TAL (tumescent liposuction)
In the days before the advent of modern liposuction techniques like water-assisted liposuction, vibration-assisted liposuction and laser liposuction, the TAL technique (tumescent liposuction) was the go-to method for extracting fat. The TAL method involves introducing large quantities of tumescent solution – a mixture of water, adrenaline and local anaesthetic – into the body (directly into the layer of fat between the muscle and the skin). The ratio of tumescent solution to volume of fat intended to be extracted is 3:1. The surgeon needs very good spatial perception and excellent technique to achieve aesthetically good results. This is because, although large amounts of fat can be extracted, it is not possible to fully control the contours of the areas of the body being treated during the operation.
Benefits of TAL:
- Low-risk technology
- Large amounts of fat can be extracted
- Surgery can be performed under local anaesthetic or general anaesthetic
Disadvantages of TAL:
- Operation takes a long time
- Involves introducing large amounts of tumescent solution, which causes the body to swell
- No precise modelling possible
PAL (power-assisted liposuction) | VAL (vibration-assisted liposuction)
The so-called VAL or PAL technique (vibration-assisted liposuction or power-assisted liposuction) is a further development of the TAL technique. A tumescent solution is introduced and, once it has had time to take effect, the fat cells are shaken out of the tissue and suctioned away with the help of a motorised, vibrating cannula. The PAL technique is a very gentle method for extracting fat. Vibration technology is the most widely used method of liposuction in the world. It is used for high-definition liposuction, which involves the athletic modelling of the body, and for lipoedema surgery.
Benefits of PAL:
- Gentle, low-risk technology
- Very precise modelling possible
- Can effectively treat tricky areas, such as the ankles, knees and back
- Consistent results
- Surgery can be performed under local anaesthetic or general anaesthetic
- System with the largest selection of cannulas – specific cannulas can be used in different regions
- Ideal for fibrotic tissue conditions such as re-liposuction / correction liposuction thanks to the mechanical support for loosening the fat from the tissue
Disadvantages of PAL:
- When used by inexperienced surgeons, vibration technology has a higher risk of injury. This is because the vibrations prevent haptic feedback from the tissue, so it is easier to misposition the cannula
UAL (ultrasound-assisted liposuction)
Further developments to technology have led to UAL (ultrasound-assisted liposuction) and LAL (laser-assisted liposuction).
Both of these methods are largely based on the classic TAL liposuction method and can therefore be performed under local anaesthetic.
In the case of UAL, a tumescent solution is injected and, once it has taken effect, an ultrasonic probe is inserted into the area to be treated via small incisions. The ultrasound waves cause the fat cells to burst and liquidise. The fat is then removed via a conventional suction cannula.
The UAL process involves heating the tissue to high temperatures, which leads to a shrinking of the skin and a good tightening effect, as the skin can lie directly on the extracted fatty areas.
Benefits of UAL:
- Gentle, fast and low-risk technology
- Precise modelling possible
- Good skin tightening effect with minimal sagging skin
- Solid regions such as the back can be effectively treated
- Very even results
- Surgery can be performed under local anaesthetic or general anaesthetic
Disadvantages of UAL:
- Skin burns possible when performed incorrectly
- The risk of injury to vessels, nerves and lymphatic tracts is higher than with other methods, as the ultrasound probe cannot distinguish fatty tissue from other types of tissue
- In our opinion, it is not suited to lipoedema, as it is not clear what effect the ultrasound heat has on the lymphatic tracts
LAL (laser-assisted liposuction)
LAL (laser-assisted liposuction) is the next stage of development of ultrasound-assisted liposuction.
LAL can be used to achieve especially good tightening effects. In some cases, LAL can even be used for abdominal wall tightening, thigh tightening or upper arm tightening.
A tumescent solution is injected. The area to be treated is then divided into different quadrants and a laser probe is inserted via a small incision. This probe emits heat radiation via laser pulses of different wavelengths, causing the fat cells to liquidise. No additional liposuction is necessary for small areas. When treating larger areas, the liquidised fat must be removed using the classic TAL technique.
Benefits of LAL:
- Gentle, fast and low-risk technology
- Very precise modelling possible
- Very good skin tightening effect
- Solid regions such as the back can be effectively treated
- Very even results
- Surgery can be performed under local anaesthetic or general anaesthetic
Disadvantages of LAL:
- Skin burns possible when performed incorrectly
- The risk of injury to vessels, nerves and lymphatic tracts is higher than with other methods, as the laser probe cannot distinguish fatty tissue from other types of tissue
- In our opinion, it is not suited to lipoedema, as it is not clear what effect the heat from the laser has on the lymphatic tracts
WAL (water-assisted liposuction)
WAL stands for water-assisted liposuction. A fan-shaped water jet is used to gently loosen fat cells and simultaneously suction them away. The fact that the fat cells are dissolved by a consistent jet of water means that it is generally necessary to use high quantities of tumescent solution. The operation can be performed on smaller areas of fat without the need for a general anaesthetic.
Benefits of WAL:
- Gentle, fast and low-risk technology
- Precise modelling possible
- Even results during the first treatment
- Surgery can be performed under local anaesthetic or general anaesthetic
Disadvantages of WAL:
- Large quantities of tumescent solution are often necessary despite the water jet technology
- This often leads to pronounced post-operative oedema
- The operation often leads to haematocrit and Hb deficiencies due to the dilution effect, as well as subsequent circulation issues
- Not ideal for repeated liposuction and fibrotic tissue
- Limited choice of cannulas
- Hard to address solid regions such as the knees, ankles and back
