An efficient technique for removing fat tissue

Surgical removal of excess fat tissue has been performed for almost 100 years. However, until recently, the incision usually left major scars and there was always a serious question as to whether the final results justified the procedure.

In the 1970s, a French surgeon developed a completely new technique for removing fat tissue using a hollow metal tube and high-vacuum suction. This method, popularly referred to as "liposuction," has since found wide acceptance from both surgeons and patients. In addition, recent refinements have made the surgery safer and less painful, and produce even better results.

Why removing fat cells makes sense

To understand the potential of suction lipectomy, it is important to understand how fat accumulates on the body. Although the shape of our bodies depends to a certain extent on our calorie intake and energy expenditure, the basic shape is a characteristic inherited from our parents.

In addition, we all have a definite number of fat cells. There is evidence to show that an increased number of fat cells is associated with early over-feeding. The removal or destruction of these cells will largely prevent the fat from re-accumulating in the areas treated.

If you have troublesome areas of fat tissue that are unresponsive to diet or exercise, suction-assisted removal may be an effective procedure.

Areas where suction lipectomy is used

  • chin and neck (alone or at the same time as a facelift)
  • breast reduction (may be used to reduce the fullness at the side of the breast)
  • accessory breast folds
  • male breast reduction
  • abdomen (this procedure may be used alone or in combination with abdominal surgery for removal of redundant skin folds)
  • waist ("love handles")
  • hips
  • thighs ("saddlebags") - this is the most frequent area for treatment, and responds remarkably well in selected situations
  • thighs (inner and upper thighs) - used alone or in combination with surgical excision
  • knees (reduction of prominent inner surfaces as well as fullness above or below)
  • ankles and lower legs
  • certain other localized fat accumulations

How much fat can be removed?

Suction lipectomy is capable of removing localized fat deposits only. It is not a treatment for general obesity. Previously, only about 2,000 mL (approx. 2 quarts of combined fat tissue and blood components) could be removed, but with recent technical innovations a significantly greater amount can be taken out. Removal of excessive amounts of fat is undesirable, however, as excessive blood loss may necessitate a blood transfusion.

In addition, with the use of new techniques such as the tumescent technique, the fat removed is nearly pure, with only a very small proportion of blood products compared to earlier methods. Nevertheless, there is still some loss of blood under the skin after completion of surgery, so some caution is still justified.

Skin elasticity is important to outcome

An important factor in determining the final result is the degree of normal skin elasticity. The skin of younger individuals is more favourable than that of older individuals, and results in shrinkage that occurs evenly and with a smoother final surface.

This elastic quality is less pronounced in older skin, and it is possible that some wrinkling or irregularity will remain following the procedure, even under the best circumstances. If skin elasticity is felt to be inadequate for providing a good esthetic result, you may be advised to have a skin-tightening operation of the areas to be treated, either alone or in combination with suction. This is most commonly done for the abdomen (tummy tucks) but is also useful in the neck, buttocks, and thighs.

Each person must be evaluated individually

Since suitability for the procedure is based on a variety of factors, individuals who are contemplating this type of treatment require a personal examination and consultation to determine what is best for his or her particular situation.

Personal attitude is also important in determining whether or not someone is a good candidate for this procedure. Unreasonable expectations can be a source of disappointment. With a realistic attitude and a clear idea of the aims of surgery, the results can be both dramatic and very satisfying.

Benjamin Gelfant, MD, FRCSC,
in association with