The Most Effective Method of Liposuction with Simultaneous Skin Tightening Using VASER® and Renuvion Systems

The editorial team of the Leading Medicine Guide spoke with Dr. Tabatabaei about two specialized techniques for liposuction with simultaneous skin tightening.

„The ultrasound–radiofrequency-assisted liposuction we use provides an effective solution for patients who not only want to reduce fat tissue but also improve skin elasticity during liposuction. While we very gently liquefy the excess, bothersome fat tissue with an ultrasound system such as the VASER device and then suction it out precisely, modern radiofrequency devices like the Renuvion system – also known as J-Plasma – tighten the skin without long, visible scars by significantly increasing skin elasticity. These combined methods allow me as the surgeon to sustainably optimize the aesthetic appearance, because not only is fat tissue removed and body contours meticulously refined, but lax skin is also tightened in the process. Thanks to the gentler approach, patients experience fewer bruises and less postoperative pain after liposuction, which significantly shortens recovery time and downtime“, explains Dr. Tabatabaei at the beginning of our conversation. 

The initial contact with the patient takes place through an in-depth consultation held in person at the clinic. 

„When I see a patient for the first time, the most important thing is their motivation. The conversation we have usually lasts an hour – deliberately so. The goal is to find out why the patient is interested in this procedure. It must be clearly evident that the desire comes from their own initiative and not from external pressure – whether from a partner, family, or social environment. That is crucial for me. Even if someone has a completely realistic idea – if the wish ultimately stems from someone else, then I am not the right person to consult. I have always taken the time because I consider it essential to understand the patient’s true motives. During the conversation, patients must make it clear to me that they are acting out of their own distress. And yes, it actually happens quite often that people feel pressured by comments like ‘You’re too fat, do something about it’ – whether subtly or directly. When people are unsettled, they look for explanations and reasons for their situation. That sometimes leads them to search for external causes, and since I don’t know anyone who is 100% satisfied with their body, you often find something and conclude that the body is the real problem. That’s why a brief consultation simply isn’t enough“, explains Dr. Tabatabaei, continuing:

„We not only need to clarify motivation, but also discuss the patient’s expectations. If someone says, ‘Basically everything about my body bothers me,’ that’s a red flag for me. It suggests something deeper is going on, and the patient hasn’t engaged with the topic seriously enough. It’s very different with patients who have a specific concern – for example, someone who is generally at peace with their body but says, ‘My upper arms bother me; it affects my daily life. When I choose clothing or when someone touches my upper arm, I feel uncomfortable.’ Then I sense there’s a specific wish, and that may be something I can address very well. But even when surgery is possible, expectations must remain realistic. If that’s the case, the conversation continues with medical history, a review of systems, and a physical examination. Once that’s clarified, I explain the procedure in detail: from the preoperative markings to the operation itself – and the possible risks and their frequency – through to aftercare, which I personally provide. I’m also happy to inform patients about alternative options to the treatment I recommend. Finally, patients want to know the cost. After this one-hour consultation, some patients decide immediately and schedule surgery with me, while others need some time to think it over, which I fully understand“.

VASER–Renuvion-assisted liposuction is the most advanced method of fat removal, using ultrasound waves to liquefy fat cells before they are gently and permanently removed from the body. Renuvion, also known as J-Plasma, is an innovative skin-tightening technology that combines helium plasma with radiofrequency energy to heat and tighten the skin from within in a controlled manner.

Unlike conventional liposuction, where fat tissue is simply suctioned out, VASER–Renuvion liposuction gives the surgeon the ability to sculpt specific body contours with great precision and achieve durable, highly aesthetic results. This method is used on nearly all body regions where fat has accumulated beneath the skin, such as the abdominal wall, back, upper arms, hips, thighs, lower legs, double chin, and even the neck, and it offers the advantages of a minimally invasive, scar-sparing treatment with manageable risks and shorter downtime. 

Dr. Tabatabaei provides specifics: „In the 1970s, physicians began suctioning fat tissue with thin cannulas. Over time, the technique evolved. Special solutions such as tumescent solution were introduced to loosen fat tissue beforehand and minimize bleeding (it also acts as a local anesthetic). But with classic methods, one recurring problem became apparent: the skin loses tension. I like to explain it to my patients this way: As bothersome as fat tissue can be, it has a positive side effect. Fat keeps the skin firm. Everyone knows the saying, ‘If you don’t want wrinkles, gain weight.’ When you gain weight, you usually have fewer wrinkles because fat fills the skin from within. However, if larger amounts of fat are suddenly removed, especially with weak connective tissue or older, less elastic skin, excess skin often results. You can see this particularly in so-called ‘bingo wings.’ Some patients report: I used to wear long sleeves to hide my big arms – after the suction, I still wear long sleeves to hide my bingo wings. That can’t be the goal. That’s why methods were developed to deliberately heat the skin after suction to tighten it. The principle is familiar from grilling. A piece of steak on the grill shrinks and gets smaller. We knew from experience that scars, especially in burn victims, tend to contract significantly. We began to heat the skin’s connective tissue in a controlled way and found that the fibers partially contract immediately; after a few weeks, you can even observe a significant improvement in skin elasticity in the treated areas – and that’s exactly the effect we harness in a controlled manner. Two technologies are used for skin tightening in conjunction with liposuction: radiofrequency with the Renuvion device and a laser device with a specific wavelength“, and adds:

„Over recent years I have worked with both methods – laser and Renuvion. My experience has shown that the radiofrequency variant, i.e., Renuvion, is actually safer and therefore the only device worldwide explicitly approved for skin tightening. With a laser device, an experienced specialist can also achieve a good result, but the risk of skin burns is higher because the temperature under the skin is harder to control. Another important component is the so-called VASER device – an ultrasound device. It is used even before the actual suction. A fine probe is inserted under the skin through tiny openings; at its tip, ultrasound waves liquefy (emulsify) the fat tissue and slowly release it from the connective-tissue matrix. The best way to describe it is like trying to eat ice cream through a straw – that doesn’t work well – but if you first turn the ice cream into a milkshake, it’s much easier to suck through the straw. That’s exactly what VASER does with fat: it is essentially liquefied before being gently and effortlessly suctioned out. Interestingly, all the other important structures, such as lymphatic channels, blood vessels, and nerves, remain largely intact. There are fewer bruises and less pain after surgery, and healing time is noticeably shorter. The VASER device enables highly precise liposuction and is regularly used in so-called ‘high-definition liposuction’ or ‘body sculpting.’ The sequence is as follows: First, the tumescent solution, which also serves as a local anesthetic, is injected under the skin. This prepares the surgical area and loosens the fat tissue. Next, the fat tissue is liquefied with the VASER device. The liquefied fat is then suctioned out with a thin cannula. Finally, the Renuvion device is used to tighten the skin. All of these measures are performed on an outpatient basis, without general anesthesia, with minimal scarring and only a few tiny openings of 3–4 mm that can be easily hidden by clothing or even a bikini“.

As mentioned, these methods can generally be applied anywhere fat is located directly under the skin – i.e., subcutaneous fat. That’s the fat you can pinch with your fingers. The only problematic fat is so-called visceral fat – deep inside the abdomen, as in a classic “beer belly.” This fat cannot be suctioned; it must be reduced through dietary changes and exercise and, in very pronounced cases, even through bariatric surgery (sleeve gastrectomy, gastric bypass, etc.).

„Typical treatment zones include, for example, the double chin, upper arms, abdomen, back, flanks, and also areas like the so-called ‘buffalo hump.’ The thighs can be treated very well. The buttocks are a bit more difficult – we suction there only in exceptional cases, such as localized, pathological fat overgrowth. Female breasts are generally not suctioned because the tissue there is mostly glandular. An exception is female-looking breasts in men – known as gynecomastia. When the cause is a fat-distribution disorder, suction can be performed. Overall, this method is highly versatile and offers a clearly better and more modern alternative to classic procedures from both a medical and aesthetic perspective – with faster recovery and more aesthetic results“, concludes Dr. Tabatabaei.

Liposuction and skin tightening are particularly effective in body areas where fat tissue has accumulated disproportionately and connective tissue is weak. The most common treatment zones include the abdomen and back, hips, thighs, lower legs, upper arms, and the double chin.

„To summarize, I want to emphasize once again that liposuction is not intended to reduce body weight, but to shape and optimize body contours. If you weigh less after liposuction, that’s fine too. Lately, more and more patients present after hearing or seeing something on social media about ‘360° liposuction’ or knowing someone who had everything suctioned at once abroad. Because my patients’ health always comes first, I usually advise against such a procedure and recommend staged treatment. There are several reasons for this: 1. Specialists recommend a liposuction volume of about 5% of current body weight per procedure to keep risks such as cardiovascular strain, blood loss, longer downtime, etc., as low as possible. With pronounced findings you can reach this amount, for example, just on the abdomen, and significantly exceed 5% if you also suction the back. 2. If you suction both the abdomen and back, healing time can be significantly prolonged. Patients can hardly rest during this time because no matter how they turn, they lie on a large wound area. The wound isn’t visible externally, but it’s under the skin and needs at least three weeks to heal. I have seen patients who couldn’t sleep at night after such liposuction due to pain, which had a very negative impact on their professional and private lives. That is unfortunately often underestimated. As a responsible specialist, it is my duty to educate my patients about such risks, especially before aesthetic procedures. 3. If you suction all the way around, the patient must be turned several times on the operating table during surgery. This automatically increases the risk of infection because things can inadvertently become non-sterile during repositioning. 4. If you want to achieve a good result, the procedure, including VASER and Renuvion, takes time. With longer operating times, there is a risk of hypothermia or more pain and bleeding due to diminishing effect of the tumescent solution. This could lead the surgeon to stop the operation early and plan the remainder for a later date“, emphasizes Dr. Tabatabaei.

Healing after treatment with VASER liposuction combined with Renuvion generally progresses faster and more gently than with conventional methods, but it does require structured aftercare and some patience until the final result is visible.

„All patients receive compression garments after the procedure to optimally support healing and minimize potential complications. After liposuction, cavities can form under the skin where wound fluid might collect. The compression clothing applies even pressure to the tissue, reducing these cavities. It also counteracts swelling and promotes lymphatic drainage from the freshly operated tissue. In addition, the garments help the skin adapt to the new body contour by supporting skin retraction and preventing irregularities. Some patients initially find these garments bothersome, but after six weeks, when they could take them off, almost all want to keep wearing them because they provide more support and a sense of security. There is nothing wrong with that. They also provide more stability and reduce postoperative swelling. However, strenuous physical activity should be avoided for a while because the treated tissue needs time to heal and stabilize. I advise patients to always listen to their bodies. I allow showering as early as two days after the procedure. However, we recommend waiting about six weeks before bathing, using saunas, or engaging in more strenuous physical activities“, says Dr. Tabatabaei.

Initial visible changes often appear within a few days; the final result is usually achieved after three to six months, once swelling has fully subsided and the tissue has remodeled. Thanks to the skin-tightening effect of Renuvion, the appearance continues to improve over time, as collagen neogenesis continues for several months. Regular medical follow-up appointments are necessary to monitor healing and respond early to potential complications. 

When deciding on liposuction and skin tightening – including modern techniques such as VASER and Renuvion – various risk factors and contraindications must be carefully evaluated. Not every patient is a suitable candidate for such procedures. Comprehensive medical assessment before the procedure is therefore essential.

„During the consultation, I inform my patients about the general risks of surgery. These are risks that exist regardless of the type of procedure, whether it’s an appendectomy, a knee prosthesis, or an aesthetic procedure such as liposuction. These include, for example, infections, swelling, bruising, postoperative pain, as well as thrombosis or embolism – complications that can in principle occur with any surgical intervention. Beyond that, I inform patients thoroughly, sometimes using images and diagrams, about the specific risks particularly relevant to liposuction. These include, among other things, that very rarely minor irregularities of the skin surface can occur or asymmetries may be perceived. It also happens that patients need a small touch-up procedure to further optimize the result. And it can indeed be the case – even when working very carefully – that it is sometimes not possible to achieve one-hundred-percent symmetry. That’s why it’s important to clearly inform patients that aesthetic procedures are not about mathematical exactness and that small refinements (touch-ups) may be possible. So, it’s also necessary to address expectations, especially with aesthetic procedures. Unfortunately, I have also seen patients who ended up with inexperienced doctors and then suffered serious complications. Such cases are extremely rare, thankfully, but they underscore how important education and qualifications are“, says Dr. Tabatabaei.

Kinesio taping is a therapeutic method in which special elastic adhesive strips – known as Kinesio tapes – are applied to the skin to support muscles, joints, lymphatic pathways, or connective tissue without restricting mobility.

„This technique originated in physical therapy and sports but has now become established after liposuction as well. The taped areas can be stabilized without having to squeeze back into tight compression garments right away. We have an excellent physical therapy department at our clinic that also offers taping. If patients wish, I refer them there, and the suctioned areas are taped professionally. Many find this much more comfortable; you can even shower with it, and it works very well in some body regions. Of course, not everywhere, but in many cases it is a nice alternative to classic compression clothing and supports the healing process“, notes Dr. Tabatabaei.

The combination of VASER liposuction and Renuvion not only provides short-term visible improvements in body contour but also has long-term positive effects on skin structure and tissue. The two procedures complement each other in their mechanisms and enable precise, gentle fat removal with simultaneously effective skin tightening.

„The long-term result of liposuction is generally permanent, provided the patient maintains their lifestyle. Fat cells do not divide or reproduce anew – each person is born with a certain number of them. When fat cells are removed during a procedure, they are gone for good. The remaining cells can enlarge again with excessive caloric intake, but the treated areas generally will never look the same as before. As long as nutrition remains balanced and one exercises regularly, the result remains stable. It is a lifelong reduction of fat cells in the respective region. Regarding age, social media influence has led to patients becoming increasingly younger. While the majority of procedures are performed on women, men are also seeking treatment more often now. While some fat deposits respond quickly and disappear with weight loss, others are particularly resistant and persist even with an active lifestyle and healthy diet. This is precisely where liposuction can be sensible and effective. Procedures are generally offered from about age 20 and can also be performed at more advanced ages, although from around 60 years onward it is assessed with particular care whether the procedure is medically justifiable in the individual case“, emphasizes Dr. Tabatabaei, and with that we conclude our conversation.

Many thanks, Dr. Tabatabaei, for this fascinating insight into aesthetic medicine!

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• Board-certified Plastic and Aesthetic Surgeon; Head of the Section for Plastic and Aesthetic Surgery at Schloss Heiligenberg, District Clinics Darmstadt-Dieburg in Seeheim-Jugenheim
• Extensive international training and many years of experience at renowned clinics. Specialist training and senior physician role at the Ecumenical Network Hospital Trier; subsequently senior physician at the Alfried Krupp Hospital Essen
• Fellowship in Tehran specializing in body contouring, aesthetic breast surgery, and rhinoplasty
• Co-founder of the Department of Plastic and Aesthetic Surgery at the District Clinics Darmstadt-Dieburg
• Additional leadership experience as medical director at Proaesthetic Heidelberg and the s-thetic clinics
• Since 2022, Head of the Section at Schloss Heiligenberg, specializing in plastic surgery procedures after massive weight loss
• Treatment focus: functional restoration and aesthetic optimization with modern surgical methods. Key areas: body contouring (liposuction, lifting procedures), aesthetic facial and breast surgery
• Additional services: wrinkle treatments, fillers, laser therapy, RF microneedling, cryolipolysis
• Member of DGPRÄC, Interplast Germany, and the State Medical Association of Hesse