With liposuction, there has been a movement to limit the volume of fat removal with a single procedure to 5 Liters. Dr. Bartlett devised a method of removing volumes in excess of 14 Liters in a safe and predictable manner. Liposuction has become almost a form of art. It is not sufficient just to remove fat; the removal of fat is done in a way to give a stylized form.
Mechanically loosening fat from its connective tissue matrix with no thermal injury is one of the biggest advances in decreasing trauma for my patients. There have been several advances which have decreased blood loss and physical trauma of the procedure over the years.
There have been some newer procedures marketed and performed which have increased trauma by utilizing heat. Laser liposuction is extremely traumatic to the patient’s tissues. Recently a patient asked me to do a revision of her abdomen. The patient previously had the laser liposuction procedure. The subcutaneous tissue had been so trashed by the burning of the tissues that it was impossible to even pass the fluid infiltration cannula through it. 270 degrees Fahrenheit is emitted from the laser and this converts the subcutaneous tissues into something analogous to scorched earth. Because I could not push the small infiltrating cannula through the scarred tissue (much less a liposuction cannula) the revision could not be performed.
I have found a very atraumatic method to loosen the fat from its fibrous bed. I am able to use only 1/3 of the usual suction and still effectively remove fat. This decreases the trauma that the patient and the aspirated fat experience. In fact the patients tell me that they have no pain, or at the most a one out of a possible 12, (12 being the most severe pain) the day after surgery.
More fat is of good quality and can be used for fat grafting. This is a real benefit for those thin patients who wish to have their buttocks enhanced with fat grafting. In most cases they do not need to gain any weight to have enough fat to make a significant improvement.
Less trauma means the patient has less painful stimuli during the procedure. The amount of local anesthetic used is less and yet most of the patients tell me that during the procedure they had no discomfort.
Liposuction has evolved into a procedure that shapes a person not just one that indiscriminately removes fat.