Liposculpture is a modern term coined for the procedures that are frequently referred to as “fat suctioning”. Having been involved in the technique since its introduction in the United States in the early 1980’s, I believe the new terminology reflects a sophistication and artistry that embodies the current day procedures. Liposculpture is one of the most commonly requested procedures in plastic surgery and it provides one of the highest levels of gratification for both me and my patients.
My concern about liposuction relates to the growing attitude that practically any patient is a candidate. Large volume liposuction for the correction of obesity has been popularized over the past year or two. A careful review of patients in my own practice reveals that the long term surgical outcome following liposuction does not relate to the surgical volume removed, specific technique or cannula size, or the the method of postoperative management but rather to the underlying metabolic nutritional state that the patient exhibits prior to and following surgery. Dr. Barry Sears, a well known nutritionist, has pointed out to me that practically every patient considering liposuction is hyperinsulinemic. Most of these patients have a preponderance of carbohydrates in their diet. Despite calorie restriction when these patients undergo liposuction a high incidence of recurrence and new sites are observed. By initiating some calorie restriction, light to moderate exercise, and a diet balanced with 40% carbohydrate, 30% protein, and 30% fat, long term results are stable without recurrence or new sites. Besides the Zone diet, popularized by Dr. Sears, other carbohydrate restrictive diets have found their place in the management of liposuction patients. The Atkins diet is a good way to initiate weight loss prior to liposuction. It is well tolerated by men (less so by women) and allows unrestricted calories of protein and fat but with absolutely no carbohydrates. The modified Atkins and South Beach diets are also good options and better tolerated by women. Even high volume liposuction patients who follow this concept of carbohydrate restriction have stable outcomes with liposuction (see diet and hormones).
The four developments that have most influenced the quality of result and overall patient satisfaction include the development and use of small cannulas, pre surgical tumescent infiltration of treatment sites, re-use of aspirated fat (fat grafting), and most recently the use of ultrasonic assisted techniques.
Small cannula size has allowed more “sculpting” in the superficial layers with less trauma and irregularity. Tumescent pre injection aides small cannula aspiration, minimizes blood loss, reduces pain, and provides the necessary fluid for cavitation when ultrasonic techniques are used. By harvesting, purifying, and re-grafting the removed fat cells, contour depressions, skin wrinkles, and areas for augmentation can be treated. The ultra-sonic techniques enable fat removal in more difficult fibrous zones thereby enabling treatment of the back and re-do areas.
The sites that lend themselves to the best and most predictable results are the inner and outer thighs, the abdomen, the flank and waist, the inner knees, the inner arms and the chin and neck. Practically any discrete, localized fat accumulation can be addressed. However, the procedure will not compensate for muscle and/or skin laxity, and it should not be viewed as an alternative to weight reduction. The ideal candidate is at their normal or preferred body weight, has good muscle tone with minimal skin laxity, and has discrete areas of diet and exercise resistant fat accumulations. Age is not a specific contraindication.
Patients spend the night in the adjoining hotel with nursing supervision to allow for fluid replacement and monitoring.
Bruising and swelling lasts for 2-3 weeks post operatively. Contour changes can generally be appreciated at this time although the best results are not seen until six weeks to three months following surgery.
As I said earlier, with our new awareness of fat metabolism I believe that all patients undergoing liposuction should have objective studies to document their insulin and cortisol levels and counseling on specific dietary measures and exercise to bring their hormones into a normal range. I believe the two most common drugs causing weight problems in females are premarin and provera. I no longer believe that the existing standard in body contouring procedures rests solely in the surgeons familiarity with techniques such as ultrasonic liposuction, tumescent liposuction, liposculpture, or syringe liposculpture, but rather in his ability and willingness to direct his patients toward life-style changes that will improve their fat metabolism and contribute to their overall wellness. I believe these considerations will do more to achieve long-term aesthetic goals than any other single factor.