SUPERFICIAL LIPOSUCTION
ÓPJWMDPA
Patients, especially
those in California, have been made aware by advertisements of the technique
called superficial liposuction since the mid to late 1990's. This is
another case of doctors and surgeons trying something "new" on the public
without testing it thoroughly on animals or with proper studies. Unfortunately,
the unsuspecting public is placed in danger because "new",
improperly tested or untested ideas, have been disseminated via the
media and mass advertising/marketing.
The face and neck have
a blood supply that is totally different from that of the rest of the
body. Surgeons who are experienced in doing face-lifts realize that
in many instances, they can snip and cut very close to the undersurface
of the skin of the face and yet not end up with patches of blood vessels
or pigment after the face-lift is done. In fact, this is the way much
standard face-lifting is done. However, the rest of the body is different.
Damage too high or close to the skin in non-facial tissues can cause
scarring or other unwanted visible changes in the overlying tissues
or skin.
Many surgeons became
unhappy with their liposuction results in patients who were a bit older
(many over 50 years of age). This was because the patient's skin became
even saggier or remained saggy following the removal of deeper fat.
If a surgeon were to remove all the fat pushing out against the skin
in older patients, the skin would usually not contract well after liposuction.
Wrinkles and bruises more commonly form in older patients following
typical liposuction procedures. As long as the patients were aware that
they would look better with "clothes on" as opposed to "clothes off,"
most patients were happy. However, some California surgeons felt that
it would be a good idea to try to perform the liposuction superficially,
or "high-up," where the dermis
meets the subcutaneous
fat. Doctors have long known that by damaging
the dermis, or leather layer of the skin, that the skin layer would
tighten and contract in response. The high-up (superficial) liposuction
was heavily marketed, as opposed to liposuction that involved removal
of fat from the traditional location, which is in the lower to mid-fatty
layers. Superficial liposuction near the surface of the skin may damage
small blood vessels and nerves leading to the dermis (leather layer
adjacent to the surface epidermis of the skin). The initial results
of the contraction on some patients may have looked good, and the skin
may have appeared "tighter." However, in many cases, the superficial
liposuctions caused the overlying skin to die, leaving holes and ulcers
that eventually scar. More commonly, over time patients receiving superficial
liposuction were seen to develop strange, net-like collections of blood
vessels under the surface of the skin as well as pigment discolorations.
These collections, discolorations, and formations of blood vessels are
unsightly, and unfortunately likely permanent. Many times the unwanted
changes do not arise right away. The author feels that some of the problems
associated with superficial liposuction are the result of stripping
the nerves that control the blood vessels that feed the surface skin.
This is followed by new blood vessel formation in irregular, net-like
patterns, as well as by the loss of the nerve control that governs whether
the remaining blood vessels will be properly closed or opened (dilated).
Some of the cases of
surface skin death (necrosis) and scarring that appeared in a linelike
or starlike pattern may have been caused by surgeons who suctioned and
rasped too close to the dermis (leather layer) of the skin. It appears
that the tiny blood vessels feeding the dermis may be cut or damaged
by the tearing effect caused by turning the suction hole of the cannula
upside-down and applying a vacuum on the delicate underside of the dermis.
The author feels that this cluster of bad results, seen over the last
six years, as a result of "superficial" liposuction will be a "fad"
phenomenon. Why? Doctors usually hear about the newest techniques at
meetings (usually before publication in the medical literature), where
there is intelligent and open debate before an article comes to press.
A certain new surgical technique might work well in four of five people
in the hands of the doctor who invented and spoke on the new technique.
But when the less-experienced doctors in the audience try the new technique
on patients, the problems mount. Besides, a 1 in 5 chance of a problem
is too high for cosmetic procedures; and if you multiply that by 1000
patients, that's 200 with problems. Bad results mount, word spreads,
ways to correct the problem are sometimes found, and if not, the procedure
is abandoned. "Superficial" liposuction began to be discussed at medical
(liposuction) meetings in the mid 1990's; it was even marketed and advertised
to the public, especially in California. Bad results are mounting, but
some doctors, are still performing the procedure. Eventually, the use
of a flawed procedure should naturally decline (to zero), unless there
is an improvement in the procedure. Many of today’s lifesaving
procedures are improvisations of what started out to be risky procedures;
take triple coronary bypass surgery, for example, which is now one of
the greatest lifesavers. The problem is how to decrease the bad effects
of "cosmetic experimentation" on the public.
The author feels that
the current practice of superficial liposuction may be undesirable for
use in most areas of the body, with the exception of the face and neck.
This is because of the difference between the vertical and horizontal
flow of blood in vessels in these body locations allows some superficial
suction there.
