Liposuction has evolved a great deal since surgeons originally used coarse curettage techniques to scrape away unwanted subcutaneous fat. Several sentinel modifications have occurred in recent decades to help produce better, safer surgical results. Included among the innovations are improved instrumentation, better patient selection and the incorporation of pre-aspiration wetting solutions.
It was Yves Ilouz, a French gynecologist who was largely credited with the popularity of the technique we now know as liposuction. American plastic surgeons, trained in Europe, adopted the technique and brought it into the mainstream. Three decades and millions of cases later, liposuction remains one of the most popular procedures in plastic surgery.
A Rough Start
The introduction of liposuction into the United States was met with mixed enthusiasm in the 1970s. Anecdotal reports soon surfaced of serious complications, even deaths associated with the new procedure. These tragic cases were especially significant because the whole concept of aesthetic, elective surgery was just evolving. The thought of a patient suffering serious complications from a medically unnecessary surgical procedure made these reports newsworthy. The negative media coverage cast a stigma upon the emerging procedure that has remained even to this day.
The reasons for the early catastrophic cases were complex. Among the problems were poor patient selection and varying degrees of practitioner skills. In addition, a lack of appreciation for significant losses of blood volume in the aspirate created hemodynamic instability. In an overzealous attempt to remove large volumes of fat, surgeons often created unacceptably low hematocrit levels.
A Safer Surgery
The mechanism of traditional liposuction, also termed suction assisted lipectomy (S.A.L.) is conceptually simple. A rigid, hollow cannula, connected to a suction machine, is inserted into the subcutaneous space. Rapid, coarse strokes by the surgeon create a series of tunnels, eventually becoming confluent, diminishing the fat panniculus. The underlying problem with the technique is that there is no tissue selectivity. The suction energy evacuates or destroys all elements of the subcutaneous tissue plane, including valuable structures such as blood vessels, nerves and fibrous tissue. microcannula
Critics of the procedure describe it as rough and traumatic, translating clinically into a painful, bloody process with a prolonged recovery. In addition, loss of essential connective tissue leads to rippling of the skin, the most common complaint following traditional liposuction. One study reported an 80 % incidence of skin irregularities following S.A.L.
The key to producing a safer result with liposuction needed to include the successful removal of fat tissue while at the same time sparing the other elements of the subcutaneous parenchyma. Several improvements were made towards this goal.
A leap forward occurred in the 1980s with the introduction of wetting solutions. Previously liposuction was a simple one-step “dry” procedure. Wetting solutions vary in their formula and quantity. However, the three fundamental elements to most infiltration solutions are saline, epinephrine and local anesthetic. The saline alters the tonicity of the adiposite, creating a more fragile cell, epinephrine is a potent vasoconstrictor, and the local anesthetic is used for pain relief. The solution is introduced into the subcutaneous tissue as a pre-aspiration step. The overwhelming benefit of wetting solutions is the significant reduction in blood loss associated with the lipoaspiration.