The History of Liposuction
As you have seen, liposuction is surgery that has brought both physical and psychological benefits to men and women who were unhappy with their bodies and determined to do something about them. Liposuction has proved a blessing for thousands of men and women with similar problems.
The doctors who developed and improved liposuction surgery found out that the process is possible because of the special nature of fat as a substance, and the way that it is deposited in our bodies.
Fat-the fat that surgeons can remove with the liposuction procedure-accumulates in pockets located just beneath the skin, where it can easily be removed through liposuction without serious complications. Liposuction does not involve surgery near any vital organs. No major blood vessels are involved. And there is virtually no cutting. In fact, the typical liposuction surgery involves only small incisions at most-perhaps less than a quarter of an inch long. Scarring is almost always non-existent, because the experienced, skillful liposuction surgeon can almost always conceal the incisions by placing them in fold lines of the body.
1. The diagram shows the cannula's path in the fatty tissue, below the skin, where fat cells can be permanently removed.
2. The diagram shows the reduction of the bulge of fat, and the smoothed contour of the skin.
3. The blunt-tipped cannula does not cut through tissue because it is not sharp-edged. Fat cells are drawn into the cannula's blunt tip and removed from the body.
Liposuction is a safe procedure, when it is performed by a well-trained, experienced surgeon.
Because of the way in which fat is deposited in your body, it is not going to come back, once it is removed by suction. Liposuction takes those fat cells out of your body-permanently. It can be a permanent "cure" for your bulges. Because of the benefits of liposuction, it has been called "the miracle surgery" by patients who describe its benefits as "wonderful," "terrific," and "fantastic."
The truth of the matter is, however, that liposuction should not be viewed by patients as the final step in their desire to improve their appearance. I tell my patients:
"You have been given a chance to make the most of the way you look. After surgery and your recovery, it is your responsibility to keep looking good. From now on, you should learn about nutrition and calorie-counting, and follow the principles of a good diet. From now on, you should incorporate exercise into your regular routine. From now on, you should use the findings of research into behavior modification and psychology to help keep you from slipping back into old habits that are self-destructive."
Liposuction has given thousands of patients a new beginning--the beginning of a life that is psychologically rewarding because they can be happy with the way they look and feel about themselves. An individual patient who realizes and accepts the responsibility for that life is a patient who is most likely to be satisfied and happy with the results of surgery.
COMPREHENSIVE, LONG- RANGE CARE IS ESSENTIAL
It is for this reason that a close and continuing relationship with the physician who performs liposuction is so important. A doctor who merely does the surgery without careful screening of patients to be sure the commitment to weight control and exercise routine is present, without making sure that liposuction candidates are in the best possible physical condition to undergo the operation, without either personally giving or referring the patient for counseling, support, and appropriate follow-up treatment in all forms of nutrition, exercise, and weight-loss therapies after the surgery is, in my opinion, less likely to be successful with patients.
1. Above, left, the doctor confers with the patient, gives a thorough checkup, and continues monitoring as treatment is carried out.
2. Long-range care and a complete physical program which includes exercise and good nutrition is important.
3. Patients who want to maintain good health will continue to exercise and follow the doctor's advice on nutrition and activity.
Such concern, however, must be shared by doctor and patient. No matter how skillful the liposuction surgeon may be, the man or woman who expects liposuction miraculously to transform the body, and who then expects to continue destructive eating patterns or physical inactivity almost certainly will be dissatisfied a year or two after the operation.
For best results, the patient and surgeon will be working closely together on their common objective... making the patient as attractive as possible by ridding the body of the refractory fat deposits which have been so troublesome. Because this relationship will most likely extend over many months, it is extremely important that you find a surgeon with whom you feel comfortable, and in whom you have confidence. That way, liposuction has the best chance of succeeding-for you.
With all this in mind, it is easy to understand why fat suction has become so popular, so quickly. But it's also easy to understand that when the process was first introduced just a few years ago, the medical fraternity as a whole, and the cosmetic specialists in particular, greeted its claims with considerable skepticism. Since then, however, liposuction has been subjected to the most rigorous scrutiny and has passed with flying colors.
In an unusually short time for any innovative medical procedure, liposuction has become an important part of the established repertoire of cosmetic surgery. Its popularity is growing rapidly-in fact, probably more quickly than almost any other medical procedure today.
THE GROWTH OF LIPOSUCTION
How did liposuction start? And why are so many people eager to benefit from this hopeful surgery? Up until the early part of the 20th century, most people were not enthusiastic about being slim
Artists who painted portraits of wealthy merchants often emphasized rotundness as if to prove that their clients could afford to be well-fed. Even Michelangelo's angels and cherubs in the Sistine Chapel or Leonardo da VinciÕs Mona Lisa are far more plump than today's standards of beauty.
Actually, the preference for a rounded appearance seems to go back even further than recorded history. The figurines that date from early times-as long ago, experts think, as 25,000 years-show female figures that by today's standards would be regarded as grotesquely overweight. Clearly, the female ideal in those ancient times was embodied in what today is called a maternal woman, especially heavy in breasts, and in the pelvic area. All through the eras of recorded history down to the early part of this century, that ideal predominated, as depicted by painters and sculptors.
A striking change in the conventional view of the shape the "ideal" woman should have took place soon after the First World War. No longer was a woman who was rounded, curvaceous, and "well endowed" thought of as the preferred figure.
Instead, the "flapper" of the Jazz Age seemed to personify all that was charming. The boyish, slender, trim figure became the desired ideal. Men and women today may laugh about it, but the cliche, "You can't be too rich or too thin!" has influenced our lives more than many of us are willing to admit.
1. To maintain an ideal body the patient must maintain an overall physical program.
2. Exercise is essential for everyone, and te doctor will help decide on the program that is best for you.
What is medically ideal, in terms of build or figure? And is the medical "ideal" the look that most of us want to achieve?
If you ask a woman who is dieting what yardstick she uses to measure success-the number of pounds she has dropped, the clothing size she can now wear, or the measurement she has lost in inches of various body parts-chances are she will base her feeling of accomplishment and satisfaction on the reduction of her hips, thighs, buttocks, or whatever body parts have worried her most. Books with titles like How to Flatten Your Stomach or 30 Days to Thinner Thighs have been overnight best sellers.
Certainly doctors and patients agree that a man or woman who is substantially overweight-20 to 30 pounds or more above the currently-accepted medical standards for age and sex-will most likely benefit from losing the extra pounds. The risks of arthritis, diabetes, high blood pressure, and cancer are thought to be lessened when patients keep weight down.
But dieting alone is often not the complete answer for maintaining an attractive body. Neither is dieting combined with exercise.
Often, men and women who are not really obese fail to correspond to the current standards of attractiveness because of the genetic constitution of their bodies. The unwanted bulges-refractory (stubborn) fat deposits-represent "failure" to many ... a "failure" that, because it affects the way they look, behave, and think of themselves, can make a substantial difference in their careers and social lives. Because so many men and women are concerned with being slim, liposuction has become a popular procedure. Liposuction helps people to come closer to their aspirations. It is a way to have their bodies "contoured" to a more fashionable form. Like so many other cosmetic surgeries, liposuction can add immensely to happiness.
EUROPEAN SURGEONS BEGAN LIPOSUCTION
The development of liposuction was originally a European phenomenon. Surgeons there were eager to try removing fat tissue, using some of the standard tools of surgery.
Various knife and scalpels techniques have been used to dig out fat. Thus, from time to time, certain physicians would try using a surgical instrument that ordinarily serves other purposes, such as a curette, which is a special kind of scalpel. These doctors attempted to cut away some of the fat to be found in a double chin, in excessively fatty knees and ankles, or in bulging thighs.
When sharp surgical instruments were used, however, there was always a danger of complications. Blood vessels could be severed, causing serious hemorrhage. Nerves could be cut. If too much fat were removed, or were taken from the "wrong" places, patients ran the risk of ending up with unwelcome misshaping of the remaining tissues.
Even though some of these early operations brought good results, the uncertainty of the outcome was so great that many doctors refused to try such procedures. Finally, operations like these were dropped.
THE PIONEERING TECHNIQUES USED BY GEORGE FISCHERS
However in 1976, a father-and-son team of two European surgeons Dr. George Fischer, announced a new technique which they called "aspiration curettage." Basically, they connected a powerful suction pump to a cutting instrument which some observers likened to a miniature guillotine. The Fischer approach involved making a three centimeter incision, (slightly more than one inch long) into which they inserted a tube, or cannula, containing a fairly long cutting blade turned by an electric motor. After the desired cutting of fatty tissue had been completed, they inserted a tube attached to a vacuum pump. Tissue which had been cut was then sucked out.
Although many doctors believed the Fischer procedure had more merit and better results than earlier attempts, there were still major difficulties. The Fischer approach had the potential for causing considerable trauma to related tissues, which could lead to complications.
Furthermore, the Fischer approach generally confined this "tissue removal" technique to the area described as "saddlebags." Even with that limitation, however, and despite strict selection of patients, the results for any one patient often remained unpredictable. Consequently, many doctors remained skeptical, and were unwilling to attempt the surgery.
THE WORK OF YVES-GERARD ILLOUZ
But the Fischer application of the vacuum pump had an unexpected off-shoot. A French physician, Dr. Yves-Gerard Illouz, began to vary the Fischer procedure. Dr. Illouz was concerned about the sharp instrument used, which he felt could destroy blood vessels and damage the lymphatic circulation. Instead, Dr. Illouz began a technique of small tunnels with a blunt instrument ... tunnels which he hoped would pass between major vessels, and leave them undamaged.
Dr. Illouz felt confident that he had made a break-through in the field of cosmetic surgery. However, he still was unsure what would happen to the appearance of the skin after such surgery. Illouz's theory was that fibroblasts (a special kind of cell that produces fiber) would quickly enter the tunnels he had created with his surgery, and would produce fibrous tissue. In essence, Dr. Illouz believed these fibroblasts would create small scar tissue in the tunnels. The scar tissue would help pull down the skin and subcutaneous tissues helping them adhere to deeper structures within the body. If his theory was true, he felt, the skin would not sag after successful liposuction, nor would it have an irregular appearance.
What Dr. Illouz developed is now known as the "bicycle spoke" technique, the term used in referring to the way liposuction practitioners direct the movements of the cannula (or hollow tube) beneath the skin.
DEVELOPMENT OF PRESENT PROCEDURE
In 1977, Dr. Illouz announced the development of what has since become the generally-accepted liposuction procedure, using only a blunt cannula--a metal tube approximately as thick as a pencil-which, in turn, is attached to a suction pump by a length of plastic tubing. Since then, in partnership with another distinguished French physician, Dr. Pierre-Francois Fournier, Dr. Illouz has performed thousands of liposuction procedures with greater and greater success.
IN THE UNITED STATES
Word of the new approach quickly spread to the United States where, with the prevailing youth-oriented philosophy, there was immediate interest, as well as skepticism. These concerns led the American Society of Plastic and Reconstructive Surgeons to send a 14-member panel to France and Switzerland to observe Dr. Illouz in action and to evaluate the liposuction procedure. They came away with a favorable conclusion. The report they issued in 1983 said, in summary, that the Committee felt that it could ... unanimously agree that suction lipectomy by the Illouz blunt cannula method is a surgical procedure that is effective in trained and experienced hands and offers benefits which heretofore have been unavailable.
Most of the misgivings of the American medical community turned out to have little or no basis. For example: doctors had worried in advance about the possibility of significant blood loss, fluid loss, and related complications. That turned out not to be a real problem, since the Illouz procedure used a blunt cannula and made tunnels in the fat layer.
Another concern doctors had was the possibility of scarring and dimpling of the skin after the operation. This too, thanks to Dr. Illouz' ingenuity, was not a major problem. In most cases, skin is elastic enough to return to an appropriately smooth contour after the surgery.
Naturally, there are exceptions. That is why each case and each patient must be considered on an individual basis.
Doctors also wondered at first whether liposuction should be limited to only the buttocks and thighs, or whether other areas of the body were appropriate for this surgery. As more and more liposuction operations were performed successfully, the medical profession has learned that liposuction can benefit many parts of the human body. We will talk about them in subsequent chapters of this book. It is my belief, however, that there is not a single subcutaneous (under the skin) fat area that cannot be removed successfully by liposuction.
Initially, doctors also had questions about who should have liposuction surgery. Based upon the experiences of literally thousands of liposuction procedures, most of the medical community now believes there should be no hard and fast rules, such as an age limit. The only realistic basis for limitation of candidates is the one that applies to all surgery-the general health and condition of the patient. If the patient is in reasonably good health, doctors today generally agreed that age is not a primary factor.
Another concern has a more realistic basis. Because liposuction has the merits of being a relatively safe procedure and without much danger of complications--in the hands of a well-trained, experienced physician/surgeon--there was fear that it might attract unqualified practitioners. After all, there are a great many people who would like to look better, and who can benefit from liposuction.
The liposuction procedure has been called "sculpture in vivo"--sculpture of the living tissue. That is something so important that a patient deserves a top-notch operation ... one which produces as attractive an appearance as possible.
From the beginnings of liposuction, pioneered by Drs. Fischer and Illouz, to today's surgery, in which new techniques are being used, physicians who realize the potential of this operation are continuously refining the way in which the operation is performed. At meetings and conferences of medical associations like the American Society of Liposuction Surgery, the American Academy of Cosmetic Surgery, the American Society of Plastic and Reconstructive Surgeons, and similar organizations, they are sharing their experiences and findings.
In a later chapter, we will talk about how you can locate a qualified, well-trained physician with substantial experience in liposuction. But first, we will look at the uses of fat injections, or, autologous fat transplants.
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