You are in: eMedicine Specialties > Plastic Surgery > BODY CONTOURING Liposuction, TrunkArticle Last Updated: Jun 5, 2006AUTHOR AND EDITOR INFORMATIONSection 1 of 12
  Author: Julian B Gordon, MD, Consulting Staff, Division of Plastic Surgery, Kennestone Hospital; Consulting Staff, Department of Surgery, Division of Plastic Surgery, Northside Hospital-Cherokee Julian B Gordon is a member of the following medical societies: American Society for Aesthetic Plastic Surgery, American Society for Reconstructive Microsurgery, American Society of Plastic Surgeons, and Sigma Xi Coauthor(s): Martha Matthews, MD, Head, Department of Surgery, Division of Plastic Surgery, Cooper Hospital University Medical Center; Assistant Professor, Department of Surgery, University of Medicine and Dentistry of New Jersey Editors: Gregory Caputy, MD, PhD, Chief, Department of Plastic Surgery, Aesthetica Plastic and Laser Surgery Center of Honolulu; Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine; Alan Matarasso, MD, FACS, PC, Clinical Professor of Plastic Surgery, Albert Einstein College of Medicine; Immed Past President of New York Regional Society of Plastic and Reconstructive Surgery; Nicolas (Nick) G Slenkovich, MD, Practice Director, Colorado Plastic Surgery Center at Swedish Medical Center; Al Aly, MD, FACS, Consulting Surgeon, Iowa City Plastic Surgery Author and Editor Disclosure Synonyms and related keywords: liposuction, trunk liposuction, upper body suction-assisted lipoplasty, upper body contouring, body contouring INTRODUCTIONSection 2 of 12
  History of the ProcedureAccounts of human interest in body weight and contour can be found throughout history. Some of the simplest attempts to change body shape and appearance can be observed in the vast array of clothing used to hide, compress, and mold the human figure. Surgical procedures were devised to alter actual body shape permanently. In 1921, Dujarrier used an obstetric uterine curette to remove fat from the knees of a ballerina. The patient sustained irreparable injury and was left with the horrendous result of an eventual amputation. In 1978, Kesselring and Meyer reported the use of a suction-assisted curettage method in which sharp curettage and strong suction were employed to remove fat. In the early 1980s, surgeons such as Illouz and Fournier began using suction cannulae without sharp curettage to remove subcutaneous fat. Illouz, in the early part of 1980, also introduced the concept of "wet" liposuction. This technique incorporates an injection of saline into the subcutaneous space before performing liposuction. He found this reduced blood loss and assisted in obtaining smoother, more satisfying results. This technique currently is used most often in liposuction procedures. ProblemFat is deposited in the subcutaneous layer in almost all areas of the body. Fat is a normal component of the subcutaneous tissue layer. Fat cells may not be distributed evenly, causing some areas to be more prominent than is ideal. Liposuction is a surgical procedure that attempts to contour specific areas of fat accumulation that patients see as undesirable. FrequencyAccording to the American Society of Plastic Surgery (ASPS) National Clearinghouse of Plastic Surgery Statistics, 230,865 liposuction procedures were performed in 1999. This is a 34% increase since 1998 and a 389% increase since 1992. Liposuction is the most commonly performed cosmetic procedure in the United States. The ASPS statistics represent only those procedures performed by ASPS member plastic surgeons certified by the American Board of Plastic Surgery or the Royal College of Physicians and Surgeons of Canada. Since many other medical specialists (eg, dermatologists) perform liposuction, these numbers probably are significantly higher. PathophysiologyPatterns of fat distribution differ among races, ages, and sexes. The actual number of fat cells remains stable during adult life. The cells get larger with weight gain and smaller with weight loss. In general, women have a proportionately higher percentage of body fat than men. Women typically have a disproportionate number of fat cells in their hips, upper thighs, and buttock, while men tend to have a more even distribution of fat cells in the trunk. Also, liposuction is effective in changing contour because it permanently removes fat cells that are distributed unevenly. The remaining fat cells still can store fat. Therefore, liposuction cannot prevent further weight gain but rather affects weight distribution. A progressive accumulation of fat occurs intra-abdominally as one ages. This intra-abdominal fat is not treated by liposuction, thus must be differentiated carefully from subcutaneous fat when evaluating a patient for surgery. INDICATIONSSection 3 of 12
The ideal liposuction patient is healthy, eats a well-balanced diet, has good skin elasticity, desires treatment of minimal-to-moderate localized fat deposits, and is within 20-30% of ideal body weight. Modern liposuction techniques allow treatment of a much broader range of patients. New "super volume" liposuctions allow for treatment of patients with more generalized lipodystrophy. In addition, ultrasound-assisted liposuction has afforded good results in patients with fatty deposits that were poorly responsive to traditional liposuction. Although beyond the scope of this chapter, excisional surgery (eg, abdominoplasty or tummy tuck) has specific indications to treat problems such as severe skin laxity and truncal obesity in patients with poor skin elasticity. Often the two procedures, excisional surgery and liposuction, are combined for an optimal result in certain patients. RELEVANT ANATOMYSection 4 of 12
Two main layers of subcutaneous fat, deep and superficial, are present. Liposuction primarily is focused on the deeper layer of fat since suctioning is safer and easier there. Suctioning in the superficial layer allows the surgeon to achieve subtle benefits in the procedure but because of its superficial location, increases risks of contour irregularities and injury to the skin. Others claim that superficial liposuction enhances skin retraction. CONTRAINDICATIONSSection 5 of 12
Liposuction carries greater risk for patients with significant medical problems. Heart disease, lung disease, diabetes, and peripheral vascular disease pose serous risk during any surgical procedure. Smoking or a recent history of smoking is a strong risk factor. Patients who have undergone previous surgery in the area to be contoured are at risk of surgical complications during liposuction. Surgery alters the local anatomy and distorts the normal subcutaneous planes in which liposuction is performed, increasing the chances of injury to local tissues. WORKUPSection 6 of 12
Lab Studies
Imaging Studies
Other Tests
TREATMENTSection 7 of 12
Surgical therapyLiposuction offers 4 techniques: dry, wet, superwet, and tumescent. Dry
Wet
Superwet
Tumescent
Much debate exists between proponents of the superwet and tumescent techniques. Most modern liposuction is a combination of these two techniques. Intraoperative detailsStandard liposuction
Ultrasound-assisted liposuction
Note: The ultrasonic energy used in UAL is delivered via the cannulae as they are passed through the fat layers. Devices do exist that deliver ultrasonic waves transcutaneously but these have not been shown to be helpful. Postoperative details
Follow-upPatients usually are seen at frequent intervals during the expected postop period (ie, first 1-2 weeks postoperatively). Although the final results are not appreciated fully for 6 months to 1 year after the procedure, most of the change can be observed after a few months. COMPLICATIONSSection 8 of 12
Short-term complications
Long-term complications
Specific incidences for the complications of liposuction are difficult to ascertain. Doctors of various specialties perform liposuction in hospitals, surgical centers, and private offices. The most devastating complication of liposuction, death, has been reviewed statistically. In January 2000, Grazer published an article in which he reported the fatal outcomes of liposuction using a census survey of cosmetic surgeons. He surveyed 1200 actively practicing North American aesthetic plastic surgeons. Of those, 917 reported that from 1994-1997, after 496,245 lipoplasties, 95 fatalities occurred. This yields a mortality rate of 1/5224, or a little less than 0.5%. This is similar to rates quoted elsewhere. Pulmonary thromboembolism was the major cause of death in 23.4±2.6% of these deaths. OUTCOME AND PROGNOSISSection 9 of 12
Liposuction is an extremely effective surgical tool that affords excellent results. Patients still can gain weight after undergoing liposuction but their shape remains more balanced than before the procedure. In most published studies on liposuction, approximately 10% of patients require a minor touch up within a few months of surgery. In appropriately selected patients, liposuction performed by skilled surgeons yields patient satisfaction rates greater than 90%. FUTURE AND CONTROVERSIESSection 10 of 12
Controversies exist regarding simultaneous use of liposuction with other procedures for body contouring. Some surgeons routinely perform liposuction while performing procedures such as abdominoplasty. Performing multiple procedures simultaneously carries a greater risk of complications. Abdominoplasties compromise blood flow to skin and fat in the treated and surrounding areas. Simultaneously adding the surgical trauma of liposuction to this therapy increases the chance of significant blood flow compromise to the tissues in the surgical zone. As more of these combined procedures take place and larger volumes of liposuction are performed, the limits of this surgical therapy will be defined more clearly. MULTIMEDIASection 11 of 12
REFERENCESSection 12 of 12
Article Last Updated: Jun 5, 2006 | |||||||||||||||||||||||||||||||||
