Liposuction and Body Contouring Surgery: A Comprehensive Review of Techniques, Safety, And Evolving Evidence

Abstract

Liposuction remains among the most frequently performed cosmetic surgical procedures worldwide and continues to evolve through technological refinement and accumulating clinical evidence. This review synthesizes contemporary literature on the history, anatomical basis, techniques, anesthetic principles, complication profile, and emerging adjuncts of suction-assisted body contouring. Traditional suction-assisted lipectomy (SAL) remains the most widely used technique, but energy-based modalities—ultrasound-assisted liposuction (UAL), power-assisted lipectomy (PAL), laser-assisted lipectomy (LAL), radiofrequency-assisted lipectomy (RFAL), and water-assisted lipectomy (WAL)—have been developed to reduce operator fatigue, decrease blood loss, and, in some cases, promote skin retraction. Tumescent anesthesia, introduced by Klein, transformed liposuction safety by enabling large-volume fat removal under local anesthesia with minimal blood loss. Reported complication rates remain low overall, with contour deformity the most common adverse outcome and gluteal fat transfer carrying the highest procedure-specific mortality risk among aesthetic interventions, primarily related to fat embolism. Comparative data on ultrasound-assisted liposuction suggest a consistent reduction in intraoperative blood loss relative to traditional suction-assisted techniques, although evidence for superior long-term skin tightening remains inconclusive. Pharmacologic adjuncts such as tranexamic acid have shown mixed results across studies, with effectiveness appearing dependent on dose and route of administration. Noncosmetic indications, including lipedema, lipodystrophy, and gynecomastia, continue to expand the clinical utility of the procedure. Overall, liposuction maintains a favorable safety profile when performed by trained surgeons in appropriately selected patients, though continued investigation is warranted to clarify the comparative advantages of newer energy-based technologies.