Liposuction, or simply lipo, is a type of fat-removal procedure used in plastic surgery. Evidence does not support an effect on weight beyond a couple of months and does not appear to affect obesity-related problems. The procedure may be performed under general, regional, or local anesthesia. It involves using a cannula and negative pressure to suck out fat. As a cosmetic procedure it is believed to work best on people with a normal weight and good skin elasticity. While the suctioned fat cells are permanently gone, after a few months overall body fat generally returns to the same level as before treatment. This is despite maintaining the previous diet and exercise regimen. While the fat returns somewhat to the treated area, most of the increased fat occurs in the abdominal area. Visceral fat—the fat surrounding the internal organs—increases, and this condition has been linked to life-shortening diseases such as diabetes, stroke, and heart attack.
Uses There are two different uses for liposuction:
Cosmetic
Cosmetic liposuction is used to change the body's contour or shape, to aesthetically improve the appearance of body parts and contour. Studies show it is not effective for weight loss. Benefits from cosmetic liposuction appear to be of a short-term nature with little long-term effect. After a few months fat typically returns and redistributes. Liposuction does not help obesity-related metabolic disorders like insulin resistance.
Reconstructive, medically necessary Reconstructive, medically necessary liposuction is used to treat lipedema, to remove excess fat in the chronic medical condition lymphedema, and to remove lipomas from areas of the body. If the documentation supports the liposuction for a medical reason (lipedema, lymphedema, lipomas) as reconstructive, and not investigational, experimental, or unproven, the claim is medically necessary and should be reimbursed. While most insurance companies may initially deny the claim, many can be won upon appeal if the documentation and the patient's need supports the criteria for reconstructive surgery. The techniques and terms listed below: tumescent, lymph-sparing, Tumescent Local Anesthesia (TLA), Water-Assisted Liposuction (WAL), Power-Assisted Liposuction (PAL), Laser-Assisted Liposuction (LAL) all apply to reconstructive, medically necessary liposuction.
Techniques
In general, fat is removed via a cannula (a hollow tube) and aspirator (a suction device). Liposuction techniques can be categorized by the amount of fluid injected, and by the mechanism by which the cannula works. If the removed fat is used as filler for the face, lips, or breasts, knowledge of the precise technique used to remove the fat is indicated. There are numerous types of liposuction. Some can be described as techniques or modalities. These techniques of liposuction are categorized depending upon the type of energy used for the liquifaction of fat. Often surgeons will use two or more of the different techniques below in the same session. Liposuction is frequently combined with other body contouring procedures to improve overall trunk proportions.
Abdominal etching Abdominal etching is a cosmetic liposuction technique intended to accentuate the visible contours of the anterior abdominal wall, including the linea alba, linea semilunaris, and tendinous intersections of the rectus abdominis. The technique was first described in 1993 and is generally discussed in the literature as part of high-definition liposculpture rather than as a weight-loss procedure.
Suction-assisted liposuction (SAL) This is the most generic term for liposuction. In the CPT manual it is referred to as "suction-assisted lipectomy" and includes codes: 15876–15879.
Micro-cannula This does not address a particular technique but the diameter of the cannula, a stainless steel tube which is inserted into subcutaneous fat through a small opening or incision in the skin. The outside diameter of micro-cannulas range from 1 mm to 3 mm.
Lymph-sparing liposuction This technique does not require a particular wand and is most often performed with either tumescent liposuction or WAL (below). It refers to the specific surgical technique, the skill of the surgeon, and the extensive training that is unique to removing lipedema fat. Because the scope is different for removal of lipedema fat versus cosmetic contouring, if lymph-sparing is not addressed in the surgical operative notes, a medical necessity review committee could determine that the procedure poses "a risk to the lymph system."
Tumescent local anesthesia (TLA)/tumescent liposuction This may be referenced either way above, but the technique is the same. This is an anesthesia technique recommended for lymph-sparing liposuction surgery. Tumescent Liposuction refers to the use of anesthesia during liposuction. The word "tumescent" means swollen and firm. By injecting a large volume of very dilute lidocaine (local anesthetic) and epinephrine (capillary constrictor) into subcutaneous fat, the targeted tissue becomes swollen and firm, or tumescent. This technique does not require a special or specific type of wand.
Power-assisted liposuction (PAL)
Referred to as "a vibrating cannula" in research studies, PAL uses a specific type of wand that creates an up and down, vibrating-like motion of the cannula to acquire greater fat removal. When compared to simple suction-assisted liposuction, PAL requires less energy for the surgeon to operate while also resulting in greater fat removal. It is commonly used for difficult, secondary, scarred areas, and when harvesting large volumes of fat for transfers to other areas. Note that techniques can be combined; for instance one could refer to the procedure as "lymph-sparing, tumescent liposuction using a vibrating (PAL) microcannula to treat lipedema."
Water-jet assisted liposuction (WAL) A specific technique and wand commonly used for patients who require lymph-sparing liposuction for lipedema. The lipedema fat is removed using a fan-shaped jet of water, which includes the anesthetic. In contrast to tumescent liposuction above, where the anesthetic solution is injected separately and beforehand, the WAL wand both injects the solution and suctions the fat. BodyJet is a Water-Assisted Liposuction system.
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