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INTRODUCTION

KEY POINTS

  • Liposuction surgery, one of the most popular aesthetic procedures performed by cosmetic surgeons, is a sculpting technique that reduces cosmetically unwanted adipose tissue in localized areas to achieve a more desirable and slender silhouette.

  • Non-Caucasians as a group represented 21% of patients on whom cosmetic surgery was performed in 2011 with the following breakdown: 8% Hispanics, 7% African Americans, 5% Asians, and 1% other non-Caucasians.

  • Advances in liposuction, including the development of smaller cannulas, blunt-tipped cannulas, quieter and more efficient aspirators, power liposuction, and laser-assisted lipolysis, have optimized results and improved safety.

Liposuction surgery is a sculpting technique developed to reduce cosmetically unwanted adipose tissue, in localized areas, to achieve a more desirable and slender silhouette. Advancements in instrumentation, anesthesia, technique, and training continue to ensure the utmost safety of patients as well as optimal outcomes. The American Society for Aesthetic Plastic Surgery ranks liposuction as the most frequently performed cosmetic procedure, with over 325,000 liposuctions being completed in the United States in 2011, representing an 84% increase since 1997.1 Non-Caucasians represented 21% of patients on whom cosmetic surgery was performed in 2011: 8% Hispanics, 7% African Americans, 5% Asians, and 1% other non-Caucasians. Dermatologists perform approximately one-third of liposuction procedures in the United States.2

HISTORICAL PERSPECTIVE

The idea of fat removal has been around for almost a century. Charles Dujarrier, credited with the earliest attempt at localized fat removal, used a uterine curette to remove subcutaneous fat from the knees and calves of a dancer but accidentally injured a femoral artery that resulted in amputation of the affected leg in 1921.3 In 1964, Schrudde tried to remove fat from the leg through incision and curettage, but the postoperative course was complicated by the development of hematomas and seromas.4 Also in the 1960s, Pitanguy performed resection of skin and fat of the thigh, but incision scars made the outcome less than ideal.5

Modern Liposuction

The era of modern liposuction began in 1976 when Arpad and Giorgio Fisher of Italy described the use of suction attached to blunt-tipped cannulas, which were inserted into 5-mm skin incisions, enabling suction of unwanted adipose tissue.6 Later, Fournier in Paris developed the “dry technique” in which no fluids were infiltrated into the patient prior to liposuction7; Illouz, also in Paris, preferred the “wet technique” in which a solution of hypotonic saline and hyaluronidase infiltrated the adipose tissue prior to aspiration.8 Both became leaders in the field, and American cosmetic surgeons traveled to Europe to learn their techniques. A task force from the American Society of Plastic and Reconstructive Surgeons attempted to monopolize this procedure by having Illouz sign a contract to only train plastic surgeons, but Fournier refused and continued to train physicians in different specialties.8

Julius Newman, an American otolaryngologist who coined the term ...

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