The numbers are in, and liposuction once again ranks as the most popular cosmetic surgery procedure of the year, according to the American Society for Aesthetic Plastic Surgery (ASAPS). In 2016, 414,335 people had liposuction to suck unwanted fat out of their arms, legs, necks, stomachs, thighs, and more.

Some liposuction advances, namely tumescent liposuction, don’t sound all that sexy, but have likely saved many lives and dramatically cut back on blood loss and the need for fine-tuning. In the past, surgeons went in dry, and the result was bleeding and bruising. Sometimes a transfusion was needed due to blood loss.

Enter tumescent liposuction. In a nutshell, this technique delivers fluid containing the numbing agent lidocaine, saline (salt water), and epinephrine to the treatment area, where it hardens fat, making it easier to remove.

“The tumescent technique has made the biggest impact on liposuction,” says Lara Devgan, MD, a plastic surgeon in New York City and an attending plastic surgeon at Lenox Hill Hospital. The epinephrine in the cocktail basically eliminates bleeding as it narrows blood vessels. “This has been a great improvement in safety.”

In many cases, this technique means no more general anesthesia and its accompanying risks.

“You can turn over and stand so we can see how the results look when gravity is working, and do any touching up before you leave the operating room,” adds Bruce Katz, MD, clinical professor of dermatology at the Icahn School of Medicine at Mt. Sinai, Director of the Cosmetic Surgery & Laser Clinic at Mount Sinai Hospital and Director of the JUVA Skin & Laser Center in New York.

All types of liposuction can be done via the tumescent technique. “This is now the gold standard,” Dr. Katz says.