LIPOSUCTION SURGERY
Both men and women can accumulate excess fat, which is not easily removed by exercise and diet. Liposuction is a surgical technique that improves the body's contour by removing unwanted deposits of fat located between the skin and the muscle. Liposuction involves the use of small, straw-like instruments called cannulas that are attached to a suction machine. The cannula is inserted through tiny skin incisions. A network of tunnels is created and the unwanted fatty deposits are suctioned. A support garment is then worn for compression during healing. The result is a more attractive contour with removal of exercise and diet resistant deposits of fat.
HISTORY OF LIPOSUCTION
Liposuction was first developed in the late 1970's in Europe. The technique was introduced to the United States in 1982 when a group of cosmetic dermatologists and plastic surgeons trained in Paris. Since then, it has become one of the most commonly performed cosmetic procedures in the United States.
WHAT IS TUMESENT LIPOSUCTION?
Developed by dermatologic surgeons in the 1980’s, a major advancement called the tumescent technique of liposuction completely revolutionized the procedure. Based on the use of local anesthesia, tumescent liposuction performed by a dermatologic surgeon can safely remove fat deposits with relatively little discomfort and improved cosmetic results. This technique is now considered the safest form of liposuction for removing fat because there is virtually no blood loss and fewer skin irregularties. Because of these dramatic changes, we are now able to treat multiple areas all in one sitting using local anesthesia, and at the same time these patients are able to get up right after surgery. Patients generally feel very good and they experience only minimal bruising and swelling.
WHEN IS LIPOSUCTION INDICATED?
Liposuction is most effective for removing localized fat deposits in body areas that do not respond to dieting or exercise. Liposuction is not intended as a substitute for weight loss, but rather as a contouring procedure. It is best utilized in a program of exercise and optimal weight maintenance. The most frequently treated areas in women are the abdomen, hips, inner thighs, outer thighs (saddlebags), knees, and beneath the chin. In men, the most commonly treated areas are the hips (love handles), abdomen, breasts, and chin. Liposuction is considered a success when the patient is happy with the results. Our goal is to optimize the aesthetic result rather than maximize the amount of fat removed. Liposuction produces a loss of inches rather than pounds.
HOW IS THE TUMESCENT TECHNIQUE OF LIPOSUCTION PERFORMED?
Dr. Jeff Klein, a dermatologic surgeon in California, developed the tumescent technique in 1985. Dr. Klein's technique has become the method of choice by practitioners performing liposuction. A survey in the American Journal of Dermatologic Surgery on the safety of the tumescent technique showed that the procedure was done in over 15,000 patients and there were no serious complications, hospitalizations, blood transfusions, or death.
Before surgery, a complete medical history is taken and a careful examination is conducted in order to evaluate the patient's condition. Patient expectation is also discussed. The tumescent technique, which is the safest form of liposuction with the quickest recovery time, is performed in an outpatient surgical suite. The word tumescent refers to swelling of the skin with local anesthetic. This local anesthetic consists of normal saline, lidocaine for numbing, and a vasoconstrictive drug called epinephrine.
The tumescent technique allows the surgeon to perform liposuction with a more accurate, gentle approach. The swollen tissue, i.e., fat, permits the use of micro-cannulas (3 mm or smaller) for extraction of the fat. These micro-cannulas require a minimal amount of force in order to advance them through the fatty tissue. As a result, the surgery is more accurate and gentle. The ultimate result is a greatly reduced risk of coming too close to the skin surface that may cause dimpling or irregularities.
As a result of the tumescent technique, there is widespread capillary vasoconstriction caused by the epinephrine in the solution and there is virtually no bleeding during the procedure and after surgery. This is a major improvement in the liposuction technique compared to older methods that rely on general anesthesia. The need for blood transfusions is eliminated, there is very little postoperative bruising, and patients may be discharged home shortly after the procedure is completed. The local anesthetic injected into the tissue remains for 18-24 hours following liposuction surgery, greatly minimizing postoperative discomfort. Patients rapidly recuperate and usually return to normal activities within one to two days and exercise generally may be resumed within seven days after liposuction.
WHAT IS NEW IN LIPOSUCTION?
Reciprocating cannulas or “Power Liposuction” has recently been invented to make the process of liposuction easier. The powered reciprocating cannulas operate by having a cannula move back and forth 2-3 mm at a time. This provides greater ease for the liposuction surgeon and limits fatigue. This method has allowed the physician to precisely sculpt difficult-to-treat areas.
Another method, Ultrasound-assisted liposuction, was developed to make liposuction easier by using sound waves to break-up the fat. Safety concerns squelched widespread adoption of the technique.
Currently Dr. Cox serves on two separate liposuction committees to verify the safety of the tumescent technique. One committee through the AAAHC (Accreditation Association for Ambulatory Health Care) has recently completed a prospective study that objectively documents the benefit of this technique. A landmark paper regarding this study will soon be published. Dr. Cox is the lead author on this paper. The other committee is the American Society for the Dermatologic Surgery Liposuction Council. This Council consists of 10 members including Dr. Cox and it was developed to establish training prerequisites, planning and supporting papers and ongoing studies for research.
SUE ELLEN COX, M.D.
Dr. Sue Ellen Cox, a board-certified dermatologist, is the Medical Director of Aesthetic Solutions. Dr. Cox received her Doctor of Medicine from Case Western Reserve University in Cleveland and was elected to the Alpha Omega Alpha Honor Society. She completed her residency in dermatology at the University of Texas Southwestern Medical School in Dallas in 1993. She is an active Fellow, member, and lecturer for the several organizations, including the American Academy of Dermatology, the American Society of Dermatologic Surgery, and the American Society of Lasers in Medicine and Surgery. Dr. Cox is a Feature Editor for Dermatologic Surgery Journal. Dr. Cox is an Associate Clinical Professor for the University of North Carolina School of Medicine. Dr. Cox has numerous publications in the Journal of the American Academy of Dermatology and the Archives of Dermatology. Her past and present research has focused on chemical peeling, laser resurfacing, Botox® and tumescent liposuction. Dr. Cox has authored the chapters "How the Skin Responds to Laser Resurfacing" in the definitive textbook Skin Resurfacing and “Violin: Hips, Outer Thigh, and Buttocks” in the book Safe Liposuction and Fat Transfer.5821 Farrington Road
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