Liposuction is just amazing. I had the opportunity to train in France with Dr. Gerard Illouz, the inventor of the procedure. For the first time, it was possible to reshape bodies and figures with almost no scarring. Different areas can be approached with liposuction. The waist and flank areas are extremely popular in men and also in women who have more of the “apple” distribution of fat. Also extremely popular are the hips and thighs in patients who have more of the “pear” distribution of fatty tissue. It is also extremely useful for suctioning of the inner knees, and the back in the bra area.  Liposuction is excellent for flank areas and for fibro fatty gynecomastia in men. Liposuction can make dramatic changes in the neck area, where the patient looks both younger and slimmer.



Liposuction can be performed under both local anesthesia and general anesthesia with the patient asleep. The choice depends on personal preference and also on the volume of fatty tissue to be removed. The surgeon initially performs tumescence which is the infiltration of a large volume of local anesthetic solution which also contains epinephrine to stop bleeding. This tumescence completely numbs the area.

The surgeon then inserts a suction cannula underneath the skin. The cannula is a hollow blunt ended metal tube with a handle on one end and some holes near the blunt end. This tube can have different lengths, different diameters, different numbers of holes, and different shapes and sizes of holes, but fundamentally it is a blunt hollow tube with some holes near the end connected to some kind of suction. When the suction is turned on, the fat does not flow into the tube. What happens is that the fat bulges into the holes. When the surgeon either advances or withdraws the tube, bulging fat is scraped off and accumulates in the tube. The suction moves the accumulated fat into the suction container. The surgeon’s skill is in the ability to guide this process to reshape the patient’s figure into a smooth and aesthetic shape. The quality of the results are very technique dependent.

When the fat is soft, all this works as expected. When the fat is quite firm, as it is in secondary liposuctions, some areas, some ethnic groups, and most men, the fat does not bulge well into the tube. When the fat does not bulge well, then fat does not scrape or accumulate well. Sometimes the fat can be so dense, as on the back, that very little free fat would be obtained, and other times the results are finally effective but the procedure requires a lot of  back and forth motion in order to get a result. In order to soften the fat in these situations and achieve an excellent result, ultrasonic energy is used in a device called a Vaser. The Vaser is a specialized ultrasonic probe which is used after the tumescence and before the liposuction. The probe is passed in the area which has received the tumescence, and it is used for a few minutes to break up the dense tissue. This loosens the fat and allows efficient and accurate liposuction in difficult areas with minimal bruising and minimal postoperative discomfort.



Removing the fatty tissue which connected the skin to the underlying muscle leaves the skin on a loose leash. Standing afterwards without correcting this would cause the tissue to sag. So the patient wears a compression garment temporarily to hold the tissues together so that they adhere without sagging. There are small bandages for approximately 4 days. All sutures dissolve and do not need to be removed. There is some swelling and bruising afterwards. Swelling comes down progressively, and bruising can take up to one month to disappear. Initial results can usually be appreciated in approximately 10 days, but final results can take up to 3 months or longer.

While this is an introduction, the links below provide authoritative sources for additional information on liposuction. There is a lot of information here, and it is reliable. You can email Dr. Friedenthal at or phone him at 1-415-752-2066 for further information and assistance.



Liposuction (ASPS) – With Animation Videos

Laser and Ultrasound Assisted Liposuction (ASPS)

American Society for Aesthetic Plastic Surgery (ASAPS)

Canadian Society for Aesthetic Plastic Surgery (CSAPS)


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