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The dynamic study of surface anatomy brings to light the existence of "fixed points." This new concept allows us to better understand the difficult problem of skin excess and the "crumpled" appearance sometimes seen after liposuction. Understanding this phenomenon will avoid unaesthetic or nonfunctional results of plastic surgery.
The distribution of the fat tissue in the subcutaneous layer is described. Since it has specific characteristics in each region of the human body, careful evaluation of the distribution before selecting patients for surgery is necessary. The subcutaneous tissue after an operation frequently demonstrates a thick and hard fibrosis which is evidence that liposuction should be performed in the lamellar layers. This type of fibrotic tissue in the subcutaneous areola layer often brings on irregularities and ungraceful waves on the skin surface.
Two aspects of liposuction procedures are discussed as ways of improving results. First, to help with the efficiency of fat removal several technical points are considered, especially the freedom and the facility of performing the liposuction procedure with a syringe without the aid of an aspirator. Surgeons are showing a growing interest with this new method. New and practical material that allows a reduced number of necessary manipulations is described. Second, we stress the importance of drainage, especially in relation to the resumption of activity which is much quicker due to the absence of postoperative bruising. When using drainage, the final result can be obtained as early as the second or third day.
The major dilemma of reduction mammoplasty and mastopexy has been the difficult choice between a procedure that yields an ideal shape of the breast versus the size of the scar. With our technique, selected breasts can now be reduced through liposuction and the mastopexy performed through a periareolar incision, resulting in virtually imperceptible scarring.
Older women seeking facial rejuvenation often exhibit another sign of middle age--the accumulation of subcutaneous fat in the torso. In the author's practice a total body evaluation approach is used. It is often suggested that the patient combine facial rejuvenation with lipoplasty of the torso if the patient is a good surgical candidate and the procedures can be performed jointly in less than six hours. The advantages are many, including a single convalescent period, decreased costs, and very high patient satisfaction with the degree of makeover in one session.
Liposuction, like all surgical procedures, is subject to complications and unfavorable results. Since it is a closed procedure and departs from the usual concept of surgery, its practice is, to a large extent, based on subjective intraoperative estimation. Therefore, it is liable to errors that might have serious local and systemic consequences. In an attempt to improve the technique, the authors have designed new instruments: the "tunnel tracer" and the "guided cannulae." They provide the basis for systematizing the procedure and applying it in a more rational manner. With these instruments and the methodology described in this article, over the last three years we have obtained very satisfactory results and notable reduced morbidity. The advantages are less trauma, less risk, less hemorrhage, less effort for the surgeon, and greater precision.
This article presents an alternative method to correct the sagging neck with a local dermolipectomy and median platysma duplication. The technique is recommended mainly for the older patient with redundant skin and fat in that region and who, for some reason, does not want to undergo a facelift.
The author describes a revolutionary body contouring technique based on the surgical use of ultrasonic energy. It allows the selective destruction of only excess adipose tissue. The technique is based on three fundamental steps: (1) preparation of the areas to be treated with a large infiltration of a special solution, (2) treatment of the areas with ultrasonic energy through special titanium probes, (3) manual remodeling of the treated areas to eliminate the fluid from the bursted adipocytes (fatty acids). The advantages of this new technique are selective destruction of just the undesired tissues, elimination of the fluid from the adipose tissues, and the possibility of a real "lifting" of the skin of the treated areas, and a reduction of physical strain on the surgeon. The author has already treated more than 280 patients with excellent results and without contraindications or undesired side effects. The fundamental steps of ultrasonic liposculpturing, including a description of the physical principles on which the technique is based, are presented.
Liposuction has been used either alone or combined with resection for the correction of male and female breast deformities. The majority of the 32 patients in our study were treated for gynecomastia (69%). Other indications were Madelung's disease, gender dysphoria, asymmetry, hypertrophy, postburn and postreconstruction deformities. In 54% of the gynecomastia cases, suction alone gave a satisfactory result. In all but one male patient suction permitted us to avoid incisions other than periareolar incisions. Thirteen aspirates from gynecomastias and three glands resected secondarily after suction were examined histologically. All aspirates included glandular tissue. We conclude that breast tissue is accessible to the suction cannula, and that this is a valuable tool for correcting gynecomastia and for use in many aesthetic procedures on female patients.
Long-term results for 167 cases of the fat injection technique performed between June 1983 and June 1987 are presented. During this four-year period, stable results appear to have been obtained in only a few cases. This report also includes the disappointing preliminary findings of attempts to use fat to fill wrinkles in the face. Although these preliminary long-term results may not be encouraging, various laboratory studies seem to demonstrate the hypothetical possibility of fat cell survival and tend to encourage continued research in this field.
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Using Webster's technique for treating gynecomastia, the removal of the excess breast tissue is facilitated by the use of liposuction introduced through the axillary incision. In the case of pseudogynecomastia, only liposuction via the axillary approach is recommended.
Even in the age of liposuction there exist certain situations for which abdominoplasty in its radical form is indicated--for example, redundant skin after radical weight loss, the stigmata of postpregnancy syndrome, and localized accumulation of adipose tissue--the lipodystrophies and resistant generalized obesity. Redundant skin after radical weight loss is resected simultaneously around the abdomen, the lumbar regions, the perineum, and the thighs. The typical stigmata of postpregnancy syndrome may be excised through an extended abdominoplasty combined with simultaneous excision and pexy of the inner aspects of the thighs leaving a "bikini" scar behind. A mastopexy may be added. Genetically predisposed localized lipodystrophies in the abdominal lumbar, and upper thigh region may be resected through a circular abdominoplasty with or without simultaneous resection of the perineum and inner thighs. Abdominal aprons often contain umbilical or ventral hernias that may need to be repaired simultaneously. Representative cases are presented and dangers and complications are discussed.
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The results of grafts of fat obtained through liposuction are presented. They are the outcome of the current revitalization of the old technique of fat extraction and transplant. Both doctor and patient should be aware that a successful treatment is achieved through continuity. Fat grafts evolve with respect to time and permanence with reabsorption a part of the normal evolutionary process. Fat reinjection is a consequence of tissue reabsorption or a complement of the preceding injection. There is no complication associated with repeated reinjection. All cases reported here include patients with two or more reinjections, depending on their pathology and evolution.
Liposuction is a widely used technique today and indications are that it is becoming even more popular due to new technical refinements. The use of cannulae with a smaller diameter allows suction of the fat immediately under the dermis. The cannula we use to perform this new kind of fat suction is straight and has an external diameter of less than 2 mm. This cannula, the so-called Mercedes cannula, has a bullet tip and a three-hole head. Moreover, the holes are not round but are slit-shaped and oriented in the same plane at 120 degrees. This cannula is specifically designed to produce less trauma. The cannula with one downward-facing orifice is not suitable for suction of the subdermal layer and an upward-facing orifice would be too traumatic. The advantage of this new technique, apart from the possibility of treating patients with very slight adiposity, is to allow an effective skin retraction. When a large amount of fat has already been aspirated, residual deformities can occur. These skin irregularities represent the lack of an effective cutaneous retraction mostly due to the permanence of the subdermal fat. In fact, the presence of a thick subdermal adipose layer decreases the possibility of skin retraction. Therefore, indications for liposuction of the subdermal fat are mainly the slight adiposities and the remnant deformities of a previous liposuction operation. Moreover, this technique is applied to every lipoplasty whenever better skin retraction is needed.
The main goal of this article is to demonstrate that biochemically, metabolically, histologically, embryologically, and anatomically there are two totally different types of subcutaneous fat. This fact has clinical and surgical consequences including the concept of dynamic and surface anatomy.
Major liposuction procedures require considerable fluid resuscitation to make them safe. A simple fluid replacement formula is presented that will estimate crystalloid and blood losses. It takes into account the daily fluid requirement, volume extracted, and the multiplicity of areas treated. Removal of 1500 mL required single-unit autotransfusion while amounts greater than 2500 mL necessitated a two-unit autotransfusion. These figures must be tempered by the surgeon's clinical assessment of each patient. The keys to successful and safe management of the liposuction patient are proper preoperative preparation and adequate fluid replacement.