In Liposuction, fat is removed via a cannula (a hollow tube) and aspirator (a suction device). Liposuction techniques can be categorized by the amount of fluid injection and by the mechanism in which the cannula works.
Here are the various types of mechanism of liposuction employed:
(1) Suction-assisted liposuction (SAL)
Suction-assisted liposuction is the standard method of liposuction. In this approach, a small cannula (like a straw) is inserted through a small incision. It is attached to a vacuum device. The surgeon pushes and pulls it in a forwards and backwards motion, carefully through the fat layer, breaking up the fat cells and drawing them out of the body by suction.
(2) Ultrasound-assisted liposuction (UAL)
In ultrasound-assisted or ultrasonic liposuction, a specialized cannula is used which transmits ultrasound vibrations within the body. This vibration bursts the walls of the fat cells, emulsifying or liquefying the fat and making it easier to suction out.
UAL is a good choice for working on more fibrous areas, like the upper back or male breast area. It takes longer than traditional liposuction, but not longer than tumescent liposuction. There is slightly less blood loss. There appears to be slightly more risk of seromas forming (pockets of fluid) which may have to be drained with a needle.
After ultrasonic liposuction, it is necessary to perform suction-assisted liposuction to remove the liquified fat. Pulsed energy delivery and a specialized probe makes ultrasound-assisted liposuction techniques to lessen the effects of exposure to ultrasound energy.
(3) Power-assisted liposuction (PAL)
PAL uses a specialized cannula with mechanized movement, so that the surgeon does not need to make as many manual movements. In all other respects, it is similar to traditional SAL.
(4) Twin-cannula (assisted) liposuction (TCAL or TCL)
Twin cannula (assisted) liposuction uses a tube-within-a-tube specialized cannula pair, so that the cannula which aspirates fat and the mechanically reciprocated inner cannula, does not impact the patient’s tissue or the surgeon’s joints with each and every forward stroke. The aspirating inner cannula reciprocates within the slotted outer cannula to simulate a surgeon’s stroke of up to 5 cm (2 in) rather than merely vibrating 1–2 mm (1/4 in) as in other power assisted devices. Superficial or subdermal liposuction is facilitated by the spacing effect of the outer cannula and since the cannulas do not get heated up, the potential for friction burns is eliminated.
(5) External ultrasound-assisted liposuction (XUAL or EUAL)
XUAL is a type of UAL where the ultrasonic energy is applied from outside the body, through the skin, making the specialized cannula of the UAL procedure unnecessary. It was developed because surgeons found that in some cases, the UAL method caused skin necrosis and seromas (pockets of a pale yellowish fluid from the body) analogous to hematomas (pockets of red blood cells)
XUAL is a possible way to avoid such complications by having the ultrasound applied externally. It can also potentially cause less discomfort to the patient, both during the procedure and afterwards; It also decreases blood loss; allows better access through scar tissue; and treats larger areas. However, it is not widely used as studies are not conclusive of its effectiveness .
(6) Water-assisted liposuction (WAL)
WAL uses a thin fan-shaped water beam, which loosens the structure of the fat tissue, so that it can be removed by a special cannula. During the liposuction the water is continually added and almost immediately aspirated via the same cannula. WAL requires less infiltration solution and produces less immediate edema from the tumescent fluid.