History of Liposuction

Liposuction has been around since the 1920s when Dr. Dujarrier used a uterine curette to remove fat from the knee of a well-known ballerina.  Unfortunately during that time, the gynecologic surgeon damaged the femoral artery which resulted to amputation of the leg.

Liposuction really began evolving in the late 1960s and became what we know it as in 1974.   Dr. Yves-Gerard Illouz of Paris France created modern liposuction in 1982.  The procedure he created was the "Illouz Method", which was actually Suction Assisted Liposuction (SAL). 

History of Liposuction:  Timeline

1921 -  Dujarrier used a uterine curette to remove fat from the knee of a ballerina

1960 -  Schrudde rekindled the interest in liposuction with sharp removal of fat

1978 - Kesselring and Meyer added suction to sharp curretage

1970 - Illouz (Paris, France) used a blunt cannula attached to suction device

1982 - "Illouz Method" of liposuction or Suction Assisted Liposuction

1983 - Hetter used epinephrine and 0.25% lidocaine as a solution to reduce post-operative bleeding

1984 - Hetter described the use of adequate pressure to induce lipolysis

1980 - Klein proposed the tumescent liposuction technique

Figure 1: Before & After Photos of 4D VASER Liposuction with Brazilian Buttlift performed by Dr. Emmanuel De La Cruz (8 weeks after surgery)

In 1985, "Tumescent Liposuction" was invented by Dr. Klein and Dr. Lillis. Liposuction could all of a sudden be performed in an office-setting with only local anesthesia via IV sedation rather than general anesthesia. The "Super Wet" technique was invented right after tumescent, because of the high volume of fluid and potential toxicity of the fluid used (lidocaine). So this lower volume 'wet' technique, Super Wet, was invented.

With modern technology, plastic surgeons discovered Ultrasound Assisted Liposuction (UAL) in the late 1990s.  It was used to emulsify fat or liquefy fat using ultrasonic energy.   Fat is subsequently removed with lower pressure liposuction.   VASER liposuction, a third-generation ultrasonic-assisted liposuction,  was subsequently invented. It's an improved liposuction machine with lower complication rates and improved skin retraction post-liposuction.

Emmanuel De La Cruz MD, PLLC
Plastic & Reconstructive Surgery

Houston, Texas

  

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Removal of Silicone from the Buttocks

Removal of Silicone Granuloma from the Buttocks using VASER Liposuction

September 14, 2017  /  emmanuel de la cruz

Patients who present with a history of silicone injection to the buttocks or gluteal region may present with debilitating complications, such as chronic pain, chronic infections such as cellulitis and abscesses; skin necrosis and silicone granulomas that may cause deformity of the buttocks.  Unfortunately, silicone toxicosis of the gluteal region (buttock) can be difficult to manage.

Management of Silicone Toxicosis of the Buttock

• An MRI of the gluteal region will need to be obtained to evaluate the location and extent of the silicone granulomas
• Treatment may range from surgical excision versus suction-assisted lipectomy with VASER liposuction with concomitant fat transfer to the buttock to correct the resulting deformity from liposuction

Clinical Study using VASER Liposuction for Removal of Silicone Granulomas of the Buttocks

• "Average patient age was 36 years (range, 25-43 years). All patients initially presented with intense pain as assessed by a visual analog scale; by the 12th week postoperatively, the entire cohort experienced remission in pain. At 1 year postoperatively, no patients had infections (vs 75% preoperatively; P = .028), visited the ER (vs 50% preoperatively; P = .058), or were hospitalized (vs an average of 1.5 hospitalizations per patient preoperatively; P = .066)."
• "Liposuction with immediate intramuscular fat transfer for buttock augmentation appears to be a safe surgical option that preserves aesthetic appearance for patients with gluteal silicone toxicosis."

References:

Salgado, et al.  Liposuction and lipofilling for treatment of symptomatic silicone toxicosis of the gluteal region. Aesthet Surg J. 2014 May 1;34(4):571-7. doi: 10.1177/1090820X14527107. Epub 2014 Mar 27.

Emmanuel De La Cruz MD, PLLC

Plastic & Reconstructive Surgeon

Houston, Texas

VASER Liposuction used for Fat Transfer

VASER Liposuction: A Good Source for Mesenchymal Stromal Cells

September 24, 2017  /  emmanuel de la cruz

Mesenchymal stromal cells (MSCs) are the spindle shaped plastic-adherent cells isolated from bone marrow, adipose, and other tissue sources, with multipotent differentiation capacity in vitro.  These mesenchymal stromal cells could differentiate to bone in vitro and a subset of the cells that has a high proliferative potential . The notion of a mesenchymal stem cell was popularized by Arnold Caplan proposing that MSCs gave rise to bone, cartilage, tendon, ligament, marrow stroma, adipocytes, dermis, muscle and connective tissue. Adipose-derived mesenchymal stromal cells (ASCs) are concentrated in fat tissue, and the ease of harvest via liposuction makes them a particularly interesting cell source.   Thus, fat has been transferred to the face for facial rejuvenation, as well as to the buttock for buttock augmentation.  It has shown that radiation-induced damage skin are dramatically improved by fat transfer.  

Recently, ultrasound-assisted liposuction using VASER liposuction and Lysosonix were found to harvest viable mesenchymal stromal cells.  "UAL samples demonstrated equivalent ASC yield and viability. VASER Liposuction adipose-derived mesenchymal stem cells showed higher osteogenic and adipogenic marker expression, but a comparable differentiation capacity was observed. Soft tissue healing and neovascularization were significantly enhanced via both UAL-derived ASCs in vivo, and there was no significant difference between the cell therapy groups."

VASER Liposuction allows safe and efficient harvesting of the mesenchymal stromal cellular fraction of adipose tissue and that cells harvested via this approach are suitable for cell therapy and tissue engineering applications.

Recent studies have shown that adipose tissue derived using the VASER liposuction system were viable at harvest and suitable for autologous fat grafts, such as in Brazilian Butt Lifts.   The study had shown that "the lipolysis assay revealed metabolically active adipocytes with a mean (SD) correlative viability of 85.1%. Direct measures of acute viability via propidium iodide staining resulted in a mean (SD) viability measure of 88.7%.

Reference:

Duscher, et al. Ultrasound-assisted liposuction provides a source for functional adipose-derived stromal cells. Cytotherapy. 2017 Sep 13. pii: S1465-3249(17)30658-8. doi: 10.1016/j.jcyt.2017.07.013. [Epub ahead of print]

Schafer et al.  Acute adipocyte viability after third-generation ultrasound-assisted liposuction.  Aesthetic Surgery Journal. 2013 Jul;33(5):698-704. doi: 10.1177/1090820X13485239. Epub 2013 May 29.

Emmanuel De La Cruz MD, PLLC

Houston Plastic Surgeon

Buccal fat Removal

Buccal Fat Removal | Bichectomia in Houston, Texas

Buccal fat removal is a facial plastic surgery procedure that involves removing fat from your face to create a slimmer appearance of one's face.  This procedure is ideal for patients who typically present with "chubby cheeks" or "chipmunk cheeks" or "baby face."

Buccal Fat Removal Before & After Photos (3 months after surgery) performed by Dr. Emmanuel De La Cruz.

Procedure:  Buccal Fat Removal performed in the procedure room/clinic

Incision: ~1.5 cm incision inside the mouth

Anesthesia: Local

Recovery time:  May go back to work the following day.

Results:  Individual results may vary.  May see improvement within 6 weeks.  Results continue to improve up to 6 months.

Emmanuel De La Cruz MD, PLLC

Plastic Surgeon 

Houston, TX

  

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Large Volume Liposuction Improves Cholesterol Level and Diabetes

October 06, 2017  /  emmanuel de la cruz

A recent systematic review was recently published evaluating whether large volume liposuction improves diabetes and decrease cholesterol levels.  Large volume liposuction (defined as liposuction of more than 3.5 L) was found to decrease the total Body Mass Index (BMI), as well as improved cardiovascular risk factors by decreasing the cholesterol levels as well as improved insulin sensitivity.

Before & After Photos of VASER Liposuction performed by Dr. Emmanuel De La Cruz.

"A total of 364 patients were pooled for analysis. The mean volume of lipoaspirate was 7440 ± 1934.9 mL. The mean body mass index at baseline and postliposuction was 30.7 and 28.4, respectively. Seven studies reported a trend toward decrease in total cholesterol levels with an overall mean reduction of 0.21 ± 0.05 mmol/L from 4.6 ± 0.79 mmol/L to 4.4 ± 0.74 mmol/L. After LVL, leptin was reported to significantly decrease in 4 studies, and TNF-α was reported to significantly decrease in 2. Adiponectin was reported to significantly increase in 2 studies. IL-6 decreased significantly in 2 studies. Two studies included participants with type II diabetes mellitus, whereas 10 studies evaluated insulin sensitivity. Of these, 6 studies reported improvement in insulin sensitivity. Six studies represented level IV and 6 represented level II evidence."

Thus, large volume liposuction may be beneficial in terms of improving cardiovascular risk factors as well as improving diabetes by increasing insulin sensitivity.

Emmanuel De La Cruz MD, PLLC

Plastic & Reconstructive Surgeon

Reference:

Sailon, et al.  Influence of Large-Volume Liposuction on Metabolic and Cardiovascular Health: A Systematic Review. Annals of Plastic Surgery. 2017 Jul 22. doi: 10.1097/SAP.0000000000001195. [Epub ahead of print]

Large Volume Liposuction may Improve Diabetes and Hypertension

Large Volume Liposuction may Improve Diabetes & Hypertension

Numerous studies have been published recently regarding the benefits of large volume liposuction.  it has been shown that large volume liposuction reduces the total BMI (body mass index) of the patient, as well as improvement of hypertension.  In a recent study investigating the safety of large volume liposuction, they had found that large volume liposuction also improved hypertension by reducing the baseline blood pressure 4 months post-operatively.   The same finding was found by multiple authors who reported that there were significant decreases in pulse rate and systolic blood pressure over the 4-months post-operative period.

Before and After Photos of Large Volume Liposuction performed by Dr. Emmanuel De La Cruz.

The study also has shown that over the 4 month post-operative period after large volume liposuction, the blood glucose level of patients with Diabetes also improved.  The authors "explained this by the fact that subcutaneous abdominal fat, as a component of central adiposity, has as strong an association with insulin resistance as visceral fat, and is an important independent marker of insulin resistance in obesity."

Although large volume liposuction may reduce the blood sugar in diabetic patients, it is not a treatment for diabetes.  Liposuction is also not an alternative treatment for hypertension.    Safety is a major concern for these kind of procedures. Large-volume liposuction should be done in a hospital-setting and a 23-hour observation post-operatively may be needed.  I recommend consulting with your plastic surgeon.

Emmanuel De La Cruz MD, PLLC

Plastic Surgeon, Houston Texas

Reference:

Commons GW, Halperin B, Chang CC. Large-volume liposuction: A review of 631 consecutive cases over 12 years. Plast Reconstr Surg. 2001;108:1753. doi: 10.1097/00006534-200111000-00050. discussion 1764

Gonzalez-Ortiz M, Robles-Cervantes JA, Cardenas-Camarena L, Bustos-Saldana R, Martinez-Abundis E. The effects of surgically removing subcutaneous fat on metabolic profile and insulin sensitivity in obese women after large-volume liposuction treatment. Horm Metab Res. 2002;34:446–9. doi: 10.1055/s-2002-33603.

Perez RA.  Liposuction and diabetes type 2 development risk reduction in the obese patient. Med Hypotheses. 2007;68(2):393-6. Epub 2006 Oct 2.

Saleh et al. Safety and benefits of large-volume liposuction: a single center experience. Int Arch Med. 2009; 2: 4. 

Sharon YG, Erwin JB, George WC, Scott LS, Jack AY. Improvements in cardiovascular risk profile with large-volume liposuction: A pilot study. Plast. Reconstr. Surg. 2001;108:510–9. discussion 520–1