From Blunt Cannulas to Pulsed Focused Ultrasound Energy – The Ever Evolving World of Body Sculpting
From Star Wars to the first Apple computer going on sale, the late 70s was also the time when women’s fashion was wrapped in a silky wrap dress from Diane Von Furstenberg. If you had any fatty bulges on your buttocks, tummy or thighs, you were either starving yourself or booking a tummy tuck that left you recuperating in a hospital bed for a week.
One Parisian surgeon was striving to change all of that, Dr. Yves Gerard Illouz. His style may have been considered rude at that time, but he was offering his patients the option to lose fat without an open surgery or scarring. Nobody would have believed at that time that he would bring huge changes into the plastic surgery world.
Illouz and his invention
What we know as Liposuction today was a technique invented by Dr. Illouz. He may not have pioneered the technique, but he catapulted into the international scene in the late 70s with his innovations. Body contouring was permanently changed with his revolutions and, in fact, it found uses in aesthetic and reconstructive surgery. The popular fat grafting of today is also based off of these innovations.
Even though forays were made into fat sculpting way back in the 20s, there were varied results and unending complications. Dr. Illouz introduced an effective, yet safe, methodology in liposuction. His method involved suction-assisted removal of fat cells through tiny incisions. Cannulas were used for injection of fluid for breaking up the fatty deposits. Before this, sharp curettes were used in the absence of suction, which lead to massive swelling and bruises.
Along with the evolution of new methods, new anaesthetic techniques also evolved, which reduced and even eliminated adverse results. Today, Liposuction is a safe and increasingly popular procedure with many uses in aesthetic, as well as, reconstructive procedures.
The Beginning of Lipoplasty
The ‘Aesthetic Surgery Journal’ published a detailed journey of Lipoplasty in 2009 as chronologically penned by Los Angeles plastic surgeon, Peter Bela Fodor. He said that Illouz was responsible for the monumental advancement of Lipoplasty. The biggest contribution was the blunt cannula for fat removal, which did not interfere with the other structures when under the surface of a patient’s dermis. This significantly reduced complications, making it a reproducible procedure in the hands of surgeons.
Another one of his inventions was the bullet shaped cannula (Mercedes), which was realized as a technique that could be adapted for use in various body parts, making it the mainstay of aesthetic surgery. He introduced his technique in the US in 1982, allowing for a surgeon to safely remove 2 litres of fat from the body. This is comparatively small to the 5 litres noted in the guidelines set by the American Society for Aesthetic Plastic Surgery.
He may not be able to speak fluent English and his presentation was considered sloppy and unprofessional, but his famous lecture in Hawaii turned the history of plastic surgery in many ways. American dermatologists and plastic surgeons started experimenting with his technique and different sedation techniques were developed that eliminated any need for general anaesthesia.
Mark Gorney, the then President of the ASAPS, constituted and sent a Blue Ribbon Committee to visit and observe Illouz at work. They published a report on their return with extensive recommendations, including safety. Teaching courses were then organized across the US.
Liposuction began as a procedure by 1983-84 with an 8mm cannula that was connected to an aspirator. Liposuction is the most important development of aesthetic surgery and is undoubtedly in the top 10 of all top innovations in plastic surgery. Fat reduction is a billion dollar industry and still growing exponentially.
Liposuction is also believed to be the predecessor to fat grafting and stem cell research. Harvested fat is being reinjected for cosmetic and reconstructive procedures globally. The adipose stem cells that have been extracted have shown good future uses in tissue engineering.
Today’s plastic surgeons cannot imagine a practice with the absence of Liposuction. Currently, you could opt for suction based, power assisted, ultrasound assisted, laser assisted, water and radiofrequency assisted liposuction. The technique and technology used depends on the characteristics of the patient and what the surgeon prefers. Most of Illouz’s techniques are still in use today, including favourable areas and techniques.
Dr. Fodor is a leader in body contouring procedures and according to him, liposuction is comparable to tissue expansion in its magnitude and also to microvascular surgery. Liposuction is the most commonly performed aesthetic procedure and has been vying for the first spot with breast augmentation for over a decade now.
A group of surgeons including Illouz, Fodor and others formed the Lipoplasty Society of North America (this was later merged into the ASAPS). As per them, patients were getting lipolysis (liposuction) procedures done in Europe, but surgeons in the US didn’t believe in its possibility until they could duplicate Illouz’s results for the very first time.
Wendy Lewis in Paris
Wendy Lewis, the president of Wendy Lewis & Co. Ltd., Global Aesthetics Consultancy heard of Illouz and his technique when she entered the world of plastic surgery. It seemed like a dream come true for a woman−knowing you could walk into a surgeon’s office with a bulge of fat and wake up with it gone! Those days, liposuction was not the minimally invasive technique of today; but it required general anaesthesia, blood transfusion, hospital stay, and even then, you felt and looked like you had been in an accident.
In the early 90s, she had attended several national meetings where Illouz has shown his methods and finally decided to travel to Paris to see him. She wrote to him and he invited her to his clinic. It was the first time she would watch a surgery being performed outside of the US and by the master of liposuction himself; undoubtedly she was excited. Before Dr. Illouz even entered the operating room, his patient was already anesthetized by his anaesthetist and he suctioned her fat away. Once he had removed the amount of fat he figured was safe, he simply exited and his able staff were left to suture the patient’s incisions. It was time for some lunch and then some more suctioning later.
The efficient running of the clinic amazed Wendy. His team was skilled and they set up his patients, anesthetized them and his skills were only required during the actual contouring procedure. Europe was witnessing an era in cosmetic surgery were the patient rarely questioned a surgeon’s authority.
Illouz performed surgeries at his clinic from 1975 to 1988 and he helped thousands of women from across the globe re-contour their bodies. It came to be known as the Paris Aesthetic Clinique Spontini in 2003 and there is a plaque honouring him in the waiting room.
In 2014, ASAPS reported 342,494 liposuction procedures performed on men and women – making it the most popular surgical procedure. On a yearly basis, all body procedures have seen a large growth in volume. Non-surgical procedures for fat reduction increased by 42%, Labiaplasty saw a rise by 49%, whereas butt augmentation increased by 86%.
Michael Edwards, the President of ASAPS, while reflecting on Illouz’s contributions says, “We stand on the shoulder of giants,” stands true in the case of surgery. Dr. Edwards explains the development of liposuction into a safe procedure today, which offers better cosmetic results when performed by well-trained surgeons. The occurrence of complications is certainly minimal.
Dr. David Hidalgo, a New York City plastic surgeon, believes that without the contributions of Illouz, plastic surgery as we know it today wouldn’t have existed. The limited procedures of lipoplasty from 35 years ago have been refined to universal applications in both reconstructive, as well as, aesthetic surgery. Illouz had the ability to adapt an existing tool to an entirely different problem, giving the world invaluable new possibilities. Today, the body contouring cannula is a tool as common as sutures or scissors for the surgeon.
Until the vast expansive scope of liposuction was realized, pioneers in liposuction were considered mere fringe players. New options of treatments were opened up from the head to the toe of a patient with liposuction.
A by-product of this fat removal methodology was replacement of fat. Patients now get the option of injecting fat into their faces, such as in the nasolabial folds. Fat grafting and fat injections have evolved rapidly in the hands of many surgeons offering facelift procedures.
Another expert opinion from Dr. Steven Teitelbaum mentions how body shaping has evolved in the last 40 years. With new developments, liposuction techniques have improved, offering safer methods with minimal blood loss or pain and other associated complications. We have achieved a lot and modern techniques continue to refine liposuction procedures.
Body contouring depends on non-invasive technologies, these are liposuction techniques which remove fat and lessen the requirement for long scars, generally associated with surgical processes. The two significant advancements in non-invasive fat reduction are considered to be cryolipolysis and high-intensity focused ultrasound.
With the advancements today, patients have several alternatives to surgical body shaping procedures. UltraShape® is one non-invasive, painless body contouring procedure which requires no downtime.
Fat reduction will always remain a desired way of eliminating unwanted fat. The key for surgeons is to determine the ideal patient who qualifies for a non-invasive method or who would benefit more from a tumescent liposuction using local anesthesia. Most patients in Tampa, Tampa Bay, Lakeland, Brandon and Riverview, FL prefer non-invasive methods for its proven results.
New advances have not overshadowed the benefits of liposuction. Most surgeons, if given a choice, would still choose traditional liposuction. Non-surgical procedures undoubtedly have benefits, however, they do not allow the surgeon to sculpt. Your surgeon can merely “debulk” an area for you with non-invasive methods. Regardless, we will surely see new and exciting technology for non-invasive modification of fatty deposits.