History of liposuction
Two major developments
are responsible for state-of-the-art liposuction as we know it today. The first was the use of suction to remove the fat, the second enabled liposuction to be performed in a much safer way, with even better cosmetic results.
Years ago, excess fat deposits could be removed only by scalpel
excision. This procedure never obtained popularity because of uneven results and a poor complication rate. Later, some attempts at using large curettes
(scraping instruments) were also tried. Both of these techniques yielded very uneven removal of fat, and both methods were prone to heavy bleeding.
The first major advance in real spot reduction:
- suction with cannulas to remove localized fat deposits
The first major advance
toward current liposuction was the idea which led to the name liposuction. Giorgio Fischer began to use an open-ended curette-like instrument attached to a suction apparatus to remove fat in the 1970s. French physicians Illouz and Fournier further developed the idea of using low pressure vacuum suction to remove excess fat through a tube-like instrument called a cannula. The use of suction and cannulas enabled large amounts of fat to be removed from the abdomen and other areas through incisions which were very small compared to traditional surgical incisions. The cannulas were smaller and less aggressive in design than the uterine curettes tried earlier. The tips of the cannula instruments were blunt or rounded, and the holes or "ports" were on the side of the cannula shaft, rather than on the end. Much more even removal of fat could be achieved with far less trauma to the tissues.
The use of suction
to remove fat deposits was a major breakthrough. But there was still a tendency for bleeding and uneven results with liposuction. Often, the endpoint for liposuction of a particular body site was when the bleeding from that area became too profuse, rather than when the contour of the body area was ideal. It became standard for many liposuction surgeons to advise patients to donate a unit of blood one month before the procedure for the patients own use; auto-transfusion during the procedure was common. In fact, auto-transfusion is still commonly used when liposuction is done by non-tumescent technique. The cannulas, about the thickness of an adult "pinky" finger (some even larger), caused unevenness, in addition to the bleeding. Also, general anesthesia was required. To varying degrees, the liposuction procedure as above is still commonly performed by some physicians.
The second major advance in liposuction: Tumescent Technique
- Local anesthesia / leads to vastly improved safety profile for liposuction, while at the same time achieving better cosmetic results:
The second major advance
in liposuction surgery made the liposuction procedure dramatically safer and also caused many other improvements. In 1987, Jeff Klein, M.D., developed the use of local anesthetic in liposuction. He named his method the "Tumescent Technique." The initial publication appeared in the Journal of Dermatologic Surgery and Cutaneous Oncology (now called the Journal of Dermatologic Surgery). Perhaps the reason physicians had not considered local anesthetic for liposuction previously was that the size of the area that doctors traditionally numb with local anesthetic is usually small. A dentist numbs a tooth or group of teeth, or a physician uses local anesthetic to numb a mole or skin cancer prior to removal. There were exceptions to this, for example Bier blocks used in orthopedic surgery, but by and large, local anesthetic was just for smaller surgical procedures.
The local anesthetic
solution, or tumescent solution, that Dr. Klein used for liposuction was dramatically lower in concentration than that used for small procedures. Therefore, much more of it could be safely used. Much larger areas could easily be numbed with local anethesia than before. Because fat has relatively few nerve endings, the low concentration of local anesthetic worked. And risks of general anesthesia were completely avoided. Tumescent technique also enabled liposuction to be done outside of the hospital (where lots of patients with contagious diseases and infections are and are operated on).
Even more important was the impact that tumescent technique had on the safety of liposuction: a dramatic improvement. In addition to the patient being awake, in control of their
own breathing and other bodily functions, and being able to constantly communicate with the surgeon, bleeding was dramatically reduced.
How bleeding in liposuction was reduced by 90%:
To decrease bleeding, doctors have combined vasoconstrictors
with local anesthetics for many years. The vasoconstrictor most often used is epinephrine, which is also known as Adrenaline. Epinephrine causes the smaller
blood vessels of the anesthetized area to temporarily constrict and become much narrower. The blood vessels are much less likely to be contacted or damaged by
an instrument when they are smaller. And if they are damaged, the much narrower diameter of the vasoconstricted vessel enables a clot to cover the leak much
more rapidly. Bleeding is dramatically reduced. The vasoconstrictor/ local anesthetic mixture makes so much difference in bleeding that some dental or cosmetic
surgical procedures would take far longer to complete without them. In fact, some procedures would become unsafe or practically impossible to perform.
In liposuction, adding the vasoconstrictor
epinephrine to the local anesthetic solution decreases the bleeding dramatically. The aspirate is the fluid that is removed during liposuction.
Without vasoconstrictors, 40% of the aspirate is blood. With tumescent technique, only about 1-3% of the aspirate is blood.
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History of Liposuction on other sites:
history of liposuction at About.com
History of liposuction
History of Liposuction Liposuction history of #2
History of Liposuction
History of Liposuction & Tumescent Liposuction - emedicine
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