Plastic surgery is art and science
combining surgical and artistic skill
to enhance and restore physical appearance
The following appeared in the Health Section
of the Wolfe News Papers in June of 1996
it was written at the request of the Medical Society
of Monroe County to give an update about
the current status of Liposuction
Have you ever been a part of a revolution ?
Fifteen years ago liposuction was considered a dangerous
operation. Caution ! Only a small amount of fat could be removed.
Blood transfusions were thought to be needed in all but
minor cases. Reports of infections were blown out of proportion.
Only women under forty could have the procedure. Only the
thinnest of patients should be operated on. Never operate
on a chubby patient. Be ready for clots or fat traveling
to the lungs. Liposuction had a stormy beginning but it
has proven to be a very safe operation.
It is interesting to understand the operation. A cannula
or metal tube the size of a straw is placed through the
skin into the fatty tissue. Surgeons were taught in pre
liposuction era that the fatty layer was the one with the
greatest chance of infections and fat should not be injured.
But liposuction actually 'beats up' the fat. The tube pushes
through the fat again and again, bruising it. Fat is actually
torn away by powerful suction. You would think there would
be much bleeding. There usually isn't. Doctors thought there
should be infections. They are very rare. The skin, muscle
and nerves are bumped and bruised and there should be a
lot of pain. There usually isn't. According to the surgeons'
theory before 1980, liposuction should not be done. But
within two years of the first operations in the U.S.., liposuction
became the most frequent procedure of plastic surgeons.
What makes liposuction possible? Dr.Yeves Gerard Illouz
(pronounced ill oooze) is a Parisian surgeon whose office
was close to the Follies Bergere'. With so many dancers
and too much hip and tummy fat, Dr.Illouz was asked time
and time again to 'suuukk zee fott' as he says in his French-English.
Over time he developed the basic principles. He preached
using a high powered suction so that few pieces of loose
fat would be left behind to cause infection. The cannulas
should not be sharp to cut nerves and blood vessels. Sterile
techniques must be used to avoid infections. The surgeon
must be prepared to give intravenous fluids if too much
tissue is removed or if there is excessive bleeding. By
adhering to these principles liposuction turned out to be
a very safe and useful procedure for millions of people,
thin and chubby.
When suction lipectomy is mentioned we think of thin women
with a little fat in the tummy, hips or thighs; an operation
to make thin women thinner. But really thin women are few
and we quickly learned that there are many other people
that can benefit from liposuction. For example, many large
fatty tumors have been removed with the technique sparing
people large scars and allowing faster healing. The chubby
faces of children with Downs syndrome have been contoured
to help prevent stereotyping a child. Pounds of fat removed
from the heavy abdomen during middle age can take weight
off the aching backs and knees, to provide relief in some
cases. Heavy arms have been lightened. In Germany liposuction
is used to reduce large breasts through small incisions.
Even the fat given up by the procedure can be used. Scars
from accidents or birth defects have been helped by fat
What's new in liposuction? You have heard about the 'new'
tumescent technique which uses small cannulas. This involves
injection of large amounts of fluid and a large amount of
local anesthetic into the tissues to be suctioned. Dr. Klein
perfected the 'tumescent' technique in 1986 making it 'new'
about ten years ago. Small cannulas (one eighth of an inch)
are not new either . Surgeons have been using small cannulas
for body sculpting since the early 1980s.
What is new is we are learning that very large amounts of
fat, four or more liters, can be removed during one operation
using the tumescent technique. Because of the large amounts
of fluid and local anesthetic infused into the tissue this
is a hospital procedure. Very careful patient selection
and monitoring is needed for safety to minimize the risk
to the heart, lungs, and infection.
What is new is that more non-surgeons are doing liposuction
in their offices. The media shows video clips of gloved
physicians, their hairy arms, heads and mustaches exposed,
no gown or mask, suctioning patients who rest on bath towels
in an office setting. What could be easier ??!! From a surgeon's
view, not adhering to sterile techniques, removing large
amounts of fat without an IV ready, and giving large amounts
of local anesthetics and adrenaline increase the risks of
liposuction surgery. Only time will tell if the safety record
of liposuction will be maintained.
Ultrasonic liposuction is a newer procedure. This involves breaking open
fat cells with an ultrasonic cannula. The cannula has a
vibrating tip which shakes open the cells. The liquid fat
is then sucked out. This is now available on a routine
basis and has benefits in some cases.
Also 'new' but very controversial is the use of sharp cannulas
right under the skin Yes it started in California !!! Apparently
some very good and some very bad results have been reported.
Caution is advised !!!!
History has a way of repeating its lessons. We have known
for a long time that changing the body can change the mind.
Over the past fifteen years we have come to know that liposuction
not only tapers a bulge or sculpts a form, but it can also
lift the spirits and that's not new !!