History of Liposuction
Until the 1970s the area of body contouring techniques consisted of traditional dermolipectomies such as breast reduction and abdominoplasty. These procedures involved surgical dissection of the skin and fat from the underlying musculature combined with resection of the excess skin and fat to achieve tightening of the involved area. Although effective and still commonly performed, areas of residual fat deposits were not corrected and long incisions with scars were produced. In studying the feminine figure areas of localized fat accumulation of the lower extremities, abdomen and hips would benefit from surgical improvement. In 1972 Schrudde of Cologne, Germany began performing a technique of fat removal using a small 2-3 centimeter incision and accomplishing fat removal employing a sharp uterine curette. Areas of fat accumulation were undermined and then the fat removed with curettage or scraping. Although this technique was used by many surgeons, the high rate of complications with skin loss, fluid collection, bleeding, and wound problems caused this technique to be abandoned.
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In 1977 Fischer and in 1978 Kesselring and Meyer reported their experience with fat removal using a slightly different technique with fat removal accomplished with suction equipment. Temourian used a similar procedure in 1981. Although the instrumentation and techniques varied, all of these procedures produced a residual cavity where the fat was removed. Wound healing problems, fluid collection and unpredictable results with a good margin of safety were problematic. When the fat was removed, the skin needed to contract to produce a good result.
In 1977 Dr. Yves-Gerard Illouz began his work on the development of a technique that would be the basis of liposuction as it is performed today. Illouz developed a blunt cannula or hollow tube, which removed fat without undermining the overlying tissues and producing a large pocket. A honeycomb effect was produced with preservation of small nerves and blood vessels, which maintained a connection to the overlying skin. Not only was a large cavity not produced, the preserved web of tissue aided in a predicable retraction of the overlying skin.
The use of a blunt cannula with suction was a significant advance over previously described procedures. Complications were dramatically decreased and a new era of body contouring was begun. Dr. Illouz presented his results his result at the annual meeting of the American Society of Plastic and Reconstructive Surgeons in Hawaii in 1982 and the technique of liposuction went on to become the most popular body contouring operation. I was fortunate to learn Dr. Illouz’s technique at a symposium in Norfolk, Virginia in 1983 and became the first surgeon to offer liposuction to my patients in the Indianapolis area.
Since Dr. Ilouz’s original description liposuction has continued to evolve with improvements in instrumentation and technique. Dr. Jeffrey Klein formulated the tumescent technique where large volumes of a saline solution combined with local anesthetic and epinephrine made possible the removal of larger volumes of fat with less bleeding and increased patient comfort. Cannulas of all varieties have been developed to lessen trauma to the tissues and improve results. Current cannulas in use range from two to four millimeters in diameter from initial size of ten millimeters. By decreasing cannula size trauma is decreased and more controlled results obtained. Fat is removed at a slightly slower rate with more control and even smaller incisions.
In the mid 1990s the innovation of ultrasonic liposuction was introduced. Previously fat was removed with high-powered vacuum suction but some areas were more fibrous and resistant to removal. With ultrasonic liposuction, fat cell membranes are lysed with high-energy sound waves and the fat emulsified and removed with suction. The ultrasonic energy aided in the contraction of overlying skin. Areas that were previously resistant to fat removal such areas of the back, hips and chest can be treated more effectively. Ultrasonic liposuction is particularly adaptable to problem areas in men such as love handles and male breast enlargement or gynecomastia. The technique is also effective in breast reduction surgery.
Liposuction continues to evolve with the development of smart lipo with addition of laser technology to aid in skin retraction. At the present time liposuction is the most common cosmetic surgical technique performed in the United States. With advances in body contouring surgery, it is frequently used in skin resection surgery for all types of patients from those requesting tummy tuck surgery to post bariatric weight loss patients.
Wound healing problems and fluid collection are now very uncommon with predictable results and a high degree of safety.
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