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Thirtyfour years of liposuction: Past, present and future
Abstract and Figures
Initial, variably successful attempts of fat sculpting date back to the beginning of the 20th Century, but Gerard Illouz was the first to introduce the modern, safe, widespread method of liposuction. Preoperative injection of local anaesthesia, saline, distilled water, adrenaline and hyaluronidase, defined wet technique, established as a safe and effective adjunct to lipoaspiration. This procedure was initially based on an automatic pump system, but then the accuracy of syringe aspiration was popularized by Toledo in the eighties. Liposuction in the subcutaneous tissue, just 3-4 mm deep to dermis, also called superficial liposuction, is a modern effective evolution of the technique, but requires a good mastery in order to avoid disfiguring outcomes. Ultrasound and laser lipoplasty methods have provided further advancement in the range of technical choices offered to the plastic surgeon. Liposuction is a purely surgical procedure, and as such, carries risks of minor and major complications. In the nineties, an interplay between abdominoplasty and abdominal liposuction as simultaneous procedures, also called lipoabdominoplasty, has become more and more popular. Reinjection of the harvested fat with the purpose of liposculpture for both reconstructive and cosmetic indications is a relatively recent development which has established as a successful, world-wide accepted procedure. Adipose stem cells, extracted from the unlimited source represented by human adipose tissue, are a great promise for future tissue-engineering. Liposuction has nowadays become a safe, effective, popular procedure for contouring adipose tissue and human body in general, in many reconstructive and cosmetic indications.
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... 12 Evidence of this process appears in the immediate postoperative period, with edema usually increasing up to 4 days after surgery, then gradually subsiding in the following weeks. 13 The time required for edema to become reabsorbed varies, but is generally between 3 and 6 months. 10 Factors predisposing the appearance (and impediments to resorption) of edema are: the use of a "thick" cannula, the amount of anesthetic infiltrated, the site of fat removal, a BMI > 25 kg/m 2 , or chronic peripheral inflammation linked to smoking. ...
... Taping reduced tension of the affected area and helped restore proper lymphatic circulation, activating self-healing processes. 13,25,31,32 Although the role of KT as an excellent antiedemigenous tool to manage lymphedema has been conservatively demonstrated in different fields, 13,26,[33][34][35][36][37][38][39] the trials in the literature are few, with limited patient samples, and there is no methodology available to apply this technique for surgical complications in plastic surgery. ...
... Taping reduced tension of the affected area and helped restore proper lymphatic circulation, activating self-healing processes. 13,25,31,32 Although the role of KT as an excellent antiedemigenous tool to manage lymphedema has been conservatively demonstrated in different fields, 13,26,[33][34][35][36][37][38][39] the trials in the literature are few, with limited patient samples, and there is no methodology available to apply this technique for surgical complications in plastic surgery. ...
Background:
Liposuction is a safe, simple and effective method of body contouring. Pain, ecchymosis and edema are often local complications at the removal site especially in the first weeks after surgery. Several studies have shown that Kinesiology tape improves the blood and lymphatic flow, removing congestions of lymphatic fluid and hemorrhages. However, there is limited data on the effect of kinesio taping in mitigating fat grafting donor site local complications.
Objectives:
The endpoint of this pilot study was to evaluate the impact of kinesio taping in reducing postoperative edema, pain and ecchymosis in the liposuction area.
Methods:
Over a period of 18 months (January 2021 to June 2022), 52 patients underwent liposuction of both flanks with subsequent breast fat grafting. Immediately after the surgery, kinesio taping was used on the right abdomen flank in all patients. Degree of edema as well as ecchymosis and pain were quantified at 7, 14, and 21 days after surgery.
Results:
There were statistically significant differences in the taping area for ecchymosis at 7 days after surgery, edema at 14 and 21 days after surgery, and Visual Analogic Scale at 7, 14 and 21 days after surgery.
Conclusions:
The authors find evidence that kinesio taping, as used in this study, is beneficial in the reduction of edema and pain and the resolution of ecchymosis after liposuction.
... An innovation in his technique was the administration of cooled saline and hyaluronidase to the tissue, achieving a cryoanesthetic effect. Fournier is known to be the first one that encouraged the use of tape compression to support and to shape the suctioned tissue in the postoperative period [28,29]. The following years of his professional work resulted in the publication of even further breakthroughs. ...
... Local anesthesia has brought many benefits, such as reduced hospitalization time, reduced surgical costs, and reduced systemic risks associated with the dose of general anesthesia. As a result of these measures, blood loss during the entire procedure was minimal, about 50 ml, equivalent to heavier menstruation, consequently reducing the risk of postoperative embolism [9,17,28,29]. Last, it is worth mentioning that tumescent local anesthesia is the only anesthetic technique that has been developed entirely by a dermatologist. This anesthesia has also been successfully used for breast augmentation and inferior vena saphena magna removal [16,28]. ...
... He was a member of the boards of both societies. Not without reason, he is considered the most important expert and appraiser on liposuction and dermatologic surgery in Germany [29]. ...
Liposuction is considered to be one of the most popular surgical procedures in the world. It consists of removing subcutaneous fat from specific parts of the body using a medical pump that creates negative pressure and a special thin cannula inserted into the fat tissue. Nowadays, it is a relatively safe procedure, but it was not always this way. Improving liposuction methods, their effectiveness, and reducing the risk of posttreatment complications are the result of aquired experience and knowledge based on practical activities over the years. The aim of this paper is to present the history of liposuction, the diversity of treatment techniques, and their modifications over the years.
... Liposuction, a key surgical technique in managing lipedema, employs negative pressure to remove fluids and loose fatty tissue through a cannula into a receptacle [22]. Originating from the work of Giorgio Fischer and Aprad in 1976, the procedure was globally popularized by Illouz [23], who developed the wet technique. This method, focusing on removing no more than 1.5L of aspirate from localized fat areas, aimed to minimize blood loss [23]. ...
... Originating from the work of Giorgio Fischer and Aprad in 1976, the procedure was globally popularized by Illouz [23], who developed the wet technique. This method, focusing on removing no more than 1.5L of aspirate from localized fat areas, aimed to minimize blood loss [23]. The field evolved with Klein's introduction of the tumescent fluid infiltration technique (FIT) and Fodor's development of the super-wet technique [24]. ...
Lipedema, a chronic and painful disorder primarily affecting women without a definitive cure, has traditionally been managed with conservative therapy, notably complete decongestive therapy, across many countries. Recently, liposuction has been explored as a potential surgical treatment, prompting this study to evaluate its effectiveness as possibly the first-line therapy for lipedema. Through extensive literature searches in databases such as CrossRef, Web of Science, PubMed, and Google Scholar up to December 2023, and using the Newcastle-Ottawa Scale for quality assessment, the study selected seven studies for inclusion. Results showed significant post-operative improvements in spontaneous pain, edema, bruising, mobility, and quality of life among lipedema patients undergoing liposuction. However, over half of the patients still required conservative therapy after surgery. Despite these promising results, the study suggests caution due to lipedema's complexity, significant reliance on self-reported data, and limitations of the studies reviewed. Thus, while liposuction may offer symptomatic relief, it should be considered an adjunct, experimental therapy rather than a definitive cure, emphasizing the need for a comprehensive approach to care.
... At the beginning of the twentieth century, Dr. Charles Dujarrier used liposuction, a cosmetic surgery, to remove or curettage fatty tissue to improve the shape of the ankles and knees of a female ballet dancer [1]. However, the dancer's leg was amputated due to a femur injury during the procedure, which had a negative impact, lasting for decades, on the development of this technique. ...
... The technique targets fat cells that are resistant to diet and exercise. It removes fat cells from the treated area and diminishes or improves the appearance of cellulite [1,3,5]. ...
Liposuction is a safe cosmetic procedure for body contouring that removes excess fat and reshapes the body parts. It is a well-known and helpful body contouring procedure that uses quick, safe, and minimally invasive techniques to remove unwanted fat deposits. The removal of excess fat reduces the risk of heart disease, stroke, diabetes, and other fat-associated health problems associated with fat while enhancing the patient's self-esteem. This review aims to investigate and summarize the historical, contemporary, and future vision of liposuction techniques, their application, benefits, and risks in weight loss and various health conditions. Also, this paper provides a concise overview of liposuction vs. bariatric surgery in weight loss.
... An uncommon technique for soft tissue augmentation is the use of energy-based devices for recipient site preparation prior to grafting the fat. While ultrasound and laser devices are successfully used for removal of fat [18,19], energy-based devices have rarely been investigated for their tissue stimulating properties regarding recipient site preparation. Tissue biostimulation using a subdermal fractional CO 2 laser was utilized by Jianu et al. to improve patient outcomes from facial fat grafting. ...
Background
Improvements to autologous fat grafting for soft tissue augmentation are needed to overcome the unpredictable volume retention. Approaches such as fat harvesting and processing, injection technique, preparation of the recipient site, and supplemental biologics are topics of ongoing research. Here, an energy-based device was investigated as a stimulatory tool for recipient site preparation for improving fat graft retention.
Objective
The objective was to measure the stimulatory responses in fat grafts after 4 weeks when using a helium-based radiofrequency device to pretreat the recipient tissue.
Methods
Using an autologous fat grafting mouse model, the inguinal fat pad was grafted in a small cranial pocket after either a saline injection alone (control) or a saline injection followed by pretreatment (treated). The fat pad was resected after 4 weeks, sectioned and stained with immunofluorescence markers to investigate tissue remodeling.
Results
Pretreatment resulted in higher viability of adipocytes, a higher concentration of viable ASCs in areas of adipose tissue regeneration, and localized macrophages in the areas of regeneration when compared to the control. There was no observable difference in vascularity or angiogenesis. The staining for ASCs was higher in the pretreated group in comparison with the control group (5.0% vs. 3.3%, p=0.36) when using a pixel classifier in QuPath in the viable adipose tissue regions.
Conclusions
The use of a helium-based radiofrequency device as a pretreatment tool appears to increase the viability of the adipose tissue likely due to higher concentration of ASCs. The apparent increase in viable ASCs may be due to enhanced proliferation or paracrine recruitment of these cells in response to the helium-based radiofrequency treatment.
No Level Assigned
This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
Bullet List of Important Points: Pretreatment of the fat graft recipient site increases the viability of the adipose tissue after 4 weeks in comparison with the control grafts.
The increased viability is likely due to the observed increase in adipose-derived stem cells in the pretreated group.
Pretreatment enhanced the adipose tissue remodeling as colocalization of adipose-derived stem cells and macrophages showed an active remodeling, whereas the control group exhibited more necrotic and fibrotic tissue.
... Contributions from researchers like Sterodimas, Coleman, Klein, Gasparotti, Zocchi, Apfelberg and others are the cornerstone for all current lipocontouring procedures performed [2][3][4][5][6][7]. Alfredo Hoyos and Peter Prendergast's book on high-definition liposculpture details advanced techniques in lipoplasty and autologous fat grafting [8]. ...
This chapter discusses the different types of procedures for augmenting body shape and size, including liposuction, lipoinjection, lipocontouring, and others. It presents a history and literature review of liposuction and details the author’s personal techniques with accompanying figures and photographs. The chapter also discusses safety and common complications of body contouring techniques.
Background: Liposuction has evolved tremendously over the past three decades and is the most frequently performed aesthetic procedure. Although liposuction has been considered a safe surgical procedure, reports indicate that it can have significant sequelae. The increasing number of liposuction procedures, often performed by inadequately trained physicians, has led to a growing number of iatrogenic post-liposuction contour complications.
Methods: Fifty-five patients with post-liposuction depressions were operated during January 2017 and October 2019. Forty-one females and 14 male patients were included in this study group. Age distribution of patients ranged from 28 to 62 years, with a mean of 46.7 years. All the patients that were included in this study were candidates for autologous fat transplantation. Patients underwent the Stromal Enriched Lipograft technique for correction of their body liposuction sequelae.
Results: The total amount of clean adipose tissue transplanted varied from 20 to 150 ml. There were no cases of liponecrosis, which developed in the grafted area, and no liponecrotic lumps were palpated on postoperative evaluation on any operated cases. There were no cases of cellulitis at the donor or grafted area, no deep vein thrombosis, and no pulmonary embolism. There were no cases that needed additional session of fat grafting.
Conclusion: Liposuction continues to be a safe surgical procedure, but for maximum avoidance of complications, the surgeon should be mindful of all the factors that could predispose to complications. Stromal Enriched Lipograft is a safe and effective technique that offers the possibility of finally fulfilling the key principle of replacing “like with like” as an aesthetic filler, without the drawbacks of the traditional autologous fat grafting technique.
Fat grafting for face and body contouring remains shrouded in the stigma of variable results experienced by most plastic surgeons when they first graft fat. The need of standardization of the autologous fat-grafting technique needs to be done. Numerous clinical reports have been published regarding techniques of fat graft harvesting, preparation, and injection. Autologous fat transplantation or adipose cell grafting incorporates adipocytes, adipose-derived stem cells (ADSCs), and growth factors already present in the lipoaspirate. The Stromal-Enriched Lipograft™ (SEL™) is a surgical technique of autologous fat grafting for face and body contouring that converts a stem cell-poor fat graft to a stem cell-rich fat graft. The clinical outcomes of scientific research on the last decade have shown that SEL is one of the core elements of regenerative medicine. The main factor in successful engraftment is the presence of ADSCs in the fat graft. The Lipocube™ is a single-use mechanical device for processing lipoaspirate, the Stromal-Enriched Lipograft™, into milli, micro, and nano fat graft according to the depth of transfer. Clinical series that have been published showing that adipose-derived stem cells offer the possibility of finally fulfilling the key principle of replacing like with like as an aesthetic filler without the drawbacks of current technology. SEL is a safe and acceptable method for face, breast, and body fat-grafting surgeries due to its high patient satisfaction and low complication rate.
Circumferential or 360° liposuction represents a significant advance over conventional liposuction, being able to enhance body contour and at the same time to sculpt a harmonious and stylized figure. Thanks to this technique, we can treat residual fat of the anterior area and the flanks, even marking abdominal muscles, and complement it with a significant improvement of the posterior region, “bra roll,” “Venus dimples,” and achieve a posterior contour with hourglass form, the feminine aesthetic ideal. We also discuss different liposuction techniques, like suction-assisted, power-assisted, water-assisted, ultrasound-assisted, laser-assisted, and radiofrequency-assisted. Comparison between their advantages and disadvantages is also explained (Table 27.1).
Background:
Although widely accepted as an optimal procedure in thigh contouring, liposuction can result in complications, such as skin irregularity or aspiration inadequacy. A main cause might be insufficient knowledge of the superficial fascial system (SFS). The authors aimed to explore the characteristics of the SFS in the thigh and propose anatomical guidelines and new zoning for liposuction-assisted thigh contouring.
Methods:
A total of 20 fresh female thighs were dissected from the skin to deep fascia to observe and compare changes in the SFS from the medial to the lateral side and from the proximal to the distal end.
Results:
The thigh was divided into four units, namely, the medial (three subunits: upper, middle, and lower), anterior, posterior (three subunits: upper medial, upper lateral, and middle lower parts), and lateral thigh. The authors found that the form of the SFS has regional variations. Therefore, based on these varied features, four anatomical scenarios (degrees I to IV) and one functional section (hip-contour support) were devised from the eight subunits. Five different liposuction methods were formulated to manage these subunits: all-layer mass liposuction, normal aspiration, border feather-out, restricted lipoplasty, and anchor.
Conclusions:
The SFS of the thigh showed a regional variation pattern, based on which the authors proposed a series of new anatomy-based liposuction approaches. A well-sculpted thigh with its different sections presented in harmony can be safely obtained using these approaches.
Criteria for diagnosing abdominal contouring candidates and a new classification system for procedures are presented. The surgical techniques for each of four patient categories of abdominolipoplasty are reviewed: type I—suction-assisted lipectomy alone, type II—mini-abdominoplasty, type III—modified abdominoplasty, and type IV—abdominoplasty with suction-assisted lipectomy. With the combination of suction-assisted lipectomy and abdominoplasty, the majority of patients can actually be treated with a limited abdominoplasty procedure or suction lipectomy. Complications noted in a series of 75 consecutive patients operated on by one surgeon are presented. The blood supply that is relevant to a combination of suction lipectomy with abdominoplasty is outlined. Specific guidelines for these combined procedures are recommended in order to safely combine full abdominoplasties with suction-assisted lipectomies.
I have used ultrasound-assisted lipoplasty for more than 6 years on more than 600 patients, using first the Ultravac Series 3 and now the Surgitron Series 2000 and 3000 prototypes. Ultrasonic energy for liquefaction of body fat evolved from the use of such energy in phacoemulsification of cataracts. I have all but completely abandoned conventional liposuction techniques in favor of ultrasound-assisted lipoplasty for the reduction of excess fatty deposits in both minimal and large volume cases.
This clinical review outlines the method of outpatient treatment of 600 cases of trunk ultrasound-assisted lipoplasty, with or without thigh reduction, 174 chin and neck suctions, 12 upper arm sculptings, 30 breast reductions with soft tissue excision, 17 calf reductions, and 40 gynecomastia reductions, most of which involved soft tissue subareolar resection. Many of the patients underwent multiple area reductions simultaneously.
Advantages of this technology to both patient and surgeon, include greater postoperative patient comfort, better refinement in body sculpting, diminished blood loss, an opportunity to provide the larger patient lipoplasty, greater speed of execution in liposuction, and, finally, reduced physical effort by the surgeon. A low complication rate (3% overall), mainly small surface irregularities, lends more to the attractiveness of this modality as being worthy of further study for widespread surgical use.
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