INTRODUCTION, DEFINITION, AND HISTORY
Liposuction, also referred to as “liposculpture,” is a form of surgical “body contouring” that aims to reduce focal subcutaneous, suprafascial fat accumulation at various sites by transcutaneous vacuum-assisted extraction of fat particles through small punctures in the skin.
Liposuction was introduced to medicine in 1976 by Fischer, an otolaryngologist who pioneered the use of the hollow cannula. In France, Illouz and Fournier refined the process of liposuction, and their contributions included the “wet technique,” or injection of hypotonic saline and hyaluronic acid prior to fat removal (Illouz)1 and the criss-cross motion of cannulas for smooth contouring and syringe removal (Fournier).2,3
While the first liposuction in the United States was performed in 1982, a sea change occurred in 1987 with Jeffrey Klein's report that liposuction with local anesthesia alone could be safe and effective. The advent of so-called tumescent liposuction eliminated the need for pain control through general anesthesia or conscious sedation. Additionally, since tumescent anesthesia entailed intralesional infusion of an extremely dilute anesthetic solution of lidocaine with epinephrine (Table 11.1), the resulting vascoconstriction markedly reduced intraoperative blood loss, one of the major causes of complications during nontumescent liposuction. This refined procedure enjoyed growing popularity and authoritative reviews of tens of thousands of cases confirmed the safety of the procedure. Ostad et al.4 demonstrated that a total dose of at least 55 mg/kg of body weight was not associated with any lidocaine toxicity.
TABLE 11.1Recipe for Commonly Used Tumescent Anesthesia Concentrations* ||Download (.pdf) TABLE 11.1 Recipe for Commonly Used Tumescent Anesthesia Concentrations*
|Ingredient ||Quantity ||Final Concentration or pH |
|Normal saline (0.9%) ||1 L ||— |
|Lidocaine 2% (select one) ||50 mL ||0.1% |
| ||37.5 mL ||0.075% |
| ||25 mL ||0.05% |
|Epinephrine (1:1000) ||1 mL ||0.1% |
|Sodium bicarbonate (8.45%) ||12.5 mL ||pH 7.4 |
|Triamcinolone acetonide (optional) ||10 mg ||— |
In recent years, there have been concerns raised by some that liposuction may not be as safe as believed and this has led to a move to restrict liposuction to physicians licensed to perform this procedure in hospital operating rooms. However, these fears have not been borne out and tumescent liposuction continues to enjoy an unparalleled safety record when performed according to accepted protocols. Paradoxically, reports of mortality associated with liposuction have been exclusively associated with liposuction performed under general anesthesia or conscious sedation by nondermatologists.
In an era of minimally invasive, extremely safe, low-downtime cosmetic procedures, liposuction remains a timely and appropriate procedure. Unlike some minimally invasive procedures, however, liposuction is associated not with mild efficacy, but rather with dramatic cosmetic improvement. Up to several liters of fat aspirate can be removed in a single procedure. The cost-benefit tradeoff ...