LIPOSCULPTURE

Since Fournier and Ilouz introduced the liposuction technique at the beginning of 80’s, this has been modified significantly.
When it was first described by Ilouz, it consisted in making an incision of 1 cm and using a 10 mm cannula suction the fat from the deep plane of the hip avoiding irregularities. The drawback of the initial Ilouz’s technique was that the skin with all that fat still attached was unable to retract properly because the suction was performed too deeply, moreover a single incision was placed within the gluteal fold and doing so some tunnels in a fan shaped manner was performed and although they were deeply placed some wavy irregularities were produced.
In 1986, I wrote a book entitled “Liposuction in Aesthetic and Plastic Surgery” edited by Salvat ed, in which I described the necessity of performing liposuction much more superficially, using thinner cannulas and accessing from 2 incision for each area separated by 90 degrees in order to cross the tunnels reproducing a mesh and regularizing the surface. This technique was the beginning of the currently named Liposculpture. Afterwards, Gasparotti systematized the superficial liposuction with thin cannulas and a protocol was elaborated explaining the better skin retraction and adaptation. This was called liposculpture.

Liposculpture is about suctioning the fat just under the skin using very thin cannulas crossing the tunnels and leaving very small scars. With this technique we are able to remodel, shape and “sculpt”, removing the exceeding fat. The advantage of the technique is that performing the suction in a superficial plane the skin is left thin and detached allowing better retraction. This remodeling is performed within very localized areas like the hip, inner aspect of the thigh, inner aspect of the knee, but in small surfaces.
In the postoperative period, the patient wears a compressive garment and goes back to a normal lifestyle with minimal discomfort during 2 or 3 days.

Liposuction in especial zones
In our Institute, we pay especial attention to liposuction in some zones that are not classically demanded when performing standard liposuction, but the contribute very significantly to enhance the final outcome. Traditionally these areas were not operated on considering the possible complications such as skin dropping, irregularities and so on:

• inner and posterior aspect of the arm
• sacral zone
• inner aspect of the thigh
• inner and anterior aspect of the knee
• around the ankle

1- Inner and posterior aspects of the arm: Classically, the accumulation of fat localized within the inner and posterior aspect of the arm was not treated by liposuction considering often development of skin dropping or sagging after surgery. The introduction of ultrasound liposuction generating a remodeling subcutaneous scar and proper skin retraction, avoids inconveniences related to previous techniques providing excellent aesthetic outcomes.

2- Sacral zone: Ultrasound liposuction is performed in this area just above both gluteus describing a fan shaped area with the vertex inferiorly directed, in order to eliminate the fat in this area to improve the profile of upper gluteus remodeling them providing an attractive and good result. Both gluteus are highlighted at the same time that the fat in this area is removed.

3- Inner aspect of the thigh: Classically, this area did not undergo liposuction since the skin is very thin and skin sagging was the rule after performing liposuction. Currently, we treat this area using ultrasound liposuction and accessing into the area from 3 different ports, groin, upper and lower part of the thigh. In this way, we can cross the tunnels and obtain a remodeling subcutaneous scar providing a retracting skin avoiding skin sagging in these areas. Ultrasound liposuction performed in inner aspect of the thigh associated to proper three dimensional design of the tunnels provides excellent aesthetic outcomes avoiding skin sagging.

4- The knees: Precaution must be taken treating this area working superficially. Usually, the zones presenting more fat deposits around the knee are the inner and anterior aspects. To access this zones we use a small incision placed within a small depression located between semimembranous and semitendinous tendons, hiding the scar. We suck the fat where it is needed an in some cases we make several mini-incisions to fulfill complete suction of the knee always considering avoiding aggressive suction in the anterior aspect, just above the knee, since a wide tendinous band as a roll can appear in men.

5- The ankle: the image of “column” looking legs very typical in women with fat deposits around the ankle can be solved by cautiously performed liposuction. Circumferential liposuction must be avoided to prevent skin impairment. We preferably treat the posterior and inner aspect, mainly below the inner calf. If anterior and outer aspect liposuction has to be performed we prefer to do so in a posterior session. In this way, we achieve to outline and shape the ankles eliminating the “column” looking legs. We have to consider that the liposuction in this area is followed by important edema with recovery time of 1 or 2 months; during that time the patient must wear a strongly compressive stockings. Currently, normal looking compressive stockings can be found, and the patients can still wear it with usual clothes without bothering them. Performing the treatment properly and with precise postoperative cares the resulting outcomes are very good.