Liposuction is an effective method of surgical correction of the contours of the figure and takes a special place in aesthetic surgery for the following reasons:
- it is the most frequent operation, as contraception due to the presence of fatty deposits occurs in most women;
- the operation technique is relatively simple;
- this is one of the most effective operations, which gives a noticeable and lasting result;
- Even with the treatment of extensive tissue sites, minimal scars remain.
History of method development
The first attempts to correct the contours of the figure were made at the beginning of this century and consisted in excision of extensive skin-fat flaps (dermolipectomy). However, this type of surgery was not widely used due to such serious shortcomings as very limited opportunities for removing adipose tissue and the formation of common skin scars.
In 1972 J.Schruddc first proposed a "closed" method of fat removal through small incisions (2-3 cm) with the help of uterine curettes. However, these interventions were accompanied by a significant number of complications, including lymphorrhoea, gray formation, hematomas and even necrosis of soft tissues. Subsequently, B.Teimourian et al. (1981), as well as U. Kesselring (1978) reported the successful use of the so-called saquer curettage, which greatly facilitates the technique of surgery and somewhat reduces the incidence of complications. It consisted in mechanical disintegration of adipose tissue followed by suction.
Meanwhile, the damages of large vessels and cutaneous nerves that were inevitable during these operations led to the need for repeated interventions for the arising complications in 10% of cases. Ultimately, only a few surgeons used this technique with good results.
The idea of suctioning adipose tissue was really effectively realized only with the development of the technique of vacuum fat extraction using cannulas, first demonstrated by Y. Iloouz in 1979 before the doctors of the French Association of Plastic Surgery. In the following 3 variants of this technique were used.
- The original Y.Illouz technique, in which the tissue in the liposuction zone is pre-saturated with a saline hypotonic solution containing hyaluronidase. As a result, emulsification of fat cells occurs, facilitating their removal. This method allows processing a large number of zones with the removal of fat up to 3000 ml.
- "Dry" technique according to P. Fournier, which precludes the preliminary introduction into the tissues of any solutions. Its advantages include the lack of tissue response to hyaluronidase and the possibility of working with an unchanged tissue contour. Disadvantages of this technique are the marked bleeding of tissues, the possibility of removing relatively small amounts of fat (up to 2000 ml), the laboriousness, as well as the technical complexity of using a cannula larger than that of a conventional technique, diameter.
- Modern technology for G. Heiter includes the use for the infiltration of adipose tissue anesthetic solution with adrenaline. This leads to a significant reduction in tissue bleeding during surgery, resulting in relatively little blood in the aspirate. It facilitates the removal of fat, which allows the use of a cannula of significantly smaller diameter. The most important advantage of this technique is the possibility of processing more zones with extraction to 3-5 liters of fat without replenishment of blood loss.
Recently there have been reports of new variants of the technique of lipoextraction, allowing to expand the indications for its use, and also to increase the effectiveness of treatment. It is interesting to note C.Gaspcroni and M.Salgarcllo, who suggested in 1989 a technique for massive liposuction with removal of fat in both the deep and subdermal layers. According to the authors, this allows not only to successfully solve the problem of removing "trapped" fat, but also to improve the results of treatment of patients with small-hummocky skin relief caused by lipodystrophic processes occurring in the most superficial layer of adipose tissue. In addition, with superficial liposuction, subdermal scars are formed, which contribute to more effective skin contraction and thus provide a "pull-up" effect, which is extremely important with reduced skin elasticity and the presence of its stretching.
The advantages of such relatively new methods for correcting contours of the figure, such as liposuction with infiltration by chilled solutions, ultrasonic fat extraction, and liposuction after fat-building of the fat layer have not yet been fully determined.
To denote fatty deposits of different locations, the names of the zones of the face, trunk and extremities are suggested.