Liposuction techniques

Suction-assisted lipectomy
Negative pressure from a syringe applied to a small-volume, blunt-tip suction cannula is used to remove fat.29 Suctioning from the superficial layer should be avoided to prevent dimpling, hyperpigmentation, and contour irregularities.19 The superficial fat layer contains vertical fibrous septa, which would result in contour deformities if disrupted; however, exploitation of this anatomy with the liposuction cannula, also known as abdominal etching, has been demonstrated to produce highly defined abdominal aesthetic contours (eg, “6-pack abs”).33
Ultrasound-assisted lipectomy
Transmitting ultrasound energy to emulsify fat prior to its removal,34 ultrasonographically assisted lipectomy (UAL) can be advantageous in fibrous areas, such as the back, chest, and upper flank, that are more difficult to target in standard liposuction. UAL has shown marked benefit in treatment of gynecomastia. However, larger incisions are required in UAL and operations require more time. There is an increased risk of thermal injury to subdermal tissues due to the exothermic energy caused by ultrasound.
Laser-assisted lipectomy
Laser-assisted lipectomy (LAL) is performed by inserting a laser fiber via a small incision.35 Although complications of LAL are rare, 1 study observed a complication rate of 0.93% that included skin burns and a local infection.36
Power-assisted lipectomy
Power-assisted lipectomy is performed with an external power source, typically an electric vacuum pump.35 This technique can be advantageous for large volumes of tissue removal and in densely fibrous areas, as the power assistance reduces operator fatigue.