Christopher Chung, M.D.
American Board of Plastic Surgery
Chief Medical Officer
History has seen the evolution of different modalities and surgical adjuncts for liposuction. The earliest techniques used large (by today’s standards) cannulas. These devices were efficient in fat extraction but difficult to control and could easily result in contour problems.
As medical devices and expertise evolved, several different types of liposuction emerged:
SAL – Suction Assisted Lipoplasty
This regains the earliest and simplest technique. This process requires a hollow cannula that is connected to a vacuum system. Extraction is performed by simple mechanical avulsion. This technique may be less traumatic, particularly with smaller cannulas. Its limitations are realized in fibrous tissues and in the substantially greater physical effort required.
UAL – Ultrasound Assisted Lipoplasty
This technique requires an ultrasound source to use sound energy through a process known as cavitation to emulsify fat. This energy may be delivered externally through the skin or internally through an incision into the subcutaneous tissue. As a consequence of this energy being delivered, heat is also imparted to that issue. The heat, as well as the acoustic energy, may sometimes result in injury to neurovascular structure in the vicinity of targeted fat. This technique has great benefit in emulsifying denser fibrous tissue. The typical technique requires an emulsification step followed by an extraction step. While there is a substantial equipment cost, an additional concern is with the protection of adjacent tissues and skin surfaces during the delivery of ultrasound energy.
LAL – Laser-Assisted Lipoplasty
This technique uses laser energy to soften the targeted fat. It is more discrete than ultrasound with less collateral tissue injury potential. It can also have an adjunctive role in skin contraction by stimulating the collagen of the deep dermis.
PAL – Power Assisted Lipoplasty
This technique requires a power source that creates 2 to 4 mm of oscillating movement. The standard equipment has a frequency of approximately 6000 cycles per minute. This powered assistance substantially augments the extraction of fat while simultaneously reducing the effort required by the surgeon. By most accounts, this technique is more effective for removing large volumes, extracting fat from regions requiring revision and addressing fibrous areas compared to SAL. With all techniques, it is equal in speed of recovery and quality of outcome. When compared with UAL, it has no cavitation, no heat generation and therefore a greater safety margin.