My history of liposuctions goes back to 1982 when I read an article on liposuction. Prior to that, fat was literally excised (cut out). No one in the southeast was doing liposuctions at that time, and I had to order my cannulas from Germany. They were huge and had cutting edges. Still, the results made my patients very happy. We have graduated to tumescent liposuction, smaller, more effective and safer cannulas, and better post operative instructions, which has made liposuction the most popular and safest procedure performed by plastic surgeons.For years liposuctions were limited to removal of 2 liters because of the loss of blood and postoperative complications. A very bright physician named Jeffery Klein, MD invented the “tumescent” liposuction technique of infusing an anesthetic containing fluid which also constricts

the blood vessels in the tissues to be removed—thus minimal bleeding. We now routinely remove 3 to 5 liters per liposuction session with an extremely low complication rate.
Recently “energy based” liposuctions such as lasers, ultrasonic, radio wave, etc. were invented with the goal of tightening the skin. Independent studies have demonstrated that these are no more effective than traditional liposuction, but add a new list of risks such as burning the tissues and skin. The energy based procedures take longer to perform than traditional liposuction, and they destroy Fat Derived Stem Cells. This is very important, as fat transfer/grafting is becoming very popular for re-volumizing the face, hands, reconstruction of the breast, and cosmetic breast augmentation and the buttocks (Brazilian Butt lift). Fat is very fragile and much of the fat when grafted does not survive. However, fat derived stem cells are quite hardy. Concentrating stem cells from the patients’ own fat increases the success of the fat transfer. More of the fat “takes.”
The “Tickle Lipo,” trademarked as NIL for Nutational Infrasonic Liposuction, is a system in which the cannula vibrates sub-sonically with a specific swirling motion so no heat is generated. The advantages: discomfort is reduced so general anesthesia is often not necessary; less post operative swelling and bruising; recovery time is reduced; the procedure takes about 25% less time to perform; and stem cells are maximally preserved. The pain reduction is due to the “Gateway phenomenon.” The cannula’s vibration occupies the nerves leaving less room for pain impulses to reach the brain. The word “Tickle” was adopted because many patients say it actually tickles.The increase in fat derived stem cell survival is important for my practice because of the number of fat transfers performed in my practice for rejuvenation of the face, hands, buttocks, and for breast reconstruction.An independent study from Belgium comparing liposuction techniques has concluded that the Tickle Lipo is the most effective liposuction technique with the least risk of unsatisfactory results, which is why I use it exclusively in my practice.

E. Ronald Finger, MD
Board Certified Plastic Surgeon
Affiliated with Savannah Plastic Surgery