What are the different options available?
Traditional tumescent liposuction as described remains the gold standard. One variation adds an electric motor to the cannula to reduce manual effort (power assisted liposuction or PAL). This method lessens surgeon fatigue and appears to cause less swelling and bruising.
Ultrasound assisted liposuction (UAL) is another variation on standard liposuction. It adds sound waves internally through the cannula to emulsify fat cells prior to their removal by suction. It was originally claimed to be more effective in certain areas of the body where fibrous tissue makes fat removal more difficult. However it can cause skin burns and abnormal fluid collections called seromas. It is less popular today and interest in it has largely been supplanted by the development of external ultrasound assisted liposuction. Ultrasound energy applied externally to the skin prior to liposuction is believed to loosen the attachments between fat cells to facilitate their removal. Although this avoids the problems associated with the internal ultrasound, the efficacy of external ultrasound is speculative and has not been proven by comparative clinical studies.
The most recent variation on traditional tumescent liposuction adds laser energy to the process. It has been marketed under the brand name SmartLipo. Laser energy is introduced under the skin through a cannula to break up fat cells. The laser also heats up surrounding tissues as a side effect and can cause skin burns. This equipment has been widely marketed prior to proof of efficacy in clinical trials. There has been only one reputable scientific study so far that compares SmartLipo with traditional tumescent liposuction. No difference in results was found between the two types.