All these terms are extremely confusing and sometimes intentionally used to confuse prospective patients.

When Dr Arthur Tjandra popularized syringe liposuction back in the mid-2000s – after having learned it from Professor Fong Poh Him and Dr Pierre Fournier, the fathers of modern liposuction – touting it as the oldest method of performing liposuction, but the safest; many plastic surgeons around the region started telling their patients that they too, were doing traditional liposuction. Many prospective patients mistakenly thought traditional liposuction meant syringe liposuction. While the definition of syringe liposuction is very clear, which is liposuction surgery performed with a syringe, the term traditional liposuction is very vague. What does traditional denote? Does it mean old? How old is old? When is the cut-off point for old and new? Is traditional liposuction the same as syringe liposuction? Dr Arthur Tjandra eventually learned from patients who have gone for consultation with other surgeons or had surgeries performed by surgeons who offered traditional liposuction, that what they really meant with traditional liposuction was power-assisted liposuction, using a vacuum-cleaner-like machine. Both syringe liposuction and power-assisted liposuction are also called suction-assisted liposuction, which means the fat is removed through suctioning power. However, suctioning using a syringe is completely different from using a machine. We have explained in great detail what the advantages and disadvantages of syringe liposuction are, in another post: What Method of Liposuction Does Dr Arthur Tjandra Practice? Just because syringe liposuction and power-assisted liposuction are both considered suction-assisted liposuction, they are not the same! A lot of damages and complications could occur in power-assisted liposuction compared to syringe liposuction, because power-assisted liposuction uses much greater power generated by a machine, while syringe liposuction uses a small vacuum pressure generated by the hands, through a syringe. As fat is being aspirated into the syringe, the suction power gradually decreases, and is eventually lost. Suction power generated through power-assisted liposuction devices remains constant. Therefore, there is a much higher risk of over-aspirating, creating dents, with power-assisted liposuction.

Liposuction process and areas for lipo. cosmetic surgery for remove fat from the human body. syringe with fat and the Human Skin layer before and after Liposuction

Syringe liposuction can be called suction-assisted liposuction (SAL). Modern liposuction devices are often referred to as power-assisted liposuction (PAL) as a group. However, SAL is quite vague, because it is also possible and not wrong to tell a patient a powered vacuum suction device as an SAL, because it does use suction. The difference is that the suction power is generated by machine, while the suction power in syringe liposuction is generated by hand/fingers. To avoid confusion, it is best to ask very specifically whether a liposuction is performed with a syringe or a mechanical powered device.

Tumescent anesthesia refers to a local anesthesia “concoction” popularized by Dr Jeffrey Klein which allows liposuction to be performed completely under local anesthesia. Tumescent anesthesia solution which is also referred to as Klein’s solution is a mixture of Normal Saline, lidocaine, epinephrine and sodium bicarbonate. This solution is injected into the fat layer to numb the area before liposuction. As it contains epinephrine which constricts blood vessels, tumescent anesthesia helps to decrease bleeding. It also allows lidocaine, a numbing agent, to stay in that area for longer period of time. Because of this, it is possible to perform liposuction completely under local anesthesia, although some surgeons prefer to combine tumescent anesthesia with deep sedation or general anesthesia to avoid distraction by patient’s movement during surgery. We have explained in great detail the benefits of performing liposuction under local anesthesia as compared to deep sedation and general anesthesia in a post on our website: Liposuction Case Studies. So, what does a plastic surgeon mean when he tells you that he offers tumescent liposuction? It simply means that the liposuction is performed with tumescent anesthesia, but basically gives you no information on what method of liposuction he performs. As all modern liposuction today are performed with tumescent anesthesia, including those performed under general anesthesia and deep sedation, it is redundant to say tumescent liposuction, because all liposuction performed today are tumescent liposuction! No surgeon with the right mind would choose not to administer tumescent anesthesia for his liposuction patient today. It only serves a purpose to mention whether a liposuction is a tumescent liposuction or not when it was performed during the transition period back in the 1990s, after Dr Jeffrey Klein invented tumescent anesthesia for liposuction, because some surgeons might have not employed that method of anesthesia yet.

Prior to 2008, the year Dr Arthur Tjandra went into private practice and established Elixir de Vie, no one ever heard of 3-dimensional liposuction. Why? Because during liposuction training, all plastic surgeon trainees would have been warned against performing circumferential liposuction on their patients, especially on the legs and arms. Why is that so?

First of all, what does 3D liposuction mean? It means liposuction is performed on the entire circumference of that particular region, from top to bottom. For instance, instead of performing liposuction on just the inner and outer thighs, which are the standard areas, Dr Arthur Tjandra performs liposuction on the entire length of the thighs, from hips down to the knees, from frontal thighs, to outer thighs, to the back of thighs and the inner thighs. Because 3D liposuction is performed on such large and extensive areas of the body, 3D liposuction may cause excessive trauma, and if performed under general anesthesia, increases the risk of deep vein thrombosis (DVT), with resultant pulmonary embolism (PE) and potential death. This risk has been documented by Dr Jeffrey Klein, in his liposuction textbook: The Tumescent Technique of Liposuction. However, based on his experience after having performed more than 10,000 liposuction surgeries with syringe technique, Dr Arthur Tjandra finds that syringe liposuction with micro-cannula inflicts minimal trauma, and hence the risk of having DVT and PE after 3D or circumferential liposuction, is non-existent. Liposuction with modern devices, as a matter of fact, inflict so much more trauma, as they use laser or ultrasound-generated heat to melt the fat, before aspirating it out with high power suction device/power-assisted liposuction. These are the types of devices which may inflict more trauma, hence increases the likelihood of complications in 3D liposuction. Based on his experience after having performed more than 10,000 liposuction surgeries, Dr Arthur Tjandra finds that performing liposuction with micro-cannulas which measure only 2 to 3 mm in diameter, under local anesthesia, is the safest way of performing liposuction! In his 15 years of performing liposuction, there was zero serious complication and zero fatality rate! 

What is 4D liposuction, then? We have no idea what 4D liposuction is, because all objects which we can touch have only 3 dimensions: width x length x depth/thickness. We have no idea what the 4th dimension is. The term, 4D liposuction, emerged just a few years ago, after Dr Arthur Tjandra popularized the term 3D liposuction. Perhaps, it is a marketing effort to make a prospective patient believe that 4D yields better result than 3D, since 4 is a bigger number than 3. There may even be surgeons offering 5D or 6D liposuction in the near future. It is most likely used to target iPhone users, who expect iPhone 10 to be better than iPhone 8, for instance.

Liposuction 360 is a term used to denote 360 degrees liposuction. A liposuction which is performed all around, or all over 360 degrees, which is also called circumferential liposuction.  Does 360 liposuction have the same meaning as 3D liposuction? Not necessarily so. A 3D liposuction is a 360 liposuction, but a 360 liposuction is not necessarily a 3D liposuction. Remember what 3D means? It means it covers 3 dimensions which consist of length, width and thickness. In 360 liposuction, as long as it is done in a circumferential manner, it is called 360 degrees liposuction. But, length is not taken into account here. Let’s say you go for thighs liposuction. Which parts are included? In Dr Arthur Tjandra’s 3D liposuction, he performs liposuction on the entire length of the thighs, from hips down to the knees, and in 360 degree, circumferential manner. Likewise, when he performs arms liposuction, his 3D liposuction includes the shoulders, armpits and upper back, while a 360 arms liposuction may just mean that the liposuction is performed all around the arms, which cover the inner arms, back of arms, outer arms and front of arms, but excluding the shoulders, armpits and upper back. Therefore, a 3D liposuction is ALWAYS a 360 liposuction, but a 360 liposuction does not necessarily mean a 3D liposuction!

When VASER High-Definition liposuction device came into the market in the mid-2000s, all surgeons believed that high-definition liposuction, often called liposculpture, was only possible with the use of ultrasound device. What exactly is high-definition liposuction, or liposculpture? As the term implies, it is a liposuction surgery which aims to sculpt out definition of the muscles rather than just reducing the size of a body part. It is done with the help of ultrasound heat to burn the fat down. Superficial fat, which is located just underneath the skin is hard to get, especially over the meeting points of muscles, such as the deltoid grooves of the arms. It is extremely easy to aspirate deep-seated fat. Unfortunately, complications of burns occur quite frequently with VASER Hi-Def liposuction, as in order to sculpt out the muscles and to give more definition, this ultrasound heat needs to be directed and applied into superficial fat layer, which is very close to the skin. When a surgeon is not careful, burns to the skin may occur. When Dr Arthur Tjandra published thousands after thousands of pictures on his website, followed by thousands and thousands of videos on his YouTube channel and this Vlog, surgeons all around the world realized that it was possible to perform high-definition liposuction with just a syringe! You just need to have strong arms and fingers like Dr Arthur Tjandra! Instead of melting those hard to get pockets of fat using ultrasound heat, you have to use brute force with the blunt tip of your micro-cannula to break up the fat pockets. It is an extremely exhausting and painful exercise for the surgeon performing it, but it is not impossible.

We have to warn that not all patients, however, can appreciate the result of high-definition liposuction, especially those who have not seen defined body parts their entire lives, because they may be surrounded by people whose muscles cannot be seen! From November 2008 to March 2020, Dr Arthur Tjandra has performed 3,008 arms liposuction surgeries. Out of those 3,000 over cases, 3 patients have complained about the results of their arms liposuction, while Dr Arthur Tjandra was actually very happy with the results and even labelled them as his masterpieces!

Those 3 patients who complained about their results, with one of them even went on as far as posting a bad 1-star rating review on are:

Patient No. 342: FCUK You, Arthur Tjandra! I want my arms fat back! 

Patient No. 383: Shit, Arthur Tjandra! Look at what you have done to my arms!

Patient No. 481: You call the result of this arms liposuction your masterpiece? Damn you! I want a refund!

All three of them were given the option of having all fat taken out during pre-op consultation, including superficial fat, and was warned that her muscles might show through if there was no fat covering the muscles anymore, or have a layer of fat left behind to cover her muscles. All three opted to have all fat taken out leaving very thin layer of fat behind.

Patient No. 481 eventually returned for a second procedure, bringing along her sister, who would also like to have arms liposuction done. Her sister, having seen arms muscles for the first time, decided that muscles were ugly and that she preferred to have a layer of fat to hide her muscles: Patient No. 502: Arms liposuction, high definition or not?

If you are coming to us for liposuction, especially arms liposuction, go through all our case studies. Patient No. 502 is the only patient whom Dr Arthur Tjandra performed non-high-definition liposuction on. Watch the videos carefully, and decide whether you prefer a non-Hi-Def or a Hi-Def liposuction! Dr Arthur Tjandra charges the same for both, while most surgeons charge double for Hi-Def liposuction!

The large majority of patients, however, loved defined arms. As an athlete himself, Dr Arthur Tjandra does not like to hide his muscles with a layer of fat, whether they are in his arms, abs, or thighs. Therefore, when he performs liposuction, he clears all fat, both deep and superficial fat, by default, making the fat layer as thin as possible. If there is only a very thin layer of fat left underneath the skin, muscles underneath the skin will definitely show through. Dr Arthur Tjandra does not help you create muscles. What he does, is to thin out the fat layer as much as possible. Whatever is underneath will show through. If you have big muscles, your big muscles will show through. If you do not want your muscles to show through your skin, tell him to leave more fat behind! Anyway, we  give all our patients an option of high-definition and non-high-definition liposuction. But, some patients may decide on getting high-definition liposuction done, only to regret it later, like the patient No. 481 above. High-definition liposuction is actually much more difficult to perform and requires more skill and experience, compared to performing liposuction in deep-seated fat. Most plastic surgeons actually charge more for high-definition liposuction compared to non-high-definition liposuction. Dr Arthur Tjandra charges the same for both. But, if a patient does not indicate a preference, he will perform high-definition liposuction by default.

Human Anatomy - Female Body
Anatomy of female muscular system

Look at the pictures of these 3 models below. Their entire bodies are covered with “dents”! If you do not like such “dents”, it is best not to get liposuction done. After all, if you want to leave fat behind to cover those “dents”, what is the point of getting liposuction done in the first place? By the way, to those who really think those are dents, those are not “dents”! Those are normal definition of muscles! Most men know anatomy, but, unfortunately most women do not. Many women believe they do not have muscles, only men do.

Deltoid grooves and separation between biceps and triceps are not the only “dents” our patients have complained about. Some patients even complained about the “dents” on their lower inner thighs and grooves separating their quadriceps from hamstrings on their outer thighs after liposuction. Take a look at the thighs of the first model below. Do you see the “dent” above her left knee on her left inner thigh, and the “long dent” along the lateral aspect of her right thigh? If you seriously think that she has gone for liposuction and those “dents” on her lower inner thighs and “grooves” separating her quads from hamstrings, are NOT normal, and possibly result from complication of liposuction, then liposuction is NOT for you! You will drive your surgeon crazy when he does a good job for you and calls you her masterpiece, but you complain to him about “dents” and even post bad review on the internet!!! If you still want to get liposuction done, it is best that you look for a mediocre surgeon who does not remove much fat, especially superficial fat. He will charge a lot of money but hardly removes any fat, leaving you with fat, smooth and round body with no “dent”! Because all the “dents” are covered by fat!

Workout to tone shoulders and legs
Are you as fit as you should be for your age? This checklist might surprise you
Shoulder, Arm, Joint, Muscle, Standing, Fitness professional, Sportswear, Abdomen, Physical fitness, Undergarment,
female toned arms 1

If you would like to see what the results of arms liposuction performed by Dr Arthur Tjandra appear like, scroll down to the footer below, and choose “Liposuction, arms-female” from the drop-down menu of “Categories“. Go through the case studies and watch the videos carefully, paying particular attention on cases labelled as “Masterpiece“. If you do not like those results, tell Dr Arthur Tjandra during pre-op consultation that you want to leave significant fat behind to hide your muscles!

Finally, take a look at Dr Arthur Tjandra’s picture below:


What do you think of the “dents” all over his body? He has got “dents” everywhere! His arms are not even and smooth. Some parts are bigger than the others. The upper parts are big, then they curve in and there are these horrible dents! After that, they curve out again! How come his arms are not straight and smooth? How come there are so many hills and valleys? What are those? There are a lot of ugly dents and grooves. So are his chest and his abdomen. What are all those oblique dents by the side of his abdomen? Are those all complications of liposuction? Has he performed liposuction on himself and over-aspirated? Perhaps his mentor did it for him? What do you think?

While you are thinking for the answers, take a look at the following pictures of 3 world-class wrestlers:


How come their arms are so smooth and straight and not ugly like Dr Arthur Tjandra’s? They have no dents, hills and valleys like Dr Arthur Tjandra’s arms? The three of them have big arms, just like Dr Arthur Tjandra’s arms, but their arms are not so ugly like his, which are dented all over. Why is that so? What happens to Dr Arthur Tjandra’s arms? Did he have an accident? Were they bitten off by some wild animals in the forests? Was it a complication of liposuction? Scroll down for the answer……




It is because Dr Arthur Tjandra’s body fat percentage was only 8% when that picture was taken! With 8% body fat percentage, it means that there was hardly any fat between his skin and muscles. As there was no fat hiding his muscles, every single strand and definition of his muscles show through his skin! This is what body builders call: DEFINITION!

On the other hand, the 3 wrestlers, although big and muscular, may have body fat percentage of 20%, hence the fat layer between their muscles and skin, hide all their muscles definition!

Therefore, if you want slim, skinny arms and legs, without any muscle definition at all, the answer is not exercise or liposuction. When you exercise or get liposuction done, you will reduce the thickness of the fat layer between your skin and muscles. When the fat layer thins down, your muscles definition will show through the skin. If you want to be slim and skinny, yet appear smooth and round, then you should just starve yourself. You must refrain from exercising, because exercising burns fat and builds muscles! You may try one of those fad diets, eating and drinking nothing but cucumber juice or protein shake every day, and take diet pills which curb your appetite. It all boils down to your calories intake versus output. If you do not exercise, you just need to ensure that you eat less than what you burn off!

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