INTRODUCTION TO LIPOSUCTION

Liposuction was brought to the United States by a French gynecologist and a French dermatologist.  In the early days it was done with large sharp (cutting) tubes (cannulas) under general anesthesia.  Blood loss was so great that patients needed to pre-donate blood which was given back to them during the surgery.  Even then some procedures had to be stopped short of completion because of excessive blood loss.  With the large cannulas it was hard to get smooth results, although I have seen some very good results nonetheless.

Jeffrey Klein, a dermatologist in San Juan Capistrano, California, originated tumescent liposuction and pioneered the use of microcannulas.  I read his article on the procedure in the Journal of Dermatologic Surgery in 1990 and continued to follow further developments in that journal (which I get because I treat varicose veins and belong to the American College of Phlebology).  By 1994 I had decided I wanted to do liposuction, but along came Group A Strep, “the flesh-eating bacteria.”  It seemed like liposuction would create a favorable environment for an infection with this bacteria, so I waited to see what happened.
Nothing happened.  A report published in the Journal of Dermatologic Surgery in July 1996 covered the experience of 66 dermatologists who performed over 15,000 tumescent liposuction surgeries between them, with no significant complications.  I read it in September 1996 and after checking around decided that I should train with Dr. Klein himself.  I took his course in January 1997 and was set up to perform the procedures by the end of March 1997.  I have performed an average of two liposuction procedures each week since then. I have done chin, armpits, male and female breasts, flanks, waist, abdomen, hips, thighs both inner and outer, inner knees, and lower legs.  My fees are in the range of sales tax plus first year’s depreciation on a new car, i.e. affordable by most people.  Since I do the procedures in the office using local tumescent anesthesia, there is no facility charge and no anesthesiologist fee.  I furnish the compression garment and dressings.

Microcannulas push aside collagen, blood vessels and nerves.  The smallest blood vessels are damaged but do not bleed significantly because they are constricted by the epinephrine (Adrenalin) in the large volume of dilute anesthetic solution that is infused.  The volume of the tissue is approximately doubled by the several liters of anesthetic solution, separating the collagen fibers and making it easier to pass the cannulas without damaging the collagen.  Collagen’s job in the body is to shorten when tension is taken off of it.  If you put your arm in a cast with your elbow bent you won’t be able to straighten it when the case is removed several weeks later—the ligaments, made of collagen, will have shortened.  Likewise when the fat is removed from under the skin, the collagen pulls the skin tight afterwards because the tension is off it.  I have seen fat aprons that covered the pubic hair disappear after the fat was removed from them.  The cannulas may be small but with time one can actually remove more fat than with the large cannulas.  The limiting factor is the amount of anesthetic solution that can be used safely.  Obviously, general anesthesia offers a way around this limitation.  However, if one operates on too large an area the loss of body fluids into the area afterwards can be a real problem.  I would rather do two safe procedures than one dangerous one.  Since everyone wants to know the maximum amount of fat I have removed in a session, it is 6.8 liters or nearly two gallons.  That’s about 13 pounds of fat.  Some more will be lost later as damaged cells die and are reabsorbed.  A more typical abdominal liposuction for a non-obese patient removes about two liters.  Whatever you can grab hold of I will be removing. 

Stop by my office and view Dr. Klein’s videotape about tumescent liposuction.  To see before and after photos, click the link to Liposuction Photos on www.roget.com.