The History of Liposuction

The urge to modify the human body’s fat deposits with surgery goes as far back as the 17th century.   Manuscripts dating as far back as the mid 1700’s discuss surgical ideas for transferring fat from a woman’s abdomen to her breasts.  Initial surgeries were crude, but over time different surgeons used their particular background and training to further hone the practice of fat removal.  Each pioneering surgeon brought with him the tools and training of their particular field – and they used those tools and experience to create an even better technique.

In the beginning, general surgeons used scalpels to remove blocks of fat and skin.  Later, gynecologists used gynecological and obstetric instruments to remove tissue.  Plastic surgeons, inspired by the work of the gynecologists, transformed the instruments into blunt tipped tubes, which improved the safety of the technique.  Decades later, a dermatologist used his background and training to develop a technique that did not require heavy anesthesia or stitches and his technique reduced the rippling and uneven results typical of early liposuction.

In the late 1890’s Dr. Howard Kelly pioneered a body contouring surgery called “block lipectomy” which removed blocks of fat and skin.  The result was a slimmer body – but one clearly marked by excessive scars.  Many surgeons followed Dr. Kelly’s technique and over time these surgeons learned to hide the scars in the body’s natural creases.

In the 1960’s, Dr. Ivo Pintanguy, the famous Brazillian surgeon, opened his first clinic in Rio de Janerio and began developing techniques that dramatically reshaped the body with minimized scars.  His buttock lift procedure, for example, is still used today in clinics around the world.  Dr. Bittner has trained with Dr. Pintanguy and has an ongoing collaboration with fellows from Dr. Pintanguy’s Plastic Surgery Institute.  Dr. Bittner has also worked on various new developments in liposuction at the Pintanguy Center at Santa Casa Hospital in Rio de Janiero, Brazil. 

In the 1950’s gynecologists began experimenting with fat removal using uterine curettes, which were instruments used for abortions and other gynocological procedures.  These first instruments were designed for scraping away fatty tissue.  As these instruments developed, they became hollow tubes with a spinning blade on the end.  The blade chopped up the fat while rubber tubing suctioned out the tissue.   

By 1974, a prominent Italian gynecologist, Dr. Giorgio Fischer, had developed a technique for fat removal based on an electronic rotating scalpel within a thin metal tube attached to an aspiration (suction) machine.  While the rotating blade did remove fat, it often led to catastrophic results, as one was never quite sure what was being removed from under the skin.

In 1978, modern liposuction, using blunt instruments to create tunnels and to pass between major blood vessels, was developed by Dr. Yves-Gerard Illouz in France.   Dr. Illouz eliminated the rotating scalpel and the aspiration machine.  His technique involved saline water and blunt metal tubes with small holes attached to basic syringes that the physician used to “pull” out fatty tissue. By using blunt instruments and mild suctioning, the safety and efficacy of liposuction increased dramatically.   Dr. Pierre-Francois Fournier further improved the technique of Dr. Illouz.  Together, Drs. Illouz and Fournier are known as the fathers of liposuction.  Their French “syringe” technique is still used today in a modified form. 

Based on the work of Drs. Illouz and Fournier, other surgeons began experimenting with the saline solution injected into the fatty tissue before removal.  Epinephrine was added to help stop bleeding and lidocaine was added to numb the fat and reduce pain.  The amounts of lidocaine, epinephrine or other ingredients varied from surgeon to surgeon.  This new technique of using fluid before fat removal was called “wet” or “super wet” technique. 

In the 1980’s, a Southern California dermatologist, Jeffrey Klein, further improved liposuction by introducing a technique that used only local anesthesia and a solution containing lidocaine, epinephrine, sodium bicarbonate and saline.  This solution is now commonly called Klein Solution.  Dr. Klein’s technique, called tumescent liposuction or tumescent liposculpture, involves using an amount of solution greater than the amount of fat to be removed.  Dr. Klein’s technique is considered the safest form of fat removal.  Dr. Alan Bittner and his team at Beverly Hills Liposculpture perform an adapted version of Dr. Klein’s tumescent technique. 

In 1987, an Italian plastic surgeon, Dr. Michele Zocchi, developed ultrasonic assisted liposuction.  In this method, ultrasonic energy is used to help dissolve fat cells prior to their removal with suction.  Due to complications from skin and tissue burns, the original ultrasonic liposuction is no longer in use.  Today, ultrasonic liposuction exists in a new form, called Vaser liposuction.  While the issue of tissue burning and related complications has improved, the rate of complication is signifantly higher than with tumescent liposculpture.  Further, the size and diameter of Vaser instruments mean that the surgeon must use larger incisions and the patient must be under IV sedation or general anesthesia.  Due to the difference in instrument size and shape, the results of Vaser or ultrasonic liposuction are not as precise as with standard canulas.  Importantly, because larger instruments cause patients increased discomfort and pain, Vaser cannot be performed with only local anesthesia.

In 2002, Power Assisted Liposuction (PAL) units were introduced and today more than half of surgeons doing liposuction use a PAL system of one kind or another. Surgeons who do not use PAL systems perform what is called “vacuum assisted” liposuction.   Power assisted liposuction refers only to the addition of a motor to the base of the canula that causes the canula shaft to lightly vibrate.  The vibration of the canula has been shown to cause less damage to the connective tissues and blood vessels surrounding the fat, which means a more comfortable procedure, less bruising, and faster recovery for the patient.  PAL has no bearing on the safety of liposuction, it is simply a minor modification of the canulas at the base.  PAL canulas come in all shapes and sizes.  Dr. Bittner and his team use only the smallest of the PAL canulas.   

In the last few years, surgeons have begun to experiment with the use of lasers in liposuction.  There are several types of lasers being currently tested.  While the idea of using a laser is appealing, real world applications have proven problematic.  If the laser’s energy is too low, only a microscopic amount of fat is affected and there is no visible change.  If the laser’s energy is too high, there is a serious risk of burning, uneven results and injury.  Medium strength laser technology means that patients need 10 or more treatments to achieve results. 

Dr. Bittner offers a skin tightening laser, called the SmartLipo laser, which was designed to help tighten skin after the fat has been removed.  The SmartLipo laser is a tiny fiber optic source of heat that works similarly to other skin tightening lasers, like Titan or Thermage.  The SmartLipo laser’s heat works on the underside of the skin to break apart the collagen bonds.  When new collagen bonds form, the skin is somewhat thicker and tighter. 

Modern liposculpture is indeed an amazing procedure.  The ability to remove gallons of flesh from the human body in a matter of hours while the patient is awake still seems futuristic – even though we do it every day.  While there are limits to what any particular form of surgery can accomplish, modern liposculpture has proved safe and effective. 

Just like previous innovators used their training and education (dermatology, plastic surgery, or gynecology) to bring about new methods or instruments, Dr. Bittner’s training as a minimally invasive surgeon has helped him develop a gentle, quick and precise technique that involves a modified Klein Solution, Power Assisted micro-canulas, and small incision sites (called adits) that give the greatest access and the best chances for the smoothest possible outcome.  Dr. Bittner’s background in mechanics and auto body repair work helped him engineer several special canulas that help him remove hard to reach areas, like the ankles or calves, and help smooth out tough to treat areas, like the inner arms.

Just like a musician might have a favorite guitar, different surgeons favor different methods and instruments.  Not every method will fit every patient or every physician.  At the end of the day, the most important tool a surgeon has isn’t his canula – it’s his experience and judgment.   The more practice a surgeon has with a particular surgery or a particular instrument, the better the results will be. 

Beverly Hills Liposculpture is dedicated to performing tumescent micro-liposculpture.   We have performed almost 6000 procedures and we have not ever had a patient experience a serious complication or infection.