Syringe Liposuction: A Safe And Effective Method Of Body
Francis Ho*, FRCSE, FHKAM (Surgery) Physiology
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
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using their semi-mastered outdated traditional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.
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
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.
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,
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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.