As its name indicates, liposuction involves suctioning fat from the body. The problem is, fat is more solid than many people realize, and it does not freely wander around the body, pooling where convenient and ready to flow out if given the opportunity. Fat cells grow and swell, remaining firmly in place after their formation. Diet and exercise may shrink them, but they stay where they are—unless acted upon by something like a liposuction procedure. St. Louis’ West County Plastic Surgeons has seen the strategies for loosening fat change over time. Techniques used to prepare fat for liposuction have ranged from cutting it into small chunks that can be removed through an incision to physically breaking up the cells with a manually manipulated wand to applying heat or other energy to the region to “melt” or liquefy the unwanted fat. These methods can be very effective, but they present a challenge for another procedure often paired with liposuction: fat grafting, which involves removing fat cells from one area of the body where they are not needed, refining them, and injecting them into a different area of the body that can use more volume. More involved methods for collecting fat cells tend to impact tissues beyond the fat. In a given part of the body targeted for liposuction, fat cells typically share the space with connective tissues, blood vessels, nerves, and muscles, all sitting under a layer of skin. Trauma can increase instances of bruising, swelling, and post-procedure discomfort and pain. Tissue liquefaction technology, however, provides an alternative. Approved by the FDA in 2013 for autologous fat grafting, the HydraSolve® device uses water to separate fat cells to prepare them for suctioning out of the body. This technique developed from technology first used in medical procedures performed on an especially sensitive part of the body: the eye. Prior to its fat transfer applications, the technology was used to help remove cataracts in patients dealing with that vision problem. When it comes to liposuction specifically, tissue liquefaction technology involves a wand, known as a cannula, with an opening in the side, rather the tip, which takes in the tissue in the targeted area, but allows only the newly released fat cells to be gently suctioned out. The cannula is inserted into the tissue targeted for liposuction via a millimeters-long incision. The sterile salt water streaming inside the cannula is brought to a precise temperature and pressure to impact the fat cells, while leaving other tissues and structures intact. The heat and motion, both considered low level for this application, disrupt the protein bonds between fat cells. As protein bonds break down, individual fat cells are freed. After they leave the body via a tube to be collected in a canister, the unharmed tissue leaves the cannula and settles back into place. This method is also gentler on the fat cells themselves. The manual fat-loosening method historically used for liposuction is more akin to stirring a spoon around in a pot before scooping out specific ingredients: Everything—even the stuff staying behind—gets impacted. Most notably, connective tissues and blood vessels are also frequently liquefied along with the fat, leading to bleeding and bruising that is visibly noticeable and requires time to heal. As much as tissue liquefaction technology represents a very modern approach to the long-popular option of liposuction, it is, as noted above, not the only option. Since every patient is unique and has personalized needs, any liposuction procedure should be handled by a board-certified and experienced surgeon, as well as start with a consultation to determine which method would be most likely to best deliver the desired results.