Together with breast augmentation and rhinoplasty procedures, liposuction is considered one of the most commonly performed cosmetic surgeries. It was introduced for the first time in 1979 and like any new procedure it was first faced with sarcasm and rejection. This continued up until 1981, where results and studies started to appear and people started to improve on the technique. Since then, several advancements to the procedure have been introduced. Like many surgical procedures, technological advancements were added that have had a mixed impact on the procedure itself due to the immature intervention of marketing and business before performing adequate studies leading to evidence based medicine. None the less, we will review the cosmetic as well as the medical indications for liposuction and explain a little bit about the technologies in the technique and their indications in the hands of the author.
The most common indication for liposuction is removal of excess fatty tissues from different parts of the body. Unlike what most people think, liposuction is not indicated to lose body weight. It is rather indicated to prune the body from areas that are not responsive to dieting and exercise. As such, the ideal patient for liposuction, is a person with ideal body weight that has some areas of fat that cannot be taken care of through dieting and exercise.
Liposuction being a simple procedure, is not without its possible complications. Although these are very rare, they can sometimes be fatal. Of these dreadful complications we can think of deep vein thrombosis (coagulation or clotting of the blood in the circulatory system) and pulmonary embolism (a blockage in one of the pulmonary arteries in the lungs), fat embolism, necrotizing soft tissue infections, blood loss and anemia, and dehydration. These complications are extremely rare, but every care should be taken to avoid these by following certain measures before and after the operation. The most common complication of liposuction remains asymmetry. The technical capabilities of the surgeon and his/her ability to think in a three dimensional way, is most important to achieve patient’s desired contour and silhouette.
As mentioned in the introduction, several technological advancements have been introduced into the procedure. The most prominent of which is the use of energy sources to help dissolve the fat and tighten the skin. Of these technologies we will mention LASER (Light Amplified Stimulated Emission Radiation) and Ultrasound, the latest of which being marketed under the name of VASER. In my humble opinion, all these technologies help in dissolving the stubborn fat and make the procedure easier for the surgeon, yet none of them has been scientifically proven to tighten the skin, if the skin really needs a tightening procedure. Those energy based machines for liposuction come with their own set of complications which can be as disastrous as leading to a full thickness burn in the skin and as such ending up with an ugly scar and an undesired result. Based on this, the indications for using those procedures are even tighter than those for liposuction. In my practice these are limited to cases where special contouring techniques like six pack contouring on a male abdomen is desired or when there is a lot of fibrosis in the area to be treated. It is worth commenting that nowadays body contouring which is a major goal of liposuction is not only achieved by subtracting fat, but rather by a combination of subtraction in some places and addition in others in order to achieve the desired contour. Hence liposuction has been combined in many situations with lipofilling or fat transfer where the suctioned fat is preserved sterile and then injected in areas of unwanted depressions or where more fat is desired.
As for the functional and therapeutic indications for liposuction, they are very limited and many times have little or controversial evidence. None the less, research in this area should continue to delineate those situations where liposuction can be helpful. Of these areas that are important is the metabolic syndrome associated with obesity. Although the peripheral fat removed during liposuction have been proven to have no direct effect on insulin resistance (the inflammation associated with this syndrome), there is some evidence that suggests an increase in the metabolism after performing liposuction. This leads to changes in the visceral fat and thus helping alleviate some of the changes that occur in metabolic syndrome the most important of which is insulin resistance. Other areas for therapeutic indications for liposuction include Lipedema, Mutiple Lipomatosis Syndrome (Medelung Sydrome), HIV associated cervicodorsal lipodystrophy, Gynecomastia, large lipomas, scar revision, flap mobilization, lymphedema, Dercum Disease, Lymphangioma, Limb Gigantism and macrodactyly, extraction of permanent fillers, treatment of extravasation injuries and many other rare and hard to manage conditions.