Liposuction, also known as lipoplasty ("fat modeling"), liposculpture suction lipectomy ("suction-assisted fat removal") or simply lipo is a cosmetic surgery operation that removes fat from many different sites on the human body. Areas affected can range from the abdomen, thighs and buttocks, to the neck, backs of the arms and elsewhere.
Several factors limit the amount of fat that can be safely removed in one session. Ultimately, the operating physician and the patient make the decision. There are negative aspects to removing too much fat. Unusual "lumpiness" and/or "dents" in the skin can be seen in those patients "over-suctioned". The more fat removed, the higher the surgical risk.
While reports of people removing 50 pounds (22.7 kg or around 3.6 stone) of fat has been claimed, the contouring possible with liposuction may cause the appearance of weight loss to be greater than the actual amount of fat removed. The procedure may be performed under general, regional("tumescent"), or local anesthesia. The safety of the technique relates not only to the amount of tissue removed, but to the choice of anesthetic and the patient's overall health. It is ideal for the patient to be as fit as possible before the procedure and not to have smoked for several months. Relatively modern techniques for body contouring and removal of fat were first performed by a French surgeon, Charles Dujarier. A tragic case that resulted in gangrene in the leg of a French model in a procedure performed by Dr. Dujarier in 1926 set back interest in body contouring for decades to follow.
Liposuction evolved from work in the late 1960s from surgeons in Europe using primitive curettage techniques which were largely ignored, as they achieved irregular results with significant morbidity and bleeding. Modern liposuction first burst on the scene in a presentation by the French surgeon, Dr Yves-Gerard Illouz, in 1982. The "Illouz Method" featured a technique of suction-assisted lipolysis after infusing fluid into tissues using blunt cannulas and high-vacuum suction and demonstrated both reproducible good results and low morbidity. During the 1980s, many United States surgeons experimented with liposuction, developing some variations, and achieving mixed results.
In 1985, Klein and Lillis described the "tumescent technique", a regional anesthetic technique which added high volumes of fluid containing a local anesthetic allowing the procedure to be done in an office setting under intravenous sedation rather than general anesthesia. Concerns over the high volume of fluid and potential toxicity of lidocaine with tumescent techniques eventually led to the concept of lower volume "super wet" tumescence.
In the late 1990s, ultrasound was introduced to facilitate the fat removal by first liquefying the fat using ultrasonic energy. After a flurry of initial interest, an increase in reported complications tempered the enthusiasm of many practitioners.
Technologies involving the use of laser tipped probes (which induce a thermal lipolysis) have been introduced in recent years and are being evaluated to examine any potential benefit over traditional techniques. There are practitioners who report that many of the modern technologies touted to improve liposuction are simply advertising hooks and that the choice of a quality surgeon is the primary determinant of a quality result.
Overall, the advantages of 30 years of improvements have been that more fat cells can more easily be removed, with less blood loss, less discomfort, and less risk. Recent developments suggest that the recovery period can be shortened as well. In addition, fat can also be used as a natural filler. This is sometimes referred to as "autologous fat transfer" and in general, for these procedures, fat is removed from one area of the patient's body (for example, the stomach), cleaned, and then re-injected into an area of the body where contouring is desired, for example, to reduce or eliminate wrinkles.
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