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    Surgeons discuss liposuction technologies, need for evidence-based data for each

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    Dr. McMenamin
    Despite the immense popularity of liposuction, there is relatively little evidence-based medicine regarding the varying liposuction devices used in cosmetic surgery today — particularly regarding the claimed advantages of one technology over the other — according to Jane Petro, M.D., a plastic surgeon in Boston and acting executive director of the Cosmetic Surgery Foundation, Chicago.

    To help fill this void, more unbiased, head-to-head comparative studies contrasting the differing liposuction technologies and their capabilities should be conducted, the results of which would help guide physicians in choosing among the available liposuction devices, Dr. Petro says.


    Dr. Petro
    Many different techniques can be used in liposuction today, including traditional liposuction or suction-assisted liposuction (SAL), power-assisted liposuction (PAL), water-assisted liposuction (WAL), laser-assisted liposuction (LAL), ultrasound-assisted liposuction (UAL) and radiofrequency-assisted liposuction (RFAL). Performing liposuction with tumescent anesthesia is a learnable procedure, and with training and experience it can be done very well, according to Patrick G. McMenamin, M.D., past-president of the American Academy of Cosmetic Surgery with a private practice in Sacramento, Calif.

    "Liposuction is a sculpting process and as such, the limiting factor initially could be the surgeon who is performing the procedure. But as surgeons gain more experience, the limiting factors could shift and be the patient's age, their skin elasticity, thickness of the dermis, the density, volume and location of the fat, degree of sun damage, hormonal history and many other confounding factors that will come into play," Dr. McMenamin says.

    THE QUEST FOR EVIDENCE Deciding which liposuction technique is most appropriate for both the patient and physician can be challenging, Dr. Petro says, as clear evidence-based comparisons between the various energy sources are lacking. "If you look at what makes absolute clinical evidence known to be true, the general history of medicine is filled with what you would call 'expert opinion.' However, expert opinion can be subjective and in part is therefore regarded as a low level of evidence," she says.

    According to Dr. Petro, evidence-based medicine is basically designed to look at a tool, technique or medication through studies that can statistically demonstrate both safety and efficacy in patients. Ideally, these studies should be randomized, prospective and blinded trials, which may or may not be placebo controlled. But determining who foots the bill for these independent studies remains a problematic issue.

    "Such studies are virtually impossible to see through in cosmetic surgery because almost all cosmetic surgeons are in private practice and not in academia, and secondly, device manufacturers that can get their products approved by the Food and Drug Administration may be reluctant to pay for prospective studies. Moreover, company-sponsored comparative trials are biased, no matter how careful the planning of the study," Dr. Petro says. Groups such as the Cosmetic Surgery Foundation could provide a basis through which multiple manufacturers donate money, and then independent centers participate in the comparative studies would be funded, she adds.

    "I think the American Academy of Cosmetic Surgery has the capacity to be an important study tool in terms of designing and funding prospective multicenter studies because we have multiple individual practitioners with significant skill levels and we work with other international organizations with a national and international reach," Dr. Petro says. "However, you've got to start a culture where such studies are valued, beginning with the medical students in the medical education system."

    Traditional liposuction has become the most commonly performed aesthetic surgical procedure in the United States, according to Gordon H. Sasaki, M.D., F.A.C.S., clinical professor of plastic surgery at Loma Linda University Medical Center, Loma Linda, Calif. When performed after competent training and in an accredited facility, traditional liposuction has a very low complication rate, predictable recovery periods and high patient satisfaction — as long as it is for the intended purpose of body sculpting and not intended for weight loss, he says.

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