Abstract
Liposuction is a cosmetic procedure to remove unwanted fat, which may be performed under local or general anesthesia. It requires three-dimensional (3D) understanding of the anatomy, of the adipose tissue, precision, skill, and artistry that is attained only with hands-on experience. There are many terms used to refer to this procedure, such as suction-assisted lipectomy, suction lipoplasty, liposculpting, and liposculpture. The concept of liposuction, suctioning out unwanted fat, traces its origins back to the early 1900s, but it was not until the 1970s that Illouz really popularized liposuction as we know it today (Table 4.1) [1, 2]. With the constantly growing worldwide body mass index (BMI), and given the fact that aside from using implants, fat contouring is the only way to really sculpt the body, it is not surprising that liposuction continues to grow and slowly become a major component, or an add-on to most procedures cosmetic plastic surgeons perform today. It is the second most common surgical procedures performed by board-certified plastic surgeons in the USA and is performed by 92% of all plastic surgeons. Overall, 289,261 liposuction procedures were performed by ASAPS member surgeons in 2018 [10]. If we add to it liposuctions performed by dermatologists and other cosmetic physicians, liposuction is likely the most commonly performed cosmetic procedure worldwide. These numbers as evidenced by the last decade will only continue to increase every year.
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Bellini E, Grieco MP, Rap E. A journey through liposuction and liposculture: review. Ann Med Surg (Lond). 2017;24:53–60.
Bellini E, Grieco MP, Raposio E. A journey through liposuction and liposculture: review. Ann Med Surg. 2017;6(24):53–60.
Fischer A, Fischer G. First surgical treatment for molding body's cellulite with three 5 mm incisions. Bull Int Acad Cosmet Surg. 1976;3:35.
Illouz YG. Body contouring by lipolysis: a 5 year experience with over 3000 cases. Plast Reconstr Surg. 1983;72(5):591–7.
Klein JA. The tumescent technique for liposuction surgery. Am J Cosmet Surg. 1987;4(4):263–7.
Hunstad JP. The tumescent technique: an evolution. Lipoplasty Newsletter. 1994;11(29).
Zocchi M. Ultrasonic liposculpturing. Aesthet Plast Surg. 1992;16(4):287–98.
Apfelberg D. Laser-assisted liposuction may benefit surgeons, patients. Clin Laser Mon. 1992;10(12):193–4.
History of Liposuction. 2020. Lipo.com: https://lipo.com/liposuction-information/history-of-liposuction/.
ASAPS 2019 statistics on cosmetic surgery. n.d. Retrieved from The Aesthetic Society: http://www.surgery.org/media/news-releases/the-american-society-for-aesthetic-plastic-surgery-reports-americans-spent-largest-amount-on-cosmetic-surger.
Pavan C, Simonato P, Marini M, Mazzoleni F, Pavan L, Vindigni V. Psychopathologic aspects of body dysmorphic disorder: a literature review. Aesthet Plast Surg. 2008;32:473–84.
Rohrich RJ, Broughton G, Horton B, Lipschitz A, Kenkel JM, Brown SA. The key to long-term success in liposuction: a guide for plastic surgeons and patients. Plast Reconstr Surg. 2004;114(7):1945–52.
Wrighton SS, Stevens JC. The human hepatic cytochromes P450 involved in drug metabolism. Crit Rev Toxicol. 1992;22(1):1–21.
Araco A, Gravante G, Araco F, Delogu D, Cervelli V. Comparison of power water-assisted and traditional liposuction: a prospective randomized trial of postoperative pain. Aesthet Plast Surg. 2007;31:259–65.
Janvrin SB, Davies G, Greenhalgh RM. Postoperative deep vein thrombosis caused by intravenous fluids during surgery. Br J Surg. 1980;67:690–3.
Klein JA. Tumescent technique for regional anesthesia permits lidocaine doses of 35 mg/kg for liposuction. J Dermatol Surg Oncol. 1990;16(3):248–63.
Klein JA. Chapter 21: Maximum recommended dosage of tumescent lidocaine. 2020. Retrieved from Liposuction101: https://www.liposuction101.com/liposuction-textbook/chapter-21-maximum-recommended-dosage-of-tumescent-lidocaine/.
Ostad A, Kageyama N, Moy RL. Tumescent anesthesia with lidocaine dose of 55mg/kg is safe for liposuction. Dermatol Surg. 1996;22(11):921–7.
Perry AW, Petti C, Rankin M. Lidocaine is not necessary in liposuction. Plast Reconstr Surg. 1999;104:1900–2.
Ausen K, Fossmark R, Spigset O, Pleym H. Randomized clinical trial of topical tranexamic acid after reduction mammoplasty. Br J Surg. 2015;102(11):1348–53.
Ors S, Ozkose M. Late postoperative massive bleeding in septorhinoplasty: a prospective study. Plast Surg. 2016;24(2):96–8.
Cansacao AL, Cansancao AJ, Cansancao BP, Vidigal RA. Effect of tranexamic acid in bleeding control in liposuction. Plast Reconstr Surg. 2015;136(4S):80.
Cansancao AL, Conde-Green A, David JA, Consancao B, Vidigal RA. Use of tranexamic acid to reduce blood loss in liposuction. Plast Reconstr Surg. 2018;141(5):1132–5.
Consacao AL, Conde-Green A, David J, Consacao B, Vidigal RA. Use of tranexamic acid to reduce blood loss in liposuction. Plast Reconstr Surg. 2018;141(5):1132–5.
Burns CA, Ferris G, Feng C, Cooper JZ, Brown MD. Decreasing the pain of local anesthesia: a prospective, double-blind comparison of buffered, premixed 1% lidocaine with epinephrine versus 1% lidocaine freshly mixed with epinephrine. J Am Acad Dermatol. 2006;54:128–31.
Hunstad JP. Liposuction and tumescent surgery. Clin Plast Surg. 2006;33(1):39–46.
Rohrich RJ, Beran SJ, Fodor PB. The role of subcutaneous infiltration in suction-assisted lipoplasty: a review. Plast Reconstr Surg. 1997;99:514–9.
Del Vecchio D. Technical advances in gluteal augmentation-simultaneous separation tumescence (SST) and expansion vibration Lipofilling (EVL). In: Baker Gordon symposium on cosmetic surgery, Miami; 2018.
Hunstad JP, Aitken ME. Liposuction and tumsecent surgery. Clin Plast Surg. 2006;33:39–46.
Hunstad JP, Aitken ME. Liposuction: techniques and guidelines. Clin Plast Surg. 2006;33:13–25.
Rebelo A. Power-assisted liposuction. Clin Plast Surg. 2006;33:91–105.
Fodor PB, Vogt PA. Power-assisted lipoplasty (PAL): a clinical pilot study comparing PAL to traditional lipoplasty (TL). Aesthet Plast Surg. 1999;23:379–85.
Schafer ME, Hicok KC, Mills DC, Cohen SR, Chao JJ. Acute adipocyte viability after third-generation ultrasound-assisted liposuction. Aesthet Surg J. 2013;33(5):698–704.
Putterman SJ. Sonoluminescence: sound into light. Sci Am. 1995;272:46–51.
Fodor PB, Watson J. Personal experience with ultrasound-assisted lipoplasty: a pilot study comparing ultrasound-assisted lipoplasty with traditional lipoplasty. Plast Reconstr Surg. 1998;101:1103–16.
Troilius C. Ultrasound-assisted lipoplasty: is it really safe? Aesthet Surg J. 1999;23:307–11.
Beckenstein MS, Grotting JC. Ultrasound-assisted lipectomy using the solid prob: a retrospective review of 100 consecutive cases. Plast Reconstr Surg. 2000;105:2161–74.
Rohrich RJ, Ha RY, Kenkel JM, Adams WP Jr. Classification and management of gynecomastia: defining the role of ultrasound-assisted liposuction. Plast Reconstr Surg. 2003;111:909–23.
Nagy MW, Vanek PF Jr. A multicenter, prospective, randomized, single-blind, controlled clinical trial comparing VASER-assisted lipoplasty and suction-assisted lipoplasty. Plast Reconstr Surg. 2012;129(4):681e–9e.
Cardenas-Camarena L, Andino-Ulloa R, Mora RC. Laboratory and histopathologic comparative study of internal ultrasound-assisted lipoplasty and tumescent lipoplasty. Plast Reconstr Surg. 2002;110:1158–64.
Igra H, Satur NM. Tumescent liposuction versus internal ultrasonic-assisted tumescent liposuction. A side-to-side comparison. Dermatol Surg. 1997;23:1213–8.
Rohrich RJ, Beran SJ, Kenkel JM, Adams WP Jr, DiSpaltro F. Extending the role of liposuction in body contouring with ultrasound-assisted liposuction. Plast Reconstr Surg. 1998;101(4):1090–102.
Anderson RR, Parrish JA. Selective photothermolysis: precise microsurgery by selective absorption of pulsed radiation. Science. 1983;220:524–7.
Apfelberg DB. Results of multicenter study of laser-assisted liposuction. Clin Plast Surg. 1996;23(4):713–9.
Apfelberg DB, Rosenthal S, Hunstad JP, Achauer B, Fodor PB. Progress report on multicenter study of laser-assisted liposuction. Aesthet Plast Surg. 1994;18(3):259–64.
Blugerman G. Laser lipolysis for the treatment of localized adiposity and cellulite. In: Abstracts of the world congress on liposuction, Dearborn (MI); 2000.
Goldman A, Gotkin RH. Laser-assisted liposuction. Clin Plast Surg. 2009;36(2):241–53.
Goldman A, Schavelson D, Blugerman G. Laser lipolysis: liposuction using Nd-YAG laser. Revista Brasileira de Cirurgia Plastica. 2002;17(1):17–21.
Gold MH. Tissue tightening: a hot topic utilizing deep dermal heating. J Drugs Dermatol. 2007;6:1238–42.
Paul M, Mulholland RS. A new approach for adipose tissue treatment and body contouring using radiofrequency-assisted liposuction. Aesthet Plast Surg. 2009;33(5):687–94.
Zelickson BD, Kist D, Bernstein E, Brown DB, Ksenzenko S, Burns J, et al. Histological and ultrastructural evaluation of the effects of radiofrequency-based nonablative dermal remodeling device: a pilot study. Arch Dermatol. 2004;140:204–9.
Sasaki GH. Water-assisted liposuction for body contouring and Lipoharvesting: safety and efficacy in 41 consecutive patients. Aesthet Surg J. 2011;31(1):76–88.
Shilu Y, Jie L, Su F, Qian W, Qiang Z. Does Water-Jet Force make a difference in fat grafting? In vitro and in vivo evidence of graft improved lipoaspirate viability and fat graft survival. Plast Reconstr Surg. 2015;135(1):127–38.
Wall SH Jr, Lee MR. Separation, aspiration, and fat equalization: SAFE liposuction concepts for comprehensive body contouring. Plast Reconstr Surg. 2016;138(6):1192–201.
Fodor PB, Cimino WW, Watson JP, Tahernia A. Suction-assisted lipoplasty: physics, optimization, and clinical verification. Aesthet Surg J. 2005;25(3):234–46.
Toledo L. Syringe liposculpture. Clin Plast Surg. 1996;23(4):683–93.
Toledo LS, Mauad R. Complications of body sculpture: prevention and treatment. Clin Plast Surg. 2006;33:1–11.
Saylan Z. Liposhifting: treatment of postliposuction irregularities. Int J Cosmet Surg. 1999;7:71–3.
Wall SH Jr, Del Vecchio D. Liposuction and correction of deformities. In: Dallas cosmetic surgery symposium, Dallas, TX; 2014.
Wall SH Jr. SAFE circumferential liposuction with abdominoplasty. Clin Plast Surg. 2010;37(3):485–501.
Ersek RA, Salisbury AV. Abdominal etching. Aesth Plast Surg. 1997;21:328–31.
Mentz H, Gilliland M, Patronella C. Abdominal etching: differential liposuction to detail abdominal musculature. Aesthet Plast Surg. 1993;174:287–90.
Hoyos AE. High definition liposculpture. In: XIII international course of plastic surgery, Bucaramanga, Colombia; 2003.
Chen SS, Wright NT, Humphrey JD. Heat-induced changes in the mechanics of a collagenous tissue: isothermal free shrinkage. J Biomech Eng. 1997;109(4):372–8.
Wright NT, Humphrey JD. Denaturation of collagen during heating: an irreversible rate process. Annu Rev Biomed Eng. 2002;4:109–28.
Rao RB, Ely SF, Hoffman RS. Deaths related to liposuction. N Engl J Med. 1999;340(19):1471–5.
Kim YH, Cha SM, Naidu S. Analysis of postoperative complications for superficial liposuction: a review of 2398 cases. Plast Reconstr Surg. 2011;127:863–71.
Grazer FM, de Jong RH. Fatal outcomes from liposuction: census survey of cosmetic surgeons. Plast Reconstr Surg. 2000;105(1):436–46.
Swanson E. Assessment of reduction in subcutaneous fat thickness after liposuction using magnetic resonance imaging. J Plast Reconstr Aesthet Surg. 2012;65(1):128–30.
Swanson E. Prospective study of lidocaine, bupivacaine, and epinephrine levels and blood loss in patients undergoing liposuction and abdominoplasty. Plast Reconstr Surg. 2012;130:702–22.
Dixit VV, Wagh MS. Unfavorable outcomes of liposuction and their management. Indian J Plast Surg. 2013;46(2):377–92.
Shiffman MA. Prevention and treatment of liposuction complications. In: Shiffmann MA, Di Giuseppe A, editors. Liposuction—principles and practice. New York: Springer; 2006. p. 333–41.
Baxter RA. Histologic effects of ultrasound-assisted lipoplasty. Aesthet Plast Surg. 1999;19:109–15.
La Trenta G. Suction assisted lipectomy. In: Rees TD, La Trenta GS, editors. Aesthetic plastic surgery. 2nd ed. Philadelphia: WB Saunders; 1994. p. 1179–239.
Igra H, Lanzer D. Avoiding complications. In: Hanke C, Sattler G, editors. Liposuction. 1st ed. Philadelphia: Saunders; 2005. p. 131–40.
Lehnhardt M, Homann HH, Daigeler A, Hauser J, Palka P, Steinau HU. Major and lethal complications of liposuction: a review of 72 cases in Germany between 1998 and 2002. Plast Reconstr Surg. 2008;121:396e–403e.
Scheflan M, Tazi H. Ultrasonically assisted body contouring. Aesthet Surg J. 1996;16:117–22.
Pereira LH, Nicaretta B, Sterodimas A. Correction of liposuction sequelae by autologous fat transplantation. Aesthet Plast Surg. 2011;35:1000–8.
Illouz YG. Complications of liposuction. Clin Plast Surg. 2006;33:129–63.
Courtiss EH, Choucair RJ, Donelan MB. Large-volume suction lipectomy: an analysis of 108 patients. Plast Reconstr Surg. 1992;89:1068–79.
Cardenas-Camarena L, Andres Gerardo L-P, Duran H, Bayter-Marin JE. Strategies for reducing fatal complications in liposuction. Plast Reconstr Surg Global Open. 2017;5(10):e1539.
Hanke CW, Bernstein G, Bullock S. Safety of tumescent liposuction in 15 336 patients. National survey results. Dermatol Surg. 1995;21:459–62.
Rohrich RJ, Leedy JE, Swamy R, Brown SA, Coleman J. Fluid resuscitation in liposuction: a retrospective review of 89 consecutive patients. Plast Reconstr Surg. 2006;117(2):431j–5.
Kearon C. Natural history of venous thromboembolism. Circulation. 2003;107(Suppl 1):I22–30.
Wang H-D, Zheng J-H, Deng C-L, Liu Q-Y, Yang S-L. Fat embolism syndromes following liposuction. Aesthet Plast Surg. 2008;32(5):731–6.
Kwiatt ME, Seamon MJ. Fat embolism syndrome. Int J Crit Illn Inj Sci. 2013;3:64–8.
Mellor A, Soni N. Fat embolism. Anaesthesia. 2001;56:145–54.
Cardenas-Camarena L, Bayter JE, Aguirre-Serrano H, Cuenca-Pardo J. Deaths caused by gluteal Lipoinjection: what are we doing wrong? Plast Reconstr Surg. 2015;136(1):58–66.
Zakine G, Baruch J, Dardour J-C, Flageul G. Perforation of viscera, a dramatic complication of liposuction: a review of 19 cases evaluated by experts in France between 2000 and 2012. Plast Reconstr Surg. 2015;135:743–50.
Coldiron B. Office surgical incidents: 19 months of Florida data. Dermatol Surg. 2002;28(8):710–2.
Klein JA. Tumescent technique for local anesthesia improves safety in large-volume liposuction. Plast Reconstr Surg. 1993;92:1085–98.
Klein JS, Kassarjdian N. Lidocaine toxicity with tumescent liposuction. A case report of probably drug interactions. 2020. Retrieved from Liposuction.com: https://www.liposuction.com/lidocaine-toxicity.html.
Feldman HS, Arthur GR, Covino BG. Comparative systemic toxicity of convulsant and supraconvulsant doses of intravenous ropivacaine, bupivacaine, and lidocaine in the conscious dog. Anesth Analg. 1989;69:794–801.
Keskin I, Sutcu M, Eren H, Keskin M. Exposure to tumescent solution significantly increases phosphorylation of perilipin in adipocytes. Aesthet Surg J. 2017;37(2):239–45.
Local Anesthetic Systemic Toxicity (LAST). 2020. Retrieved from Core EM: https://coreem.net/core/last/.
Rosenblatt MA, Abel M, Fischer GW, Itzkovich CJ, Eisenkraft JB. Successful use of a 20% lipid emulsion to resuscitate a patient after a presumed bupivacaine-related cardiac arrest. Anethesiology. 2006;105:217–8.
Weinberg G, VadeBoncouer T, Ramaraju GA, Carcia-Amaro MF, Cwik M. Pretreatment or resuscitation with a lipid infusion shifts the dose-response to bupivacaine-induced asystole in rats. Anesthesiology. 1998;88:1071–5.
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Dr. Martin Jugenburg provides a detailed account of the various steps of liposuction, the instruments required, and also the various technologies that can be used during liposuction. Instrumentation: 0–2:13 s. Infiltration: 2:15–4:53 s. Safe Liposuction technique: Use of VASER and PAL Lipo, 4:54–11:00 s. Fat Equalization: 11:02–12:23 s. Addressing contour deformities: 12:24–end (M4V 988817 kb)
Difference between use of VASER and power-assisted liposuction (M4V 161775 kb)
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Jugenburg, M., Jalil, W. (2022). Liposuction: Principles and Techniques. In: Thomas, M., D'silva, J. (eds) Manual of Cosmetic Surgery and Medicine. Springer, Singapore. https://doi.org/10.1007/978-981-19-4997-5_4
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