Liposuction is a minimally invasive body contouring procedure that suctions localized fat cells from the body to slim and smooth stubborn areas that have been unresponsive to traditional weight loss techniques such as diet and exercise. This procedure has successfully helped patients achieve an enhanced appearance for many years.
Although effective, the conventional liposuction procedure was often painful and involved long recovery times. New technology has allowed for different liposuction techniques that improve the accuracy and reduce the pain associated with this procedure. Today, liposuction can be performed using the tumescent technique or with the help of ultrasound imaging or a laser, which has transformed liposuction into a much safer and less invasive procedure.
Dr. De La Cruz performs both the traditional suction-assisted lipectomy (liposuction), and VASER Liposuction.
What is a VASER?
VASER stands for Vibration Amplification of Sound Energy at Resonance. It's is a 3rd-generation ultrasound-assisted lipocustion tool that delivers energy in pulses through a specially designed probe. The Vaser instrument used during surgery liquefies the fat and allows the surgeon to target specific areas of the body.
The VASER device is capable of selectively delivering ultrasound energy to liquefy the fat in the body without damaging other types of tissues. Once the fat has been melted, it can be suctioned out of the body through very small 2.2 mm to 3.7 mm sized cannulae without causing great trauma to the surrounding tissue structures. Thus, the incisions made are less than 5mm in size.
What is the 4D VASER Hi-Definition Liposuction?
The 4 D High-definition liposuction, also known as hi-definition liposuction, hi-definition liposculpture, or simply hi-def lipo, is a surgical procedure that involves suctioning excess fat out of target areas of the body to create a slim, muscular and athletic appearance in different areas of the body.
This procedure may involve transferring fat to different areas of the body, such as the chest muscles in men or buttock in women (Brazilian Butt Lift), to enhance one's features.
Typically the procedure may involve liposculpture of the arms, abdomen, flanks, back, and possibly thighs. This would be based on an individual basis since every patient is different.
Make sure your plastic surgeon is certified and trained to perform the 4D VASER High-Definition liposculpture.
Dr. De La Cruz learned the art of the 4D VASER High-Definition Body Sculpting with Dr. Alfredo Hoyos in Bogota, Colombia in addition to 9 years of surgical training in Plastic Surgery, General Surgery and Microsurgery in the United States.
As of September of 2015, there are only 17 plastic surgeons in the United States who are trained and certified by Dr. Alfredo Hoyos to perform the 4D VASER Hi-Definition Liposculpture (based on 4D certified plastic surgeons list from Dr. Hoyos.)
Who is a candidate for liposuction?
Liposuction is ideal for patients who are in good overall health and maintain a healthy lifestyle, but have one or more problem areas with unresponsive fat deposits. It is important to realize that liposuction is not a means for major weight loss, but instead removes localized areas of stubborn fat after the patient has attempted other natural weight loss methods.
Figure 1: Before & After Photos of Large Volume Hi-Definition Liposuction (2 months after surgery) performed by Dr. Emmanuel De La Cruz, Houston Plastic Surgeon
Figure 2: Before & After Photos of 4 D VASER Liposuction (Back View 2 months after surgery)
What areas of the body can be treated with liposuction?
Liposuction can be used to remove unwanted areas of localized fat from nearly any area of the body, and is most commonly used on the:
In many cases, more than one area can be treated during the same procedure in order to reduce operating costs and recovery times. Your doctor will develop an individualized treatment plan for you during your initial consultation.
Figure 3: Before & After Photos of 4 D VASER Liposuction (Oblique View 2 months after surgery.) Procedure performed by Dr. Emmanuel De La Cruz M.D.
What happens during the 4D Hi-Definition liposuction procedure?
This procedure consists of high-definition liposculpting of the abdomen, flanks, back, arms, and possibly the thighs or chest in men with gynecomastia. This procedure also involves reshaping the buttock in women as well which would involve either liposculpture or fat transfer to the buttock. In men, fat may be transferred to the deltoids to improve the shoulders or to the chest to create a more masculine pectoralis muscle.
The extent of the procedure varies from individual to individual since every patient is different. Dr. De La Cruz will tailor the procedure based on the patient's body habitus and based on what the patient desires.
What is the difference between VASER Liposuction versus Traditional Liposuction?
Recent randomized clinical trials showed that the VASER liposuction is superior over traditional liposuction methods. With the VASER liposuction, there is LESS BLEEDING, and MORE SKIN RETRACTION compared to traditional liposuction methods. 
 Nagy, et al. A multicenter, prospective, randomized, single-blind, controlled clinical trial comparing VASER-assisted Lipoplasty and suction-assisted Lipoplasty. Plastic Reconstructive Surgery 2012 Apr;129(4):681e-9e
There's also less contour irregularities with the VASER liposuction in the hands of an experienced plastic surgeon. Dr. De La Cruz refined and honed his lipoplasty techniques, especially the 4D VASER liposuction, under the tutelage of Dr. Alfredo Hoyos, the pioneer of the 4D VASER High-Definition liposculpture.
How is the Large Volume High-Definition Liposuction procedure performed?
Dr. De La Cruz performs the procedure using several techniques and method. He uses three different machines when he performs this procedure.
1) VASER liposuction - this emulsifies/liquefies the fat. It reduces the risk of contour irregularities and causes significant skin retraction. Less bleeding occurs with this liposuction method.
2) Infrasonic Power-assisted liposuction - this is used to contouring of the abdomen. This produces a smoother contour than other power-assisted liposuction methods, like MicroAire.
3) Renuvion or J-Plasma (Mandatory) - this is an optional procedure that causes further skin retraction as well as smoothens the contours produced.
Patient Safety During Surgery
Dr. De La Cruz values patient safety during your surgery. For large volume high-definition liposuction, there are certain criterias that should be met before your plastic surgery.
For patients who have co-morbidities, such as Diabetes, obstructive sleep apnea, a medical and cardiac clearance are required prior to surgery. For patients whose age >45, a cardiac clearance from a cardiologist is required by Dr. De La Cruz prior to your surgery. Safety is priority in our practice.
Prevention of Infection: During your surgery, a peri-operative intravenous antibiotics are given to prevent a wound infection. Fat that is harvested for fat transfer (if included in your procedure) will be washed with antibiotic irrigation to further reduce your risk of infection.
DVT Prophylaxis: Dr. De La Cruz calculates your Caprini Score to evaluate your risk for Deep Venous Thrombosis. All patients would have an intermittent sequential compression device during your surgery to prevent a DVT. Moreover, an anti-coagulant, such as Heparin or Lovenox, is given to further reduce your risk for a Deep Venous Thrombosis.
For large volume high-definition liposuction patients, all patients are admitted in the hospital overnight to monitor your recovery. A hospitalist and Dr. De La Cruz would typically oversee your care while you are in the hospital.
The use of the VASER liposuction system is associated with less bleeding when it comes to large volume liposuction. A randomized clinical trial had shown that the VASER liposuction is associated with less bleeding during surgery when compared with traditional tumescent liposuction. This is key when it comes to large volume liposuction. It is essential to minimize your risk of bleeding when it comes to undergoing this procedure.
How long does recovery take?
After the liposuction procedure, patients will be able to return to work and other regular activities as soon as they feel comfortable, which is usually after a few days. Exercise and other strenuous activities should be avoided for a few weeks. It is not uncommon to experience mild swelling, bruising and discomfort in the treated area, which can be reduced through pain medication and the use of compression garments.
There will be drainage tubes in the groin and sacral areas to collect any fluid for the first few days after treatment.
When will results be visible?
The results from the liposuction procedure are often visible right away, but will continue to improve as swelling and bruising subside. Typically, one would see the results 8 weeks after surgery. Swelling will continue to decrease, and skin will continue to retract up to 6 months after surgery. Scars usually heal well and will fade with time to become less and less noticeable.
The results of liposuction can be permanent as long as patients maintain a healthy and active lifestyle. If substantial weight is gained after this procedure, results may be altered.
What is Large Volume Liposuction?
Large volume liposuction is when the liposuction aspirate exceeds over 5 Liters. Certain states, such as New York and Florida, are limited to 4-5 Liters of fat that can be aspirated. The maximum amount of fat that can be harvested or aspirated depends on the amount of tumescent fluid and lidocaine in the tumescent fluid infused. One cannot exceed over 35 mg/kg of lidocaine in the tumescent fluid. Some studies have shown that the safety level of lidocaine in the tumescent fluid that can be infused can be up to 50 mg/kg. Dr. De La Cruz does not exceed over 35 mg/kg to avoid any adverse outcome from lidocaine toxicity.
Is there any criteria or pre-operative requirements before Large Volume Liposuction?
Dr. De La Cruz requires a cardiac clearance from your primary care physician, preferably from a cardiologist if your age is over 45. For those patients with comorbidities, such as Diabetes, or has a family history of cardiac problems (such as heart attack), a cardiac clearance is also required for patients whose age is over 40. Safety is our number one priority!
Where is the procedure performed?
Large volume high-definition liposuction is performed in a hospital. Patients will be subsequently admitted overnight for observation, and for fluid maintenance. Dr. De La Cruz and a hospitalist physician will oversee your care while you are in the hospital after surgery.
Are there any risks or complications associated with liposuction?
Liposuction is considered a safe procedure with only minimal downtime and a low occurrence of mild side effects. However, as with any kind of treatment, there is a risk of complications such as infection, scarring, allergic reactions, hematoma or unsatisfactory results. Liposuction is one of the most commonly performed cosmetic procedures and is almost always performed with no serious complications.
Patients can reduce these risks by choosing an experienced doctor, such as a plastic surgeon, to perform their procedure and by following their doctor’s instructions before and after treatment.