Liposuction has been used since the mid-1970s. First used by an Italian gynecologist, French surgeon Dr. Illouz was the first to apply the procedure to purely cosmetic cases. The technology has come a long way since then, but traditional liposuction remains a mainstay in plastic surgery.
The main goal of the evolving technology is to add some sort of power to the tip of the liposuction instrument to destroy the walls of the fat cells, causing them to break down and be more easily removed. There are three ways to break down the cells: ultrasound, laser energy and mechanical energy.
Smart Lipo is the laser instrument commonly used today. The laser destroys the integrity of the cells, and small holes behind the tip vacuum up the cell debris. The instrument slides easily through the tissue, requiring very little force from the surgeon. This differs from traditional liposuction in the sense that traditional lipo requires a lot of force, strength and repetition on the part of the surgeon. I've always joked that a good liposuction surgeon looks like a guy you wouldn't want to challenge to a fist fight.
The ultrasound-assisted device I prefer is called the Vaser. The tip of this device emits a small shock wave in front of the tip, which further breaks up the fatty tissue. A standard liposuction instrument is then inserted and it is very easy to extract the remaining fat. This technique is particularly useful for resistant fat that would be difficult or impossible to remove with a standard liposuction technique. One example is secondary liposuction, an area where lipo was used in the past. Another example is gynecomastia, an excessively enlarged male breast. In general, male fat is more attached and more difficult to remove than female fat, and gynecomastia is the hardest of all fats.
Both Power-Assisted Liposuction (PAL) and Tickle Lipo use mechanical energy to assist in fat removal. PAL uses a tip that thrusts in and out a fraction of an inch. Tickle Lipo orbits the tip in a circular motion. Both of these devices reduce the amount of force needed by the surgeon, allowing doctors to more easily perform the procedure with less force.
Both ultrasound and laser create some heat under the skin, which is the biggest risk of the procedure. This heat can cause burns that may be visible on the skin. Also, some fat can be destroyed but not vacuumed away, which can cause long-term swelling, fluid buildup, or indentations. For this reason, traditional liposuction is still used in nine out of ten cases.
When using fat as a harvesting material for grafting, as in the famous Brazilian butt lift, it is important to rely on traditional liposuction as well. Devices that "destroy" the fat as it is removed also eliminate any usefulness of the material as grafting material. The same is true for procedures where fat is harvested for its stem cell content.
As with most things, experience counts. Surgeons who have been performing the procedure for decades have the experience and judgment to select candidates well, perform the procedure perfectly, and ensure excellent results. While plastic surgeons are specifically trained in this procedure, it seems that many OPs, gynecologists, general surgeons and others often practice under the title of "cosmetic surgeon". We see many dissatisfied patients who have previously put price before experience and credentials. In my opinion, only plastic and reconstructive surgeons (preferably board certified) should do liposuction.
Most people who think liposuction would benefit them are right. It will. But it is a significant procedure, and claims of techniques that offer faster recovery and lower prices are not necessarily the wisest choices. Strong liposuction techniques are not necessarily better, and traditional liposuction is applicable in most cases.