Liposuction

Liposuction, or simply lipo, is a type of fat removal procedure used in plastic surgery.[1] Evidence does not support an effect on weight beyond a couple of months and it does not appear to affect obesity related problems.[2][3] In the United States it is the most commonly done cosmetic surgery.[4][5]

Liposuction
A plastic surgeon performing liposuction surgery
Other namesLipoplasty, fat modeling, liposculpture, suction lipectomy, suction-assisted fat removal, lipo
ICD-9-CM86.83
MedlinePlus002985

Serious complications include deep vein thrombosis, organ perforation, bleeding, and infection.[6] Death occurs in about one per ten thousand cases.[7]

The procedure may be performed under general, regional, or local anesthesia. It then involves using a cannula and negative pressure to suck out fat.[4] It is believed to work best on people with a normal weight and good skin elasticity.[4]

While the suctioned fat cells are permanently gone, after a few months overall body fat generally returns to the same level as before treatment.[2] This is despite maintaining the previous diet and exercise regimen. While the fat returns somewhat to the treated area, most of the increased fat occurrs in the abdominal area. Visceral fat ⁠— ⁠the fat surrounding the internal organs ⁠— ⁠increases, and this condition has been linked to life-shortening diseases such as diabetes, stroke, and heart attack.[2]

Uses

Liposuction is generally used in an attempt to change the body's shape.[1] Weight loss from liposuction appears to be of a short term nature with little long term effect.[2] After a few months fat typically returns and redistributes.[2] Liposuction does not help obesity related metabolic disorders like insulin resistance.[3] It can also be used to remove excess fat in the chronic medical condition lymphedema.[8]

Risks

There exists a spectrum of complications that may occur due to any liposuction. Risk is increased when treated areas cover a greater percentage of the body, incisions are numerous, a large amount of tissue is removed, and concurrent surgeries are done at the same time.

Some side effects and complications include, but are not limited to, the following:

  • Death
  • Pain, which may be temporary or chronic
  • Post-liposuction fat redistribution or post liposuction weight gain
  • Bruising
  • Infections can become serious issues.
  • Embolisms may occur when loosened fat enters the blood through blood vessels ruptured during liposuction. Pieces of fat can wind up in the lungs, or even the brain. Fat emboli may cause permanent disability or, in some cases, be fatal.
  • Puncture wounds in the organs (visceral perforations) may require surgery for repair. They can also prove fatal.
  • Seroma is a pooling of serum, the straw-colored liquid from your blood, in areas where tissue has been removed.[9]
  • Paresthesias (changes in sensation that may be caused by nerve compression) is an altered sensation at the site of the liposuction. This may either be in the form of an increased sensitivity (pain), or numbness in the area. In some cases, these changes in sensation may be permanent, although typical patients recover over the span of several weeks.[9]
  • Swelling, in some cases, may persist for weeks or months after liposuction.
  • Skin necrosis occurs when the skin above the liposuction site changes color and falls off. Large areas of skin necrosis may become infected with bacteria or microorganisms.
  • Burns can occur during ultrasound-assisted liposuction if the ultrasound probe becomes hot.
  • Fluid imbalance may impact you after you go home. The condition can result in serious ailments such as heart problems, excess fluid collecting in the lungs, or kidney problems.
  • Toxicity from anesthesia due to the use of lidocaine, a skin-numbing drug, can cause lightheadedness, restlessness, drowsiness, a ringing in the ears, slurred speech, a metallic taste in the mouth, numbness of the lips and tongue, shivering, muscle twitching and convulsions. Lidocaine usage has already been linked to deaths from liposuction.[10]
  • Scars at the site of the incision are usually small and fade with time, although some may be larger or more prominent.
  • Deformities in the shape of the body may occur at the liposuction site after the procedure for about 20% of patients.[9]

Techniques
Liposuction aspirate

In general, fat is removed via a cannula (a hollow tube) and aspirator (a suction device). Liposuction techniques can be categorized by the amount of fluid injected, and by the mechanism by which the cannula works. If the removed fat is used as filler for the face or lips, knowledge of the precise technique used to remove the fat is indicated.

Power-assisted liposuction

PAL uses an up and down, vibrating-like motion of the cannula to acquire greater fat removal. When compared to simple suction-assisted liposuction, PAL requires less energy for the surgeon to operate while also resulting in greater fat removal. It is commonly used for difficult, secondary, scarred areas, and when harvesting large volumes of fat for transfers to other areas.[11]

Ultrasound-assisted

Ultrasound-assisted liposuction techniques used in the 1980s and 1990s were associated with cases of tissue damage, usually from excessive exposure to ultrasound energy.[12] Third-generation UAL devices address this problem by using pulsed energy delivery and a specialized probe that allows physicians to safely remove excess fat.[13] UAL is beneficial in people with a particular skin tone, in liposuction of areas that are more difficult to remove fat, that include treatment of gynecomastia, or areas where secondary liposuction is being performed.[14]

Sutures

Doctors disagree on the issues of scarring with not suturing versus resolution of the swelling allowed by leaving the wounds open to drain fluid. Since the incisions are small, and the amount of fluid that must drain out is large, some surgeons opt to leave the incisions open, while others suture them only partially, leaving space for the fluid to drain out.[15]

History

In 1977, Fischer and Fischer reviewed 245 cases with the planotome instrument for treating cellulite in the lateral trochanteric (hip-thigh) areas. There was a 4.9 per cent incidence of seromas, despite incision-wound suction catheters and compression dressings; 2.0 per cent of the cases presented pseudo-cyst formation that required removal of the capsule (cyst) through a wider incision (+ 5.0 mm) and the use of the panotome.[16][17]

Relatively modern techniques for body contouring and removal of fat were first performed by a French surgeon, Charles Dujarier, but a 1926 case that resulted in the amputation of the leg of a French dancer due to excessive tissue removal and too-tight suturing set back interest in body contouring for decades.[18][19]

Liposuction evolved from work in the late 1960s from surgeons in Europe using techniques to cut away fat, which were limited to regions without many blood vessels due to the amount of bleeding the technique caused.[18] In the mid-1970s Arpad and Giorgio Fischer created the technique of using a blunt cannula linked to suction; they used it only to remove fat on the outer thighs.[20] Yves-Gérard Illouz and Fournier extended the Fischers' work to the whole body, which they were able to use by using different sized cannulae.[18] Illouz later developed the "wet" technique in which the fat tissue was injected with saline and hyaluronidase, which helped dissolve tissue holding the fat, prior to suctioning.[18] Lidocaine was also added as a local anesthetic.[18] Fournier also advocated using compression after the operation, and travelled and lectured to spread the technique.[18] The Europeans had performed the procedures under general anesthesia; in the 1980s American dermatologists pioneered techniques allowing only local anesthetics to be used.[18] Jeffrey Klein published a method that became known as "tumescent" in which a large volume of very dilute lidocaine, along with epinephrine to help control bleeding via vasoconstriction, and sodium bicarbonate as a buffering agent.[18]

In 2015 liposuction surpassed breast augmentation surgery as the most commonly performed cosmetic procedure in the US.[21]

See also

References
  1. Dixit, VV; Wagh, MS (May 2013). "Unfavourable outcomes of liposuction and their management". Indian Journal of Plastic Surgery. 46 (2): 377–92. doi:10.4103/0970-0358.118617. PMC 3901919. PMID 24501474.
  2. Seretis, Konstantinos; Goulis, Dimitrios G; Koliakos, Georgios; Demiri, Efterpi (2015). "Short- and Long-Term Effects of Abdominal Lipectomy on Weight and Fat Mass in Females: A Systematic Review". Obesity Surgery. 25 (10): 1950–8. doi:10.1007/s11695-015-1797-1. PMID 26210190.
  3. Seretis, K; Goulis, DG; Koliakos, G; Demiri, E (December 2015). "The effects of abdominal lipectomy in metabolic syndrome components and insulin sensitivity in females: A systematic review and meta-analysis". Metabolism: Clinical and Experimental. 64 (12): 1640–9. doi:10.1016/j.metabol.2015.09.015. PMID 26475176.
  4. Norton, Jeffrey A. (2012). Surgery Basic Science and Clinical Evidence. Berlin, Heidelberg: Springer Berlin Heidelberg. p. 2014. ISBN 9783642572821.
  5. Khan, MH (November 2012). "Update on liposuction: clinical pearls". Cutis. 90 (5): 259–65. PMID 23270199.
  6. Tierney, Emily P.; Kouba, David J.; Hanke, C. William (December 2011). "Safety of tumescent and laser-assisted liposuction: review of the literature". Journal of Drugs in Dermatology. 10 (12): 1363–9. PMID 22134559.
  7. Draelos, Zoe (2011). Cosmetic Dermatology: Products and Procedures. John Wiley & Sons. p. Chapter 56. ISBN 9781444359510.
  8. "Lymphoedema treatment". NHS Choices. NHS GOV.UK. July 18, 2017. Retrieved February 24, 2018.
  9. Stephan, PJ; Kenkel, JM (2010). "Updates and advances in liposuction". Aesthetic Surgery Journal. 30 (1): 83–97. doi:10.1177/1090820X10362728. PMID 20442081.
  10. Paik, AM; Daniali, LN; Lee, ES; Hsia, HC (2014). "Local anesthetic use in tumescent liposuction: an American Society of Plastic Surgeons survey". Annals of Plastic Surgery. 74 (2): 145–151. doi:10.1097/SAP.0000000000000420. PMID 25590254.
  11. Tabbal, Geo N.; Ahmad, Jamil; Lista, Frank; Rohrich, Rod J. (November 2013). "Advances in Liposuction". Plastic and Reconstructive Surgery Global Open. 1 (8): e75. doi:10.1097/GOX.0000000000000007. ISSN 2169-7574. PMC 4186292. PMID 25289270.
  12. Jewell, M (2008). "Innovation in Plastic and Aesthetic Surgery Lipoplasty". Innovations in Plastic and Aesthetic Surgery. pp. 443–53. doi:10.1007/978-3-540-46326-9_55. ISBN 978-3-540-46321-4.
  13. De Souza Pinto, Ewaldo Bolivar; Chiarello De Souza Pinto Abdala, Priscila; Montecinos Maciel, Christovam; De Paula Turchiari Dos Santos, Fabiana; Pessoa Martello De Souza, Rodrigo (2006). "Liposuction and VASER". Clinics in Plastic Surgery. 33 (1): 107–15, vii. doi:10.1016/j.cps.2005.09.001. PMID 16427979.
  14. Tabbal, Geo N.; Ahmad, Jamil; Lista, Frank; Rohrich, Rod J. (November 2013). "Advances in Liposuction". Plastic and Reconstructive Surgery Global Open. 1 (8): e75. doi:10.1097/GOX.0000000000000007. ISSN 2169-7574. PMC 4186292. PMID 25289270.
  15. MedlinePlus Medical Encyclopedia: Liposuction
  16. Fischer A.; Fischer G. (1977). "Revised Technique for Cellulite fat reduction in Riding Breeches deformity". Bulletin of the International Academy of Cosmetic Surgery. 2 (4): 40–43.
  17. Schiffman, p. 3.
  18. Bellini, E; Grieco, MP; Raposio, E (December 2017). "A journey through liposuction and liposculture: Review". Annals of Medicine and Surgery (2012). 24: 53–60. doi:10.1016/j.amsu.2017.10.024. PMC 5681335. PMID 29158895.
  19. Glicenstein, J (1989). "L'affaire Dujarier" [Dujarier's case]. Annales de Chirurgie Plastique Esthétique (in French). 34 (3): 290–2. PMID 2473691.
  20. Sterodimas, A; Boriani, F; Magarakis, E; Nicaretta, B; Pereira, LH; Illouz, YG (March 2012). "Thirtyfour years of liposuction: past, present and future". European Review for Medical and Pharmacological Sciences. 16 (3): 393–406. PMID 22530358.
  21. Chia, CT; Neinstein, RM; Theodorou, SJ (January 2017). "Evidence-Based Medicine: Liposuction". Plastic and Reconstructive Surgery. 139 (1): 267e–274e. doi:10.1097/PRS.0000000000002859. PMID 28027260.


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