaller the cannula, the more precise liposculpting can be. Also, there is typically less chance for irregularities and seromas when performing liposuction using smaller-diameter instruments. The micro-instruments also improve how well we replace fat in addition to the skill by which it is removed."

TECHNIQUE TIPS The surgeons emphasize that there is an art to the redeployment of these micro amounts of removed fat elsewhere in the body, because with fat injection, what you see is not necessarily what you get. "The injected fat has a partial reabsorption of about 40 percent to 50 percent," Dr. Toledo explains. Therefore, to obtain an ideal result, the surgeon needs to inject more fat than appears necessary, to proactively account for this reabsorption. Even then, he says, it is sometimes necessary to "tailor" the result with a repeat procedure after a few months.

Dr. Cuzalina says that recently, the use of 1 mm laser-assisted liposuction has become popular with surgeons and patients, noting that these probes offer good control and are increasing in power as surgeons continue to make suggestions for their improvement. "One nice advancement with the newer energy liposuction devices," he says, "is the ability to remove areas of fatty excess from parts of the face, such as heavy nasolabial folds or even periorbital regions; previously, this was too traumatic. The 1-mm devices liquefy fat without the need for vigorous movement and therefore greatly lower the risk for bruising in delicate areas. Small areas of fat anywhere on the body that may require a minor touch-up are also candidates for these micro devices under local anesthesia."

Medical devices for micro procedures continue to evolve to meet the growing needs and demands, and "A variety of micro devices will inevitably create even more choices for surgeons in the future," says Dr. Cuzalina. But some of these devices are marketed to patients too early and, "More often than not, I have to advise against a particular new procedure that a patient has read about [because too often] early hype and hope is followed by the actual facts a few years later."

And therein may lie the micro-liposuction caveat. Dr. Cuzalina points out that, "The biggest problem for the experienced surgeon is realizing the limitations and not trying to over-promise the results."

Drs. Toledo and Cuzalina report no disclosures.

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