Hollywood movie stars have made liposuction seem mundane, so much so that it’s become commonplace. According to Cosmopolitan, liposuction was on the rise in 2020, and younger generations were taking note: in 2019 alone, 265 000 people got the procedure done on areas like their butt, stomach, and arms — and one out of every six of them was under 30 years old. The procedure is the second most popular cosmetic surgery in the US, right behind breast augmentation, it noted.

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While the nature of this procedure may raise gruelling images of stabbing-like gestures to dislodge the fat in the body, liposuction is really a far gentler elective surgical procedure, explains the New York Times. The cosmetic procedure involves removing fat deposits from under your skin with a long thin tube called a cannula. A separate article by the Times adds that, over the last several years, the procedure has become safer, in part because smaller amounts of fat are removed.

As experts at the Cleveland Clinic explain, liposuction is not an alternative to weight loss, but the procedure offers a way to a smoother, trimmer body for people with areas of fat that won't go away with weight loss or exercise.

According to the Cleveland Clinic, there are different types of liposuction procedures, including:

Below, we take a look at three of these methods: laser-assisted liposuction, PAL, and vaser liposuction. 

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For many years, liposuction has been the second-most commonly performed cosmetic procedure or surgical removal of excessive fat after massive weight loss, notes Frank Graewe Aesthetics. Professor Frank Graewe is a Cape Town-based plastic and reconstructive surgeon.

Speaking to News24, Graewe explains laser-assisted liposuction uses a laser to create heat around the tip of what’s known as a ‘laser diode’ to break down fat and help with skin tightening. 

“Laser liposuction has been around for a number of years and is not a new technique. It can assist with fat removal and skin tightening,” says Graewe.

To achieve good and consistent results with liposculpting, the professional performing the surgery needs to be knowledgeable of the anatomy of the body’s fat compartments, and experienced with 3D sculpting and with the equipment that is used. 

Graewe says traditional liposuction can be very efficient in removing fat and sculpting and body contouring. He adds:

“Liposuction on its own, and the trauma and inflammation it causes in the tissue, will lead to some extent of skin contraction and skin tightening already. Adding heat can further improve skin tightening. Adding heat and heat injury to the liposuction procedure will, on the other hand, also increase downtime and healing and the time to reach visible results.”

Graewe prefers to use power-assisted liposuction (PAL) to loosen and remove the right amount of fat, as this method doesn’t use heat or ultrasonic energy but has different levels of mechanical vibration to remove and loosen fat. It is also more powerful and advanced than conventional liposuction, he says. 

“If necessary, in older patients or patients with loose skin, I will then add radiofrequency, which can be applied with precision in the areas where skin tightening is needed. I prefer this to the Laser liposuction as it gives me more control,” he explains. In younger patients and patients with tight skin, Graewe prefers not to apply heat as it is not needed and because it leads to longer healing and recovery times.

If skin tightening is necessary, Graewe uses a radiofrequency device called Renuvion in most cases and sometimes Bodytight and Morpheus8. “Sometimes the skin excess is too much, and then I recommend surgical tightening in the form of skin excision, like a tummy tuck, Brachioplasty or thigh lift.”

Ultrasound-assisted liposuction, or vaser (vibration amplification of sound energy at resonance) liposuction, is an alternative to the techniques used in traditional liposuction. This ultrasound technology uses powerful waves to break apart and loosen fat from your deeper tissues so that it can more effectively be removed with a cannula during the treatment.

Dr Deon Weyer, Sandton-based plastic and reconstructive surgeon, explains: “Advances [in liposuction] has had this whole realm of what’s called energy-assisted liposuction and [with that] you get various forms - vaser, laser and power-assisted liposuction.”

Like traditional liposuction, vaser liposuction also liquifies the fat, but surgeons using this method refer to it as ‘emulsifying’ the fat - “you can see it [fat] as melting … so that’s why it was developed - just to make it more comfortable with less bruising to the patient.”

The downtime is exactly the same as traditional liposuction and you still follow the same steps, says Weyers. However, it is a longer procedure because a step is added to the surgery. “But besides having less bruising and less discomfort, the other benefits are that you have less bleeding, so you can remove a larger volume of fat than you can with traditional liposuction without having that much blood loss,” explains Weyers.

Another benefit of vaser liposuction is that heat generated by the ultrasound energy also creates a degree of skin and soft tissue tightening, which gives a better 3D-toned appearance, says Weyers. 

“The ultrasound-assisted liposuction has also opened up the whole realm of what’s called liposculpture, or high-definition liposuction, which is basically now an advanced technique which typically originates from Colombia … where you can now create even more toned appearances.”

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Ultrasound-assisted liposuction has also opened up the procedure to anyone - “it can be a thin patient; it can be a very overweight patient. Just because you get a better high definition it doesn’t have to necessarily be an overweight type of category patient,” he says. 

Weyers adds that laser-assisted liposuction has decreased a bit in popularity, due to some constraints: “You can’t do as much liposuction as you can, for instance with your traditional or ultrasound-assisted liposuction,” he says. “But … there you get a superior skin tightening. So, if it is a patient with more loss of elasticity, and loose skin, then laser-assisted liposuction will be superior to ultrasound-assisted liposuction or vaser.”

However, this is more costly as it adds another step to the surgery, and you are limited to the number of areas or volume you can remove in one setting. “Patients would potentially have to come back for a staged procedure to be able to address all the areas that they are concerned about.”

Weyers says that in South Africa, energy-assisted devices are becoming more and more implemented, although the vast majority of plastic surgeons in South Africa still opt for traditional or conventional liposuction, one potential reason being that many surgeons don’t have the cash flow to commit to buying these devices, as they are quite expensive. “But for us who do use it, it’s pretty much a gold standard internationally.”

Ensure you go to a professional

To have this procedure done, it’s important you see a plastic surgeon who is professionally trained. Says Weyers:

“There is a controversy at the moment in South Africa about GPs doing liposuction procedures. It is a plastic surgery procedure, or procedure that should be done by a specialist.” This is because plastic surgeons are best equipped to do the surgery and handle the energy-assisted devices and to handle and deal with any side effects or complications.

Laser Lipo is a non-invasive type of body treatment, which Graewe says can probably be performed by therapists in a salon. “It [uses] a Laser applied from outside to the skin to create heat with the purpose to dissolve or melt fat.”

However, Graewe says it can’t really be compared with liposuction, which is an invasive surgical procedure and can remove large amounts of subcutaneous fat during a single surgical procedure.

Laser lipo can be compared to cryolipolysis, also known as fat freezing, as well as external applied ultrasound and external applied radiofrequency, he adds. “Non-surgical body treatments can be used for small and limited areas. The main indication is probably for people with very small problem areas, who don’t want invasive procedures and downtime and who can’t afford surgery.”

However, with such types of non-invasive treatments, Graewe has seen that there can be significant complications and problems. “For example, Linda Evangelista, an international supermodel can’t work anymore due to complications after fat-freezing treatments, burn wounds after radiofrequency, ultrasound or laser treatments. Costs can spiral and become high due to multiple treatments performed as it is not a once-off treatment,” he says, adding:

“I don’t offer non-invasive body treatments at all in my practice, so I can’t give … first-hand experience. However, I frequently see patients who had non-surgical treatments and who are not satisfied or want more results and ask for surgical body contouring. 

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“My experience during surgery is that patients who had non-surgical treatments often have more subcutaneous fibrosis (scarring) that was caused by these treatments, and it makes liposuction and liposculpture or tuck procedures, like tummy tuck and facelift surgery more difficult to perform. This can also negatively impact surgical results.” 

Price depends on areas treated

Drum notes that “The costs of the treatment are determined by the number of areas you want to have treated, but medical aid does not pay for liposuction.”

According to Graewe, the cost for liposuction and liposculpture ranges - small areas can start from about R 30 000 upwards while large or multiple areas can cost around R 100 000.

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