The Evolution of Liposuction Techniques and Technology

June 18, 2019

Liposuction is the most popular cosmetic surgery procedure in the world, along with rhinoplasty and breast augmentation. The procedure sucks up excess fat cells accumulated in certain areas (thighs, belly, back, arms, love handles, calves, ankles, knees, etc). Discover its indications, its techniques, the types and the cost of this operation.

A surgical technique created by Dr. Yves Gérard Illouz in the late 70's, liposuction is now the most widely practiced aesthetic procedure in the world. Liposuction is by far the only reliable way to effectively remove localized and refractory fat surpluses from sports diets and activities. Whatever the origin of the fat deposits removed, the results are in the great majority of cases very satisfactory and definitive.

How did liposuction begin?

Invented by Dr. Illouz in 1977, liposuction involves the introduction, through small incisions, of small (3-4 mm) cannulas of rounded tip (non-cutting) foam perforated at their ends with several orifices. Connected to a closed circuit with negative pressure, these cannulas allow a harmonious and non-traumatic aspiration of excess fat cells. Knowing that these cells (adipocytes) do not have the ability to multiply, the results should be permanent.

Advancements in Instrumentation and Technology

Water jet assisted liposuction (WAL)

With the water-jet-assisted liposuction, the surgeon loosens the fatty tissue in a tissue-friendly manner with a wafer-thin stream of water. It requires up to 70% less tumescent solution, which limits saline and drug burden. With a fine, fan-shaped water jet, the surgeon deliberately releases the fat cells from the environment. Through a second channel, the fat is removed simultaneously with the previously introduced liquid. This procedure also allows the treatment of small and problematic body areas. During the WAL, the surgeon controls the natural shape and contours of the body throughout the entire process and can thus assess the end result very realistically during the operation. Even small bumps can be eliminated. Dents are thus avoided more safely. The WAL method is also of particular importance if the patient wishes for a lipo-transfer -- for breast augmentation with autologous fat, for example. In addition, waterjet-assisted liposuction is often performed in a lipoedema, as this method usually allows very large amounts of fat to be sucked off.

Vibration-assisted liposuction (VAL)

The vibration-assisted liposuction, also named "Power Assisted Liposuction" (PAL), is particularly suitable for sensitive skin types and complex body zones such as knees and ankles as the tissue is spared to a greater extent than in the classic liposuction with this method. After introducing the tumescent solution, oscillating cannulas (about 6,000 oscillations per minute) are introduced via small skin incisions. The vibration causes a faster bursting of the fat cells than with a classical liposuction.

Ultrasound-assisted liposuction (UAL)

The ultrasound-assisted liposuction is essentially based on the classic liposuction method using TLA, or tumescent lidocaine anesthesia. Ultrasound probes are inserted into the area to be aspirated, causing the fat cells to burst and liquefy. Because the fabric is heated to a high degree, an additional tightening effect can be achieved with this method.

Laser-assisted liposuction (SmartLipo)

A further development of ultrasound-assisted liposuction is laser-assisted liposuction (LAL), with SmartLipo being the most popular type of LAL. Instead of ultrasound probes, laser probes are introduced into the area to be treated. The delivery of laser pulses of different wavelengths liquefies the fat cells. The LAL is particularly suitable for solid body regions such as the back area.

Areas Treated with Liposuction

A large number of areas of the body can benefit from liposuction: belly, saddlebags (trochanteric region), hips, thighs, knee, calves, ankles, arms, back, and even the face (neck, double chin) can undergo the procedure. Surgery for gynecomastia (a hypertrophy of the breast in men) may include liposuction to remove excess fat. The craze for this procedure arose from the fact that people today feel much less guilt having resorted to an aesthetic intervention to find a harmonious silhouette. This is coupled with the fact that it is now a proven technique, which has more than 40 years of research to back its safety and benefits.

Objectives and Limitations of Liposuction

Be careful though, liposuction is not a cure for obesity . It is an alternative to thinning and can only be practiced in well-defined areas where exercise or dieting is ineffective. The goal is not a thinning but the search for a harmony of shapes and silhouette, we also speak of "liposculpture".

Cosmetic surgeons always advise patients to be closest to their ideal weight before performing liposuction. Thus, only fats that could not be eliminated by diet or exercise will be treated, and more efficiently so.

Using liposuction does not save you from a healthy lifestyle. Indeed, if the liposuction of fat is effective and the final results, the patient who emerges from a healthy lifestyle may see the accumulation of fat occur in areas that have not been treated. Some general advice for healing after liposuction include: eating healthy, exercising regularly, avoiding stress, quitting tobacco and alcohol, and just taking care of your body in general.

Before the procedure, the plastic surgeon will check the candidate's skin and its quality to make sure they are suitable for surgery and will not result in unsightly irregularities such as waves or folds on the skin. What qualifies as a good candidate skin-wise would be skin that is elastic yet firm.

For the majority of people, the procedure is very short, and can last between 20 minutes and 1 hour. It is also is most often performed on an outpatient basis, although in some cases an extra night of hospitalization is required, especially for procedures that require the withdrawal of larger amounts of fat.

Before the Procedure

One to two prior consultations with the plastic or cosmetic surgeon are essential in order to clearly define the patient's goals and the relevance of the request. The surgeon performs an interrogation then a careful examination of the areas to be treated. The quality of the skin, especially its elasticity, is carefully examined by the surgeon. In fact, poor skin elasticity does not guarantee a satisfactory result, the skin has to have the ability to shrink on a reshaped and refined silhouette too.

In cases of substantial skin laxity in the abdomen, the surgeon has other operative procedures to conduct a re-tightening of the skin, or an abdominal dermolipectomy (also called abdominoplasty or tummy tuck), where skin and fat are removed.

If it is not a repair intervention (cases of diseases where there is a disorder of the distribution of fats called lipodystrophy), a period of 15 days between the first consultation and the operation must be respected. This is a mandatory reflection period for all aesthetic acts. Before the operation, a visit to the anesthesiologist is mandatory as well. A detailed estimate and an operative record are then given to the patient.

Pre-Operation Assessment

Preoperative blood work is performed according to the following prescriptions:

  • It is recommended to stop smoking at least one month before and after surgery to avoid impairing healing;
  • Taking aspirin is prohibited during the 10 days preceding the operation;
  • Stopping oral contraception may be required in case of other risk factors for phlebitis (obesity, poor venous status, coagulation disorders);
  • The skin will be disinfected with an antiseptic solution or soap applied the day before and the morning of the operation;
  • It is recommended to eat nothing or drink 6 hours before the operation in case of general anesthesia.

After Liposuction

After the operation, cosmetic surgeons recommend bed rest of a week or so. For major liposuction, the doctor prescribes anticoagulants, which are medicines that prevent blood clots. Moderate pains can also be felt after, but can be easily alleviated by taking conventional analgesics. Fatigue often follows the procedure. As incisions are very shallow, scars are usually minimal.

The recovery time is proportional to the amount of fat removed. Taking a leave from work for 3 to 10 days is advisable. Avoiding activities that are too intense or strenuous for a month is recommended as well.  The appearance of edema is common, but wearing compression clothing allows it to abate one month, then its total disappearance after 6 months. The cosmetic surgeon may possibly advise lymphatic drainage sessions for certain areas.

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