What is liposuction?

Liposuction is an effective method of surgical correction of body contours and occupies a special place in aesthetic surgery for the following reasons:

• It is the most common operation, since contour irregularities due to the presence of fatty deposits occur in most women;
• the technique of the operation is relatively simple;
• This is one of the effective operations that gives noticeable and lasting results;
• Even when treating large areas of tissue, minimal scarring remains.

History of the development of the method

The first attempts to correct the contours of the figure were made at the beginning of this century and consisted of excising large skin-fat flaps (dermolipectomy). However, this type of surgery has not become widespread due to such serious drawbacks as very limited possibilities for removing fatty tissue and the formation of widespread skin scars.

In 1972, J. Schruddc first proposed a "closed" method of removing fat through small incisions (2-3 cm) using uterine curettes. However, these interventions were accompanied by a significant number of complications, including lymphorrhea, seromas, hematomas, and even soft tissue necrosis. Subsequently, B. Teimourian et al. (1981), as well as U. Kesselring (1978) reported the successful use of the so-called sac curettage, which significantly facilitated the surgical technique and to some extent reduced the incidence of complications. It consisted of mechanical disintegration of fatty tissue with subsequent suction.

Meanwhile, the inevitable damage to large vessels and cutaneous nerves during these operations led in 10% of cases to the need for repeated interventions due to complications. Ultimately, only a few surgeons used this technique with good results.

The idea of suctioning fat tissue was effectively implemented only with the development of the technique of vacuum extraction of fat using cannulas, first demonstrated by Y. Illouz in 1979 before doctors of the French Association of Plastic Surgery. Subsequently, 3 versions of this technique were used.

• An original method by Y.Illouz, in which the tissue in the liposuction area is pre-saturated with a saline hypotonic solution containing hyaluronidase. As a result, the fat cells are emulsified, facilitating their removal. This method allows for the treatment of a large number of areas with the removal of fat in a volume of up to 3000 ml.
• "Dry" technique according to P. Fournier, which excludes preliminary introduction of any solutions into tissues. Its advantages include the absence of tissue reaction to hyaluronidase and the possibility of working with an unchanged tissue contour. The disadvantages of this technique are pronounced tissue bleeding, the possibility of removing relatively small amounts of fat (up to 2000 ml), labor intensity, as well as the technical complexity of using cannulas of a larger diameter than with the conventional technique.
• The modern technique according to G. Heiter includes the use of an anesthetic solution with adrenaline for infiltration of adipose tissue. This leads to a significant reduction in tissue bleeding during surgery, resulting in a relatively small amount of blood in the aspirate. Fat removal is facilitated, which allows the use of cannulas of a significantly smaller diameter. The most important advantage of this technique is the ability to treat a larger number of areas with the extraction of up to 3-5 liters of fat without replenishing blood loss.

Recently, there have been reports of new variants of lipoextraction techniques that allow for a wider range of indications for their use and improve the effectiveness of treatment. Of interest is the report by C. Gaspcroni and M. Salgarcllo, who in 1989 proposed a method of massive liposuction with fat removal in both the deep and subdermal layers. According to the authors, this allows not only to successfully solve the problem of removing "trap" fat, but also to improve the results of treating patients with finely lumpy skin relief caused by lipodystrophic processes occurring in the most superficial layer of adipose tissue. In addition, superficial liposuction results in the formation of subdermal scars that promote more effective skin contraction and thereby provide a "lifting" effect, which is extremely important in the case of reduced skin elasticity and the presence of stretch marks.

The advantages of such relatively new methods of body contouring as liposuction with infiltration of cooled solutions, ultrasonic fat extraction, and liposuction after electrodestruction of the fat layer have not yet been fully determined.

To designate fat deposits of various localizations, names of zones of the face, trunk and limbs are proposed.