A deep dive into modern liposuction: PAL, Microaire, Renuvion and more

Among the most iconic procedures in plastic surgery, liposuction is undoubtedly right at the top of this list. Liposuction has consistently been in front of the public eye because of the many decades of amazing results it has provided for women and men alike. This powerful procedure offers an effective solution for removing areas of stubborn fat that can't be tackled using diet and exercise alone.

Due to its undeniable popularity, this range of procedures is constantly evolving to keep up with modern advancements within the field. With new technologies being introduced year after year to enhance or improve liposuction, the sky's the limit for what we can expect from the future.

To gather further insight into the evolution of liposuction and its bright future within the specialty, we reached out to ASPS Member Surgeons Katerina Gallus, MD, FACS, and Suzanne Trott, MD, for their perspectives.

The modern evolution of liposuction

From its initial introduction in the 1970s, liposuction has maintained its position as one of the most popular and effective plastic surgery procedures available.

"Liposuction remains popular because it is the gold standard for removing stubborn areas of fat that aren't responding to diet and exercise," said Dr. Gallus. "Almost everyone has an area – for some big, for others small – that is the last place you can lose weight from no matter how healthy you are."

Its ability to eliminate stubborn fat is exactly why it remains one of the most popular plastic surgery procedures each year.

"Liposuction has retained its popularity because it really is the only effective way of removing fat," said Dr. Trott. "Noninvasive procedures just don't work well enough."

When thinking about patients for whom modern liposuction would work best, it's important to realize that you should already be at a healthy weight before surgery.

"The patients that are already exercising and trying to eat healthy, cutting back on alcohol will have the best results," said Dr. Trott. "If someone is already on a regimen and taking care of themselves, then liposuction is the final piece of the puzzle."

Unfortunately, one of the most common myths in plastic surgery is that liposuction is for weight loss.

"I always point out that liposuction is not a weight loss procedure," said Dr. Gallus. "It is best in those who really want to enhance an area that is tough to improve with diet and exercise."

Surprisingly, many of the most significant improvements in liposuction are actually decades-old, tried-and-true methods.

"The big advances in this field were made in the late 1990s with super wet and tumescent techniques, as well as the Microaire power-assisted liposuction system, or PAL, which allows the fat to be removed in a more even fashion to give a better result with less surgeon fatigue," said Dr. Trott.

Modern inventions, such as noninvasive CoolSculpting, are less popular, as the results that patients can expect from them are less compelling than liposuction.

Power-assisted liposuction has remained the top-of-the-line technique for completing modern liposuction procedures in partnership with the unique skills and techniques of the individual surgeon.

"I personally use the SAFE liposuction technique developed by an ASPS member and leader in our field, Dr. Simeon Wall, Jr.," said Dr. Gallus. "It employs power-assisted liposuction, but really focuses on the technique because, in the end, the surgeon holding the device is what matters, not the technology."

One key shift within the contemporary field of liposuction involves the use of adjunct procedures to boost results.

"The one technology that does add to results is Renuvion, which uses heated helium and radiofrequency to 'shrink wrap' tissues," said Dr. Trott. "I think it helps tremendously in patients who might otherwise get subpar results because of loose skin, especially in the abdomen, neck and arms."

Another major shift that we've seen over the last several years within the field of liposuction involves the perception and expectations of the patients pursuing it.

"I think that patient expectations are high for liposuction due to the availability of skin tightening adjuncts, the evolution of high-definition techniques and patients' understanding of the recovery and timeline to achieve results," said Dr. Gallus.

Unfortunately, in an age of filters and Photoshop, the expectations for liposuction have become warped.

"I do think patient expectations are higher than they used to be because of all the false advertising of results, filters and false information," said Dr. Trott.

Another evolution within the field of liposuction is the introduction of new weight loss medications, such as semaglutide and tirzepatide. These medications can be used prior to undergoing liposuction to amplify results, especially if the patient is struggling with weight loss while maintaining a healthy lifestyle.

"I recommend that a lot of these patients look at tirzepatide or other weight loss medications to get a jump start if they are already working out and eating healthy," said Dr. Trott.

The future of liposuction

It's easy to see that this field will continue to evolve as new technology emerges with the established core methods remaining tried-and-true. This can apply to both liposuction and adjunct procedures that are used in tandem to boost your results.

"I think the gold standard remains power-assisted liposuction, and we are at a point where combining therapies such as skin tightening under the dermis or from above – like radiofrequency microneedling – is employing all the technology we have at this stage," said Dr. Gallus.

Getting the most from modern liposuction

As with any plastic surgery procedure, there are steps you can take both ahead of time and following your procedure to make the most of your results. Here is what our experts would recommend.

Don't forget that liposuction is actual surgery

While many modern liposuction procedures can be done under local anesthesia rather than general anesthesia, it's important to remember that it's still considered an operation.

"Understand that this is still a surgical procedure, and you will be sore afterward," said Dr. Gallus. "I think the average patient underestimates the recovery. Expect a couple of weeks of discomfort, six weeks of swelling and at least three months before seeing anything approaching a final result. This all can depend on the area being addressed, the amount of fat removed, any procedures done at the same time and then the variable of how well or fast an individual heals."

Always consult a board-certified plastic surgeon who is an ASPS member about whether or not liposuction is right for you.

Take the time to rest and recover

Following a liposuction procedure, always make sure to plan ahead and set yourself up for success with adequate rest and relaxation. This can involve taking enough time off work, preparing compression garments for after the procedure and bringing in a friend or family member to help you recover.

"I counsel them that they will need about 10 days of 'no plans,'" said Dr. Trott. "That's not 10 days in bed, but 10 days of no obligations because she will be sore and tired. You should also have someone with you that first night recovering if you have any type of anesthesia."

Compression is your new best friend

Following any liposuction procedure, you will experience discomfort, pain and swelling. One method to control this is to wear adequate compression garments immediately following the procedure.

"You should be in some kind of compression for six weeks," said Dr. Trott. "The initial garment I put on my patients has zippers but as soon as I can, I switch them to the second-stage garment that I created. 'The Vixen' in my Lipo Queen shapewear line usually gets all the areas and is thin and comfortable and is seamless under clothing."

The future of liposuction is here

Liposuction remains one of the most popular procedures in plastic surgery and shows little sign of declining. This ever-evolving procedure is beloved for its effective results that can rid patients of even the most stubborn fat that can't be removed using diet and exercise alone.

With its steadfast popularity, this procedure will continue to remain at the forefront of surgical advancements. It's exciting to consider how this specialty will continue to evolve over the next several years as improvements are continually made and more effective adjunct procedures are introduced.

To find a qualified plastic surgeon for any cosmetic or reconstructive procedure, consult a member of the American Society of Plastic Surgeons. All ASPS members are board certified by the American Board of Plastic Surgery, have completed an accredited plastic surgery training program, practice in accredited facilities and follow strict standards of safety and ethics. Find an ASPS member in your area.