Chaeum & Bium Surgical Archive — Dr. Han Gru, M.D. — Dr. Han Gru, M.D.

Evidence-Based Liposuction, Fat Grafting & Body Contouring Medical Library in Seoul, Korea

The easiest way to choose a good hospital for liposuction #1

Take a cue from advertising

Dr. Han Gru, M.D. (Board-Certified Surgeon · Chaeum & Bium)

2026-11-12

Today, I would like to tell you about the easiest and most reliable way for general consumers to choose a good liposuction hospital. In the medical advertising market, there is a significant information gap and gap between the perspectives of doctors who perform surgery and the perspectives of general consumers. From the surgeon's perspective, patients often feel the gap between reality and the flashy marketing phrases, as parts that are immediately distinguishable just by looking at a single photo are not visible to the patient's eyes. In today's column, we will point out the criteria for clearly distinguishing between good surgery and artificial staging through objective medical papers and the principle of layer separation in an actual canister. They must be viewed separately according to site and surgical history. Reoperation with severe adhesions due to previous surgery or cases with densely developed blood vessels, such as in the thighs or back.

Finding a Good Liposuction Hospital Project 01 · Surgeon Medical Column

The easiest and most reliable way to choose a good liposuction hospital: The truth seen through the science of layer separation of surgical extracts (collector containers)

Chaeum & Bium Surgical Clinic Dr. Han Gru (Chief Surgeon) · Wise hospital selection criteria based on published medical papers and physiological common sense

Hello? Chaebi Everyone, Dr. Ai lipoplastic surgery. Han Gru (Chief Surgeon)It is.

SECTION 01 Verification of public medical papers

1. Changes in liposuction extract over time as seen in medical papers

International academic journals to aid objective understanding Regenerative TherapyLet’s first look at the open medical papers published in (December 2023 issue) [1. Study on time-dependent layer separation and cell preservation of liposuction extracts]. This paper describes the data collected during liposuction. Mixture of pure fat, blood, tumescent anesthetic solution and body fluidsWe are investigating with actual photos how the layers naturally separate depending on the passage of time and density differences.

🔗 View PMC official paper original text and photos (PMC10667615) ↗ 🔗 Go to PubMed bibliographic information (PMID: 38028938) ↗

1. Mixed state

Immediately after inhalation, all ingredients are mixed together and the overall appearance is opaque, with small fat particles floating in the solution.

2. 2nd floor separated status

It is divided into an opaque oil/fat layer at the top with low density and a transparent red blood/anesthetic solution layer at the bottom with high density.

3. 3rd floor separation status

It is clearly divided into three parts: a translucent yellow oil layer at the top, an opaque pure fat layer in the middle, and a bloody blood/solution layer at the bottom.

🔬 Summary of human physical layer separation principles (natural gravity floating and settling due to density difference)

Immiscible mixtures of fluids and cells are ordered by intrinsic density (ρ) under gravity. Free pure lipid oil (≈ 0.90 g/cm³) < intact adipocyte lobular layer (≈ 0.92-0.96 g/cm³) < water-based tumescent anesthetic solution and red blood cell layer (≈ 1.00-1.06 g/cm³)Since there is a clear difference in specific gravity, if there is no artificial shaking, it is clearly divided in the following order from the top: oil → pure fat → water-soluble anesthesia and blood layer.

[1] Inaki, R., Sato, Y., Nakamura, D., Aikawa, Y., Takato, T., Hoshi, K., & Hikita, A. (2023). "Lipoaspirate stored at a constant low temperature by electric control suppresses intracellular metabolism and maintains high cell viability." Regenerative Therapy, 24, 662–669. PMID: 38028938 / PMCID: PMC10667615.

SECTION 02 · Surgical technique and bleeding safety

2. Liposuction technique and risk factors: Hyper-wet vs. Super-wet

Most modern safe liposuction surgeries are Hyper-wet (Tumescent technique) The method is used as standard. This is compared to the expected amount of fat to be inhaled. 2 to 4 times the amount of tumescent anesthetic solutionBy injecting enough into the subcutaneous fat layer, it constricts microvascular vessels, dramatically reducing bleeding, minimizing bruising and pain after surgery, and speeding up daily recovery. On the other hand, lowering the injection solution ratio to 1:1 level Super-wet This method requires special attention because the risk of blood loss greatly increases when performing large-scale liposuction of more than 3,000 cc.

Compare items	Hyper-wet / tumescent method (Hyper-wet / standard)	Super-wet and excessive inhalation (Super-wet / Caution)
Anesthetic solution injection rate	Compared to the amount of fat absorbed Inject 2~4 times enough	Compared to the amount of fat absorbed About 1:1 level
Vascular protection and hemostatic effect	Due to hydrostatic pressure and blood vessel constriction within the tissue Minimize bleeding	When inhaling large quantities Increased risk of tissue and blood vessel damage and bleeding
Bruises, pain, and recovery after surgery	Minimize bruising and swelling, pain relief and quick initial recovery	Possibility of severe bruising, hematoma, anemia and Delayed recovery from daily life
Anesthesia and systemic safety	Induces sleep and sedation Easy to house within a safe physiological range	Due to general anesthesia and long surgery Increased risk of thrombosis and embolism

⚠️ Surgeon's note on mass liposuction:
in one surgery 3,000 to 5,000 cc or more of pure fatMassive liposuction that removes excess fat carries the risk of excessive bleeding and toxicity beyond the allowable dose of local anesthetics (lidocaine, etc.). In addition, it can be fatal as it requires general anesthesia or the surgery time is prolonged. Risk of deep vein thrombosis and pulmonary embolismIt is not medically recommended as it increases the risk significantly.

• Summary of the physiological and pharmacological principles of tumescent hemostasis : Increase in hydrostatic pressure in subcutaneous tissue due to injection of a large amount of fluid + vascular smooth muscle α of epinephrine mixed in a very small amount₁-Adrenergic receptor action → Selective contraction of subcutaneous capillaries and arterioles → Minimization of blood loss during surgery and preservation of anatomical surgical layers.

SECTION 03 · Standard amount of pure fat by part

3. Appropriate amount of liposuction for each area (based on the average body type of Korean women)

Domestic women of average body type (Height 160cm, weight 55~60kg), each area meets both anatomical stability and aesthetic completeness. Pure Fat The appropriate intake standard amount is as follows.

Arms (total of both sides)

400~500cc of pure fat

each 1 milk carton Quantity

Abdomen (complete)

1,000~1,500cc of pure fat

1.5L water bottle Inside and outside amount

thighs (both sides)

1,000~2,000cc of pure fat

2L water bottle Quantity

With just this amount of pure liposuction, you can expect a visually significant and natural improvement in your body line. (However, depending on the stage of overweight or obesity, the required inhalation amount may increase by 2 to 3 times the standard value, but even in this case, for patient safety, a safe schedule division is preferable rather than an unreasonable one-stop large-scale inhalation.)

SECTION 04 · Practical collection bin identification guide

4. Correct hospital classification method based on the condition of the container (collector)

In some hospitals, the total volume is inflated by shaking and mixing the anesthetic solution, saline solution, and fat, or, conversely, the lower blood + anesthetic solution layer (tumescent) is artificially removed to make the pure fat ratio appear abnormally high. ‘Inflated marketing’You can also use . Specific criteria for distinguishing good surgeries from questionable presentations by looking at the actual physical state of surgical extracts are as follows:

Type 01 · Normal and Excellent Surgical Standards

[Example of desirable surgery]

Forms a thin, transparent oil layer on top (gray arrow)
Thick pure fat/oil mixture layer in the middle (blue arrow)
The color of the lower blood and anesthetic solution layer is clear and transparent, and the amount of bleeding is small, reflecting minimal damage to surrounding tissues and blood vessels during surgery (green arrow)

💡 Natural variation in fat tone by individual and area:
Unlike other fats, the fat sucked into the third collection container, etc. White~pinkThis tends to occur, and in severe cases, cream colorIt may come out close to . This is because, just as each person's skin color is different, the subcutaneous fat layer also has natural differences in texture and color depending on the individual and area (fiber content, etc.).

Type 02 · Shake and inflate / Be careful with saline solution dilution

[Example of suspected artificial mixing/manipulation]

If the fat is floating loosely or mixed together without separation of layers, it is necessary to make the total suction capacity appear large. state of being intentionally shakenIt may be.
When 500cc of pure fat is mixed with physiological saline and shaken, the total volume is visible to the naked eye. Because it looks 2-3 times bigger Consumers must be especially careful.
Usually, when artificial dilution is performed, the diluted fat-anesthesia solution (green arrow) It looks like a lump of fat inside Granulated like an aloe drink It appears irregularly spread out (blue arrow).

Type 03 · Determination of intermediate blood loss by site vs. stitching of other collection tubes

[Example of moderate blood loss & determination of color mismatch in multiple containers]

Reoperation (tissue adhesion)It's this thighs and backIn areas where blood vessels are anatomically developed, the color of the lower solution may become somewhat darker, but the natural layer separation form is maintained over time.
Desirable case: Similar consistency of fat tone and underlying blood-solution layer properties in multiple collection vessels is a normal result of a single patient's surgery.
In case of suspicion of weaving: If the color of fat is different in each collection container (indicated by different arrow colors) and the ratio of fat to solution is also different, There is a possibility that fat from other patients was mixed or brought together for the image.This is high.

Type 04 · Risk of serious tissue and blood vessel damage

[Example of surgery with excessive bleeding]

upper part Even the fat layer is red.The bottom layer is Dark red and cloudyThis is the case.
This means that the surrounding soft tissue and subcutaneous blood vessels were severely damaged due to rough manipulation during surgery, and severe bruising and hematoma occurred after surgery. Risk of anemia and blood loss shockThis increases.

Type 05 · Deterioration due to sap replacement, cleaning, and long-term neglect

[Example of photo production, such as washing the lower part of the sap]

The lower layer is bloodless and has an excessively clear yellow color. The lower blood layer is removed several times and new fluid is mixed again.There is a possibility that it did.
In most cases, a long time has passed since surgery. Decay of fat and weakening of cell wallsAs the process progresses, the unique color fades, rice cake formor oil flows out from ruptured cells. The top oil layer is excessively thick. It becomes visible.

Type 06 · Replacement / Suspicious mixing of existing fat with another person

[Excessive amount of bleeding + possibility of reuse of fat that has elapsed over a long period of time]

Natural to the upper fat layer Texture where the fat layer is abnormally dense even though there is no oil part.In the case of so-called ‘Change’I had already selected Mixing with fat from other patientsmust be suspected.
In fact, when a feeling of heterogeneity occurs or when it is mixed with another person's tissue, it shows some hardening and deformation due to adverse reactions (agglomeration/denaturation).
As a result, the blood mixed in the middle cannot settle down due to the density difference and is trapped between the fat lumps. A more severe form of stickingIt's easy to do.

REAL CASES · Practical discrimination practice

Actual cases of medical advertisement photo identification (Case 1 ~ Case 3)

[Case 1] Comparison of left side (inflated by shaking with solution) vs. right side (normal density fat layer)

The right side is normal It is an extract, On the left, the amount is inflated by shaking with the solution.It is. In fact, there is a clear difference in density with the naked eye, and the left side is relatively likely to take on a pink or red color as it mixes with blood.

In more severe cases, remove the blood altogether. It is also called by mixing tap water or saline solution., In that case, the characteristic is that the fat is floating and spread irregularly, as shown on the left. On the other hand, in the normal case (right) Transparent oil droplets are interspersed between the dense yellow fat layers.Do it.

[Case 2] Close-up shooting with the lower part of the collection container intentionally covered

Fat granules float and the diluted solution is visible between them.
compositionally Photographed so that only a portion of the fat collection container is visible (in particular, the lower blood/anesthetic solution layer is cleverly obscured)This is an example of a product made so that consumers cannot know the actual percentage of pure fat and degree of bleeding.

[Case 3] Case where only the fat-oil layer occupies most of the collection container

The fat-oil layer alone accounts for almost 90% or more of the entire collection container.
Bottom before shooting When the anesthetic solution-blood layer is artificially discharged and removedThere are a lot.
(Clinical exception: Even if the actual amount of suction is very large and the capacity of the collection container prepared during surgery is insufficient, the method of withdrawing the lower solution may be unavoidable, so the freshness of the fat and the thickness of the oil layer must be considered together.)

CONCLUSION · Standards for wise medical consumers

Conclusion of a surgeon: Proper medical care based on basic common sense

In the current cosmetic surgery medical market, the best results can be achieved when consumers make wise decisions on their own with accurate knowledge and information uncontaminated by commercial exaggeration. When you look at the suction product in a liposuction advertisement, don’t just look at the color of the removed fat. How much time has passed since the surgery when the picture was taken based on the type of layer and the composition ratio of the layer (delay time)We ask you to guess first.

✅ Checklist of 5 things you must check when looking at liposuction advertisement collection bin photos

1. Rather than just the color of the removed fat Separation of floors and three-floor compositionDid you guess the delay (elapsed) time when the photo was taken? 2. Compared to the bottom solution Abnormally excessive fat layerOr did you cut off the lower part and take pictures? (Whether or not to artificially remove the anesthetic solution) 3. The color of the bottom solution is A blood clot that is too dark red or cloudyIsn't it? (Whether there is a risk of excessive blood vessel rupture and blood loss) 4. Fat It is too sticky or the top oil layer is excessive. Isn't it? (Whether it is left for a long time to produce decay or sap washing) 5. Several collection bins placed side by side Various colors and proportions of fatDoesn't it sound like this? (Whether or not to mix or weave with other people’s fat)

There is no surgery anywhere in the world that is said to be good for damaging normal blood vessels.
There is no surgery that involves a lot of bleeding.
Medical care also operates based on basic common sense.

Surgeon Dr. Han Gru (Chief Surgeon)'s medical principles: Principle of blood vessel preservation to protect remaining skin

“The true quality of liposuction depends not simply on the amount of fat extracted, but on how healthy the skin and subcutaneous tissue left behind after the surgery are restored. Only by preserving the small blood vessels under the skin as much as possible can you prevent severe bruising, swelling, and permanent pigmentation that turns the skin dark.”

SECTION 05 · Q&A from the patient’s perspective

Frequently asked questions from patients (Q&A: Choosing a good liposuction hospital)

Q1 If a hospital is full of yellow fat all the way to the top in promotional photos, isn't it a place where surgery is much better?

Not necessarily. When surgery is performed using the safe hyperwet (tumescent) method, some of the anesthetic solution used to protect blood vessels is absorbed along with the fat, and a clear solution layer naturally settles at the bottom. If the entire container is more than 95% filled with yellow fat, it is highly likely that the lower anesthetic solution and blood layer was artificially removed before filming to make the volume appear large (except in exceptional cases where the suction volume was very large and the collection container was insufficient). Therefore, more than the total volume Is the three-layer separation natural and the bottom solution clear and transparent?You should see .

Q2 If the color of the extracted fat is not dark yellow but white, light pink, or cream, was it extracted incorrectly?

no. Just as each person's skin color is slightly different, subcutaneous fat also naturally varies from bright yellow to white-pink to a shade close to cream, depending on the individual's constitution and suction area (fiber density, etc.). However, if the colors and solution ratios of the various canisters lined up as the result of one person's surgery are completely different for each canister, you should be cautious of the possibility that the collection canisters of different patients were mixed together.

Q3 Isn't it more beneficial to extract as much as possible, 4,000 to 5,000 cc at a time, while under anesthesia?

This is a very dangerous idea. Based on average body type Korean women (160cm, 55~60kg) Arms 400~500cc, Abdomen 1,000~1,500cc, Thighs 1,000~2,000ccEven just precise removal of pure fat is enough to create a noticeable change in smooth lines. If more than 3,000 to 5,000 cc of pure fat is extracted at a time, the risk of excessive bleeding, excessive local anesthetic capacity, and thrombosis/embolism due to extended surgery time increases rapidly. Therefore, even in large patients, the principle is to safely perform surgery in separate areas.

Q4 If the liquid at the bottom of the collection tube is red, does it necessarily mean that the blood vessels were damaged, a bad surgery?

They must be viewed separately according to site and surgical history. In areas where there are severe adhesions from a previous surgery, or in areas where blood vessels are densely developed, such as the thighs or back, the color of the lower solution may be somewhat dark red. Even in this case, if the upper fat layer and border are clearly separated and the properties of the various barrels are consistent, it is normal. What is problematic is When the upper fat layer is stained red and the lower part is opaque and cloudy like a dark red blood clot.This means excessive tissue and blood vessel damage.

Mechanical vs. Handmade Is the paper really trustworthy?

Limitations and facts of plastic surgery papers

Dr. Han Gru, M.D. (Board-Certified Surgeon · Chaeum & Bium)

2026-11-12

“Is power-assisted liposuction (PAL) really superior to handmade (SAL)?” - Chaeum & Bium Surgical Clinic Dr. Han Gru (Chief Surgeon) Column

Surgeon Dr. Critical Medical Column by Han Gru (Chief Surgeon)

“Is power-assisted liposuction (PAL) really superior to handmade (SAL)?” — A surgeon's record of delving into a landmark liposuction paper to the end

Chaeum & Bium Surgical Clinic · Verification of academic papers behind commercial marketing and guide to anthropophysical body shaping

Hello? Chaebi Everyone, Dr. Ai lipoplastic surgery. Han Gru (Chief Surgeon)It is.

※ Terminological information before entering the text:
The standard medical name in the title is ‘Powered liposuction (PAL)’and ‘Traditional negative pressure liposuction (SAL)’ instead '기계식 지방흡입'and ‘Handmade’The reason why the expression is included is because it is a familiar term that is currently widely spread among patients in private practice for marketing purposes. However, what you should not misunderstand is that there is no such thing as an automated method where a machine performs surgery on its own. Both PAL and SAL methods are ultimately surgeries performed from start to finish by the doctor holding the handpiece and stroking it.It is true.

As a surgeon who performs liposuction surgery and as a clinician who must promise the safest and most precise results to patients, there is a fundamental question I always ask myself.

“Between Power-Assisted Liposuction (PAL, Power-Assisted Liposuction), which uses the power of a motor to finely vibrate the tube, and traditional Negative Pressure Liposuction (SAL, Suction-Assisted Liposuction), which involves suctioning using only the doctor’s touch without a vibration motor, is there really a scientific paper designed well enough to change the patient’s final surgical outcome?”

Today, many hospitals advertise specific expensive equipment (such as PAL) or, alternatively, specific techniques, as if one guarantees superior results. However, when we open the original text of the actual medical academic database (PubMed), not just a marketing phrase, and verify the design step by step, we come across loopholes behind the paper that we believed to be 'scientific evidence'. In today's column, I looked for and read comparative papers between PAL and SAL. 5-step critical verification processWe would like to share this transparently with our dear Chaebi readers.

OVERVIEW · Schematic diagram of the five stages of critical thinking

PAL vs SAL landmark paper verification process at a glance

Even if it is a paper published in a famous academic journal, a completely different truth is revealed when the research design, sample, and interests are dismantled step by step from the perspective of a surgeon.

Step 1. Search and surface conclusion of landmark papers

• Question: “What representative randomized controlled trials (RCTs) have demonstrated significant differences between PAL and SAL?”
• Surface area reported: increased suction rate (mL/min), reduced surgical time, and reduced surgeon arm fatigue (Katz et al., 2001)

▼

Step 2. Decomposition of patient epidemiology data: disappearance of BMI distribution

• Question: “What is the body mass index (BMI) of the patients studied? Weren’t they mainly selected for overweight and obesity?”
• Limitations found: Individual height, weight, and BMI values are not indicated → A defect in ‘generalization (external validity)’ in which the mechanical time reduction effect is exaggerated when focusing on the obese group

▼

Step 3. Shock of Sample Size: Paradox of only 18 people ($N=18$)

• Question: “After checking the original text, isn’t the total number of patients only 18?”
• Limitations found: Minimum statistics were obtained through symmetrical comparison (split-body), but actual safety could not be verified due to skin necrosis, discoloration, and asymmetry with a sample of 18 people.

▼

Step 4. Structural conflict of interest (COI) and absence of reproducibility verification in plastic surgery papers

• Insight: “Aren’t the authors of the paper themselves commercial stakeholders in the organizations and techniques they promote?”
• Academic evidence: bias in positive conclusions due to financial interests (Lopez et al., 2015) and lack of independent reproducibility review by opposing experts.

▼

Step 5. Analysis of exaggerated vocabulary ('Significantly', 'Than') and the three major physical, physiological, and tactile essences of liposuction.

• Linguistic analysis: Excessive superiority framing (Spin phenomenon) compared to the restrained description of orthodox medical and surgical papers
• Surgeon's conclusion: ① Fat lobule hydrodynamics, ② Microvascular preservation, and ③ The delicate tactile sense of the opposite hand (guide hand) that is taken away by vibration, and the risk of vibration damage to the surgeon (Wu et al., 2021)

STEP 01 & 02 · Paper search and pitfalls of BMI distribution

1. The superficial results presented in the paper and the limitations of the ‘hidden BMI distribution’

In academia, the most widely cited early literature comparing PAL and SAL as a prospective randomized controlled trial (RCT) was published in 2001. Dermatologic SurgeryThis is a multicenter study by Katz et al. published in [1. PAL vs SAL prospective comparative study]. The researchers used a split-body design, dividing the left and right symmetrical parts of a patient's body and inhaling on one side with the PAL and the other with the SAL.

• The superficial advantages reported by the paper: The liposuction speed per minute was faster in PAL, which shortened the overall surgery time ($p < 0.05$), the arm fatigue felt by the operating surgeon was significantly reduced ($p < 0.01$), and there was no difference in the survival rate of the collected fat cells. [1, 2. Comparison of suction efficiency and operator fatigue].

If you read this far, it seems like PAL is superior in every way. But as a surgeon, the next question I asked was: “Is the BMI (body mass index) distribution of the patients who participated in the study provided?”It was.

Surprisingly, the original paper did not specify the patients' individual height or BMI values, but only presented basic epidemiological summary values such as the average range of weight, age, and gender. [1. Limitations of patient group epidemiological data]. If individual height and weight had been recorded, BMI ($\text{Weight (kg)} / \text{Height (m)}^2$) could have been back-estimated, but the summarized statistics alone cannot tell whether these patients are slim body shape correction patients or severely overweight and obese patients who require large-dose inhalation.

① Disparity between internal validity (accuracy within the study) and external validity (generalizability)

Since the left and right sides of one person were compared, the internal causal relationship (internal validity) that “PAL was faster in this experiment” is established regardless of obesity level. But What if the research team had selected samples mainly from obese and overweight patients with a large amount of fat to extract in order to maximize the time-saving effect of PAL?

The thicker the fat layer and the greater the suction volume, the greater the effect of reducing time and doctor fatigue caused by the machine's reciprocating vibration. On the other hand, in normal weight to slightly overweight patients who want detailed line sculpting, the time difference between PAL and SAL may be clinically insignificant. The fact that epidemiological summary values are lumped together so that they cannot be distinguished is an obvious limitation that makes it difficult to generalize the study results to all patients.

[1] Katz, B. E., Bruck, M. C., & Coleman, W. P. (2001). "The benefits of powered liposuction versus traditional liposuction: A paired, randomized, prospective evaluation." Dermatologic Surgery, 27(10), 863-867. PMID: 11722518 [2] Fodor, P. B., & Vogt, P. A. (1999). "Power-assisted lipoplasty (PAL): a clinical pilot study comparing power-assisted lipoplasty with traditional suction-assisted lipoplasty." Aesthetic Plastic Surgery, 23(6), 379-385. PMID: 10629292

STEP 03 & 04 · N=18 sample impact and commercial conflict of interest

2. Sample of only 18 people ($N=18$), and structural conflict of interest in plastic surgery papers

The bigger shock I encountered when I read the original text of the paper directly was The total number of study subjects is only 18 (1 male, 17 female).was true [1. Limitations of very small sample design].

The very small sample of 18 people was only an initial exploratory study (pilot study) to gauge the operating speed of the device. With such a small sample, patients are really worried. It is completely statistically impossible to verify differences in serious side effects, such as skin necrosis, severe bruising and hematomas, uneven skin asymmetry, and permanent pigmentation.I do. In fact, a plastic surgery journal PRS Global OpenA study by Swanson (2014) published in also sharply criticized the fact that many clinical papers comparing expensive liposuction equipment are being used as a tool for purchasing and marketing expensive equipment, even though their reliability is low due to sample design flaws and failure to control confounding variables. [3. [Criticism of the level of evidence in cosmetic plastic surgery clinical papers].

💡 Why is ‘reproducibility review by opposing experts’ essential for plastic surgery papers?
In my opinion, plastic surgery papers are better than other medical and surgical departments. The relationship is so strong that the authors themselves are direct commercial stakeholders of the research results. This is because the moment you prove your surgical ability and publish a paper on the superiority of the procedure or equipment you are advertising, enormous commercial benefits follow, including hospital publicity, increased surgical costs, and consulting fees for equipment manufacturers.

In fact, researchers at Johns Hopkins University (Lopez et al., 2015), the most authoritative journal in plastic surgery, Plastic and Reconstructive SurgeryAccording to an analysis published in Plastic surgery papers written by researchers with financial conflicts of interest (COI) from equipment companies, etc. had a statistically significantly higher probability of reaching a 'positive and superior conclusion' about a specific device or procedure compared to papers by researchers without a conflict of interest. [4. [Financial conflicts of interest and conclusion bias in plastic surgery papers].

Moreover, surgical research is different from drug research, where the doctor's 'manual skill and skill' itself determines the results. We cannot rule out the risk that authors trying to promote PAL are already proficient in PAL, and may unconsciously perceive higher levels of fatigue or manipulate it in less detail when performing SAL, which is the control group. Therefore, what is more important than the design of the paper itself is: Will the same results be obtained when an opposing expert (traditional SAL master) or an independent third party whose interests conflict with the content of the paper examines reproducibility under the same conditions?It is.

IMAGE SLOT 01 · Powered liposuction machine (PAL)

MicroAire® PAL® (Power-Assisted Liposuction) Handpiece

It is an electric handpiece equipment that reduces fiber passage resistance and operator's arm fatigue with thousands of microscopic reciprocating strokes per minute.

🏢 MicroAire® (PAL original manufacturer) official product page ⬇ Check/download original high-quality catalog images

IMAGE SLOT 02 · Precision Cannula (SAL)

Medela® Precision Liposuction Cannula & Surgical Negative Pressure Suction System

Based on Swiss Medela®'s precision-processed cannula and stable vacuum negative pressure (Dominant Flex, etc.), this is a standard SAL system that reads tissue resistance and blood vessel running surface and suctions in detail using only tactile feedback from the tips of the surgeon's hands without vibration of the motor.

🏢 Medela® Healthcare (original manufacturer) official product page ⬇ View Medela® Surgical Suction Systems & Cannulas Catalog

[3] Swanson, E. (2014). "Levels of Evidence in Cosmetic Surgery: Analysis and Recommendations Using a New CLEAR Classification." Plastic and Reconstructive Surgery Global Open, 2(9), e218. PMID: 25289261 [4] Lopez, J., Lopez, S., Means, J. et al. (2015). "Financial Conflicts of Interest: An Association between Funding and Findings in Plastic Surgery." Plastic and Reconstructive Surgery, 136(5), 690e-697e. PMID: 26505726

STEP 05 · Comparison of academic vocabulary and the essence of physics, physiology, and tactile

3. Abuse of “Significantly” and “Than”: Language gap with orthodox medical and surgical papers

Throughout the paper, sentences and vocabulary that emphasize the superiority of surgery—especially 'Significantly'Wow 'Than (superior to)'If we compare the use of — with similar orthodox internal medicine or essential surgery papers, we can see that it is a so-called verbal exaggeration for commercial persuasion. ‘Spin’ phenomenonThis is clearly revealed [5. Verbal exaggeration and spin phenomenon in clinical papers].

↔ You can check the full contents by sliding the table left or right

Lexical and descriptive analysis items	Academic norms for orthodox internal medicine/essential surgery papers	Description of the relevant plastic surgery instrument comparison paper (Katz et al.)
Framing of the Title	"Comparative Evaluation of A and B..." Adopt a value-neutral comparison structure	"The Benefits* of Powered Liposuction..."* Promotional title that puts the ‘benefits’ of a specific device at the forefront
Usage of "Significantly"	Strictly limited to predefined primary endpoints only. When $N=18$ level Immediately add the proviso that “the sample is small and interpretation requires caution.”	Throughout the abstract and conclusion "Significantly faster", "Significantly less fatigue"By repeatedly arranging Exaggerated as ‘clinical overwhelmingness’
Comparative composition using “Than”	"Relative to", "Compared with" Confidence interval (CI) values are calmly presented along with neutral phrases such as	"Faster than", "Easier than", "Superior to"By using in succession Traditional handwriting method (SAL) downgraded to an outdated standard
Subjective Indicators and Conclusion Tone	Physician fatigue, which cannot be blinded, is reduced to an auxiliary indicator and the need for large-scale follow-up verification is specified.	“Effortless” Conclusively recommend the justification for introducing the organization by mobilizing tangible modifiers such as

Surgeon's conclusion: 'Physics of skin', 'preservation of blood vessels', and 'tactile sensation of the opposite hand' that motor vibration can never replace

In the end, whether PAL or SAL, the passage through which fat is suctioned is a thin tube (cannula) with a diameter of several millimeters, and the place through which the tube passes is the living patient's skin. What determines the success or failure of surgery is not the vibration motor attached to the handle. Basic principles of human physics and physiology and the surgeon's sense of both handsIt is.

① Physics of grape cluster-like fat grains (fat lobules) and thin tubes:
The fat in our body is not a flowing liquid like water, but a lump (fat lobules, 1-4 mm) tightly bound together with a collagen net like small grapes. [6, 7, 8. Size of fat lobules and cannula hydrodynamics]. As the diameter of the tube becomes too thin, the internal flow resistance rapidly increases ($R \propto 1/r^4$), and grape cluster grains may get caught in the hole and block the tube, or large fat lobules may be skipped without being absorbed. [6. Mechanism of occlusion of fatty lobules within the lateral foramen]. At this time, if you use force with machine vibration or excessive sound pressure, only the surrounding flesh tissue will be injured, so only the surgeon's delicate handling of selecting an appropriate tube according to the size of the fat lobule and reading the tissue resistance with his fingertips can create a smooth line.

② ‘Preservation of thin blood vessels’ is more important than extracting a lot and finishing it quickly:
Even if the surgery time was shortened by 20 to 30 minutes with the power of the machine, what would happen if the thin blood vessel network under the skin was injured through rough manipulation relying on fast vibration? The oxygen path to the skin is blocked skin necrosiscomes, or the blood that leaks out accumulates Hematoma and infection, long swellingcauses the iron content in the blood to seep into the skin. Permanent dark skin staining (pigmentation) due to hemosiderin depositionwill leave behind [9, 10. Preservation of subcutaneous vascular network and prevention of complications].

③ Risk of sensory damage to the opposite hand (guide hand) and vibration damage to the surgeon due to vibration:
In liposuction, the movement of the main hand holding the suction device (handpiece) is also important, The sensation and role of the ‘opposite hand (pinching & sensing hand)’ that judges the thickness and roughness of the remaining tissue on the skin in real time and secondarily adjusts the suction pressure by gently pressing it.This is no less decisive. If PAL is fully adopted during surgery, the continuous mechanical vibration (approximately 74 Hz, acceleration $5.69\text{ m/s}^2$) generated by the cannula and handpiece at tens of times per second will fatigue and dull the fine tactile receptors in the fingertips, resulting in loss of precise thickness discrimination sensation. [11, 12. Tactile nerve dullness and sensory loss due to mechanical vibration].

In fact, it is an authority on cosmetic plastic surgery. Aesthetic Surgery JournalIn a paper by Wu et al. (2021) published in When performing surgery using the vibrating mechanical method (PAL), the actual measured vibration intensity is significantly higher than the manufacturer's published value ($p < 0.001$), and when used for more than 1 hour and 30 minutes a day, the vibration exposure caution limit (action value) has already been reached, which can cause 'Hand-Arm Vibration Syndrome (HAVS)', which causes permanent loss of sensation, peripheral nerve damage, and blood vessel constriction in the operator. Be very careful of damage to the surgeon.has warned safety guidelines [11. Risk of exposure to vibration of surgeon when using PAL and HAVS caution recommendation]. We must calmly ask ourselves whether strong mechanical vibrations, which can dull the senses of the surgeon's fingertips and cause cumulative damage to the nerves of the hand, are really unconditionally beneficial to delicate body sculpting.

Surgeon Dr. Han Gru (Chief Surgeon)’s medical principles: Principles of truthful treatment without exaggeration
“We do not rely on the names of expensive expensive equipment, commercially inflated numbers of papers, or promotional slogans from provocative YouTubers. We honestly diagnose the patient’s body condition as it is, transparently explain the limitations of the surgery, and prove it only with the results in the operating room.”

[5] Boutron, I., Dutton, S., Ravaud, P., & Altman, D. G. (2010). "Reporting and interpretation of randomized controlled trials with statistically nonsignificant results for primary outcomes." JAMA, 303(20), 2058-2064. PMID: 20501928 [6] Klein, J. A. (2000). Tumescent Technique: Tumescent Anesthesia & Microcannular Liposuction. Mosby. ('Inspissed fat' mechanism of occlusion of fat lobules within the cannula side hole) [7] Coleman, S. R. (1997). "Facial recontouring with lipostructure." Clinics in Plastic Surgery, 24(2), 347-367. PMID: 9140628 [8] Tonnard, P., Verpaele, A., Peeters, G. et al. (2013). "Nanofat grafting: basic research and clinical applications." Plastic and Reconstructive Surgery, 132(4), 1017-1026. PMID: 23783059 [9] Grazer, F. M., & de Jong, R. H. (2000). "Fatal outcomes from liposuction: census survey of cosmetic surgeons." Plastic and Reconstructive Surgery, 105(1), 436-446. PMID: 10626999 [10] Klein, J. A. (1990). "Tumescent technique for regional anesthesia permits lidocaine doses of 35 mg/kg for liposuction." The Journal of Dermatologic Surgery and Oncology, 16(3), 248-263. PMID: 2312842 [11] Wu, C., Laswell, S., Mentz, J. A., & Morales, R. (2021). "Vibration Exposure Safety Guidelines for Surgeons Using Power-Assisted Liposuction (PAL)." Aesthetic Surgery Journal, 41(7), 783-791. PMID: 33336695 [12] Aarhus, L., Veiersted, K. B., Nordby, K. C., & Bast-Pettersen, R. (2019). "Neurosensory component of hand-arm vibration syndrome: a 22-year follow-up study." Occupational Medicine, 69(3), 215-218. PMID: 30690546

SECTION Q&A · Frequently asked questions from patients

4. Frequently asked questions about liposuction equipment (PAL vs SAL) and medical literature

In the consultation room, we will organize in an easy-to-understand manner the four questions dear Chaebi readers are most curious about regarding liposuction equipment advertisements and thesis evidence.

Q1. If you look at hospital advertisements, they say that you should use vibration equipment (PAL) to reduce bruising and swelling and to prevent sagging skin. Is this true?

Not necessarily so. The key advantages of PAL demonstrated in the paper are ‘It reduces arm fatigue for surgeons and passes through hard fibers quickly.’The point is. The real key to determining bruising, swelling, and skin discoloration after surgery is not whether the machine vibrates, but rather how accurately the surgeon suctions at a precise depth and angle without damaging the thin blood vessels under the skin (vascular preservation technique).

Q2. So is PAL equipment bad equipment? When does it help?

PAL itself is by no means a bad device. In areas where the skin is particularly hard and tough, such as the back or gynecomastia areas, or in reoperation areas where scar tissue has hardened from previous surgery, it is an excellent 'auxiliary tool' that reduces the doctor's physical expenditure. However, if you rely solely on vibration, even the delicate sense of the other hand, which measures the thickness of the skin, may become dull, so in the end, the doctor's sense of both hands and detailed hand skills are essential to controlling the machine.

Q3. Is PAL better if you have a slim body type and want to precisely trim the flab in some areas?

For those of normal weight or seeking partial body sculpting, there is little difference in surgical time between PAL and traditional manipulation (SAL) because the absolute volume of fat to be extracted is not large. Rather, authentic manual handling, in which the thickness of fat grains and skin is directly felt in 1mm increments with the fingertips through a thin tube and delicately refined, is very advantageous in producing smooth results.

Q4. How should we accept the phrase ‘SCI-level thesis proof’ posted by plastic surgery clinics or clinics on their websites?

Rather than the fact that there is a thesis itself, ‘Is this a poorly based paper in terms of research design or data?’, and ‘Isn’t this a promotional paper written with support from an equipment company?’You should doubt it at least once. Even the famous paper we looked at today was an early study with only 18 patients. It is wiser to choose a doctor who can honestly explain your body's anatomical condition and the limitations of surgery, rather than a screenshot of a flashy English paper or a popular machine name.

Is general anesthesia really safe for liposuction (suction) surgery?

General anesthesia in a private operating room setting should be limited.

Dr. Han Gru, M.D. (Board-Certified Surgeon · Chaeum & Bium)

2026-11-12

hello? Dear Chaebi readers, Dr. Ai lipoplastic surgery. This is Han Gru (Chief Surgeon). Chaeum & Bium Surgical Clinic, surgeon specialist Dr. Chaeum & Bium Surgical Clinic will prepare you. It was Han Gru. thank you

Surgeon Dr. Medical Column by Han Gru (Chief Surgeon)

Is general anesthesia truly universal? : A surgeon's consideration of the risk of thrombosis and embolism and the reality of private clinics

Chaeum & Bium Surgical Clinic · Guide to safe body shaping based on physiological and anatomical principles

Hello? Chaebi Everyone, Dr. Ai lipoplastic surgery. Han Gru (Chief Surgeon)It is.

When conducting liposuction or body shaping consultations, one of the things patients are most concerned about is the method of anesthesia. often “Isn’t general anesthesia the most convenient and versatile, so you can wake up soundly asleep without knowing anything at all?”People often ask,

Of course, from the surgeon's perspective, general anesthesia, in which the patient does not move at all, can make the surgery much easier. However, if you take a dispassionate look at the surgical environment of a local private practice rather than a university hospital, from the perspective of a surgeon who deals with basic physiological and anatomical principles, the story is completely different. Today General Anesthesia (GA)Wow Sleep/sedation-induced anesthesia (MAC / IV Sedation)One of the most fatal complications after surgery Venous thromboembolism (VTE)—In other words, blood clots accumulate in the deep veins of the legs. Deep Vein Thrombosis (DVT)and block pulmonary blood vessels Pulmonary embolism (PE)—I would like to tell you what difference it makes in the risk of occurrence based on medical evidence and the reality of private practice.

SECTION 01 · Comparison of physiological mechanisms

1. General anesthesia vs. anesthesia under sedation: key differences in blood clot risk

General anesthesia and induced sedation anesthesia do not simply differentiate the patient's level of consciousness during surgery. The three major conditions for the formation of blood clots Virchow's TriadWhen comparing the two anesthesia methods, clear physiological differences occur in the blood flow and blood coagulation system within the human body.

↔ Swipe the table left or right to see full details

Evaluation items	General Anesthesia	Sedation induction / regional anesthesia + sedation (MAC / Sedation)
relative blood clot risk	high (reference group)	low (Risk reduction trend of about 35-45% [2. Meta-analysis of thrombosis by lower extremity surgery anesthesia method])
venous stasis (Venous Stasis)	Use of muscle relaxants and suppression of spontaneous breathing Intensified blood flow stagnation	Maintaining spontaneous breathing, when accompanied by local anesthesia Improved blood flow by dilating blood vessels
hypercoagulable state (Hypercoagulability)	Due to the increased stress response to surgery Activation of the coagulation system	By suppressing the neuroendocrine stress axis Relieves coagulation activation
Early mobility after surgery	Due to residual anesthetic gas and narcotic analgesic movement delay	Rapid recovery of consciousness and pain control Early mobility possible [1. Comparison of early behavior and thrombotic indicators]

① Differences in Venous Stasis

One of the biggest causes of blood clot formation is stagnation, where blood flow slows and pools.

• General anesthesia: Mechanical ventilation (ventilator) and muscle relaxants completely stop the muscles in the lower body from pumping blood to the heart. For this reason, the longer the surgery time, the higher the incidence of deep vein thrombosis (DVT) as blood accumulates in the lower extremity veins [2, 3].

• Sedation-induced anesthesia: Spontaneous breathing, where the patient breathes on his own, is maintained, and when local/regional anesthesia is used, the lower extremities are warmed and blood vessels dilate due to the sympathetic nerve blocking effect, thereby improving venous blood flow.

② Body stress response and hypercoagulability

The physical stimulus of surgery easily causes blood to harden (hypercoagulable state) to defend our body.

• General anesthesia: Since the pain signal itself cannot be blocked at the spinal cord level, the secretion of stress hormones such as catecholamines and cortisol is relatively higher than in the sedation group. This increases fibrinogen in the blood and inhibits fibrinolysis, causing blood clots.

• Sedation-induced anesthesia: When combined with regional and local anesthesia, the pain pathway is blocked at the source, blunting the neuroendocrinological stress response. In fact, in the latest clinical studies, it is an indicator of postoperative thrombus formation. D-dimer levels were observed to be significantly lower in the sedation-induced anesthesia group.and walks on its own First Ambulation Time also proved to be much faster [1. Early behavior and D-dimer numerical analysis].

[1] Jia et al. (2026). "Comparison of postoperative deep vein thrombosis incidence between regional anesthesia with monitored anesthesia care and general anesthesia alone in total knee arthroplasty patients". Frontiers in Medicine, 10.3389/fmed.2026.1800865. (Proven to shorten early ambulation time and reduce postoperative thrombotic index D-dimer) [2] MDPI Meta-Analysis (2024). "The Effect of General Versus Neuraxial Anaesthesia on Bleeding and Thrombotic Outcomes in Neck of Femur Fracture Surgery: A Meta-Analysis". MDPI, 2(4), 25. (Reported relative risk of deep vein thrombosis increased by approximately 45% in the general anesthesia group compared to the regional/sedation anesthesia group) [3] PMC Systematic Review & Meta-Analysis (2025). "Impact of Regional Versus General Anaesthesia on Outcomes Following Total Knee Replacement: A Systematic Review and Meta-Analysis". PMC, PMC12648450. (Reported increased frequency of pulmonary complications and cardiovascular thrombotic episodes under general anesthesia)

SECTION 02 · Gap between university hospital data and local data

2. Fatal gap between the other side of the latest thesis and the ‘reality of private practice’

Past data (early 2000s) reported that sedation/regional anesthesia reduces the risk of blood clots by almost half (45%) compared to general anesthesia [2]. On the other hand, according to the latest studies (as of 2024-2026), in a modern university hospital surgical environment where post-operative thromboprophylaxis protocols such as anticoagulants and compression devices are basically well administered, the gap in final DVT/PE incidence between the two anesthesia has narrowed to the point where it is not statistically significant [1].

⚠️ Key points from the surgeon: In the university hospital paper, the prerequisite for keeping the blood clot rate low during general anesthesia was ‘This is because a thorough pharmacological and physical prevention safety net was fully operational.’It is. Arguably, Under the poor setting of a private practice, general anesthesia surgery overwhelmingly carries a high risk of thrombosis and embolism.

① Absence of preventive treatment with antithrombotic drugs (Clexane, etc.) before and after surgery

It is used to prevent deep vein thrombosis (DVT) in local plastic surgery, which is the mainstay of cosmetic surgery. Clexane (enoxaparin) There is no way to use anti-thrombotic drugs such as pre- or post-operative treatment. There are problems with rising drug costs and poor patient compliance with injection treatment, but above all, due to misconceptions and resistance to bleeding and bruising, which are unique to the cosmetic surgery industry, blood clot prevention drugs are excluded altogether.

IMAGE SLOT 01 · Standard antithrombotic drugs Sanofi

Sanofi Clexane® (Clexane® 40mg/0.4mL) Original Package

Low-molecular-weight heparin anticoagulant administered as a standard drug to prevent venous thromboembolism in the surgical department of a university hospital.

⬇ Download original high-quality image direct link 🏢 Sanofi official drug information

IMAGE SLOT 02 · Safety syringe formulation Sanofi PREVENTIS™

Crexane® PREVENTIS™ Safety Syringe (Make Prefilled Syringe)

Prefilled syringe for subcutaneous injection into the abdominal wall filled with a single dose — virtually no administration in private clinics due to concerns about bleeding and bruising and cost issues

⬇ Download original high-quality image direct link 📄 EMC official product specifications guide

② Not wearing lower body pneumatic compression device (IPC) and medical compression stockings.

When the pumping action of the lower body muscles stops due to general anesthesia, the calves and thighs are periodically squeezed externally. Lower body pump device (IPC, intermittent air compression device)me Medical anti-embolic compression stockingsIt is mandatory to wear. However, in actual general anesthesia operating rooms, it is extremely rare for these basic physical prevention equipment to be properly equipped and applied.

IMAGE SLOT 03 · Air pressure pump (IPC) Cardinal Health / Arjo

간헐적 공기압박기구 Kendall SCD 700 및 Flowtron ACS900 IPC 펌프

Intermittent pneumatic compression device (Kendall SCD™ 700 / Flowtron® ACS900 IPC pump and sleeve)

An essential equipment for university hospitals to prevent blood pooling by sequentially compressing the ankles, calves, and thighs in place of the lower body muscle pump that stopped during general anesthesia.

🏢 Cardinal Health Kendall SCD™ official page 🏢 Arjo Flowtron® ACS900 official page

IMAGE SLOT 04 · Anti-embolic compression stockings Cardinal Health T.E.D.™

수술용 단계적 항색전 압박스타킹 T.E.D. Anti-Embolism Stockings

Surgical graded anti-embolism compression stockings (T.E.D.™ Anti-Embolism Stockings)

Medical compression stockings that gradually reduce pressure from the ankle to the thigh to prevent dilation of lower extremity veins and stagnation of blood flow during surgery.

🏢 Cardinal Health T.E.D.™ Compression Stockings Official Page ⬇ Direct link to IPC/compression sleeve reference image

SECTION 03 · Medical ethics and professional calling

3. The nature and ethics of medical care as a surgical specialist

Every time I encounter this reality of private practice, as a doctor, I feel a bit absurd and have deep doubts. Is it really true that the anesthesiologists participating in the surgery do not check the risk of blood clots?

I believe that the anesthesiologist in question did not have in-depth experience in ultra-obesity metabolic surgery or large-scale orthopedic surgery for high-risk groups of blood clots during his training at a university hospital. If not, there would have been strong demands or pressure from the hospital owner (plastic surgeon).

If it's the above problem, it's fortunate. Even though I may have given up on my ethics as a medical professional, At least they are aware of the risk of thrombosis and embolism that comes with general anesthesia.Because it is. However, if general anesthesia is performed inertically without even being aware of these physiological risks, that would be the worst thing. Not only is there a lack of ethics, but even the meaning of existence as an expert has been completely lost.Because it is.

[Surgeon Dr. Han Gru (Chief Surgeon)'s medical principles: Safety-first anesthesia and surgery principles]
“As a surgeon, it is a non-negotiable standard to choose patient safety and a quick recovery process after surgery, even if it requires a little more work and is more difficult, rather than a method that allows the surgeon to complete the surgery comfortably and quickly.”

SECTION 04 · Safe body shaping solution

4. Anesthesia and surgery scheduling that prioritizes patient safety

From the perspective of the surgeon performing the surgery, general anesthesia is more comfortable than when the patient is breathing on his own, but performing the surgery while under anesthesia under sedation and sedation while applying detailed local (tumescent) anesthesia can be a bit more difficult and labor-intensive. But When considering patient safety, it is my firm belief as a surgeon that surgery through induction of sleep and sedation is much safer.It is.

especially liposuction surgeryThis is a surgery that is mainly performed on people who are overweight or have a high body mass index (BMI), which in itself puts them at high risk of venous thrombosis. It is never advisable to apply general anesthesia to patients at high risk for thrombosis without appropriate anticoagulation or pneumatic compression device (IPC) for the convenience of the operator.

Of course, if the area to be suctioned is large and the surgery time is long, general anesthesia may be discussed for various other medical reasons. However, even in such cases, rather than performing surgery on the entire body simultaneously with one unreasonably long general anesthesia, The patient and doctor coordinate the schedule through sufficient consultation to safely divide the surgical area (split surgery).I believe this is the wisest way to reduce the physiological burden and risk of blood clots for this patient.

SECTION 05 · Frequently Asked Questions (Q&A)

5. Q&A about anesthesia and blood clot safety, which patients are most curious about

If you perform liposuction under sedation (induced sedation) anesthesia, won't you wake up or feel pain during the surgery?

No need to worry. Sleep and sedation-induced anesthesia is performed by precisely injecting a local (tumescent) anesthetic solution that blocks pain signals at the surgical site while inducing a deep sleep that allows the patient to breathe safely on his or her own. You can sleep and wake up comfortably without pain, but the burden on your body is much less since you don't have to use a respirator or muscle relaxant.

Isn’t general anesthesia done with a large machine like at a university hospital actually safer?

The risk of general anesthesia can be effectively controlled in a university hospital operating room where all thrombosis prevention safety nets, such as administration of antithrombotic injections (e.g., crexane), intensive care unit-level monitoring, and lower body pneumatic compression devices (IPC), are operated simultaneously. However, in a general practice environment where such preventive measures are easily omitted, sleep/sedation-induced anesthesia, which allows the patient to breathe independently and maintain blood flow to the legs, is much safer in terms of preventing thrombosis and embolism.

Is full-body large-volume liposuction, where there is a lot of fat to be removed, such as the abdomen, thighs, and arms, possible under sedation?

If too many areas are operated on for a long time at once, the total amount of anesthetic administered and the burden of bleeding increases, and the time spent lying on the operating table increases, dramatically increasing the risk of blood clots. Therefore, rather than unreasonably removing the entire body in one day, performing planned surgery (split surgery) on parts such as the abdomen, upper body, and lower body according to the patient's physical strength and safety standards allows for faster recovery and higher completeness of results.

Can I know before surgery if I am at a higher risk of developing thrombosis than others?

Those who are overweight or obese with a high body mass index (BMI), are taking oral contraceptives or hormones, have varicose veins, smokers, or have jobs that involve sitting for long periods of time have a relatively high risk of blood clots. If you transparently inform the medical staff of the medications you are taking and your general health status during the consultation, we will design the safest anesthesia plan and guide to early walking after surgery.

(Hwang Woo-seok's thesis fabricated) Is the plastic surgery and dermatology thesis trustworthy?

We analyze the limitations of specialized subjects that are easily commercialized from the perspective of a surgeon.

Dr. Han Gru, M.D. (Board-Certified Surgeon · Chaeum & Bium)

2026-11-12

When talking with patients inside or outside the clinic or reading numerous hospital promotional materials on the Internet, it is very common to come across flashy phrases such as “a procedure whose effectiveness has been proven in SCI-level academic journal papers” or “unrivaled technology listed in world-class academic journals.” Rather than only emphasizing trendy new technologies or exaggerated before-and-after changes, please honestly diagnose each patient's flesh, fat layer, and anatomical structure and check whether the doctor recommends only surgeries in which the patient's advantages far outweigh the disadvantages in light of basic physiological and anatomical principles. The safest and most trustworthy hospital is one that transparently explains limitations that cannot be improved through surgery and even possible side effects.

Surgeon Dr. Medical Column by Han Gru (Chief Surgeon)

The reason why I, as a surgeon, look critically at ‘medical papers’: commercialization of papers and wise medical consumption

Chaeum & Bium Surgical Clinic · The other side of medical statistics and a guide to choosing the right hospital and surgery

Hello? Chaebi Everyone, Dr. Ai lipoplastic surgery. Han Gru (Chief Surgeon)It is.

When talking with patients inside and outside the clinic or seeing numerous hospital promotional materials on the Internet, “A treatment whose effectiveness has been proven in SCI-level academic journal papers.”Or “Unrivaled technology listed in world-class academic journals” You come across the same fancy phrase very often.

As a surgeon who has undergone training based on strict evidence-based medicine, and as a surgeon who currently holds a scalpel and cannula every day in the field of body plastic surgery and cosmetic surgery, I would like to share an honest and essential story today. We will take an in-depth look at the structural aspects of how medical papers are actually made, and why medical consumers should not take all claims labeled 'papers' at face value.

SECTION 01 · Why should medical consumers know?

1. Why should medical consumers know the other side of the paper?

Every day, every time we open a portal site, we come across papers related to psychology, diet, and health that are frequently cited in gossip articles. Articles that exaggerate provocative one-line conclusions while omitting complex research prerequisites or sample limitations are often consumed as our daily knowledge.

Obesity treatment that has recently become a global craze WegovyWow MounjaroThe same goes for the flood of information surrounding us. If you do not carefully consider what patient group and strictly controlled environment the clinical trial was conducted in, and what the yo-yo effect or metabolic limitations are after discontinuation of medication, it is easy to be deceived by fragmentary figures. Also, just a few years ago, the entire human race experienced COVID-19 pandemic situation At that time, I still vividly remember how numerous medical papers coming out every day from around the world were overturned to completely opposite conclusions in a short period of time, causing great social confusion.

💡 Standards for choosing medical care that are relevant to real life:
Medical papers are by no means limited to the laboratory. From deciding on plastic and cosmetic procedures to entrusting your body to routine health checkups and general hospital treatment, information based on theses has a direct impact on the judgment of medical consumers. In order to protect your precious health and costs, it is essential to be able to look beyond the phrase 'paper citation'.

SECTION 02 · Commercialized academic ecosystem

2. Commercialization of medical papers and the shadow of ‘paper factories’

By nature, medical papers should be purely a tool of academic advancement to identify disease mechanisms and improve treatments. However, unfortunately, many medical papers today are intended to immediately increase the lack of public trust in hospital advertisements or specific medical devices, medicines, and health products. Highly commercial marketing toolis being adopted.

In fact, the international academic community produces so-called false data and fake papers in large quantities in exchange for money for the purpose of commercial promotion or inflating research performance. ‘Paper mill’ The problem is being pointed out as a serious threat to the academic ecosystem. [1. Report on the status of fake paper factories]. The world's most authoritative scientific journal NatureAccording to investigative reporting, data manipulation and poor peer review resulted in More than 10,000 research papers have been officially retracted.An unprecedented situation in history was recorded. [2. Record of more than 10,000 paper withdrawals per year].

🔗 Nature 2021 View original text (paper factory investigative report) 🔗 View original text of Nature 2023 (10,000 papers withdrawn per year)

Nature(2023)가 보도한 전 세계 학술 논문 연간 철회(Retraction) 건수 급증 추이 자료 — Data on the rapid increase in the number of annual retractions of academic papers around the world reported by Nature (2023)

[1] Else, H., & Van Noorden, R. (2021). "The fight against fake-paper factories that churn out sham science". Nature, 591(7851), 516-519. PMID: 33758408. [2] Van Noorden, R. (2023). "More than 10,000 research papers were retracted in 2023 — a new record". Nature, 624(7992), 479-481. PMID: 38087103.

SECTION 03 · Structural limitations of medical papers

3. Structural limitations of medical papers: statistical and humanistic and social insights

Even if no intentional manipulation was involved, medical papers are inherently difficult to become absolute truths that are always and everywhere the same as pure sciences such as physics and chemistry or mathematics. Here, there are both medical statistical limitations and humanistic and social structural issues.

① Medical and statistical perspectives

• Low reproducibility and limitations of human control: Unlike pure science or mathematics, medical research must be conducted on controlled living ‘humans’ with different genetic predispositions, lifestyle habits, and tissue characteristics. For this reason, there are clear limits to temporal, financial, and ethical control, and it is difficult to perfectly reproduce the same conditions, making it very difficult for other researchers to refute and verify experimentally even if the conclusions of the previous paper are distorted.

• Realities of journal verification and barriers to verifying original data: There are few academic journals that are more rigorous and of higher quality than the general public thinks. This is because the reviewers who participate in the paper review (peer review) and rebuttal stages are often intertwined with social interests within a narrow academic community. Above all, it is the basis of research original dataIt is realistically difficult for a third party to individually compare and verify, and it costs an astronomical amount of money to conduct a proper due diligence.

• Mutual reporting structure within the Institutional Bioethics Committee (IRB): The same interpersonal logic operates within the IRB, which reviews the ethics and validity of research. First, if I sharply object or reject someone else's paper, I feel a realistic burden that they may retaliate in the same way the next time my paper is reviewed. Second, most of the committee members are made up of people who are involved in personnel within a narrow academic society or in personal relationships at the same hospital. Third, even in the case of neutral committee members appointed from other hospitals, original dataThere are clear limitations in that it is difficult to directly look into and verify due diligence.

② Insight from humanities and sociology

• Distinct differences in inclinations by participating group: Even within the medical field, the tendencies of those who actively participate in writing papers, the tendencies of those who are enthusiastic about external academic activities and volunteering, and the tendencies of those who are willing to raise critical objections to others' research even at the cost of uncomfortable friction with those around them are clearly different.

• The structure of modern society where it is easy to win if your voice is loud and the power of YouTubers: Even if the same academic achievements are achieved, the ‘loudness of the voice’ that resonates in the world is bound to be different. For example, both doctors are authors of the world's most prestigious medical journals. NEJM(New England Journal of Medicine) Let’s assume you are the lead author of a highly cited paper. What would be the result if one person made a name for himself by actively attending domestic and international academic conferences and giving lectures at international conferences, while the other person quietly devoted himself to working in the clinic for his livelihood and patients? The former's fame gives rise to other famous people and they are revered as so-called 'medical influencers' and 'masters', but the latter remain as 'good doctors' who only know the patients around them.

Furthermore, today, not only within academia but also in society at large, We are rapidly transitioning to a society where the words of popular YouTubers who use provocative and decisive speech methods are more easily recognized by the public and exert a much greater influence than the cautious opinions of orthodox authorities in the field who have devoted their entire lives to research.It is done. This is because true academic authorities use more careful and restrained expressions because they have a deeper understanding of medical exceptions and limitations, while YouTubers and influencers riding media algorithms make clear and confident assertions that the public wants to hear.

• Exponentially rising research costs and corporate sponsorship: Medical research is not structured in such a way that original value is recognized by ‘homaging’ or ‘remaking’ past works like in the fields of film or art. Therefore, as time passes, the cost of discovering a new fact or innovative technology that has not yet been discovered increases exponentially, and this is a common problem not only in medicine but also in all modern researchers. In the end, due to the enormous research costs, they receive financial support from pharmaceutical and medical device companies with a stake in their interests, and even if they try to attend overseas international conferences to make their name known, the cost burden is high for the individual, so this also ultimately ends up being a burden on the company. Sponsorshipbecomes entangled in.

SECTION 04 · Reasons for the gap in reliability by department

4. Reasons for differences in reliability of medical papers by department

If we apply the commercialization of the paper (Chapter 2) and the statistical and sociological limitations (Chapter 3) mentioned above to actual clinical practice, we can clearly understand why the qualitative weight of the papers published varies greatly between the essential medical department centered on university hospitals and the aesthetic and plastic surgery department centered on private practitioners.

↔ Swipe the table left or right to check

Evaluation items	Essential medical subjects centered on university hospitals (Internal medicine, surgery, neurosurgery, etc.)	Private practice-centered aesthetic medicine and plastic surgery Latest treatment papers
Research environment and motivation	Focused on employed doctors and faculty at university hospitals and large hospitals, and is unrelated to sales of private businesses, so the temptation for commercial distortion is relatively small.	The majority operate private businesses (practitioners); As soon as business viability surpasses professional conscience, use it as a marketing tool.
data size and design level	Large-scale case/control group alignment, strict randomization (RCT), and sufficient sample size (n) secure	Simple case report (case report) level based on other specialties, control group sorting/random placement and patient nFrequently falling below par
Academic journal verification method	Active accumulation of multicenter cross-validation and subsequent replication studies	Review focused on formal procedures and completeness of sentences and composition, original data Absence of verification or due diligence verification at the journal level
Descriptive tone and Sponsorship	Moderate statistical description, transparent disclosure of research limitations and conflicts of interest (COI)	Hiding sponsorship ‘Key Doctor (sponsored advertising influencer)’Packaged as authority, many expressions of comparative and superiority are used to show off.

① Structural differences between self-employed doctors at university hospitals and private practitioners operated as private businesses

Essential medical specialties such as internal medicine, surgery, and neurosurgery have relatively less commercial temptation because the subjects researching technological superiority are salaried doctors and professors working at large hospitals, mainly university hospitals, rather than business owners running private businesses. On the other hand, in aesthetic medicine and plastic surgery, regardless of whether in the East or the West, the majority of experts run private clinics or work at commercial clinics, so it is physically difficult to write a purely academic paper by strictly organizing a large amount of data in the midst of busy medical treatment and surgery. And above all, since the hospital is operated for personal business purposes, ‘Business > Professional conscience as a doctor’The moment you go beyond that, even your thesis becomes a good tool to grow your business.

② The reality of ‘Key Doctor’ and exaggerated description at the level of a case report

In some of the latest technologies in aesthetic and plastic surgery, manufacturers' sponsorship is hidden or cleverly told differently for personal commercial success, so that in reality, they are the equivalent of advertising influencers sponsored by medical device companies. ‘Key Doctor’ Titles are often promoted as if they are recognized as having great academic authority. Additionally, due to the nature of aesthetic and plastic surgery journals, it is safe to say that, strictly speaking, there are no academic journals that conduct rigorous, objective due diligence verification. Most of them only review formal procedures or the structural completeness of the paper. original dataThere is no process for verifying or conducting on-site inspection at the academic journal itself. As a result, when viewed from other specialties, it is at the level of a simple case report, including the sorting and randomization of patient and control groups, and the nAlthough there are many papers where the numbers themselves are substandard, the comparative tone (statement for bragging) that shows off the superiority of other methods appears much more frequently.

⚠️ Cases of verification failure proven by history: The Hwang Woo-suk incident and the withdrawal of the paper by the world’s most authoritative journal (Lancet · NEJM)

The most representative example of what happens when a researcher's desire for fame and commercial and social interests obscure the truth is the incident that shook Korea and the world's scientific community in the past. Hwang Woo-seok incidentis [3. Science Stem Cell Paper Manipulation and Retraction]. Furthermore, at the time of the COVID-19 pandemic, the world's most authoritative medical journal The Lancetand NEJMThis is an unprecedented case in which a large paper related to COVID-19 drug treatment was canceled (retracted) after the fact.occurred [4, 5. Lancet·NEJM publication cancellation due to failure to verify original data]. Even the most authoritative journals are submitted by researchers. original dataThis is an incident that clearly shows that serious distortions cannot be filtered out if direct due diligence cannot be verified.

🔗 The Lancet’s official publication retraction (PubMed) 🔗 NEJM official publication retraction (PubMed)

원본 데이터 실사 검증 실패로 공식 철회(Retraction)된 세계적 의학 학술지 사례 — Case of a world-renowned medical journal officially retracted due to failure to verify original data due diligence

[3] Kennedy, D. (2006). "Editorial retraction". Science, 311(5759), 335. PMID: 16410485. — ※ Hwang Woo-seok incident: In 2004 and 2005, Professor Hwang Woo-seok’s team at Seoul National University published an article in a world-class academic journal. ScienceThis is a representative case of academic verification failure in which a paper on human embryonic stem cell cloning published in was officially withdrawn after being found to have violated research ethics and manipulated photos and original data. [4] Mehra, M. R. et al. (2020). "Retraction—Hydroxychloroquine or chloroquine with or without a macrolide for treatment of COVID-19: a multinational registry analysis". The Lancet, 395(10240), 1820. PMID: 32511943. [5] Mehra, M. R. et al. (2020). "Retraction: Cardiovascular Disease, Drug Therapy, and Mortality in Covid-19". New England Journal of Medicine, 382(26), 2582. PMID: 32511942.

SECTION 05 · Surgeon’s conclusion

5. Surgeon’s conclusion: Which paper should I believe and which doctor should I choose?

In conclusion You don't have to trust everything that's a medical paper. Compared to pure science or mathematics papers that allow for strict experimental control and repeatability, medical papers involving human subjects are inherently less reliable. Still, if we were to summarize the areas of medical papers that medical consumers can relatively trust and refer to, they are as follows.

📌 4 areas of relatively trustworthy medical papers

① Large-scale essential medical clinical papers: Accumulated through large-scale multicenter research Internal medicine, surgery, obstetrics and gynecology, mental health medicine Related papers

② Classic surgical clinical papers: proven over a long period of time Classic orthopedics, urology papers (However, caution is required with expensive equipment or the latest technology combined with commercial properties, as there is a risk of contamination.)

③ Aesthetic medicine field: Proven over a long period of time rather than a short-term fad equipment promotion Treatment of classic pigmentation and skin lesions Related papers

④ Plastic surgery field: Rather than trendy cosmetic procedures Reconstructive surgery, breast implant surgery Related papers (However, even in this case, the design level and sample size of each individual paper must be carefully checked.)

Even if you do not have complex statistical knowledge, the clearest standards that you can apply in your daily life are simple. “Even if I think about it, I would be tempted by money, right?” You can look at the topic from a slightly critical perspective.

Additionally, what I would like you to remember is: Just because someone is famous for their papers doesn't mean they're a good doctor, and just because they're famous internationally doesn't mean they're good at performing surgery.It is. Just because you were good at studying in school does not mean that you will always be a great teacher to your students, and there are countless cases where you achieved great success as an athlete during your active career but failed as a manager or coach. I personally believe that academic research capabilities and actual operating room surgical skills will probably be separate variables with only a slight similarity if objective research is conducted in the future.

[Surgeon Dr. Han Gru (Chief Surgeon)'s medical principles: truthful treatment without exaggeration and compliance with basic principles]
“We do not rely on the names of expensive expensive equipment, commercially inflated numbers of papers, or promotional slogans from provocative YouTubers. We honestly diagnose the patient’s body condition as it is, transparently explain the limitations of the surgery, and prove it only with the results in the operating room.”

In my opinion, a good procedure or surgery has far more advantages than disadvantages based on basic physiological, human physical, pathological, and anatomical principles.

Rather than being deceived by fancy thesis titles or conference records, I sincerely hope that you will meet a doctor who honestly diagnoses the patient's anatomical condition, transparently explains the limitations and side effects of the surgery, and above all, a doctor who silently proves the results with the results in the operating room.

SECTION 06 · Frequently asked questions from patients

Q&A: Medical papers and hospital selection

Q1 Can I absolutely trust the procedures promoted by hospitals with ‘SCI-level papers listed’?

You should not blindly trust it. The paper itself is more important than the fact that it was published in an academic journal. Is the paper poorly based in terms of research design or data?, or whether it is a rigorously verified study with sufficient patient samples and an objective control group. In particular, in the field of non-benefit beauty and plastic surgery, there are many studies designed for the purpose of marketing and securing public trust with financial support from medical device companies or companies, so it is wise to look at them with a critical eye.

Q2 If a doctor has been appointed as a ‘Key Doctor’ for a specific device or procedure, isn’t he or she the highest authority?

It is easy for general consumers to misunderstand 'Key Doctor' as the best medical doctor recognized by academia, but in the field of aesthetic medicine, Key Doctor is a person who mass-introduces equipment from a specific manufacturer or takes the lead in promotional lectures. Sponsored Advertising Influencer It's often a personality trait. The commercial title granted by the equipment company must be judged separately from the surgeon's pure anatomical surgical skills.

Q3 Aren’t famous doctors with a lot of YouTube subscribers or frequent lectures at academic conferences also better at performing surgeries?

Public awareness, presentation skills, and thesis writing skills are completely different from the fingertip skills of delicately handling a scalpel and cannula in an operating room. Just as a star athlete does not necessarily become a famous coach, instead of external publicity and media activities, a solid specialist who silently interacts with the patient's tissue in the clinic and operating room every day to produce results often produces more precise and safer results.

Q4 So, from the perspective of an average patient, what are the criteria for choosing a really good surgery and a trustworthy doctor?

Rather than emphasizing only popular new technologies or exaggerated before-and-after changes, we honestly diagnose each patient's flesh, fat layer, and anatomical structure. A doctor who recommends only surgeries in which the advantages to the patient far outweigh the disadvantages in light of basic physiological and anatomical principlesPlease check if it is correct. The safest and most trustworthy hospital is one that transparently explains limitations that cannot be improved through surgery and even possible side effects.

Medical Columns & Scholarly Reference Library4 Scholarly Articles

The easiest way to choose a good hospital for liposuction #1

Mechanical vs. Handmade Is the paper really trustworthy?

Is general anesthesia really safe for liposuction (suction) surgery?

(Hwang Woo-seok's thesis fabricated) Is the plastic surgery and dermatology thesis trustworthy?

Chaeum & Bium Surgical Archive — Dr. Han Gru, M.D. — Dr. Han Gru, M.D.

The easiest way to choose a good hospital for liposuction #1

1. Changes in liposuction extract over time as seen in medical papers

1. Mixed state

2. 2nd floor separated status

3. 3rd floor separation status

🔬 Summary of human physical layer separation principles (natural gravity floating and settling due to density difference)

2. Liposuction technique and risk factors: Hyper-wet vs. Super-wet

3. Appropriate amount of liposuction for each area (based on the average body type of Korean women)

4. Correct hospital classification method based on the condition of the container (collector)

[Example of desirable surgery]

[Example of suspected artificial mixing/manipulation]

[Example of moderate blood loss & determination of color mismatch in multiple containers]

[Example of surgery with excessive bleeding]

[Example of photo production, such as washing the lower part of the sap]

[Excessive amount of bleeding + possibility of reuse of fat that has elapsed over a long period of time]

Actual cases of medical advertisement photo identification (Case 1 ~ Case 3)

[Case 1] Comparison of left side (inflated by shaking with solution) vs. right side (normal density fat layer)

[Case 2] Close-up shooting with the lower part of the collection container intentionally covered

[Case 3] Case where only the fat-oil layer occupies most of the collection container

Conclusion of a surgeon: Proper medical care based on basic common sense

✅ Checklist of 5 things you must check when looking at liposuction advertisement collection bin photos

Frequently asked questions from patients (Q&A: Choosing a good liposuction hospital)

Mechanical vs. Handmade Is the paper really trustworthy?

PAL vs SAL landmark paper verification process at a glance

1. The superficial results presented in the paper and the limitations of the ‘hidden BMI distribution’

① Disparity between internal validity (accuracy within the study) and external validity (generalizability)

2. Sample of only 18 people ($N=18$), and structural conflict of interest in plastic surgery papers

MicroAire® PAL® (Power-Assisted Liposuction) Handpiece

Medela® Precision Liposuction Cannula & Surgical Negative Pressure Suction System

3. Abuse of “Significantly” and “Than”: Language gap with orthodox medical and surgical papers

Surgeon's conclusion: 'Physics of skin', 'preservation of blood vessels', and 'tactile sensation of the opposite hand' that motor vibration can never replace

4. Frequently asked questions about liposuction equipment (PAL vs SAL) and medical literature

Q1. If you look at hospital advertisements, they say that you should use vibration equipment (PAL) to reduce bruising and swelling and to prevent sagging skin. Is this true?

Q2. So is PAL equipment bad equipment? When does it help?

Q3. Is PAL better if you have a slim body type and want to precisely trim the flab in some areas?

Q4. How should we accept the phrase ‘SCI-level thesis proof’ posted by plastic surgery clinics or clinics on their websites?

Is general anesthesia really safe for liposuction (suction) surgery?

1. General anesthesia vs. anesthesia under sedation: key differences in blood clot risk

① Differences in Venous Stasis

② Body stress response and hypercoagulability

2. Fatal gap between the other side of the latest thesis and the ‘reality of private practice’

① Absence of preventive treatment with antithrombotic drugs (Clexane, etc.) before and after surgery

② Not wearing lower body pneumatic compression device (IPC) and medical compression stockings.

3. The nature and ethics of medical care as a surgical specialist

4. Anesthesia and surgery scheduling that prioritizes patient safety

5. Q&A about anesthesia and blood clot safety, which patients are most curious about

If you perform liposuction under sedation (induced sedation) anesthesia, won't you wake up or feel pain during the surgery?

Isn’t general anesthesia done with a large machine like at a university hospital actually safer?

Is full-body large-volume liposuction, where there is a lot of fat to be removed, such as the abdomen, thighs, and arms, possible under sedation?

Can I know before surgery if I am at a higher risk of developing thrombosis than others?

(Hwang Woo-seok's thesis fabricated) Is the plastic surgery and dermatology thesis trustworthy?

1. Why should medical consumers know the other side of the paper?

2. Commercialization of medical papers and the shadow of ‘paper factories’

3. Structural limitations of medical papers: statistical and humanistic and social insights

① Medical and statistical perspectives

② Insight from humanities and sociology

4. Reasons for differences in reliability of medical papers by department

① Structural differences between self-employed doctors at university hospitals and private practitioners operated as private businesses

② The reality of ‘Key Doctor’ and exaggerated description at the level of a case report

5. Surgeon’s conclusion: Which paper should I believe and which doctor should I choose?

📌 4 areas of relatively trustworthy medical papers

Q&A: Medical papers and hospital selection