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Liposuction and nonsurgical fat reduction modalities (ie, body contouring) are among the most commonly performed cosmetic procedures in the United States. Liposuction is an invasive surgical procedure in which adipose tissue is dislodged and suction is used to remove it. The procedure originally was performed with a regional nerve block or general anesthesia; a tumescent technique for local anesthesia now is used. There are several types of liposuction, each uses application of energy to allow for removal of fat. These methods include laser-assisted, power-assisted, and ultrasound-assisted liposuction. Abdominoplasty can be performed in combination with liposuction for management of loose skin. Nonsurgical fat reduction modalities include cryolipolysis, use of radiofrequency lipolysis devices, and ultrasonographic modalities. Cryolipolysis uses cold temperatures to achieve lipolysis, whereas radiofrequency lipolysis devices use heat to destroy adipose tissue. Nonthermal low-intensity, low-frequency ultrasonography uses mechanical methods to destroy fat cells. High-intensity focused ultrasound uses thermal methods. Body contouring procedures can be performed alone or in combination with other procedures.

Case 3. Charlie is a 45-year-old man with prediabetes, obesity, and hypertension. The prediabetes and hypertension have improved with weight loss. However, Charlie continues to have “love handles” and a “beer belly” that have not improved with exercise. He asks about options to help reduce or eliminate the abdominal fat. He asks if there is a noninvasive liposuction method.

Liposuction and nonsurgical fat reduction procedures (ie, body contouring) are among the most commonly performed cosmetic procedures in the United States.1 Although surgical liposuction remains the most commonly performed procedure for fat reduction, body contouring procedures have increased in popularity and offer alternatives to surgery.

Liposuction

The most common areas for liposuction are the abdomen, flanks, and brassiere line.1,89 Other areas include the arms, thighs, buttocks, and upper back (ie, buffalo hump).

Liposuction is an invasive surgical procedure that consists of use of a probe for mechanical dislodging of adipose tissue and then application of suction to remove it.90 Originally, this procedure was performed with a regional nerve block or general anesthesia. Because of the risks and complications related to use of general anesthesia, tumescent anesthesia was developed.91,92 Tumescent anesthesia minimizes intraoperative blood loss, limits bleeding complications, and prevents complications that occur with use of general anesthesia.92

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