Liposculpture of the Abdomen in an Office-Based Practice

Abstract

Fat removal for the purpose of improving body shape was first described in 1921 by Dujarrier [1], whose crude technique using a uterine curette to extract fat from the lower limb of a dancer resulted in dramatic failure. Fifty five years later, Giorgio and Arpad Fischer published their work using blunt cannulae to suction fatty deposits, heralding the era of modern liposuction [23]. Ilouz and Fournier followed with their formidable work on the development of liposuction and were instrumental in popularising the technique amongst physicians of several specialties throughout the world. Although office-based surgery was performed over a 100 years ago, initially, liposuction was only practiced under general anaesthesia in a hospital setting [3]. It was not feasible to remove large volumes of fat using blunt or sharp instruments under standard infiltrative local anaesthesia, since the doses required for body contouring would have almost certainly resulted in lidocaine toxicity. The practice of liposuction was revolutionised in 1987 when Jeffrey Klein published his ingenious technique of anaesthetising large areas of subcutaneous fat using a mixture of diluted local anaesthetic and epinephrine [4]. Klein’s tumescent technique has stood the test of time, allowing liposuction to be performed safely, effectively, and outside the hospital setting with an admirable safety record [5–8]. In 2007, liposuction was the most common cosmetic surgical procedure in the United States, with over half of all cosmetic surgical procedures (54%) performed in office-based settings [9]. The abdomen is the most commonly treated area and that is the focus for this chapter. However, the principles of office-based liposculpture of the abdomen can be applied to any aesthetic unit, including thighs, back, arms and face.