Over the years, liposuction has evolved into one of the most popular tools in the body-beautifying arsenal. Fortunately, this method has become even safer and more useful as time goes on. Most liposuction is done under general anesthesia in controlled surgery centers by board-certified plastic surgeons.

    While we refer to this broad category  of  body sculpting as ‘liposuction,’ there are many methods that fall under its aegis, like ultrasound-assisted liposuction, standard liposuction and laser-assisted liposuction, which is marketed under several trade names, including Smart-Lipo.

    “Both the laser and ultrasound devices emulsify the fat and help it break down for easier suctioning. However, laser liposuction is more limited in its applications,” explains Dr. Terry Myckatyn, a plastic surgeon with Washington University School of Medicine.

    The best candidates for that, he says, are patients with small amounts of fat and good elasticity to their skin. Myckatyn has used the laser-assisted liposuction in his office on necks, and he says it works well in younger people without excess skin, but isn’t practical for someone with larger amounts of fat, loose skin or stretch marks, who will still need skin removed. People who want liposuction because their stomachs protrude post-childbirth often have weakened and separated abdominal muscles that need repair, in addition to liposuction. “Non-surgeon physicians who do the laser-assisted liposuction in their office can’t offer the other procedures that may be needed, such as the tummy tuck,” Myckatyn says.

    He cautions that the laser should be used only by a plastic surgeon proficient in regular liposuction and familiar with the body’s tissue planes. “If the laser is too close to the skin, there can be heat injuries,” Myckatyn says. “The skin can scar down to the tissue below, creating dimples, and those are hard to fix.”

    Dr. Judith Gurley, a plastic surgeon in private practice, doesn’t use laser-assisted liposuction because of its limited application, but she finds ultrasound-assisted liposuction a useful tool. She agrees that liposuction should be done in a controlled setting, like a surgery center. “That way, I can handle large-volume fat removal, keep it safe, and provide a painless surgery while the patient sleeps,” she says. “At the same time, I can do any skin tightening or lifting required.”

    She says the techniques and cannulas have become more sophisticated, allowing for very smooth contours. Frequently, liposuction is part of a total approach that may include a breast lift, tummy tuck or buttock lift. The key is not taking too much fat and doing it in a broad area to keep the contour smooth, Gurley explains. “What I can do in an hour in the OR might take three hours in an office. Fixing a deformed liposuction job is very hard because you can’t put the fat back.” An extra advantage of having the plastic surgeon do the liposuction in a controlled setting is that some of that fat can be reinjected into smile lines, hollow cheeks, lips or dark circles under the eyes.

    Dr. Michele Koo with Aesthetic Surgery Institute cautions prospective patients not to expect liposuction to be a silver bullet. It’s a good tool, she says, especially when combined with other procedures to achieve an overall look. So how does a person know what he or she needs and who should do it?

    Koo recommends coming to the surgeon with an open mind. Choose a board-certified plastic surgeon, and visit several. Ask how many cases he or she has done—and where. Ask to see before and after pictures from at least five patients who have had similar procedures and who have similar body types. Then ask to talk to patients. A real patient will give you a more realistic idea of what the surgery and recovery are like.

    “Keep in mind that while you can achieve results with liposuction that you can’t get with exercise (such as eliminating hereditary fat deposits like saddle bag thighs), you can also get skin sagging and slight asymmetries,” Koo says. “Sometimes less is more; we can always remove more fat, but it’s hard to fix if we take out too much. Liposuction by itself often won’t be enough to meet your body goal. It may be one part of an approach that also involves removing excess skin from the tummy or arms.” She advises being your own advocate. You must feel confident with the honesty and experience of that doctor. Trust your instincts and be open to his or her assessment.