History and Terminology
General term, which contains all modern invasive and non-invasive methods serving to body shaping. One of the most used invasive techniques is liposuction.
The word comes from Greek lipos-fat and suctio-to suck. It describes permanent removal of undesired fat tissue in certain locations.
The word comes from Latin tumescere – to swell. It describes the look of subcutaneous tissue of treated area, which is filled with larger amount of special solution with a mixture of anesthetics and adrenaline.
First liposuction experiment
It is considered to be a French Dujarrier in 1921. There was used a gynecological curette under pressure, the sucked area were knees and calves and the experiment ended with leg amputation caused by damage of large vessels.
First successful liposuction
Performed in 1974. Italian Fischer broke and sucked fat tissue in dermis with the help of small rotation scalpel deposited in a cannula.
First usage of canulla with blunt tip
It was shown by French lllouz in 1978. At the same time he worked with a technique of subcutaneous tunneling of fat tissue from more approaches and their crossing. This system has been used until now with various changes and improvements although it was applied on modern liposuction techniques.
Method used for body shaping before the origin of tumescent liposuction. There was “dry” and “wet” type. The first method was performed under general anesthesia without filling the subcutaneous fat layer with a solution with the need of patient’s hospitalization. Relatively thick cannula sucked fat tissue under high under pressure. This method had many complications (blood losses, ungentleness, fat and blood embolism, odds and asymmetries) and it has not been used anymore. The second (wet) method of this technique uses filling of fat tissue with a mixture of local anesthetics and adrenaline, which reduces the possibility of bleeding and simplifies the suction. Other risks remain though, therefore it has been used only limited for extremely strong individuals or as a part of other procedures under general anesthesia (e.g. abdominoplasty).
Modern liposuction techniques
Tumescent liposuction (filling of fat tissue with anesthetics only locally without the need of general anesthesia)
Since 1984 and 1985 Peter Fodor and then American Klein introduced “super wet” technique. It is characteristic with large volumes of added mixture, great concentration of anesthetics in this solution, epinephrine (adrenaline) and minerals that change inner atmosphere of treated area. This method enables to suck fat tissue with thin cannulas (from 1 mm to 3mm mean) symmetrically and practically with no blood loss. Recommended values of different ingredients of a mixture were definitely set in 1990 and the instructions have been used with small changes until now. Method with the greatest number of treated patients is now in literature marked as “classic tumescent” or “conventional tumescent”. In the range of modern shaping liposuction techniques it presents “golden standard” today.
Ultrasound assisted liposuction
It was performed probably in 1993 for the first time. There serves again cannula as a performing device, which is inserted subcutaneously. It transmits ultrasound waves into fat tissue, the cells break due to formed energy and they are sucked out at the same time. At the beginning the technique caused high percentage of damaged skin and muscle membranes and large swellings. Till 2000 it went through many technical improvements, although even today the opinions on the safety of its usage have not been unified.
Power assisted liposuction
First efforts for construction of cannulas that also vibrate with great frequency, break and release fat cells and suck the fat at the same time can be found in 1994. The source of vibrations are gracile pneumatic or electromotoric systems. Significant technical perfection were achieved in 2002 (Flynn) and today is liposuction with the help of these cannulas relatively valuable and appreciated method. To its advantages belong gentleness, reduced operating time and reduction of surgeon’s fatigue.
Laser assisted liposuction
Using laser for dissolving fat was described in 1992 (Apfelberg). First larger studies were described in 1999 to 2004 and they concerned laserlipolysis of chin. At present NdYAG laser is used practically on all body parts with subcutaneous fat excesses. It is based on dissolving of fat cells and suction of formed lysate by gentle classic or vibration cannula. In case of very small parts it is possible to leave these parts without suction and presume to remove the dissolved fat by natural metabolism. The gentleness of the technique and the possibility of laser stimulation of subcutaneous collagen and therefore also reaching of perfect skin lift ranges this method among most perspective.
Water assisted liposuction
The principle of this method is twin cannula, where there is a jet of water under great pressure in the inner cannula together with small dosages of local anesthetics. This water beam is precisely defined for fat tissue that it does not cut, but it breaks the fat cells and frees them from the cellular membranes. Such released fat is at the same time sucked by outer cannula. The beginning of water jet technique in other surgical branches started in 1995 “water scalpel), the usage of liposuction procedures began around 2004 and first larger numbers of such performed liposuctions were described in 2006 (Hernuss-Vienna). Longer experiences and evaluation on larger number of patients is still missing and even though this liposuction method is known for more that 4 years, it has not been much used by plastic and aesthetic surgeons.
Body shaping via liposuction techniques is at present one of the most performed procedures in the field of aesthetic surgery. It is caused also by no medical risks and possibility of out-patient performance only under local anesthesia (tumescence). Its still increasing number is also caused by stricter assessment of aesthetic appearance of an individual. Regarding life style of temporary population still more women and men can be expected to undergo one of the shaping procedures. They should choose clinics that specialize on these procedures, have many years of experience, own complete needed equipment and that are able to professionally treat all requested parts by a client.
Author of the article is Martin Tomanek M.D., aesthetic surgeon with specialization on liposuction of LaserPlastic Clinic.