Body shape is a symbol of charm, and the three major bases of body shape are the development of bones, the shape of muscles and the degree of fat accumulation. As people age, their body shape is constantly changing, mainly in the form of a fuller forehead and an expanded abdomen. The basic basis of body contouring is the change in the distribution of body fat, such as excess in some areas and lack in others, which is constantly changing with age. Body contouring should therefore be a process of realigning the distribution of fat.
According to the official website of ASAPS in March 2012, more than 9,000,000 surgical and non-surgical cosmetic treatments were performed in the United States in 2011, a 1% increase from 2010, with surgical and non-surgical cosmetic treatments accounting for 63% and 37% of total treatment revenue, respectively, with liposuction treatment showing the most significant increase (13%). Yin Guoqian, Department of Plastic and Reconstructive Surgery, The First Affiliated Hospital of Guangxi Medical University
In the report, the top five surgical cosmetic procedures were: liposuction (325,332 cases), breast augmentation (316,848 cases), abdominoplasty (149,410 cases), blepharoplasty (147,540 cases), and breast lift (127,054 cases). Female patients underwent nearly 8.4 million procedures, or 91% of the total, and their top three surgical treatments were: breast augmentation, liposuction, and abdominoplasty. Male patients, on the other hand, had nearly 800,000 surgeries, accounting for 9% of the total, and their top three preferred surgical procedures were: liposuction, rhinoplasty, and blepharoplasty.
China has a large population, and with the development of society, people’s standard of living is constantly improving, and the change of diet structure, the large intake of high-calorie and high-protein diet, coupled with human labor and activities gradually replaced by machine operation, resulting in an imbalance between energy intake and consumption. Therefore, there are more and more overweight and obese people in China, and experts predict that in the near future, liposculpture will climb to the first place in China’s plastic surgery projects.
With the development of various fields of medicine, the medical methods used to maintain, repair and reshape the beauty of the human body are becoming more and more sophisticated. At present, the main methods of body sculpting are classical subcutaneous lipectomy and fat aspiration, and liposuction technology has been changing over the past 30 years in terms of liposuction machines and instruments, and there are many improved surgical methods based on this.
As early as 1890, Demars and Marx in France successfully removed the skin and fat from the abdominal wall when repairing a huge umbilical hernia, and this procedure became known as subcutaneous lipectomy. Subcutaneous lipectomy of the abdominal wall continued and developed throughout the 20th century, with numerous modified incisions. In contemporary times, when minimally invasive techniques are more sophisticated, endoscopic techniques have become an important tool for small-scale abdominoplasty.
In the 1920s, French surgeon Dujarrier used a spatula to scrape fatty tissue from the knee, which eventually caused the recipient to be amputated due to infected vascular damage. Although the procedure was a failure, it had a profound impact on the development of fat aspiration.
In 1976, Americans Arpad and Giorgio Fischer performed subcutaneous fat aspiration using a hollow blunt-tipped cannula attached to a negative-pressure suction device. in 1977, French plastic surgeon Illouz used hypotonic saline and hyaluronic acid for local adipose tissue injection followed by aspiration with a blunt-tipped cannula to minimize injury and bleeding. in 1978, Kesselring combined the In 1987, the fat aspiration technique was introduced to China and pioneered by Jinan Central Hospital in Shandong Province, with surgical operators such as Han Binggong and Zhou Xingliang, and reported experience with 102 cases in 1988, with The weight loss effect and the safety effect of shaping were good, and after that major hospitals carried out this technique one after another.
Traditional negative pressure liposuction is performed under general anesthesia or epidural anesthesia, and the fat tissue is disrupted and released by using different diameter and shape cannulas attached to the negative pressure suction equipment. The use of electric negative pressure suction device is not only laborious, but also destroys more skin vascular nerve endings while removing fat cells, which is easy to bleed and form hematoma, and the skin is prone to postoperative complications such as unevenness and numbness.
In order to solve the complications of traditional negative pressure liposuction, Klein first proposed the application of a large amount of liquid containing epinephrine and lidocaine injected into the aspiration site in 1987, namely the swelling local anesthesia technique. Since the application of swelling technology, negative pressure liposuction has been transformed from one with a lot of damage and bleeding to one with high complications to one with local anesthesia and long duration of action, good pain relief, little tissue damage, little bleeding and low complications, which is accepted by the majority of plastic and cosmetic surgeons, and is the commonly used liposuction technique in clinical practice at present. Clinical practice has proved that slim, blunt-tipped cannulae cause little mechanical damage to tissues; thick, pointed cannulae cause great damage to tissues; in actual operation, different caliber types of cannulae can be used according to the situation of fatty tissues.
The basic components of the infiltrating solution commonly used at present are: saline (or lactated Ringer’s solution), lidocaine, epinephrine hydrochloride and/or sodium bicarbonate. The maximum dose of lidocaine used in swollen liposuction is 55 mg/kg, and numerous cases have been shown to be safe for patients in swollen liposuction. In order to reduce mortality in negative pressure liposuction, swelling anesthesia should be avoided in conjunction with general anesthesia.
The syringe method of liposuction was developed by Geoge Fisoher, an Italian plastic surgeon, in 1974 and matured in the 1990’s. It is simpler and easier to perform than electric negative pressure liposuction. The syringe aspiration acts like a machine, creating a vacuum when the syringe core is withdrawn, compared to the syringe, which has no or few dead chambers and is therefore more widely used clinically.
Combined with the swelling technique syringe method liposuction makes the operation of facial and neck fat aspiration simple and easy, with little trauma, less bleeding and fewer complications, and has become one of the plastic surgery methods to improve facial contour and facial rejuvenation, the fat after syringe liposuction can be utilized for autologous fat transplantation, so it is often used in combination with other facial cosmetic surgery. Although the syringe method of fat aspiration has the above-mentioned advantages, its effect is affected by the slow speed of liposuction and incomplete liposuction, and it is only suitable for small-scale liposuction of exposed areas such as the upper arm of the jaw and neck.
In 1992, Zocchi (Italy) first applied ultrasound-assisted liposuction (UAL), an ultrasonic liposuction technique. The ultrasound liposuction device consists of an ultrasound initiator, ultrasound transducer, connecting wire and titanium probe. The ultrasound-assisted liposuction device converts electrical energy into mechanical vibrations through a piezoelectric crystal, and then amplifies the vibrations through a titanium probe and transmits them to the fat tissue, causing alternating expansion or contraction of fluid pressure in the fat tissue, resulting in a “cavitation” effect that causes cell membrane destruction, and triglycerides, swelling fluid and intracellular fluid to This causes the cell membrane to break down and triglycerides, swelling fluid and intracellular fluid to overflow to form emulsified fat.
Ultrasonic liposuction can emulsify or shatter the fat through ultrasonic waves, which enhances the fat extraction, less bleeding during the operation, and can effectively reduce the work intensity of the operator. Ultrasonic liposuction routinely applies swelling anesthesia technology, and the configuration of its swelling solution is basically the same as that of negative pressure liposuction. Ultrasonic liposuction is highly selective, targeting only fatty tissues and not damaging blood vessels and nerves. The method has light tissue damage and low bleeding; the liposuction process reduces only the liquid part (fatty acid) in the fat cells, while the high-density solid part remains in its original position, making the skin appear flat and smooth after surgery. The complications of ultrasonic liposuction and the final cosmetic effect may be related to the increase of ultrasonic liposuction tissue temperature, for this reason ultrasonic fat remover is constantly improved, and ultrasonic probe with sheath and extracorporeal ultrasonic-assisted liposuction for weight loss are invented, which to some extent overcome the deficiencies of ultrasonic liposuction for weight loss.
In addition ultrasound can stimulate skin retraction, so that patients with loose skin can obtain more satisfactory results. Ultrasonic liposuction has a certain effect on simple mild to moderate obesity, with the advantages of low risk, simple operation, safe treatment, low requirements for the operator, little pain for the patient treatment, and does not affect working life, etc. However, this method is slow and inefficient for its defects, which limits its application in clinical practice.
In 1994, American plastic surgeon Apfelberg first reported the study of Laser-Assisted Liposuction (LAL) by inserting optical fibers into catheters and operating on subcutaneous tissues, mainly through the selective photothermal action of laser or the powerful shock wave generated by Q-switched laser, which acts on local fat cells, extracellular matrix and microvessels. The laser is used to treat the fat cells, extracellular matrix and microvasculature, causing reversible or irreversible cellular damage.
The laser can also stimulate local collagen formation and remodeling, increase skin elasticity and tighten the skin at the site of application while vaporizing and dissolving tissue and coagulating blood vessels. Laser lipolysis can be performed on multi-vascular areas and areas where larger cannulae cannot be liposuctioned; it has the dual effect of lipolysis and skin tightening; the advantages of less bleeding, less damage, less visible swelling, shorter recovery time, and good patient tolerance make this technique widely used in Europe and the United States.
Although laser lipolysis-assisted aspiration has better aesthetic effects and fewer complications, it is still an emerging technology, and treatment specifications need to be further improved in practice, and its long-term effects need to be further observed. Laser lipolysis cannot completely replace traditional liposuction due to the disadvantages of expensive machines, high noise level and inconvenient surgical operation, and is only used for lipolysis of small volumes of cellulite or minor adjustments after other liposuction procedures.
Electronic liposuction was invented and launched in Italy in 1994 after years of research. The principle of this technology is that the high frequency electric field liposuction machine generates a high frequency electric field between two electrodes, relying on this high frequency electric field to break up the local excessive fat tissue masses, liquefy them into celiac-like and suck them out, about 1.5 kg of fat can be sucked out per treatment hour. Its clinical features can be set to a variety of intensities as needed, and different procedures are selected for fat and fibrous tissues of different toughness, which are applicable to all parts of the body for fat removal. Due to the local thermal coagulation effect of high-frequency electric field, electronic liposuction bleeds less, and there are only complications such as seroma subcutaneous stasis after surgery.
The suction head of high-frequency electric field liposuction machine is two kinds of thick needle holes, so there is no need to place drainage tubes in the trauma cavity after the operation, and the electrode entrance heals itself without sutures. The treatment process can be controlled by computer machine, which is convenient for clinical operation and postoperative record, and the postoperative satisfaction rate is high. However, the method also has shortcomings. The speed of fat removal is slower than that of negative pressure liposuction, and the fat extracted has been destroyed and cannot be used for fat transplantation. The machine and consumable materials are more expensive, and the handle and its connecting line are not conducive to long-time operation, which limits its clinical application.
Vibratory liposuction technology was first adopted by European plastic surgeons in 1997. It consists of a resonator that sends out resonant waves of a certain frequency to break up fat cells without damaging tissues such as nerves, blood vessels, muscles, tendons and skin, and the liposuction and lipolysis are performed simultaneously, which is safe and simple. Since its suction head can move back and forth rapidly, similar to the surgeon holding the suction head to pump back and forth, it reduces the labor intensity of the physician.
In the use of Harmony Resonance Liposuction, the concentration of lidocaine is reduced to 0.015% ~0.03%, which improves the speed and volume of perfusion, and makes the gap between fat tissues bigger and compresses blood vessels, so the suction tube is easier to suction freely, so the fat suction is more thorough and even, and the skin retraction is bigger and the surface is smoother after the operation. This method has the advantages of fast liposuction, less bleeding, large liposuction volume, satisfactory anesthesia, high safety, and smooth and flat skin surface after surgery.
The shortcomings of this method are similar to negative pressure liposuction, which can result in uneven skin, asymmetry on both sides, skin necrosis, hematoma subcutaneous fluid accumulation, delayed healing of incision, and dull skin sensation. Careful preparation before surgery, high-frequency B-ultrasound to detect and mark the local subcutaneous fat thickness and distribution, skilled operation during surgery, and close observation of postoperative changes can reduce the occurrence of postoperative complications.
Water jet-assisted liposuction (WAL) is a new type of medical liposuction device that was developed by the German brand Human Med in 2000 after electronic liposuction, negative pressure liposuction, ultrasound liposuction, resonance liposuction, and polygraphic liposuction, and was only completed in 2004. Its principle is to use the Body-jet hydrodynamic liposuction system to selectively separate fat cells and dissolve them in layers by using a spiral waterjet to inject infiltrating fluid into the fat tissue through a pipeline system under the action of a pressurized water stream. Using hydrodynamic liposuction and stratified lipolysis, the flow and pressure levels of the jets can be controlled by intelligent software to loosen the fat tissue with the least possible damage.
The released fat can be suctioned out with an independently operated cuffed negative pressure system. Simultaneous lipolysis and aspiration increases the efficiency of the operation without causing excessive accumulation of fluid in the body, minimizes damage to blood vessels and nerves, and the aspirated fat is less destructive and can be used for granular fat grafting, which has the advantage of rapid treatment results compared to syringe liposuction. The extremely short residence time of swelling fluid in the body greatly reduces the risk of medication and increases the total number of sites and areas that can be treated in a single liposuction procedure.
The low volume of swelling fluid injected and the low degree of tissue swelling improve the accuracy of the liposuction procedure, reduce the occurrence of asymmetric unevenness in the liposuction area, shorten the postoperative recovery time, and make the operation very labor-free. Related studies have shown that the water flow formed by WAL can selectively separate fat tissues and form delicate fat particles with a graft viability rate of up to 80%.
Radiofrequency-assisted liposuction uses radiofrequency to cause molecules and ions in the body to vibrate violently in a balanced position under the action of a high frequency electric field, and the thermal effect generated by mutual friction causes a series of physicochemical effects by uniformly heating the surface and deep tissues of the body. The thermal effect leads to fatty acid decomposition and apoptosis of adipocytes, and triglycerides are released from adipocytes.
Triglycerides are readily cleaved into free fatty acids and glycerol by the action of lipase (LPL). The free fatty acids (fat-soluble ones) are bound to serum proteins and transported to the liver; meanwhile water-soluble glycerol can be transported to the liver through intertissue fluids and eventually metabolized and excreted from the body. Studies of clinical applications have shown that subcutaneous radiofrequency liposuction is safe and effective for patients with moderate liposuction volume, with the advantages of good patient tolerance and rapid recovery, generally in about 6 weeks. As a new radiofrequency-assisted liposuction technique, its safety and feasibility and its advantages over traditional liposuction techniques need more clinical observation.
Power assisted liposuction (PAL) is a new technology that uses a new generation of mechanical power assisted liposuction equipment, the Power Assisted Liposuction (PAL) machine, to perform fat suction. The principle of PAL is that the handle converts compressed air into a combination of rotational and reciprocal movements of the liposuction needle, which effectively removes fat from its attachment site, making removal easier while maximizing the protection of non-fat components such as blood vessels and nerves.
The concentrated energy shock wave fat aspiration technique reduces the operator’s effort in the handle and allows more concentration on controlling the range and level of motion of the suction tip, making the aspiration area more uniform and consistent and reducing post-operative unevenness. The endoscopic view shows that the fatty tissue is completely removed, while the connective tissue remains intact in a mesh pattern. Liposuction by the polygonics method has the advantages of effortless operation, precise suction, easy depth control, and less hematoma and unevenness after surgery, which is especially suitable for some areas that require fine sculpting.
Lipodissolve: Lipodissolve was developed from mesotherapy (mesotherapy). Lipodissolve is a procedure in which drugs are injected into the fatty tissue to dissolve the fat. Drugs include vasodilators, cleansing carbon dioxide gas, non-steroidal anti-inflammatory drugs, enzymes, nutrients, antibiotics, and hormones, but the commonly used drug components are phosphatidylcholine (PC) and its emulsifier deoxycholic acid (DC).
The mechanism of action of phosphatidylcholine for local injection lipolysis is still inconclusive phosphatidylcholine is probably a bipolar molecule with both hydrophilic and lipophilic properties, and fat cells are emulsified by it and then hydrolyzed by tissue enzymes. It is very important to select patients with indications and to master the correct injection site. For patients with localized fat accumulation volume between 100 and 500 ml, lipolysis injection can be considered as a treatment option, and it can also be used to fine-tune the shaping of abnormal fat accumulation after other liposuction procedures or for other reasons. Although injectable lipolysis has its own unique advantages, the FDA has not yet approved this technique due to the lack of understanding of its mechanism of action and the long-term effects on tissue after treatment, which can result in complications such as blistering, skin breakdown, localized small vessel growth, and uneven contouring.