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Thinking About Liposuction? Part I
By Gilly S. Munavalli, MD, MHS
Charlotte HEALTH&FITNESS magazine, May 2006
What
can you do about those stubborn love handles, the “turkey
gobbler” under the neck, or that little bit of “junk
in the trunk”? There’s plenty you can do
about it. Liposuction is an incredibly safe, in-office procedure that
can jump start a new healthy and fit lifestyle or fine tune the finest
figure. In this two part series on liposuction, I will attempt to
demystify the past, present, and future of one of this country’s
most popular cosmetic procedures….
WHEN WAS LIPOSUCTION INVENTED?
Well, the modern procedure known as liposuction has been around since
the mid 1970’s when it was practiced by a pair of Italian physicians
in Rome. They were the first to develop and report on the use of blunt
hollow cannulas for fat extraction. Why is this important? The cannula
is a long cylindrical, tapered, surgical instrument, which is primarily
used to suction adipose tissue, AKA fat or subcutaneous tissue of
the skin, which lies below the epidermis and dermis of the skin. It
has several openings or ports along the sides of the tip. The blunt
nature of the cannula tip allows for movement back and forth through
the subcutaneous tissue without risk of cutting or damaging any important
structures such as arteries. This technique was picked up and modified
by Drs’ Fornier and Illouz in Paris who refined the use of the
cannula. Dr Illouz, in particular, modified the technique by injecting
saline and enzymes into the fat prior to extraction. This so called
“wet technique” made for a much less traumatic procedure.
However, general anesthesia was still required for the procedure to
be performed. The first American physician, a Dermatologist / Dermatologic
surgeon, traveled to France in 1977 to learn about liposuction.
 HOW
DOES LIPOSUCTION REALLY WORK?
In a nutshell, liposuction is a very straightforward and well-defined
procedure. The thickness of the adipose layer varies from person to
person and from one location of the body to the other; for example
the cheeks or the scalp of a healthy person are usually much thinner
than the abdomen or thighs. Prior to the surgery, the physician marks
out the areas for fat removal. During the surgery, he/she creates
entry points in the skin using a small blade or needle and passes
the cannula through the skin and back and forth in a criss-cross pattern
in the adipose layer, removing fat with each pass. Great care is taken
to stay within the same level of adipose, not going too deep or too
superficial. The entry points are later either sewn shut after the
procedure or left open to heal in by themselves. In any event, they
usually heal imperceptibly.
The oscillating movements of the cannula break up the fat and adhering
connective tissue into smaller particles that can pass through the
hollow space in the cannula. Back in the 1970’s, the cannulas
were huge, almost 1 cm (2.5 inches) in diameter. This created wide
tunnels in the adipose and may have caused damage to neurovascular
bundles and occasionally may have led to uneven contours, large bruising
and fluid collection under the skin in some patients. Today’s
cannulas are usually 6 mm or less and provide the liposuction surgeon
with much more control, leading to very narrow tunnels in the fat
layer, efficient fat removal, and very even contours. An aspirator,
or suction machine is attached the hand piece of the cannula (opposite
the tip) and provides constant suction to draw the fat out of the
hollows of the cannula and into the collecting jar for measurement
and ultimately, for biohazard disposal.
DO I FEEL ANYTHING DURING THE PROCEDURE? AM
I SEDATED OR KNOCKED OUT WITH GENERAL ANESTHESIA?
Of course, the goals of any surgical procedure are to: A) be safe
for the patient, B) be comfortable for the patient, C) be effective
for the patients. One of the biggest revolutions in liposuction in
the past 15 years has really been in the way that anesthesia in administered
prior to and during the surgery, to numb the treatment area. Traditionally,
liposuction was done under general anesthesia in the operating room
of a hospital-based setting, with the assistance of an anesthesiologist.
In 1987, dermatologist Jeffery Klein, MD reported on his development
of tumescent anesthesia. This innovation involved the infusion or
infiltration of a dilute solution of lidocaine with epinephrine to
allow more extensive liposuction totally by local anesthesia, significantly
reducing bleeding. Patients no longer needed general anesthesia. This
truly has revolutionized the field of liposuction for all specialties.
Complex calculations of fluid and blood loss were no longer required.
Peri- and postoperative monitoring was simplified. Patients avoided
the inherent risks of “going under”.
Klein demonstrated that very dilute concentrations of lidocaine with
epinephrine are not absorbed to the same degree as standard “out
of the bottle” commercial solutions of lidocaine. This pharmacologic
discovery allowed large volumes of fat to be removed using only local
anesthesia. The tumescent technique has been the key to the safety
and accuracy of modern liposuction, and has been recognized throughout
the world for its importance.
While some specialties continue to perform liposuction in a hospital-based
setting, dermatologic surgeons have clearly shown that tumescent liposuction
is safe as an office-based outpatient surgical procedure. To date,
there have been NO fatalities and very few complications when the
tumescent anesthesia technique is employed as a local anesthetic approach
without excess intravenous fluids or general anesthesia.
Gilly Munavalli, MD, MHS is medical director of the Goslen Aesthetic
and Skin Center in Charlotte, NC. He has been performing in-office
liposuction for 5 years and speaks internationally on liposuction,
skin cancer surgery, and laser surgery.
go to Part II >
back to Newsletter >
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