Early Liposuction

Early Liposuction

The first written description of liposuction was published by Fischer of Italy in 1977. Soon afterward the French surgeons Illouz and Fournier popularized liposuction using blunt-tipped cannulas. The common adverse sequelae of liposuction were excessive bleeding, prolonged recovery times and disfiguring irregularities of the skin. Preoperative infiltration of a small volume of vasoconstrictive solution of epinephrine into the targeted fat was termed the wet liposuction technique. Using no preoperative infiltration was known as the dry liposuction technique.

By 1982 several American dermatologists had been to France to observe Illouz do liposuction using anaesthesia together with a subcutaneous injection of a small volume of a hypotonic solution of epinephrine and hyaluronidase. For many years, general anaesthesia was a prerequisite for liposuction. The standard cannulas of 1980’s were huge, with diameters of 6 to 10mm and cross-sectional areas 9 to 25 times greater than todays 2mm microcannulas. Dolsky et al reviewed the development of early liposuction techniques and the associated complications.

By 1983 dermatologists were doing liposuction of lipomas, the submental chin, and limited areas of the body using general anaesthesia, epidural regional anaesthesia or heavy intravenous (IV) sedation supplemented by small volumes of local anaesthesia. The IV sedation usually consisted of disazepam (Valium) and a narcotic analgesic and the local anaesthesia 0.25% to 0.5% lidocaine (Xylocaine) with epinephrine 1:200,00.

With increasing experience, dermatologic surgeons gradually began to use larger and larger doses of lidocaine without signs of toxicity. Eventually they were routinely giving lidocaine doses two to three times the 7mg/kg maximum dosage specified by the FDA. The common, erroneous, explanation for this lack of toxicity was that liposuction removed the lidocaine before it could be absorbed into the patient’s blood.

In late 1984 Dr Klein a dermatologist, focused on starting a private practice and learning more dermatoligic surgery. At that point, he had years of advanced training and study of other areas of medicine. In retrospect, two master degrees (mathematics as well as public health biostatistics) 2 years as a National Institutes of Health research fellow in clinical pharmacology and board certification in internal medicine provided the level of experience and knowledge that produced the concept of the tumescent technique.

Ironically, I had mixed reactions on first hearing about liposuction. Larry Field, a pioneer of modern dermatologic surgery, convinced Dr Klein that liposuction was destined to become an important dermatologic surgical procedure. In February 1985 Dr Klein attended a liposuction course given by Gary Fenno and sponsored by the American Society for Liposuction Surgery. None of the faculty had done liposuction by local anaesthesia, which was thought to be impractical, if not impossible. The plastic surgery literature stated without discussion that liposuction required general anaesthesia.

In April 1985, using local anaesthesia, Dr Klein performed his first liposuction procedure. By the end of that year an elementary form of tumescent liposuction with intramuscular (IM) diazepam sedation and meperidine (Dermerol) analgesia had evolved. I
He first described the tumescent technique at the Second World Congress of Liposuction Surgery sponsored by the American Academy of Cosmetic Surgery held in Philadelphia in June 1986. The first article describing the tumescent technique was published in the American Journal of Cosmetic Surgery in January 1987.

Subsequent years have seen continual improvement. With the tumescent liposuction technique is now a procedure of exceptional finesse and gentleness that is accomplished totally by the local anaesthesia.