This page is to give an idea about the history of Liposuction all these techniques has been refined over 30 years of experience
Liposuction or SAL first burst on the scene in a presentation by the French surgeon, Dr Yves-Gerard Illouz, in 1982.1 His method was quite straightforward and consisted of the following:
- Instill a hypotonic saline solution into areas of fat (theoretically to "rupture" the adipocytes).
- Insert blunt-tipped, hollow metal cannulas (of 5-, 8-, and 10-mm internal diameters with a lateral side opening) into these fatty deposits.
- Attach the cannulas via hose or tube to a high-power suction machine.
- Move these cannulas in and out of the fat in a fan-shaped pattern.
This process aspirated the fat and allowed the operator to sculpt the fatty areas into a more pleasing shape.
Evolution of technical aspects
In the 28 years since Illouz's presentation, as liposuction has become a mainstay of the cosmetic surgeon's armamentarium, the technique has evolved considerably. When first described, the technique by its very nature had certain limitations. For example, candidates for liposuction were restricted to generally younger individuals with good skin elasticity to avoid postoperative laxity. The volume that could be extracted was constrained by the considerable blood loss, and the large diameter of the cannulas restricted use of the technique in certain anatomic areas.
Blood loss and lidocaine replacement
The issue of blood loss cannot be minimized, and the limitations it placed on liposuction led to an evolution of subcutaneous fluid instillation. It began with the movement from the dry technique (where no fluid was injected into the fatty tissues and blood loss was significant) to the wet technique, in which an adrenalin solution is injected into the tissues to be liposuctioned. This allowed surgeons to remove greater fat volumes with reduced (though still not negligible) blood loss.
Subsequently, larger and larger volumes of dilute lidocaine and adrenalin were injected, with improved results. This culminated in Jeffrey Klein's description of the tumescent technique (his term), in which dilute buffered lidocaine and adrenalin are injected into the tissues to be suctioned to the point of turgidity.
As mentioned earlier, blood loss has been reduced to a minimal level. Various studies have been performed in which most agree with the general range quoted by Pitman that estimates average blood loss after tumescent SAL at 1-5% of total aspirate volume.
Cannulas
The size, shape, and design of cannulas have evolved. Currently, surgeons use much finer cannulas of inner diameters seldom greater than 4 mm. These usually have a design that includes multiple holes either on one side or around the entire tip (see image below). Shapes, sizes, and positions of the holes allow for faster yet more exacting shaping and sculpting of fatty tissues.
Improvements
Other changes that have occurred with time and greater experience and understanding of the surgery include (1) size, number, and location of incisions; (2) drainage and dressings; (3) postoperative compression; and (4) patient selection criteria. Incision size is reduced to barely several millimeters yet the number of incisions has increased, as surgeons have felt liberated to use as many small access incisions as necessary to effectively perform the surgery. While most surgeons still close these incisions, they usually can be closed only with a subcuticular suture. Many surgeons do not close the incisions at all.
Some surgeons have elected to leave access incisions open postoperatively to promote drainage of tumescent fluid and blood and have reported no adverse effects on wound healing and scarring. Other surgeons have instituted the use of fine drains for several days post procedure to evacuate fluid collections, which, theoretically, reduces postoperative soft-tissue edema and, ultimately, reduces the formation of scar tissue.
Postoperative taping and dressings have become less important, although compressive garments are still considered important to obtain a good result. Initially, age was believed to be a major criterion in selection because of the assumption of poor skin elasticity, yet current practice judges patients on an individual basis, regardless of age. Surgery itself generates a surprising degree of skin contraction, allowing for further liberalization of skin elasticity criteria.
Ultrasonic assisted liposuction and external ultrasonic assisted liposuction
Finally, evolution of the technique has included the introduction of Ultrasound Assisted liposuction (UAL) and External Ultrasound Assisted Liposuction (EUAL). The latter technique remains controversial and of questionable value. In UAL, ultrasonic energy is applied to specially designed liposuction cannulas, causing cavitation of fat deposits in its direct path and surrounding its tip and leading to more bloodless, easier, and more efficient removal of fat. The technique is normally used in concert with standard SAL. UAL is performed first to break up and liquefy large areas of fat, and SAL thereafter removes liquefied fat as well as the remaining areas that require sculpting and removal. Among the developments in ultrasonic-assisted liposuction is the so-called
US technology uses a low-power ultrasound that produces a more selective fat cavitation has low risk of injury or burns to surrounding tissue.
Other options in liposuction include power-assisted liposuction hand pieces that reduce the surgeon's work effort while increasing the movement of the cannula in and out of the tissues.
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