1976 · Arpad Fischer, Giorgio Fischer
Suction-assisted liposuction (SAL)
How it works. Blunt cannula under suction, moved by hand
The surgeon moves a blunt cannula connected to suction by hand through many tunnels in the fat. Manually performed liposuction is now called suction-assisted liposuction. Illouz described even contraction of the skin over the tunnels, without wide undermining or skin removal.[1][2][3]
Suits. Localized fat in people of normal weight with firm, elastic skin.
Trade-offs. In a series of about 600 SAL cases, surface irregularities followed 8.2%, under-correction 5.3%, seroma 3.5% and transfusion 2.5%.
1987 · Jeffrey A. Klein
Tumescent liposuction
How it works. Dilute lidocaine and epinephrine injected into the fat before suction
Large volumes of dilute local anesthetic are injected before suction: Klein's solution held 0.05% lidocaine and 1:1,000,000 epinephrine. Tumescent infiltration puts in 2 to 3 mL of fluid for each mL removed. Blood loss is about 1% of the volume removed.[1][2][3]
Suits. Large-volume liposuction under local anesthesia. In Klein's 112 patients, 9.7 mL of blood was lost per 1,000 mL of fat removed, and the last 87 received no sedation by injection.
Trade-offs. Infiltration takes significant time, and finer cannulas take longer to remove a given volume.
1999 · A. Rebelo
Power-assisted liposuction (PAL)
How it works. Motor-driven cannula that moves back and forth
A powered cannula moves back and forth while it suctions. In Fodor's 1999 pilot, a nitrogen-powered cannula moved 2,000 to 4,000 cycles a minute over a 2 mm stroke.[1][2][3]
Suits. In a paired comparison, power cannulas shortened the operation, lowered surgeon fatigue and removed more fat per minute, with less pain, bruising and swelling afterward.
Trade-offs. In Fodor's 30 patients, PAL on one side and traditional liposuction on the other gave the same recovery speed and the same appearance.
1992 · M. Zocchi
Ultrasound-assisted liposuction (UAL, VASER)
How it works. Ultrasound energy breaks up fat before suction
Ultrasound has thermal and mechanical effects on fat, and the heat is carried off by the infiltrated fluid. Third-generation ultrasound (VASER) is used in about 20% of liposuction cases.[1][2][3]
Suits. In a randomized trial in 20 women, the VASER side had 53% more skin retraction per liter removed and 26% less blood in the aspirate than the suction-only side.
Trade-offs. Early UAL was largely abandoned after skin loss, burns and seromas. In the trial, pain, swelling and appearance did not differ at 6 months, and a 2025 review found little long-term data for better results.
1992 · D. B. Apfelberg
Laser-assisted liposuction (LAL)
How it works. Laser fiber in the cannula ruptures fat cell membranes
Laser energy ruptures the membranes of fat cells before suction. One system emits 1,064 nm and 1,320 nm wavelengths, alone or in sequence.[1][2][3]
Suits. In a split-abdomen trial in 10 women with mild to moderate loose skin, the laser side shrank more at 1 and 3 months and was tighter at 3 months.
Trade-offs. Five of seven studies in a systematic review reported benefits over traditional liposuction, but high risk of bias prevented a reliable conclusion.
2000 · Taufig
Water-jet assisted liposuction (WAL)
How it works. Water jet combined with suction
A jet of fluid is used with the suction cannula. In 41 consecutive office patients, fluid in and fluid out averaged 1.1 to 1, and lidocaine averaged 10.5 mg/kg for small volumes and 20.0 mg/kg for moderate volumes.[1][2][3]
Suits. Body contouring and harvesting fat for grafting: 23 of the 41 patients had their fat saved for grafting.
Trade-offs. In a randomized trial of 60 patients, 87% after power water-assisted liposuction were free of pain at day 4, against 3.6% after traditional liposuction, with less bruising. The 41-patient series called for larger, longer studies.
2009 · M. Paul, R. S. Mulholland
Radiofrequency-assisted liposuction (RFAL, BodyTite)
How it works. Bipolar radiofrequency heats the fat and the underside of the skin
Bipolar radiofrequency energy is applied to the fat and the underside of the skin during liposuction. Biopsies showed the fat liquefied before suction, small vessels coagulated and the tissue heated evenly. BodyTite is one RFAL device.[1][2][3]
Suits. Fat removal with skin contraction. One series of 50 patients also treated HIV-related fat buildup and fibrous male breast tissue.
Trade-offs. Two of the 50 patients had superficial burns.
2007 · A. E. Hoyos, J. A. Millard
High-definition liposculpture
How it works. Deep fat removed, then superficial fat thinned over and between the muscles
Fat is removed from the deep layer, then from the middle layer and between muscle groups. Superficial fat is thinned to outline each muscle group and show the surface musculature. Hoyos moved from suction alone to VASER to dynamic definition liposculpture over 18 years.[1][2][3]
Suits. An athletic look. Hoyos treated 5,052 patients from 2002 to 2019.
Trade-offs. Results were satisfactory in 84% of the first 306 patients, with 20 seromas and 9 burns at the incision ports. In a 2020 cohort of 417 patients, 276 had darkened skin, 125 seroma and 83 firm nodules, and 94% were satisfied.
1995 · S. R. Coleman
Fat transfer after liposuction
How it works. Fat removed by liposuction is injected elsewhere
Fat taken out by liposuction is processed and injected into another area. Coleman's controlled cases from 1987 showed a grafted facial crease still corrected after six years while the untreated crease stayed the same or deepened.[1][2][3]
Suits. Adding volume with the patient's own fat. In water-assisted harvests, about 90% of fat cells were alive one hour after removal.
Trade-offs. Surgeons reporting on 198,857 buttock fat grafts listed 32 fatal and 103 nonfatal fat emboli to the lung. Injecting into deep muscle carried more emboli, and the task force advised against it.