**1.2 Power-assisted liposuction (PAL)**

Power-assisted liposuction (PAL) was introduced in 1998 by MicroAire Surgical Instruments (Charlottesville, VA, USA). The original handpiece utilized compressed air to power the device with later generations powered by electricity [4]. PAL is advantageous in fibrous areas and for secondary liposuction cases and has been noted to decrease surgeon fatigue with less plugging of the cannula and shorter operative times [5–7]. Some disadvantages of PAL are cost, learning curve, potential vibratory injury, and noise [4].

## **1.3 Ultrasound-assisted liposuction (UAL)**

Ultrasound-assisted Liposuction (UAL) was first described by Zocchi nearly 30 years ago [8]. The ultrasonic probe transforms electrical energy into mechanical energy leading to cavitation and cellular disruption. The emulsified fat is then aspirated via traditional suction-assisted lipectomy (SAL). The third-generation UAL devices such as VASER™ (Solta Medical, Hayward, CA, USA), use pulsed rather than continuous energy allowing for greater fragmentation of adipocytes at a lower energy setting [9].

Proponents of UAL have found that the addition of UAL leads to decreased intraoperative blood loss, decreased postoperative ecchymoses and discomfort, decreased operative time, and enhanced skin contraction [9–15].

The drawbacks of UAL include increased expense, larger incisions, technical difficulty with a steep learning curve, and the risk of thermal burns [16–19].

The addition of VASER should be considered for patients undergoing largevolume liposuction or liposuction of fibrous areas such as the back and hip rolls (posterior flanks) where increased blood loss is expected [11]. VASER may also be considered in patients where additional skin tightening is desired [13].

We have combined the techniques of SAFE and ultrasound-assisted liposuction by utilizing the VASER to separate and emulsify the fat prior to suctioning. Fat equalization is still performed using the basket-tip cannula.

### **1.4 Laser-assisted liposuction (LAL)**

Laser-assisted liposuction (LAL) relies on selective photothermolysis to target and lyse adipocytes [20] and interest in LAL began after studies conducted by Apfelberg [21] and Apfelberg et al. [22, 23] in 1992.

The wavelengths utilized in LAL target fat, collagen, vascular structures, hemoglobin, and water to varying degrees. Obliteration of these targets leads to photolysis of adipocytes, release of adipocyte lipases, dermal collagen contraction, and photocoagulation of small vessels [24–26].

The three main lasers utilized for LAL are the 1064 nm Nd:YAG, the 980 nm diode, and the 1064/1320 nm Nd:YAG lasers [27]. The most studied wavelength is 1064 nm Nd:YAG which has hemoglobin as its target [28]. Both SmartLipo™ (Cynosure Inc., Westford, MA, USA) and ProLipo PLUS™ (Sciton, Inc., Palo Alto, CA, USA) utilize 1064 nm wavelengths. ProLipo PLUS combines 1064 nm with 1319 nm in hopes of providing additional dermal contraction [29].

#### *Enhanced Abdominal Contouring DOI: http://dx.doi.org/10.5772/intechopen.99398*

LAL can either be performed at the same procedure as SAL or in a two-stage procedure with SAL performed at the second stage.

Initial studies showed minimal cosmetic benefit with the addition of LAL to traditional SAL [22] The disadvantages of LAL include increased cost, increased operative time, and potential for thermal burns [30].

## **1.5 Radiofrequency-assisted liposuction (RFAL)**

Radiofrequency-Assisted Liposuction (RFAL) takes advantage of a high frequency oscillating electrical current to create a thermal effect which dissolves fat cells and causes dermal contraction. RF devices lead to contraction of the fibroseptal network (FSN) through immediate contraction of collagen fibers, subdermal remodeling, and neocollagen formation [31–34]. The devices that we currently use for the abdomen and trunk are BodyTite and Renuvion (formerly J-Plasma).
