Liposuction is used to remodel the contours of the body by removing excess subcutaneous fat and is one of the most frequently performed aesthetic surgery procedures in western countries. Men or women can receive this surgery to a range of areas of the body including thighs, hips, back, abdomen, chest, upper arms, chin, and neck. It is fascinating to follow the development of liposuction throughout the 20th-century to the present.
The first known attempt to remodel body shape was in 1921. This involved the removal of skin and tissue from the desired areas where excess fat was present. The results varied and complications weren’t unusual. Decades later in 1972, a German physician developed a new technique to remove subcutaneous fat (the fat which lies between the skin and the muscles). He used an instrument which cut the fat away beneath the skin. This was used through to the mid-1970s.
In 1976 surgeons used a similar instrument attached to a low-powered aspirator to suck the fat away, once it was disturbed or cut. It wasn’t possible to use this technique over the entire body. It was restricted to areas which had fewer blood vessels, to reduce the risk of complications.
In 1975, cosmetic surgeons, Arpad and Giorgio Fischer, developed the precursor to the modern liposuction technique. They introduced a blunt-ended, hollow cannula attached to a suction device. This “blunt” method ensured fewer complications and a more predictable result for patients.
Two Parisian surgeons, Illouz and Fournier, popularised the Fischer technique, adapting equipment specifically for its application. They began to use narrower cannulae, which further reduced damage to the surrounding tissues.
At first Fournier preferred the “dry technique”, where no fluid was injected prior to the procedure. He believed it was a more precise and accurate method of fat removal. However, as time passed, it became clear that a lidocaine infiltration into the treatment area before surgery reduced the risk of bleeding. Throughout this time, liposuction had been done under general anaesthetic only.
In the late 1980s, Californian dermatologist Jeffrey Klein began using large volumes of diluted anaesthesia administered to the treatment areas. This allowed liposuction to be performed over larger areas at a time without the need for general anaesthetic or sedation. This dilute anaesthesia administered to the treatment area caused constriction of the nearby blood vessels, and greatly reduced bleeding, during and after surgery. Not having to use general anaesthesia had the added benefit of reduced hospitalisation, costs and risks associated with general anaesthesia.
In the early 1990s, Italian, Zocchi introduced ultrasonic liposuction as an alternative to the blunt-cannula method. “This technique is based on the application of ultrasounds to the fatty tissue to be aspirated, resulting in both thermal effects and mechanical effects to the surrounding adipocytes.”
The thermal and mechanical effects begin to dissolve the fat so it can be suctioned away. Zocchi believed the benefits of the ultrasonic technique was more selective targeting of the fat to be removed while not disturbing surrounding tissues. This also created a smooth skin surface and less physical wear on the surgeon. Ultrasonic liposuction was embraced initially in South American and Europe and then largely rejected after experience with skin sloughs, burns, and seromas.
At around the same time, laser-lipolysis became popular following the publication of studies about the interaction of the laser and fatty tissue. The laser beam can be aimed at specific tissues, while leaving other areas alone and the laser causes the fat to be dislodged and begin to melt into a fluid that is easy to suction out.
Laser liposuction is the state-of-the-art technique used today at Sculpture Clinic. The surgeon administers tumescent anaesthetic to the treatment area and is allowed to settle. Then the specialised cannula containing the laser fibre is used to simultaneously laser and suction the fat out of the body. The laser/cannula is so effective that the action used by the surgeon is very gentle and this causes less trauma to the area and less bruising, when combined with the tumescent anaesthesia.
VASER is another up-to-the-minute technique that works in a largely similar way to laser lipo, except for the method of melting the fat. VASER uses amplified ultrasound emitted through a small probe to dislodge and break up the fat so it can be suctioned out of the body.