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A Review of Liposuction as a Cosmetic Surgical Procedure
Abstract
Liposuction (suction-assisted lipectomy) is today an accepted, closed surgical technique utilized by physicians practicing in a number of different specialties. It is a procedure that can be learned and used as an adjunct to a number of open procedures, including rhytidectomy and abdominoplasty.THE TWO PRINCIPAL KEYS TO SUCCESSFUL LIPOSUCTION PROCEDURES ARE: (1) good patient selection, and (2) realistic expectations. Good selection should be based on physiological skin age of the patient rather than chronological age. Many liposuction procedures can be performed under local anesthesia in an office surgical suite. A conservative approach is always appropriate, as overcorrection is difficult to treat.Areas that can be suctioned effectively include the face, chin, neck, anterior and posterior axilary areas, arms, breasts, abdomen, waist, hips, buttocks, thighs, knees, and ankles. Using the blunt cannula technique pioneered by Fischer and modified and popularized by Illouz and Fournier yields a high percentage of good results. A low percentage of possible complications and undesired sequelae have been documented.
... After that, in the early 1980s, many other surgeons traveled to France to study this procedure. The blunt cannula technique came to be the accepted liposurgical method in this country and around the world, and in 1982, the American Society of Lipo-Suction was formed to bring surgeons from both the United States and foreign countries into one group to establish a teaching program [15,16]. ...
... Small incisions are performed in different places depending on the area to be treated, but always designed to hide the small surgical scar [16]. ...
... Other incisions can be placed under the breast or through an existing scar. Of course, different situations require different incisions [16,39]. ...
Introduction
Nowadays, liposuction is the most frequently performed aesthetic surgery procedure in Western Countries. This technique has had rapid development since the 1970s, when it was experimented for the first time by A. and G. Fischer. It is currently widely used in clinical practice for many different situations in aesthetic, reconstructive and functional fields.
Materials and methods
This review aims to describe the historical evolution of liposuction by analyzing the transformation of the method in function of the introduction of innovative ideas or instruments. We have also focused on reporting the major clinical applications of this surgical technique, applicable to almost the entire body surface. We finally analyzed the complications, both major and minor, associated with this surgical technique.
Results
Liposuction is mainly used to correct deep and superficial fat accumulations and remodel the body contour. It has become an essential complementary technique to enhance the aesthetic result of many other aesthetic procedures such as reduction mammoplasty, abdominoplasty, brachioplasty, thigh lift and post bariatric body contouring. However, it can be largely used for the treatment of innumerable pathologies in reconstructive surgery such as lipomas, lipedema, lipodystrophies, pneudogynecomastia and gynecomastia, macromastia e gigantomastia, lymphedema and many others. The complication rate is very low, especially when compared with conventional excisional surgery and the major, complications are generally associated with improper performance of the technique and poor patient management before and after surgery.
Conclusion
Liposuction is a safe, simple and effective method of body contouring. It has enormous potential for its application in ablative and reconstructive surgery, far from the most common aesthetic processes with a very low complication rate.
... Liposuction rapidly gained popularity but did not replace dermolipectomy, as limited skin surface area contraction was noted with SAL alone [10]. The development of energy-assisted liposuction was rapid and included ultrasound, laser, power, water-jet, shock wave, and radiofrequency-assisted liposuction [11][12][13][14][15][16]. ...
... This saves time as little gas is retained. 10.Dr. Gerhard Sattler likes to use a bit more tumescent fluid in a secondary treatment, as well as the PAL handpiece. ...
... Therefore, it is difficult to draw conclusions about the distribution of SMF between the preplatysmal and postplatysmal fat compartments in the general population from these limited data. Current treatment options for submental contouring often target preplatysmal fat (as extensive removal of postplatysmal fat can result in a concave and distorted neck shape [4,18]) and include invasive procedures such as surgical rejuvenation [2,4,[18][19][20][21] and targeted liposuction [2,19,[21][22][23]. Although energy devices (lasers, radiofrequency, and ultrasound) offer a noninvasive option for submental contouring [24][25][26], these treatments focus on tightening the skin within the submental area versus reducing SMF. ...
Introduction:
The shape and contour of the chin and neck play an important role in facial aesthetics. As such, excess fat within the submental area (double chin) can negatively affect facial aesthetics and body image. Common treatments for submental contouring include invasive procedures such as surgical rejuvenation and targeted liposuction. Energy devices (lasers, radiofrequency, and ultrasound) may be used to improve submental skin laxity while cryolipolysis was recently cleared in the United States for use in the submental area. However, ATX-101 (deoxycholic acid injection) is the only injectable drug approved in the United States and Canada for reduction of submental fat.
Areas covered:
The efficacy and safety of ATX-101 have been extensively evaluated in a global clinical development program including multiple Phase I/II studies and four large Phase III trials. Available data from ATX-101 trials are reviewed. Expert Review: Injectables have been well established for facial rejuvenation. Extending injectable treatment into the chin and neck is a major advance for nonsurgical cosmetic correction. Overall, the evidence supports ATX-101 as a safe and effective, minimally invasive treatment alternative for reduction of submental fat that will provide a major tool for the aesthetic physician.
Despite the dark side of obesity in the pathogenesis of metabolic diseases, adipose tissue has been shown to be a good therapeutic tool. First, autologous fat grafting, also named lipofilling, has been used for over a century and represents a safe technique for soft tissue filling. However, although the technique has seen marked improvements over time, surgeons are still facing graft resorption that often requires overcorrection of the treated area or other interventions so that the aesthetic result is in line with expectations of the patient. Thus, MICROFILL® process has been developed in order to increase the rate of engraftment by promoting cell survival within the graft. The latter is enhanced by: - sampling and reinjection of small fat lobules in order to reduce ischemia and poor nutrition of the cells-elimination of deleterious elements (anesthetics, inflammatory cytokines) by a non-traumatic protocol involving soft centrifugations and washings. Furthermore, in recent years, adipose tissue has been found to have a greater therapeutic power by hosting mesenchymal stem cells with great potential. These adipose stem cells (ASCs) are present in large quantities and can be easily obtained from a simple liposuction. However, liposuction procedure often involves the use of a local anesthetic and a vasoconstrictor that can harm cells. Our studies have shown that lidocaine, an anesthetic commonly used, exerts cytotoxic effects on adipose stem cells, inhibiting cell proliferation (cell cycle arrest in G0-G1 phase) and inducing necrosis. Nonetheless, appropriate handling of adipose tissue, quite similarly to MICROFILL® protocol, reduces cell death. The deleterious effects of lidocaine appear to be related to the occurrence of cytoplasmic vacuolization whose nature is so far unclear. In addition, lidocaine also induces a process of autophagy, including molecular mechanisms of induction also unknown and whose physiological purpose could be cell survival despite the stress. The findings of these studies lead to some recommendations to follow regarding the use of lidocaine for the extemporaneous reinjection of ASCs in a patient. Also, in order to treat equine tendinopathy, these studies have been used to optimize adipose tissue harvest by liposuction on horses and the protocol of extraction of ASCs.Finally, this thesis has allowed developing a kit for veterinary use to treat equine tendinopathy. This new method of cell therapy has been tested in horses and has shown very promising results for tendon regeneration, knowing that treated horses could rapidly return to work.
Background:
Centrifugation is a popular processing method, with an unclear mechanism of action. Hypotheses include fat concentration, reduced inflammatory response by removal of blood, and concentration of adipose-derived stem cells. The authors performed multiple experiments to determine the role of centrifugation and compared it with a different processing method (mesh/gauze technique).
Methods:
Lipoaspirate components were quantified after centrifugation at increasing speed to determine concentration efficacy. For comparison, the authors quantified the concentration efficacy of mesh/gauze. They also compared the number of adipose-derived stem cells isolated by either method. To determine the effects of each component, they compared fat alone to fat mixed with various spinoff components in a mouse model. They also compared centrifugation to mesh/gauze.
Results:
The adipocyte fraction remains constant above 5000 g, whereas 1200 g results in 91 percent concentrated fat. Mesh/gauze also results in 90 percent concentrated fat. The number of adipose-derived stem cells in 1 g of fat was 1603 ± 2020 and 1857 ± 1832 in the centrifuge and mesh/gauze groups, respectively (p = 0.86). Five "add-back" groups were created: fat plus oil, fat plus surgical tumescence, fat plus fresh tumescence, fat plus cell pellets and fresh tumescence, and fat plus cell pellets. The fat-only group had better retention than the groups mixed with tumescence, regardless of whether it was surgical, fresh, or had cell pellets. Oil did not affect grafts. Centrifugation at 1200 g was equivalent to mesh/gauze (0.73 ± 0.12 g and 0.72 ± 0.13 g, respectively).
Conclusions:
Centrifugation improves graft retention by concentration of the adipocyte fraction. The concentration efficacy of mesh/gauze is equivalent to centrifugation at 1200 g, with equivalent in vivo outcomes.
Limiting liposuction volumes to avoid transfusion is sound surgical practice. Although the plastic surgery literature reports frequent use of transfusions in liposuction surgery, dermatologists almost never use blood replacement after liposuction. Techniques which favor less bleeding include sufficient use of fresh epinephrine, cryoanesthesia, use of smaller cannulas, fluid preloading, proper preoperative evaluation, serial liposuction, intramuscular steroids, and rapid application of pressure garments. A review of the literature and personal experience are detailed.
The availability of cosmetic surgical procedures to the general public, especially blacks, has become increasingly widespread. Aesthetic surgeons should not be deterred from performing these procedures in blacks. The myth that all black patients develop keloids or dyspigmentation after surgery should be dispelled; however, in those patients with a history of keloid formation or hypertrophic scarring, elective cosmetic procedures should be either withheld or performed with extreme caution. In general, the cosmetic surgeon can proceed with surgery in blacks and attain good aesthetic results if the procedures are slightly modified when indicated to minimize pigmentary changes and scarring and to maintain ethnic congruency.
It is the position of the American Dietetic Association that successful weight management to improve overall health for adults requires a lifelong commitment to healthful lifestyle behaviors emphasizing sustainable and enjoyable eating practices and daily physical activity. Americans are increasing in body fat as they become more sedentary. Obesity has reached epidemic proportions and health care costs associated with weight-related illnesses have escalated. Although our knowledge base has greatly expanded regarding the complex causation of increased body fat, little progress has been made in long-term maintenance interventions with the exception of surgery. Lifestyle modifications in food intake and exercise remain the hallmarks of effective treatment, but are difficult to initiate and sustain over the long term. The dietitian can play a pivotal role in modifying weight status by helping to formulate reasonable goals which can be met and sustained with a healthy eating approach as outlined in the Dietary Guidelines for 2000. Any changes in dietary intake and exercise patterns which decrease caloric intake below energy expenditure will result in weight loss, but it is the responsibility of the dietitian to make sure the changes recommended are directed toward improved physiological and psychological health. A thorough clinical assessment should help define possible genetic, environmental, and behavioral factors contributing to weight status and is important to the formulation of an individualized intervention. The activation of treatment strategies is often limited by available resources and cost. Reimbursement by third party payers for services is limited. Health care dollars are consumed for treatment of weight-related diseases. Public policy must change if the obesity epidemic is to be stopped and appropriate weight management techniques activated.
Suction lipectomy has been used to treat localized collections of fat in 100 patients. Best results were obtained in patients with good skin tone and near normal weight. Good candidates achieved good results; however, lesser candidates also achieved improvement. The technical details have been reviewed, and particular note has been taken of the difficulty of assessing contour during the operation. This is suggested to be the cause of the most frequent undesired sequelae, postoperative contour irregularities.
In October of 1983, we sent a questionnaire on suction lipectomy to 2524 U.S. and Canadian members of the American Society of Plastic and Reconstructive Surgeons. Six-hundred and twelve plastic surgeons returned questionnaires (24.2 percent response rate). One-hundred and seven responding surgeons reported 1573 operations in which suction lipectomy with or without skin excision was used for 2685 procedures on various parts of the body. In the subset of 1249 operations in which suction lipectomy only was used to treat 2261 anatomic areas, surgeons reported greater than 80 percent good or excellent aesthetic results. The overall complication rate was 9.3 percent. The most frequent complications were persistent hypesthesia (2.6 percent), seroma (1.6 percent), and persistent edema (1.4 percent). Skin pigmentation, pain, hematoma, infection, and slough each occurred with an incidence of 1.0 percent or less. Based on the results of this survey, suction lipectomy is a valuable new modality for surgical improvement of body contour.
Suction lipectomy of the neck has been advocated in other reports. However, because of skin laxity, a simultaneous face/neck lift has been performed usually. In this series of 49 patients, ages 18 to 73, removal of submandibular fat was performed by suction lipectomy. A simultaneous face/neck lift was not done. In addition, no skin was excised. On the contrary, the apparent excess skin was found to be required for contouring. Approximately one-third of the patients had a simultaneous chin implant. Others had different aesthetic surgical procedures performed during the same operation. The removal of neck fat by suction has proven to be more efficacious than excisional methods of lipectomy. The risks of operation have been found comparable to suction lipectomy performed in other anatomic locations.
A technique is described in which suction-assisted lipectomy is used for excessive fat removal in association with the standard rhytidectomy. It is safe, reliable, and can be performed through a small horizontal submental incision. A more natural appearing neck is produced by adjusting the amount of fat removed. Areas previously considered dangerous for excision because of possible damage to branches of the facial nerves, such as the cheek areas, jowls, parotid, and nasolabial folds, can now be approached.
Our experience with the original suction lipectomy is presented. The fat removal, done with a specially designed suction tube, is performed layerwise, creating a continuous, regular cavity that is transformed into a virtual space by compressive dressings. The main indication being excessive peritrochanteric fat pads, the operation is done under either epidural or general anesthesia. No antibiotics or anticoagulants are administered, and the patients are mobilized as soon as fully awake. Practicing suction-assisted lipectomy for more than seven years, we have never observed an infection, thrombosis, or fat embolism. In experienced hands, good results can be expected in about 80 percent of patients. Complications are almost always of an aesthetic nature as a result of bad indications. The method is not a surgical treatment for severe obesity.
We have used the honeycombed suction lipectomy (wet and/or dry) in over 700 patients. It represents a major advancement in the treatment of the localized adiposities of the body. Its advantages are eliminating the need for long, unsightly scars and reducing operating time and morbidity. Selection of appropriate patients is of paramount importance for reliable results because this technique is truly sculpting of the soft tissues. Results improve also with the proper training and experience of the surgeon. The indications and complications have been discussed. This technique (honeycombed suction lipectomy) appears more reliable than suction curettage that employs sharp dissection.
We have significantly expanded the use of a lipectomy procedure which heretofore had been restricted to the removal of strictly localized excess fat deposits by curettage through a small incision. By modifying the suction curette and utilizing it for extensive body contouring, we have been successful in correcting relatively major fat deformities without causing any postoperative surgical deformities. All our results to date have been satisfactory. This procedure may be helpful to those surgeons who have been seeking a simplified method for removing excessive fat without extensive scarring. The improvement in body contour is often beyond the preoperative expectations of both the surgeon and the patient.
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