Innovative Cosmetic Surgery Center - Liposuction / Fat Transfer Specialist

Liposuction History

Liposuction was first introduced in the U.S. during the early 1980's. The early procedure was very barbaric with large cannulas that were designed to rip and tear large pieces of fat out. The goal was merely to reduce the large volumes of fat and not for body contouring. The results often left the patients with severe scarring, lumpiness, and a long painful recovery. Despite these problems liposuction had remained unchanged for nearly 20 years. In 2006 Laser Liposuction, utilizing the Smartlipo machine, was first introduced in the U.S. Dr. Malan was one of the first doctors in the U.S. to embrace this new technology and was the first doctor in the U.S. to offer certified training courses to other doctors desiring to learn this new technique. Patients who would have never previously considered liposuction were drawn to the new laser procedure that could provide contouring without the pain and lumpiness associated with traditional liposuction. In addition doctors now had the ability with the laser to help tighten loose skin. Medical device manufacturers seeing this new increased interest in liposuction began creating newer and better laser devices and other tools for removing fat that could provide even better results and tighter skin. The era of true minimally invasive body sculpting has finally come.

Types of Liposuction:

Traditional Liposuction:
All liposuction techniques used today is done with a tumescent technique. The word tumescent means swelling and simply refers to the injection into the fat layer of a mixture of sterile saline, numbing medication (lidocaine), and epinephrine that controls bleeding and lessen the toxicity of lidocaine. Even when liposuction is performed under general anesthesia doctors still use tumescent solution. With all forms of liposuction the first step is to make small incisions through which a large hollow needle is placed to fill the fat layer with the tumescent solution. Typically the doctor attempts to place these incisions in areas hidden by clothing or within a natural crease. Traditional liposuction refers to the use of a high-pressure vacuum attached to suction cannulas with large sharp openings. The high-pressure vacuum pulls large pieces of fat into the sharp cannula openings. The doctor moves the cannula back and forth and the sharp openings in the cannula tear the fat. Unfortunately this method creates tunnels and irregularities that can lead to lumpiness. While the cannulas are tearing fat they also tear nerves causing pain, blood vessels causing swelling which can prevent the skin from shrinking, and damages connective tissue. The connective tissue is those little bungee cords that hold the skin to the muscle. When connective tissue is destroyed you end up with loose saggy skin. Traditional liposuction is for removing large amounts of fat in the person who simply wants their clothing to fit better and doesn't mind lumpiness and loose skin. It is not the ideal procedure for body contouring.

Laser Liposuction:
Smartlipo is simply the brand name of the first laser liposuction device invented 10 years ago in Italy. There have been many improvements in the laser equipment since the original Smartlipo device and Dr. Malan was the lead FDA investigator in the latest of these devices. With laser liposuction the fat layer is first filled with tumescent solution and then a small laser fiber the size of a spaghetti strand is inserted into the fat layer. The laser energy boils the oil trapped inside the fat cells causing the fat cells to rupture. Once the fat cells burst they cannot reseal and are dead. The oil that is released can then be suction with a micro liposuction cannula. Because there is no longer a need to rip and tear large pieces of fat the micro cannula has small dull openings and is used under much lower vacuum pressure. This allows the doctor to remove the oil released from the fat cells without tearing blood vessels, nerves, or connective tissue. The result is less swelling, bruising, pain, tissue sagging, and smoother precise results without lumpiness. The laser also has the ability to generate heat under the surface of the skin. This heat when used correctly can cause the skin to shrink and allows new collagen to form. Tightening of the surface of the skin can diminish wrinkles, cellulite, and even stretch marks. It requires a great deal of expertise to provide just the right amount of heat to tighten without burning or scarring the skin. Unfortunately laser liposuction used alone does not provide the best results. The small cannulas used to remove the oil do not remove the majority of the ruptured and dead fat cells. These dead cells left behind create a layer of swelling between the skin and the muscle that prevents the skin from shrinking and reattaching to the muscle. So although the laser does provide for tightening to the surface of the skin the dead fat cells prevent the skin from sealing fully back to the muscle. This can cause the skin to bunch for example in the abdomen when in a sitting position. Using sharp cannulas to remove the dead fat cells would cause damage to the blood vessels, nerves, and connective tissue defeating the purpose of using the laser at all.

Body-Jet Liposuction:
The Body-Jet or water jet liposuction is the latest approach to less invasive fat removal and skin tightening. The Body-Jet relies on a powerful jet of tumescent solution that is sprayed in pulses from the tip of a microsuction cannula the same size as used in laser liposuction for removing melted fat. The clusters of fat break apart like grapes on a vine under the Body-Jet water pressure. Like the laser, the Body-Jet will not damage nerves, blood vessels, or connective tissue. Unlike the laser, the Body-Jet does not leave behind ruptured dead fat cells that cause swelling and prevents the skin from resealing back to the muscle below. Sealing of the skin back to the muscle leads to the most dramatic sculpting results. To create a real abdominal six-pack requires that the skin be firmly attached to the muscles. Sealing the skin to the muscles is vital in making the inner thighs not touch and for blending liposuction areas in which fat is not being removed. A large number of Dr. Malan's patients have had bad liposuction results done by another doctor and seek him out for corrective work. The Body-Jet allows the lumpy areas of old fat to be smoothed out as the water can gently separate scar tissue caused by the original liposuction surgery. The Body-Jet is so gentle that it removes the fat without damaging the fat itself thus allowing the fat to then be transferred to areas such as the hands, face, buttock or even the breasts. The fat can also be stored or used to harvest stem cells. The only advantage that the laser has over the Body-Jet is the lasers ability to shrink the surface of the skin for treating wrinkles, cellulite, and stretch marks. Dr. Malan developed the technique of first using the laser to shrink the undersurface of the skin addressing problems like wrinkles, cellulite, and stretch marks followed by the Body-Jet to gently remove the bulk of the fat and to wash out any dead fat cells left behind by the laser preventing swelling and allowing the skin back to seal back to the muscle. Doctors have traveled from all over the world to learn this technique from Dr. Malan.

Other Types of Liposuction Techniques:

Vaser Liposuction:
Vaser utilizes ultrasonic energy instead of a laser to rupture fat cells. It was actually available in the U.S. long before the laser but was not widely accepted by doctors. The ultrasound causes a great deal more heat than the laser and it is difficult for the doctor to control where that heat goes. Burns and fluid collections called seromas are a frequent problem with this device. Dr Malan, who was a national trainer for Vaser before laser liposuction became available, abandoned Vaser for the safer more effective laser and Body-Jet combination. Recently doctors have been promoting the use of Vaser to gently remove fat and then state that they are using that fat to transfer into the breast. Melted fat will not survive long term in the breast or any area and may increase the risks of complications. During the time that Dr. Malan was a trainer for Vaser he studied the use of Vaser to harvest fat for transfer into the breast. Unfortunately the Vaser fat did not survive and he has since abandoned that method. Other doctors promoting this technique may simply not have the experience to evaluate long term results as they themselves are new to fat transfer procedures to the breast.

Vibro or Tickle Lipo
This device utilizes a suction tip that oscillates side to side and up and down so as to loosen the fat much like the Body-Jet. Like all new techniques and methods, Dr. Malan is currently studying this technique to determine what is the best option for his patients.

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