Tumescent liposuction or Laser lipo?

Hi. This is Dr. Ricardo Rodriguez, and today I want to talk to you about liposuction. You know, I’ve been hearing on blogs and, you know, answering questions from different blogs, and there seems to be a lot of confusion about the different technologies used in liposuction. It’s a large subject, it has a lot of variations, but I’m just going to focus today on the tubing that we use to do the liposuction with.

You know, liposuction, when it started, started with quite large tubes and the emphasis was on efficiency. The surgeon wanted to be able to take out a lot of fat quickly. The problem with that was that when they started taking out too much fat, you could get irregularities in the skin. And in the beginning of liposuction, as a matter of fact I remember a show on Oprah that had this woman that had a lot of irregularities in her skin from a liposuction and, you know, when you look at the size of the cannulas, and I mean, you can look at this and see the large holes in it, it’s easy to see how you could, you know, create a defect.

Now, this cannula, for example, you see how it has two barrels? The two barrels are so that you can guard yourself against the skin. In other words, it would put this barrel up in here, right up against the skin, and suck with the other one, and that way you could make sure that you are not sucking too close to the skin, so that you wouldn’t damage the skin. So obviously, you know, there had to be an answer to that and people started focusing more and more on finer cannulas.

So in the beginning of the 90’s, people started developing what was called a small cannula liposuction. And here’s one, and, you know, when you compare it to the other one, I mean you can easily see the difference in caliber. I mean how much smaller it is. And even the holes are smaller. This is what’s called a Mercedes tip, the tips are smaller. But, you know, in general it’s a much smaller cannula. This is, in particular, a 3mm cannula. With this cannula, I mean, you can pretty much stay free of trouble and liposuction as close to the skin as you want to and as long as you’re careful, you’re not going to get any defects. And, this is great. I used this a lot. As a matter of fact, I still use it.

But about 10 years ago, a friend of mine told me about this cannula that he was using for liposuction. The interesting thing about it was that the cannula was the cannula that we were originally using for infusion. In other words, you know you had the apparatus in here, and this goes to the tube, to the IV fluid, and it comes in under pressure and you have a little valve in here to make the fluid go, or not go, or stop it, but anyways, the point is that what goes in through these little holes – and again, I’m going to show it really close to you so you see how small the holes are – what goes through the small holes is just fluid. The fluid that we call the tumescent solution. So the tumescent solution goes in through there.

Now, you normally wouldn’t think that fat could go through there, like you could suck through fat. But the fact is, you can. And this friend of mine, Verne Weisberg, who now lives in Portland, in Maine, tells me about this cannula and I started doing suction with it. And believe it or not, it worked.

And, you know, it’s a little bit harder on you – you know, it tires your muscles more and you have to be in better shape, but the results were incredible. I mean, for the first time, I had really, really smooth results. And this is something I haven’t been able to find with any other technology.

Now, right around that time when I was starting to do that, came out Ultrasonic Liposuction. And ultrasonic liposuction was going to be the “end-all” and “be-all”… It’s going to be a great thing and everything’s going to be smooth because it just melts the fat. And then, you know, came the new machines and again, I started doing a lot of it, and I found that I was beginning to have tissue irregularities again. I mean, when I have been using the very small cannula, I wasn’t getting any. Now I’m using the newest and the best and this and that, and I’m getting problems again. So I said, you know, I’m just going to let this technology develop further.

And then now recently, the newest thing is the laser lipo. You know, that’s supposed to be great, too, because it just melts the tissue with laser. But the two techniques have something in common. The laser liposuction and the ultrasonic liposuction and it’s that they both destroy the tissue around them.

Now, I have a little illustration here that I’m trying to show you about how these work. Okay? For example, if you take a regular liposuction tubing, and it’s in fat – let’s say this is all fat right here – and the tube has negative suction, you’re suctioning here, so it has negative pressure. This is the direction of the pull so that when you have the suction through the little hole in the tube, you know, like I showed you in the Mercedes tip cannula, through that little hole, you can imagine the fat going in, and going back through to the tube so, you get that fat coming out and it just goes into a canister and that’s it, that’s how regular liposuction works.

With the newer liposuction techniques, including laser and ultrasound, the process is different in that what happens is you get a wand, they don’t even call it a cannula, it’s a wand, that comes in and at the tip it has – it emits energy and the energy can be laser, or ultrasound, but the end result of the energy, no matter how it’s delivered, is that it does its work by transferring the energy into the tissues and that transfer is ultimately transferred as heat. And it just melts the fat.

Now, you can do it in such a way so that it doesn’t melt tissues adjacent to it, but any one of these techniques can damage the tissue surrounding it. And, as a matter of fact, with ultrasound and laser, there have been, you know, burns through the skin. So, you know, it’s not without danger. But the important point to remember about this is that when the wand comes in, it leaves an area of destruction around it. It melts that tissue around it. And you’re never quite sure how big this hole is.

When I’m doing liposuction, I know how what it is, the hole is the diameter of my cannula, and that’s why the smaller the cannula, the less defects and the better the thing is going to look. With a melting, you don’t really know. And, you know, parts might be more melted than other parts. And then you come back, after you have done, you know, that melting of the tissue, and you come on in and you suck out the melted part.

What I’m concerned about is two things, number one that there’s a zone of damage around it that you don’t know how it’s going to heal. I mean, it’s just wasted tissue in there, and some of the tissue might survive, some of it might not. And, on top of that, you know, when you start getting close to the skin, you don’t know how the skin is going to react. Now, all these laser vendors and all that will tell you, “Oh, it’ll shrink the skin” and, you know, the skin shrinks because it’s been damaged and there’s going to be a process of scarring but there is some damage to the skin and as a matter of fact, when we went through laser through the face, the problem was that sometimes it was too much damage to the skin. And people would get red-faced for months and, you know, there were problems with it. Hardly anybody is using the full strength laser to the skin anymore.

Now, there have been, with ultrasound, at least, that I know of, you know, areas of skin that have died and you know big problems with it, too, so I don’t . . . I’m not really convinced that this is the best way to go. We have an older way which works very well and which is very predictable. There have even been comparison studies and the ASPS has put out a position paper where that so far, the results, the long-lasting results, between traditional liposuction and the newer forms haven’t been deemed to be that much better. So, you know, if you’re going to ask me – the older technique is still the gold standard. It’s safer. I like it better. And it provides for much more finesse.

Let me just show you, for example, when I do liposuction of the face, where I really want a nice result, I mean I can ridiculously thin with the cannulas. I mean, I’m using little cannulas like this big in the face. You know, and it works. Compare it to even a 3mm cannula and look at the difference. So, I mean, this technique can provide great results, it’s very dependable, and it’s my favorite technique.

I know that there’s always the newest and the greatest and all that but, you know what, what we do know is that it’s the newest, but what we really don’t know is if it’s the greatest. And if you ask me, the greatest is fine cannula liposuction.

Alright, well, thank you very much! This is enough for a Saturday. And I’ll try to make this blog as frequent as possible. I really, if you really want to know something, just drop by in the comments any question that you want me to answer and I’ll be very happy to answer them in video. I mean, it’s easy to explain, I can pull up a slide like this and sort of make it graphic and show you what I mean. But the most important thing is that you guys give me some feedback so that I know what subjects interest you.

Thank you!