One of the limiting factors of liposuction is that the quality of the skin of plays a vital role. If the quality of the skin is good, namely is it supple, toned, with a good overall nutrition and without stretch marks? If yes, the skin will react well during the retraction process after the sculpting and the suctioning of fat.

On the other hand, tissues that are less tonic or covered with cellulite make this procedure less precise, even to the point of contraindication of the intervention.

For this reason, many types of technologies have been paired with liposuction to improve the postoperative healing (swelling, bruising and pain), the quality of the operation (speed, bleeding control) and the quality of the postoperative cutaneous retraction that is key to improving the quality of the results. In addition to standard suction-assisted liposuction, which gives up to 10% linear cutaneous retraction there are other technologies (ultrasound and laser) that use heat to improve the retraction of the skin after the liposuction procedure.

However, we must acknowledge:

• Ultrasonic liposuction in existence for about 15 years, destroys fat by cavitation. The heat released is difficult to control therefore there is risk of skin burns and the skin retraction process is limited.
• Laser Assisted Liposuction is newer. This technique uses a small probe (around 800 microns) which is introduced into the hypodermic tissue, is moved slowly and uses thermal technology to destroy the adipocytes (fat cells). The lipolyzed fat is then suctioned at a later time or smaller amounts can be slowly reabsorbed by the body.

When using thermal technology, we see a significant increase in linear retraction of around 20%.

However, the heat generated is circumferential radiating out from the probe making it potentially dangerous for deep tissues; also, due to the micro size of the probe it is not recommended to treat large areas of the skin because of the slowness of the process.

This is a recommended technique for small areas such as neck or arms for example.

Radio Frequency Assisted Liposuction (RFAL) is a new process that began in 2007 in Canada. I introduced the technique in France in 2008. This technique uses a hand piece equipped with 2 probes: an internal emitter probe that while it draws in the fat and also generate heat by radiofrequency and an external probe receiving the current that has a temperature gauge that will allow us to continually control the temperature of the skin.

he huge advantage of this technique is its ability to retract the skin and at the same time suction the fat. The heat is precisely controlled and can target fat, blood vessels and dermis.

The movement is fast which reduces the trauma to the tissues (less swelling) and allows for a better coagulation of the blood vessels (less bruising).

The technique is safe, without risk of burns and the linear skin retraction obtained is around 30 to 40%.

The work carried out at the Salpetriere hospital with Professor Sylvie Boisnic shows that this selective heating allows a rapid improvement of the quality of the dermis with a thickening of collagen and elasticity fibers clinically improving the appearance of cellulite.

This technique is in full use and is recommended for all areas of the body: body, arms, neck, etc. and continues to evolve.