Syringe Liposuction A Safe And Effective Method Of Body Contouring

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Syringe Liposuction: A Safe And Effective Method Of Body
Francis Ho*, FRCSE, FHKAM (Surgery)                                  Physiology
  Honorary Consultant
  Plastic Surgery & Laser Dermatology                                     Many individuals are troubled by the
  St. Teresa's Hospital                                              problem of excessive fat accumulating in
                                                                     unattractive areas. While men store their fat
                                                                     usually around the flanks and abdomen, women
                                                                     tend to accumulate excessive fat in a typical
Summary                                                              pattern around the hips, thighs, and lower
                                                                     abdomen, forming the so called "violin"
      Liposuction is not meant for weight reduction.                 deformity. The fat in these areas is notoriously
It is however a very effective means of body                         resistant to dieting and exercise. Often patients
contouring procedure for improving unsightly body                    lose significant amount of fat in other areas
profile due to localised fatty deposit.     The old                  before they can reduce these stubborn areas.
technique was traumatic and potentially risky.                       Exercise and dieting produce general effect but
With the new syringe technique, "tumescent" local                    do little to reduce these areas.
anaesthesia and use of finer cannulae, lipositction
has become an extremely safe clinic            office                Figure 1: Cannulae and              Syringes   used   for
procedure.                                                                     Liposuction

Keywords:       Liposuction,          syringes,        body


     In the hands of amateured practitioners,
using their semi-mastered outdated traditional
technique, liposuction could be a dangerous and
complicated procedure to undertake. However,
new syringe liposuction is in fact an extremely
safe and effective procedure to perform
nowadays. It is by no means a weight reducing                            Until recently, it was assumed that fat cells
procedure, but is the most effective, if not the                     were formed primarily in childhood and that the
only, means of body contouring for those                             number of adipocytes remained static. However
patients having a near optimal body weight.                          recent studies suggest the existence of fat

"Address for correspondence:   Dr. Francis Ho, St. Teresa's Hospital, 327 Prince Edward Road, Kowloon.

Syringe Liposuction

precursor cells in adult. As a result of weight                   Figure 3: Post-liposuction
gain, existing individual fat cells increase in size.
Beyond a certain threshold, the enlarged
adipocytes send out signals that induce new
adipocytes formation from precursor cells to
accommodate the excess fat. The formation of
adipocytes from precursor cells take place in
typical areas around hips, thighs, and lower
abdomen in women and around the flanks in
men. Once these new fat cells are formed,
there is no turning back, diet can only reduce
the lipid content but can never remove the fat
cells. Individuals undergoing successive phases
of dieting and weight gain find themselves more
and more deformed by localised fat deposit
because new generations of adipocytes are
formed in each phase of weight gain. Diet can
do nothing to remove them.

     Liposuction is the most effective if not the
only medical approach developed thus far that           Principle of Liposuction Procedure
allows the selective removal of localised
adiposities. Liposuction works by selectively
                                                             Basically what the surgeon needs are just
removing and damaging fat cells, thus decreasing
                                                        cannulae and negative pressure. Cannulae of
the reservoir of adipocytes capable of storing fat
                                                        appropriate sizes and configuration are
and producing deformities.
                                                        introduced into the affected areas. Multiple
                                                        tunnels are made. With the application of
      Figure 2: Deformity of Lateral Thighs             negative pressure, columns of fat cells
                     -Preop                             conforming with the size of the cannulae are
                                                        cored out. Under post-op compression, healing
                                                        and retraction brings the skin surface to its new

                                                             In the old days, the procedure was a major
                                                        one. General anaesthesia was required. Large
                                                        gynaecological cannulae connected to suction
                                                        machines were used.          Suction was very
                                                        traumatic and control was difficult. Uneven
                                                        suction led to waviness of skin surface. The
                                                        fatty aspirate contained a large proportion of
                                                        blood and thus the amount of fat that could be
                                                        sucked out in each session was limited.
                                                        Postoperative      bruising    was    alarming.
                                                        Transfusion was sometimes necessary.       Skin
                                                        surface necrosis occurred as a result of
                                                        hematoma and traumatic suction.
                                                            Hong Kong Practitioner 17 (3) March 1995

     With more refined technique of syringe                For face and neck, 10 or 35cc syringes
liposuction, most procedures can now be done          coupled with 2.1 or 3mm cannulae are used. For
under local anaesthesia (LA) with or without light    the body, 35 or 60cc syringes coupled with 3, 3.7
intravenous (IV) sedation. Two to three litres of     or 4.6mm cannulae are appropriate.
"pure" fluid fat can be removed comfortably while
blood loss is minimal. Waviness of skin surface is         After suctioning, multiple layers of elastoplast
rare and postoperative bruising does not normally     are applied for splintage of the area for 5-7 days.
occur extensively. Patients could be discharged       After that, elastic garment is worn for a month to
home the same day.                                    control edema and to secure the skin in its new
                                                      surface contour.

The Technique
     LA with or without light sedation is used
most of the time. The anaesthetic solution                 Liposuction is becoming one of the most
consists of 50ml of 1% xylocaine, 1ml of 1:1,000      frequently performed cosmetic operation. If
adrenaline and II of normal saline making up a        performed well, it is a very safe and effective
solution of 0.05% xylocaine with 1:1,000,000          operation to treat localised unattractive fatty
adrenaline. This solution is injected enormously      deposits which are usually very resistant to dieting
into the deposit until turgid. 500 to 700ml of this   and exercises.
solution can be injected into an affected area of
approximately lOOOcc of fat deposit. Suctioning            In order to make liposuction a more "friendly"
with ordinary syringes (Figure 1) is started 10-15    operation, the old method was refined. Syringe
minutes later.          Analgesia is excellent.       liposuction using the tumescent local anaesthetic
Vasoconstriction is profound, suctioning is           method is now the widely accepted method. The
essentially bloodless and only pure fat (Figure 4)    technique is simple. Good result is consistently
is sucked out. Characteristically exact amount of     reproducible. There is minimal blood loss and
aspirate can be measured with the syringe.            morbidity. It is done as an ambulatory procedure.
Without heavy sedation, patients recover fast and
can be discharged soon after the operation.                 Instead of suction machine, syringes are used
                                                      to generate the negative pressure. With a simple
                                                      pull of the piston, one negative atmospheric
    Figure 4: Bloodless "Pure" Fat Aspirate           pressure is immediately produced. The syringe is
                                                      more friendly to the tissue and it is easier to work
                                                      with. Suctioning is as effective. Added advantage
                                                      is that it is a closed system, and there is absolutely
                                                      no contamination to the operating theatre and its

                                                           Minimally sized cannulae in the range of 3 to
                                                      4mm are generally used. Smaller cannulae are as
                                                      effective as the larger ones and they are less
                                                      traumatic. Suction is better controlled with small
                                                      cannulae and thus waviness of skin surface,
                                                      commonly produced by uneven suction by large
                                                      cannulae is rare.

Syringe Liposuction

      Blood loss used to be a major problem in          Conclusion
liposuction. The fat sucked out by old methods
contained a large percentage of blood (20%-30%).             With the use of tumescent local anaesthetic
This greatly limited the amount of fat that could       technique, minimally sized cannulae and syringe
be sucked out in each session. It was believed          generated negative pressure, liposuction has
that 2 litres was the upper limit and blood             become an extremely safe, effective and
transfusion was needed if this amount was               convenient outpatient procedure for the treatment
exceeded.           This is no longer true now.         of body contouring deformities due to excessive
Popularised in USA and Europe the so called
                                                        fat deposit. B
 tumescent local anaesthetic method described
 above produces excellent local anaesthesia and
bloodless suction. The anaesthetic solution is
 injected generously to the affected area.
 Analgesia is excellent. Thanks to the widespread       References
 vasoconstriction, the aspirate is essentially "pure"
 fat. In the author's experience, removal of 2.5        1.   Foumier P: Liposculpture: Ma technique. Paris: Arnette, 1989.
 litres of fat is a comfortable amount. There is no     2.   Illouz YG: Body sculpturing by lipoplasty. London: Churchill-Livingstone,
 postoperative orthrostatic hypotension nor             3.   Illouz YG: Study of Subcutaneous Fat. Aesth. Plast. Surg. 1990; 14:16S-
 tachycardia. Postoperative IV fluid replacement             177.
                                                        4.   Illouz YG: A Plea for a "White" Liposuction. Ann Chir Plast Esthet 1990
 or blood transfusion is also not needed. Heavy IV           35: 62-65.
 sedation is generally unnecessary. Patients            5.   Klein JA: The Tumescent technique for liposuction surgery. Am J Cosmet
                                                             Surgery. 1987; 4: 263.
  therefore recover fast and are usually discharged     6.   Toledo LS: Syringe liposculpture: a two year experience. Aesth. Plast. Surg.
  a few hours after the operation.                           1991; 15: 321.


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