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Saturday, June 29th, 2013
Whether man or woman, do you have undesirable fat in areas such as your abdomen, waist, flanks, hips, buttocks, thighs, knees, ankles, cheeks, neck and/or upper arms that has not responded to diet and exercise? If you could, would you like to reduce these areas and/or make them smooth? This desire is actually very common, but frequently nothing you can do will change these areas other than Liposuction, the most popular cosmetic surgical procedure in the world. It allows you to do this with minimal risks, fast recovery and almost no scars.
The history of Liposuction goes back to 1921 when a French surgeon, curetted a ballerina’s knees to create a better shape, but the patient developed gangrene and required an amputation. Beginning in 1964 Drs. Georgio and Arpad Fischer of Italy began removing fat by suction using powered cutting instruments like those used on hard tissue in joint arthroscopy. A number of other European surgeons, including Dr. Fournier of France, and several United States surgeons followed their lead but used modified uterine suction instruments, with an opening at the end and sharp edges. However, the results were far from reasonable, with marked irregularity of the tissues and significant bleeding and bruising. In 1978, Dr. Yves-Gerard Illouz of France developed a blunt cannula with a hole on the side just above the end. He presented his method later that year with very reasonable cosmetic results and minimal bruising and bleeding.
Dr. Illouz came to the United States the next year and presented his technique to 50 surgeons from around the country, including yours truly. Although we were somewhat skeptical of the procedure, we imported his instruments and began studying the procedure. Within a couple of years we had determined that the procedure did what it was intended to do with minimal risks as long as certain precautions were taken.
One of the biggest problems with the procedure was mild irregularity in the skin surface, which occasionally required going back a second time. It quickly became apparent that the reason for this was the size of the cannulae. Dr. Illouz’s original cannulae were 10 (almost ½ inch), 8 and 6 mm in diameter. These were exceptionally aggressive and removed the fat very rapidly. By reducing the size of the cannulae and criss-crossing the area, much like grounds keepers do on baseball fields and golf courses, we got excellent cosmetic results with very smooth contours. Presently, the largest cannula used is about 5 mm, smaller than Dr. Illouz’s smallest cannula.
Dr. Illouz’s second contribution to liposuction was the use of an infiltrate containing epinephrine to constrict the vessels and reduce bleeding into the area to be suctioned. Shortly thereafter, Dr. Jeffrey Klein added an anesthetic and increased the amount of medications injected so that the procedure could be done under pure local anesthesia. Although many people still use this methodology, many of them do so because they do not have access to any other type of anesthesia. I have found that most people undergoing any significant liposuction desire to know as little of what is going on as possible, and other methods of anesthesia are more appropriate.
Additionally, since its inception, many other modifications have occurred. Lasers have been developed to, theoretically, melt the fat; however, except in one very uncommon situation, this is no better than regular liposuction. Ultrasound and water injection have also been added to liposuction, again without any proven benefit.
The only thing that has consistently shown to improve results is the experience of the surgeon doing the procedure. Unfortunately, because the procedure is seemingly simple and the technology to perform it is readily available, many people with no or little training and no surgical background have begun doing liposuction, occasionally with disastrous results.
The most popular areas for Liposuction are the neck under the chin, the lower tummy, the hips, the “love handles,” the thighs and any area of localized fat accumulation. Although many people have tried liposuction in order to jumpstart weight loss or to reduce large areas, it is generally considered inappropriate for this and not a substitute for weight loss. Where more than localized areas are involved, I have found that lifestyle modification and/or Zerona™, an externally applied laser that is not surgery and has no pain and no down time, works much better. They can get you where Liposuction would be indicated to correct any areas not reduced adequately.
Liposuction is also an excellent adjunct to other procedures like tummy tuck, breast reduction, gynecomastia correction, arm lift and any procedure where blending the procedure into the surrounding area is desirable.
Local anesthesia or general anesthesia may be used, and the procedure can last anywhere from less than one hour to several hours depending on the amount of fat being removed and the number of areas treated. We generally recommend staying overnight in the hospital when we remove larger amounts of fat, though we rarely do so now.
In summary, liposuction is an excellent technique that has been around for 35 years and has been constantly modified to improve it. Like Liposuction did with other procedures, technology like Zerona™ is now making some liposuction less necessary. However, for localized fat reduction, it is still the best option, with the most reliable results and a rapid recovery.