General principles of liposuction on the face and neck

Localized obesity can be attributed to hereditary factors, hormonal imbalance, poor diet, and insufficient exercise. Evenly distributed fat deposits on the body, unlike isolated fat deposits on the face, can be corrected with diet and exercise. Unfortunately, localized fat deposits are often the first signs that require increased attention to weight gain.

Extensive studies of adipocyte physiology were conducted by Illouz, one of the pioneers of liposuction. He found that the number of human adipocytes increases from birth to puberty, and then stabilizes. Based on histological studies, he found that obese children are characterized by a large number of adipocytes (hyperplastic obesity), and obese adults by "large" adipocytes (hypertrophic condition). Their volume increases due to the accumulation of triglycerides and fatty acids. Therefore, weight loss is a reduction not in the number of fat cells, but in their volume. Ideally, surgical intervention should be aimed at the irreversible removal of fat cells from the sites of their accumulation. The main task and purpose of vacuum lipectomy is to recreate aesthetic contours by removing unattractive fat deposits.

Most new technological advances, with one exception, have their origins in body contouring research, which often finds application in facial surgery. The use of rigid, blunt-tipped suction cannulas attached to a suction device continues to be the mainstay of vacuum-assisted lipectomy.

Invisible incisions for liposuction on the face and neck can be located in the submental area, the fold behind the ear, the vestibule of the nose and in the hair growth area on the temple. Restoration of the contours of the skin is achieved by removing torn fat cells, followed by a decrease in the thickness of the subcutaneous tissues during the healing process. Fat cells are mobilized using the hypotonic infiltration technique, under the influence of ultrasound or by simple mechanical tearing.

Compared with direct lipectomy, traditional liposuction allows for a relatively precise reduction of fat cell mass with a relatively lower number of complications. Since liposuction preserves the vascular and nerve bundles in the skin, there is less bleeding and fewer hematomas. A disadvantage of liposuction is the incomplete removal of deep fat in the middle of the submental area, which often requires a direct midline incision. Restoration of contours occurs as the network of subcutaneous tunnels created using the tunnel liposuction technique heals and contracts. A carefully designed and evenly distributed tunnel system rarely leads to recurrence of bulges and irregularities caused by local fat deposits. In the early period of healing, irregularities may be observed, which are usually temporary.

Aspiration lipectomy has a number of advantages over techniques designed for direct excision of fat. This type of lipectomy does not require large incisions, the duration of the operation and recovery period is reduced, as well as irreversible damage to the nerves. Aspiration lipectomy, due to tissue tunneling, allows preserving the vascular-nerve bundles to the skin. Preservation of innervation means a lower degree of numbness of the skin. Achieving perfect aesthetic results that bring joy to the patient will be possible by selecting patients with elastic skin and localized fat deposits for the procedure, as well as using appropriate surgical and postoperative techniques.

This section is a guide to selecting suitable candidates for liposuction. It provides an overview of the physiology and technique of liposuction, describes the equipment needed, and suggests ways to prevent complications. Finally, the most recent advances in the field are discussed.

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