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DONALD J. CAPUANO, M.D.
Plastic Surgeon

Plastic surgery is art and science combining surgical and artistic skill to enhance and restore physical appearance and self-esteem. The following appeared in the Health Section of the Wolfe News Papers in June of 1996 it was written at the request of the Medical Society of Monroe County to give an update about the current status of Liposuction

Have you ever been a part of a revolution ?

Fifteen years ago liposucton was considered a dangerous operation. Caution ! Only a small amount of fat can be removed. Blood transfusions were thought to be needed in all but minor cases. Reports of infections were blown out of proportion. Only women under forty could have the procedure. Only the thinnest of patients should be operated on. Never operate on a chubby patient. Be ready for clots or fat traveling to the lungs. Liposuction had a stormy beginning but it has proven to be a very safe operation.

It is interesting to understand the operation. A cannula or metal tube the size of a straw is placed through the skin into the fatty tissue. Surgeons were taught in pre liposuction era that the fatty layer was the one with the greatest chance of infections and fat should not be injured. But liposuction actually 'beats up' the fat. The tube pushes through the fat again and again, bruising it. Fat is actually torn away by powerful suction. You would think there would be much bleeding. There usually isn't. Doctors thought there should be infections. They are very rare. The skin, muscle and nerves are bumped and bruised and there should be a lot of pain. There usually isn't. According to the surgeons' theory before 1980, liposuction should not be done. But within two years of the first operations in the U.S., liposuction became the most frequent procedure of plastic surgeons.

What makes liposuction possible? Dr.Yeves Gerard Illouz (pronounced ill oooze) is a Parisian surgeon whose office was close to the Follies Bergere'. With so many dancers and too much hip and tummy fat, Dr.Illouz was asked time and time again to 'suuukk zee fott' as he says in his French-English. Over time he developed the basic principles. He preached using a high powered suction so that few pieces of loose fat would be left behind to cause infection. The cannulas should not be sharp to cut nerves and blood vessels. Sterile techniques must be used to avoid infections. The surgeon must be prepared to give intravenous fluids if too much tissue is removed or if there is excessive bleeding. By adhering to these principles liposuction turned out to be a very safe and useful procedure for millions of people, thin and chubby.

When suction lipectomy is mentioned we think of thin women with a little fat in the tummy, hips or thighs; an operation to make thin women thinner. But really thin women are few and we quickly learned that there are many other people that can benefit from liposuction. For example, many large fatty tumors have been removed with the technique sparing people large scars and allowing faster healing. The chubby faces of children with Downs syndrome have been contoured to help prevent stereotyping a child. Pounds of fat removed from the heavy abdomen during middle age can take weight off the aching backs and knees, to provide relief in some cases. Heavy arms have been lightened. In Germany liposuction is used to reduce large breasts through small incisions. Even the fat given up by the procedure can be used. Scars from accidents or birth defects have been helped by fat injections.

What's new in liposuction? You have heard about the 'new' tumescent technique which uses small cannulas. This involves injection of large amounts of fluid and a large amount of local anesthetic into the tissues to be suctioned. Dr. Klein perfected the 'tumescent' technique in 1986 making it 'new' about ten years ago. Small cannulas (one eighth of an inch) are not new either . Surgeons have been using small cannulas for body sculpting since the early 1980s.

What is new is we are learning that very large amounts of fat, four or more liters, can be removed during one operation using the tumescent technique. Because of the large amounts of fluid and local anesthetic infused into the tissue this is a hospital procedure. Very careful patient selection and monitoring is needed for safety to minimize the risk to the heart, lungs, and infection.

What is new is that more non-surgeons are doing liposuction in their offices. The media shows video clips of gloved physicians, their hairy arms, heads and mustaches exposed, no gown or mask, suctioning patients who rest on bath towels in an office setting. What could be easier ??!! From a surgeon's view, not adhering to sterile techniques, removing large amounts of fat without an IV ready, and giving large amounts of local anesthetics and adrenaline increase the risks of liposuction surgery. Only time will tell if the safety record of liposuction will be maintained.

Ultrasonic liposuction is new. This involves breaking open fat cells with an ultrasonic cannula. The cannula has a vibrating tip which shakes open the cells. The liquid fat is then sucked out. This is not yet available on a routine basis because it has yet to pass the investigational requirements in the U.S. It is available in Europe and South America. While the technique is new, remember that it doesn't mean it's better or safer than traditional suction lipectomy.

Also 'new' but very controversial is the use of sharp cannulas right under the skin Yes it started in California !!! Apparently some very good and some very bad results have been reported. Caution is advised !!!!

History has a way of repeating its lessons. We have known for a long time that changing the body can change the mind. Over the past fifteen years we have come to know that liposuction not only tapers a bulge or sculpts a form, but it can also lift the spirits and that's not new !!

REVOLUTION
and
LIPOSUCTION

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