The so called stubborn or chronic fat has to be well distinguished from the caloric or energy fatty deposits, since the latter are candidates to dieting and exercise and not surgery; applying surgery to caloric deposits is unwise and potentially hazardous, and dieting or doing sports for stubborn fat is always healthy and positive for the person but point and useless in terms of getting rid of them. To be clear, liposuction is not and should not be the treatment of overweight and obesity, however liposuction is irreplaceable for stubborn fat.
Typically the stubborn fat areas showing genetically conditioned adipose deposits refractory to weight loss may be the flabs or rolls at the double chin, bra line, love handles, abdomen, mons pubis, saddle bags, thigh gap, subgluteal banana and inner knee, with some other special areas and situation like pseudogynecomastia in males, drug induced deposits elsewhere, rare genetical syndromes, etc.
Once treated and removed surgically the stubborn fat will never or scarcely or rarely return, in opposition to the caloric fat which indeed does have the ability to regenerate and oscillate; this makes liposuction an essential treatment in body contouring but also a dangerous one or at least disappointing if not used judiciously and scientifically grounded.
Surgery of liposuction itself is a very simple and well tested principle allowing fat extraction via minimal keyhole incisions and powered by a suction pump, adding some accessory maneuvers to minimize the blood loss. This has been the technique for decades and still should be practiced without changes; any other added sources of energy like laser, ultrasound, heat, water jet, etc are in general very dangerous and add no real enhancement of results or safety benefits, just make the surgeon's work easier and less physical, but paying a very high price in terms of risks for patient's health and eventually leading to irreversible deformities like necrosis, overcorrections, discolorations, retractions, etc or medical problems like chronic neuritis pain, vascular issues, etc. Traditional tumescent liposuction, in spite being such an old technique, is the real golden standard no matter how old fashioned may sound its name, actually its well tested safety background makes it a very reliable procedure for patients and surgeons.
The technique begins with the introduction within the fatty deposits of saline with some local anesthetic and adrenaline to prevent postoperative pain and intraoperative blood loss. Once the drugs are making their effect the surgeon introduces a cannula of different caliber depending on each area and patient, with highly recommendable blunt tip to prevent complications. With a back and forth movement and associated to the suction power connected to the cannula the fat tissue is torn into the cannula holes and extracted in a straightforward way. Making a grid of tunnels at the treated areas helps to achieve a smooth contour. Finally a postoperative compression garment helps to reduce postoperative fluids loss, prevent seroma or hematoma and promotes early attachment of the loose skin.