Tumescent liposuction vs. Laser liposuction : Which is the best?

In Episode #3 of my CosmeticSurg Video Blog I discuss the difference between two types of liposuction: tumescent (suction) liposuction vs. laser/ultrasonic assisted liposuction. If you are considering laser or ultrasonic liposuction you must watch this video to understand why these new technologies may not necessarily be as good as regular tumescent liposuction!

Traditional tumescent liposuction

Tumescent liposuction has been around well over a decade and allows the surgeon to have complete control of the amount of fat being taken out.

The  tumescent liposuction technique is mechanical as it involves the surgeon using a long rod called a cannula to extract the fat. The motion is a continuous back and forth rhythm to remove the fat.   Since the motions are repeated over the course of 1-3 hours, your surgeon must be in good aerobic shape to give YOU a good result! Honestly, this is one reason why some surgeons do not use this technique.

While the basic technique used in tumescent liposuction has not changed, the size of the cannulas used to extract the fat have gotten much slimmer over the years. In the past, surgeons used larger 5mm cannulas, but  this sometimes resulted in lumpy or uneven results. Most surgeons now use 3mm or smaller cannulas. This will increase the length of the surgery as it does take longer to remove the fat from small cannulas, but the results are well worth the longer surgical time! The thinner 3mm cannulas produce excellent and consistent liposuction results. With thin cannulas, traditional tumescent liposuction can achieve the smoothest and most even result possible.

Laser and ultrasonic liposuction

The new technologies for liposuction technique include laser liposuction and ultrasonic liposuction. They emit high energy that liquefies and destroys tissue around the cannula. I do not think these technologies are worth the risks they pose to the patient. Both of these techniques essentially melt the fat under your skin. As they melt the fat, other tissues are damaged. I am not a fan of damaging tissue or fat cells that are not being extracted. Often times, the extracted fat could be used for fat injections to rejuvenate another area of the patient’s body. These technologies destroy that possibility. Additionally, these high energy ultrasound and laser technologies can have complications such as burning, and results can be very unpredictable as it is impossible to tell how much damaged tissue is left behind.

Best technique is tumescent liposuction with slender cannulas

In summary, the best technique available for liposuction is the traditional tumescent liposuction technique with small diameter cannulas. It has stood the test of time. Sometimes the latest is not the greatest. I perform hundreds of liposuction procedures each year and I do not remember the last time a patient asked for a touch up for lumpiness or unevenness. Thin cannulas give you the best chance to get the result right each and every time!

By Dr. Ricardo L. Rodriguez MD Board Certified Plastic Surgeon Cosmeticsurg Baltimore, Maryland Ricardo L. Rodriguez on American Society of Plastic Surgeons.

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69 thoughts on “Tumescent liposuction vs. Laser liposuction : Which is the best?”

  • Samantha says:

    Hello Dr. Rodriguez, I had tumescent liposuction 6 weeks ago on my stomach and inner thighs and I can see already that I have all these dents on my stomach and a long indented lines along my inner thighs. My thighs also look like they aged 10 years and look quite wrinkled (which they didn"t before surgery). This was the surgery note regarding my stomach area - "Abdomen was infused with tumescent fluid approx. 800 CC"s. The upper and lower abdomen was treated with 3:38 of "internal ultrasound" with 200 CC"s aspirate. Fat was minimally suctioned from lower area." The board certified surgeon that I used told me after 3 weeks to stop wearing the garment as the stomach issue might have been caused by it. I have stopped wearing it but every day my stomach looks worse than the day before. Is there anything that can be done after the fact to correct indents caused by liposuction? And what is internal ultrasound? Is that different than tumescent? Thank you!
    • Dr. Ricardo L. Rodriguez says:

      It looks like the surgeon used ultrasound liposuction. The tumescent infiltration is to make the tissues numb. The problem with Laser liposuction is that it causes a lot of heat damage to the surrounding tissues and the healing process can have too much scarring. Your indentations are probable due to scarring as 200cc fat removal really is not much at all. In your case the solution may be fat grafting or skin excision, but I would need a lot more information to make a judgment. If you are interested in further information, call the office at 410 494-8100 for a virtual consult
  • Diana McGraw says:

    Dr. Rodriguez, I found your video very helpful but wanted to challenge you with a question. You mentioned that laser liposuction causes a lot of tissue destruction. Does that include the destruction of fibrous septae? Wouldn"t that be benefitial for cellulite reduction? Releasing fibrous bands, reducing the number of fat cells, and stimulating the growth of new collagen?
    • Dr. Ricardo L. Rodriguez says:

      Apologize for the late reply. If Laser worked for cellulite, I guarantee you many plastic surgeons would be rich by now, and I certainly would be doing it. Laser liposuction can result in excessive scarring that increases pull on the skin. Fibrous septae are flexible and adaptive, scar is tight and inflexible. The new "collagen" is mainly type 3 collagen, the one predominant in scar tissue.So yes, laser stimulates new collagen formation- scar collagen.
    • Dr. Ricardo L Rodriguez says:

      Sorry about the delay in answering, I don't use this from for patient contacts I will put you in contact with Leeza, our patient coordinator. Her email is leeza@cosmeticsurg
  • Sorn phoukieo says:

    I am interested in a liposuction for mainly my tummy and possibility under my arms. I would like to get an idea of the cost before I commit. My friends are going to Thailand for tummy lipo this September. I am trying to compare price and the pro and cons of over sea procedures vs in state procedures.
    • Dr. Ricardo L Rodriguez says:

      Contact my office at contact@cosmeticsurg.net for pricing info. I recommend against overseas surgery. Any surgeon can have complications. But if you are out of country you cannot control the quality of follow up or the hospital you will be treated at. Many people do well, but when something goes wrong it's a disaster because adequate care will be very hard to find.
  • Keith R Moser says:

    Doctor thank you. Im a 65 year old male with a weight no fat problem 355lbs of a problem. Result, extreme back issues related to back my weight. Problem is there are now so many places it's like a Starbucks on every street corner. How do I find a like you a great surgon. Help me Please.
    • Dr. Ricardo L Rodriguez says:

      Keith: Your BMI is too high for plastic surgery. You need to control your fat problem and/or lose weight. At this point you should consider bariatric surgery, then after you have lost 100 pounds consider plastic surgery for the excess skin.
  • hans hailey says:

    Hi, I found your video very helpful in understanding the process, but I do have a question. How can laser assisted liposuction result in sepsis? I'm an attorney and I have a client who suffered this problem.
    • Dr. Ricardo L Rodriguez says:

      Mr. Haley: Thank your for your interest in my blog. There are many things which could have caused infection in this case completely independent of the use of laser liposuction. Your medical expert will be able to pore into the case and give you a better idea of a likely cause of infection in this particular case. Laser liposuction causes a lot of tissue destruction which can result in diminution of vascular supply, release of inflammatory mediators, large areas of "dead space" (not literally dead, more like open space), and even actual dead tissue, all of which can be contributory to infection.
  • Lisa Mcghee says:

    I'm considering liposuction for the abdomen area. Which is the best option for a woman over 40? What are the relative costs of each? Which procedures do you perform?
    • Dr. Ricardo L Rodriguez says:

      Lisa: These are a lot of questions because there are a lot of options. Secondly, I would have to have a better general idea of your condition now such as the condition your skin, your muscles, how much fat, etc. I will have Kelly at kelly@cosmeticsurg.net get in contact with you.
  • Theresa says:

    I forgot to add that I also would like to have my thighs lipo. Would this along with what I've mentioned in the below previous comment of what I would like to have lipo be called a mommy makeover, and be done on the same day. Also, what is the down time for everything to be done with tumescent lipo. Could you let me know approximate price range, so that I'll know what to expect with lipo for thighs, tummy, waist, muffin top, bra fat area, and back fat area. Thanks.
    • Dr. Ricardo L Rodriguez says:

      Theresa: I will have Kelly at kelly@cosmeticsurg.net get in contact with you to answer these questions.
  • Theresa says:

    I am currently having chemo for breast cance, but after I am finished with chemo I would like to get tumescent lipo. Is it safe for me to get this lipo after chemo, and if so how long should I wait after chemo before doing it? I would like to have my tummy (lipo or tummy tuck-which is better), muffin top area and waist lipo, and bra fat area on sides lipo, and back fat lipo. Can all these areas be tumescent lipo at the same time? And would it be called the mommy makeover? You should do a page comparing between smart lipo and the lap band weight loss surgery. I was trying to decide between those two. I'm 5'4" and weight 207, and am looking for answers. Thanks
    • Dr. Ricardo L Rodriguez says:

      Theresa: First of all, best luck on your therapy. My daughter is a twice cancer survivor so believe me when I tell you I will pray for you. First get healthy then contact us. But it is very good to focus on the future and how you will overcome this. I do not like smart lipo. I have seen so many bad problems with it. I have a separate blog post on it. Anyways, keep us posted!
  • Theresa Jones says:

    I'm interested in tumescent lipo of the abdomen. Can this procedure ne done under local anesthesia or sedation.
    • Dr. Ricardo L Rodriguez says:

      Theresa: Sorry for the delay in answering. I'll have Kelly at Kelly@cosmeticsurg.net contact you. We do most of our cases under IV sedation. If it is a small area such as the lower half of the abdomen we can do it under local, but if it is the entire abdomen we do IV sedation.
  • lucille says:

    Hola Doctor: Muchas gracias por su respuesta. Otra pregunta si es posible, usted conoce al Doctor Contantino mendietta en Miami??? si es si, quisiera saber si el sigue las mismas tecnicas de usted para realizar el aumento de gluteos con la grasa, si me recomienda. Vivo por la area de Miami.. Gracias Doctor.
  • Lucille says:

    Hola Doctor, Muchas gracias pro su respuesta. Por casualidad usted conoce al Dr. Constantino Mendieta en Miami? Si la respuesta es si, sabe usted si el es un buen cirujano para aumento de gluteos con la grasa? osea si sigue los pasos de como limpiar y inyectar la grasa etc...
    • Dr. Ricardo L Rodriguez says:

      Lucille: El Doctor Mendieta es bien conocido. Estoy seguro que sus procedimientos son diferentes a los míos, pero no puedo decirle exactamente como el hace sus procesos. Si he visto pacientes que no han estado contentos. Indisputablemente, el Dr. Mendieta ha hecho muchísimos casos, quizás mas que nadie. Le aconsejo que hable con otras pacientes antes de hacer su decisión final.
  • Lucille says:

    Hola Doctor Mi pregunta es, La tecnica " Lipolisis" es bueno para realizarse un aumento de gluteo con inyecciones de grasa???
    • Dr. Ricardo L Rodriguez says:

      Lucille: La respuesta simple es que no. La lipolisis mata a las mismas células que necesitas para aumentar el volumen del gluteo. Es mas, diria que crea riesgos innecesarios.
  • alica says:

    Hello doctor. What about Tickle-Liposuction? I am considering having this procedure to remove tummy fat and love handles.
    • Dr. Ricardo L Rodriguez says:

      Alica: It's not the racket, it's the Tennis Player that wins matches. Look at my different blog posts about definition of the back area and flank lipo, that is more important that whether you take out the fat with this cannula or that other one. Having said that, thin cannula traditional lipo has the least risk of post op deformities.
  • Ashok says:

    Dear Dr. Rodriguez, Your video presentation is highly enlightening. thank you very much. I am not aware that how old this video is, but recently i have been reading as well as talking to the clinincs that perform the procedure of Laser and/or Ultrasonic Liposuction. I am informed that the latest machines do not harm the tissues around the fat cells and break the cells to release the triglycerides, which are then passed through the urine. How correct is this information? I would be obliged if you could enlighten me on this. Thanks
    • Dr. Ricardo L Rodriguez says:

      Ashok: Don't take my word, read thru the comments in this same thread. Read also my other posts. No matter how old my posts are the science is the same. When a cell is broken up it release a ton of cytokines and DNA attached molecules that act as a huge danger signals to the surrounding tissue. The inflammatory cells then release a very brisk and intense cycle of tissue destruction and reparatory scarring. This process is unpredictable and varies with each patient. That is why you see some patients that do OK, others that don't do well at all. The statement "the triglycerides are passed thru the urine" is woefully incomplete in describing the tremendous cytokine cascade that occurs in the tissues after high energy liposuction techniques such as laser lipo or ultrasonic lipo.
  • Amanda Castaneda says:

    Hi doctor, I am curious to know when any type of liposuction is done on the legs, hips or thighs is cellulite reduced or eliminated as well?
    • Dr. Ricardo L Rodriguez says:

      Amanda: Unfortunately, nobody can promise to reduce cellulite. If they are, they want your money. Every few years there is a new cream or apparatus that supposedly takes care of cellulite. They all bite the dust.
  • breast augmentation utah cost says:

    Hello, I want to say thanks for the superb plastic cosmetic surgery guidance. Your website seriously helped me along with my decision to move forward with surgical procedures. This really helped me out. Thank You So Much.
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  • Sue says:

    Dr.Rodriguez I made an appt for next month to get the smart lipo procedure done. Am I making a wrong choice?
    • Dr. Ricardo L Rodriguez says:

      Sue: What can I tell you? Beware. Make sure you get very clear with the surgeon about how the cost of revisions would be handled if you needed them. If you were my daughter I'd tell you don't do it, but you are not my daughter, and that particular surgeon might be very good with Laser lipo. If you are having doubts, take your time, don't rush into it.
  • milla says:

    This has been extremely helpful and I ecstatic that I have happened upon your blog. Thank you. My sister and I have been looking into lipo for a long time and came across a fantastic deal. Unfortunately the fellow is not a plastic surgeon, but a PA who claims to have years of experience and thousands of lipo procedures under his belt, as well as many patient recommendations. The funny thing is my sister and I have had countless consultations with surgeons around our state and out of state and nobody has been as informative or honest as he has been about what to expect and what we can achieve. If he were a surgeon we would have been sold, but how do we verify his experience and is it worth the risk?
    • Dr. Ricardo L Rodriguez says:

      Milla: This fantastic deal may be one of those that is too good to be true- as in BEWARE! If he is a PA (Physician's Assistant), he is doing something illegal, as he is not supposed to practice medicine unless under the direct supervision of an MD, and he knows it. Having a blog like mine I get tons of emails from across the US from people who have had disasters from procedures done by non plastic surgeons. Thus I really would be reluctant to recommend it. Check out this blog post on why board certification is important. Regarding this PA, remember the word "con man" comes from "confidence man" as from somebody who gains your confidence before fleecing you. Trust your instincts, there is something that was not right and that is why you posted here.
  • jaki medley says:

    Dr. Rodriguez is there a certain weight u have to be... and generally what is a base price for this procedure i want to have it within the next 3 months or so depending on the price if it will be sooner than that. Your blog is very informing thank you so much. For the brazilian butt lift.
    • Dr. Ricardo L Rodriguez says:

      Jaki: The weight is not as important as your body proportions. We have done this procedure on slim mpatients as well as fulsome patients. We do his procedure a lo and love doing it. Kelly should be getting in contact with you over the next few days.
    • Dr. Ricardo L Rodriguez says:

      Roza: NONE of the liposuction techniques tighten skin. Not laser lipo, not ultrasound lipo, not tumescent lipo. Do not believe the promises of marketers. Not a single study has shown long term tightening of skin. Once skin has lost it's elasticity your choices are more limited. I do believe use of very small cannulae during lipo, as well as proper skin splinting and compression during the postoperative period help minimize skin changes after surgery. By the way, Adr is an interesting last name, where is it from?
  • Christine White says:

    Hi Dr. I was watching your video. It was very informative, and I appreciate that. A question that I have, that has come up in all the research I've been doing is what about body-jet lipo? I see so many different doctors talking about laser, smart, slipo and so many others, but not a lot talk about water assisted. What are your thoughts about it? Thank you so much! Christine
    • Dr. Ricardo L Rodriguez says:

      Christine: Body jet lipo is a brand new technique. I find it curious that the same people pushing the laser lipo are now pushing the jet lipo. If the laser lipo was so great, why are they now fooling around with the jet-lipo? If they stopped using laser lipo and they were so gung ho about it, why should I believe them now about the jet lipo? The main advantage of the jet lipo is that it injects the tumescent solution right as it suctions the tissue. The theoretical benefit is that the patient gets less of a fluid overload. That to me is counterintuitive. As a matter of fact I like the fact that tumescent injects so much fluid, as it acts as a reservoir of fluid that the body reabsorbs slowly over the next few days. After surgery, there is a lot of fluid loss and this fluid reservoir from the tumescent is a big help. In general, I like to wait a year or two after the dust settles and all the bugs are worked out of any new technology before I try anything, otherwise the patient and I are just guinea pigs beta testing a new medical device. Thanks for your interest!
  • Chicago liposuction says:

    I had Liposelection (Smart Lipo) performed on an outpatient basis with minimal pain, and some bruising and swelling. Within 2 months my inner thighs were back to normal. However, there was no change in the "little extra" that I carried there. Occasional swelling occurs that is easily resolved with massage. Major swelling occurs with vigorous exercise – exercise that is focused toward tighten the inner thigh muscles. It is not a procedure that I will have performed again. However, I am still on the look out for anything that will help with alleviating the cellulite on my thighs which is very embarassing to me. I would definitely recommend Tumescent liposuction.
    • Dr. Ricardo L Rodriguez says:

      Lester: I agree with you. We'd be happy to help you. We get lots of out of town patients, we are used to it.
  • ISA says:

    • Dr. Ricardo L Rodriguez says:

      Dear Isa: First of all, I have not seen you so I cannot make any judgements. Having said that, if you have a lot of stretch marks, there is no way laser lipo will tighten your skin like you wanted to. Your doctor has even warned you the result is not going to be what you hope for when he said: "...SINCE I HAVE SO MANY THAT IT WON'T BE THE SAME AS IF I HAD MY BELLY TIGHT WITH NO STRETCH MARKS" Is your doctor a Board Certified Plastic Surgeon? Here's how you can check, go to this link Did he offer the option of a dermatolipectomy? That would get rid of your stretch marks and give you tight skin. You would have a scar, but it would be better than laser lipo, which believe me, will not tighten your skin like you want to nor get rid of your stretch marks.
  • eve says:

    had lipo done 9 yrs ago, it left many lump in my arms and couple big one in my tummy. Lumps in my arms cause pain all the time. What can I do to remove them or smoothing them? Also I have hvy back and love handles and fat arms, I heard the back is hard to lip and results are so so, is it true? thanks
    • Dr. Ricardo L Rodriguez says:

      Dear Eve: That is a lot of questions, and I'll try to answer as best as I can. About the hard lumps, that is probably scarring. I would first try massage, or external ultrasound massage. Physical therapists do that kind of work, but you may need your primary doctor's referral. If that doesn't work the next step might be steroid injections. A Physiatrist, or Physical Medicine and Rehabilitation specialist may be able to help you with that. Failing that, a revision surgery may be necessary. As for the heavy back, I have had great success with the use of a serrated cannula. As for the flanks, read this post. I do a lot of cases like you and would love to hear from you. Email kelly@cosmeticsurg.net to get more info.
  • chris says:

    thank you for your explanation for the hard lumps and deformities that i'm experiencing after laser lipo. i haven't been able to get a straight answer up until now. my comment also includes a question, can these lumps be corrected by a skilled surgeon such as yourself or are all the botched lipo jobs out there dumbed to living with our poor decisions. thank you for any imput you can give me/us.
    • Dr. Ricardo L Rodriguez says:

      Without seeing you or pictures of your condition, there is no way I could express an opinion. Before taking any drastic action, try a compression garment for a while. sometimes these lumps settle down after a while, as they are scar tissue which can remodel with compression. These lumps can be improved, and I would encourage you to contact Kelly at kelly@cosmeticsurg.net to set up a virtual consultation.
  • Laser Lipo Dallas says:

    Hi, You determined very well between tumescent liposuction vs. laser liposuction. As per your explanation, tumescent liposuction is the best for reducing fatness from human body. But, I think sometimes new technique worth it as every technique has its benefits and drawbacks.
  • Dr York Yates says:

    Dr Rodriguez, very nice video and post. I subscribed to your interesting blog. I couldn't agree more regarding the disadvantages of laser lipo. I have been skeptical from the first time I heard about laser lipo. I recently had a rep bring a laser lipo device to demo on a patient I was doing lipo on. We treated a few areas with PAL and the abdomen with laser lipo. The experience was just as I would expect. The claims are decreased pain, skin retraction and improved results. In reality it seems to just be an additional step that costs the patient additional money ($90,000 for the platform plus $250 disposables for each procedure) and the surgeon more time. It took 45 minutes to do the laser of the abdomen. The pain was worse than the other areas. I saw no skin retraction. The consistency of the fat extracted was no different than traditional liposuction. The most important issues are #1 a board certified plastic surgeon with experience and #2 small cannulas. No need to destroy fat that you are going to remove anyways. Smartlipo and laser lipo are a great marketing tool but that is all.
    • Dr. Ricardo L Rodriguez says:

      Thank you for the comment! There's no better feedback than from a fellow professional. I saw your website and liked it. Here's a link to your website for those of you who live near Utah BTW, another thing that concerns me as far as the scarring and healing process is the destroyed fat that is left behind, because it is technically impossible to remove it all.
    • Dr. Ricardo L Rodriguez says:

      Baltimore, Maryland We have lots of patients from out of town and would love to hear from you!
  • JK says:

    Dr. Rodriguez- I have been struggling with horrible results to bad lipo I had done while I lived in Costa Rica. I wish I would have seen this video and/or researched more before I accepted whatever method they through at me. In fact, I have no idea what method was used. I simply trusted it because it took place at one of the best, well known, private hospitals in the country.All I do know is that Ii was left with an uneven, lumpy mess, so I assume it was a large cannula. Now I am faced with the frustration of doing ridiculous amounts of research this second time around and not knowing what to believe. I often feel defeated and hopeless, and as if many surgeons are out just to trick me and take my money.I know I'll never have a perfect body, but I hope, with helpful information, such as what you put in your videos and on your blogs, I can fix my bad situation and get some successful surgery as an informed consumer!! I was convinced that I wanted to try ultrasonic or laser assisted lipo to try and smooth out my lumps from my ambiguous lipo #1, especially since it talks about tightening skin (my tummy was left with loose skin after my lipo, when the Dr. told me it would bounce back at my age of 30 yrs). In addition many times I have seen it aimed at consumers, like myself, who have had previous lipo go wrong. I thought this was going to be my saviour until I started reading surgeons discuss the negative aspects. I assumed many of these surgeons were just saying bad things about new technology because they didnt want to upgrade their equipment yet still wanted to keep their own businesses flowing. You were the first doctor to thoroughly explain simply AND in detail why you are skeptical about these new, trendy, procedures in addition to explaining the benefits of your chosen modality, in this case, tumescent with a small cannula. Thank you so much for taking the time to do so. You will, for sure, influence my future decisions no matter what I choose. I feels empowering to be properly informed.
    • Dr. Ricardo L Rodriguez says:

      Thank you for your thoughtful response. My best advice to you is that before making the plunge again, interview a few doctors. Ask questions, and make sure the surgeon addresses issues such as complications. Good Luck