Review of the Liposuction Applications

Keywords:fibers, laser, treatment, liposuction,  Time:14-01-2016

Despite its widespread popularity, it should nevertheless be stated that it is not trivial surgery, not always benign and not as safe as intimated in the glossy office brochures. Since the initial description of liposuction, numerous changes have taken place. Today, surgical indications are well defined and the liposuction procedure is well codified. However, several surgeons and manufacturers have developed new equipment and techniques. We propose to  survey all the techniques showing the real place of each of them. Their advantages and disadvantages will be discussed. The various techniques dealt with are : the wetting solution techniques, standard liposuction or Suction-Assisted Lipoplasty (SAL), internal UltrasoundAssisted Liposuction (iUAL), VASSER assisted liposuction, external Ultrasound-Assisted Liposuction (eUAL), LaserAssisted Liposuction (LAL), Power-Assisted Liposuction (PAL) and Vibroliposuction (VL). On the basis of this review of the literature and of our clinical experience, we conclude that VL is the safest, most effective and precise surgery that can be used in any of the modern indications for liposuction. We concluded that VL seems to have all the advantages and none of the disadvantages associated with iUAL.

Introduction

Liposuction is currently the most frequently performed aesthetic operation in the world. Despite its widespread popularity, it should nevertheless be stated that it is not trivial surgery, not always benign and not quite as safe as intimated in the glossy office brochures. Mortality and morbidity related to liposuction procedures still exist today (1, 2). The first surgical procedure was performed, by DUJARRIER in 1921. He used a uterine curette to remove fat from the knees of a well-known ballerina, with a disastrous outcome. In the 1960s SCHRUDDE removed subcutaneous fat deposits through stab incisions by sharp curettage (3). In 1978 KESSELRING added strong suction to this sharp curettage method (4). Shortly after, ILLOUZ replaced the curette by a blunt cannula inserted subcutaneously and connected to a vacuum pump to aspirate the fatty tissue (5). He also proposed irrigation of the subcutaneous space with a hypotonic saline solution in the belief that the fat cells would swell and rupture, but this process has never been confirmed clinically. In the past decade, many innovations have been made and the anatomy and physiology of the fatty tissue have been studied in ever greater depth. Modern innovations in suction lipectomy include the superwet and the tumescent wetting techniques, Ultrasound–Assisted Aspiration (UAL), VASSER, Medical Laser fibers-Assisted Liposuction (LAL), Power Assisted Liposuction (PAL) and finally Vibroliposuction (VL).

Indications and Patient Selection

The best results are still obtained when treating moderate localized fat deposits in a normal-weight patient which cannot be managed by diet and exercise (Fig. 1). At the present moment, the key to success is the capacity of the skin to redrape on the new adipose tissue shape, in order to avoid surface irregularities and wrinkles due to skin excess. This important property has to be evaluated preoperatively (Fig. 2). Although a smooth, young and tight skin is a desirable criterion in patient selection, patients with less elastic or older skin, skin wrinkling or multiple fine irregularities (cellulite) may also benefit from liposuction and more specifically from superficial liposuction inducing more skin retraction (6). Good health is a basic requirement for aesthetic body contouring procedures. Failure to screen out patients whose health is suboptimal is one of the important contributing factors to serious morbidity following liposuction. Most surgeons agree that liposuction is NOT a weight loss technique (7). However, it can be used for patients who far exceed ideal body weight, but the results are less dramatic, although very helpful in improving the fit of clothing in problem areas, such as the hips.