Liposuction

Artistry in Liposuction

Each resource article presented to the right of this page, are individual cases that have educational value. I hope that by studying them, you too will gain insight into the challenges of our profession.

In 1984, I made a trip to Paris, France to spend a week observing liposuction by Dr. Gerard Illouz. Dr. Illouz is considered by most plastic surgeons to be the founder of modern day liposuction. I left home as a non-believer, I returned home as a convert. I had my doubts that dramatic changes could be made by introducing a blunt cannula through a small incision. Prior to this, we made large incisions to remove large wedges of skin and fat, often leaving unsightly scars that at times looked worse than the deformity.

Other surgeons worked on this technique using sharp cannulae; however, there were complications, especially fluid collection under the flaps (seroma) and bleeding. It was Dr. Illouz who developed the blunt technique with few to no complications that was the birth of modern day liposuction.

Early liposuction started with the use of large bore cannulae and the so called "dry technique” (no local injected). With time, there was a refinement of the shape and size of the cannula used. The “wet technique” of injecting dilute local anesthesia became popular. Further developments included the use of the “tumescent technique” and the “wetting technique” with the instillation of larger quantities of diluted local anesthesia combined with diluted adrenalin. A variety of pressure garments were developed. The combination of diluted local anesthesia with adrenalin, and post-op pressure dressings resulted in a much faster recovery with reduced swelling and bruising.

As the procedure developed and more refinements were made, our results continued to improve. Today's liposuction allows for considerable finesse, and sculpting using a variety of techniques. We have a better understanding of how different areas in the body react to liposuction and how the tissues retract. We also have a better appreciation for proper fluid replacement and the postoperative care of our patients. Later developments included injecting the fat into areas of depression (fat grafting). Here, too, further developments made this technique more effective.

Peter T. Pacik, MD, FACS