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10.2.3.2 Background on Liposuction
The surgical technique of removing fat through a small incision using suction was
developed by Dr. Giorgio Fischer, a gynecologist from Rome, Italy, in 1974. His
instrument, the planatome, contained an electric curette that would cut the fat before
suctioning the tissue. Liposuction was popularized with a lipoplasty technique dem-
onstration by the French surgeon, Dr Yves-Gerard Illouz, at the 1982 annual meet-
ing of the ASAPS. The Illouz method involved suction-assisted lipolysis after
infusing fl uid into tissues using blunt cannulas and high-vacuum suction generated
by a mechanical pump system (Illouz 1983 ).
Classical liposuction consists of two types of techniques as described in the lit-
erature, namely, the wet or tumescent and the dry technique. Both techniques are
currently being used in clinical practice. The wet/tumescent technique was devel-
oped to reduce excessive bleeding to <1 % compared to the 30 % observed with the
dry technique and was introduced by Klein in 1978 (Agostini et al. 2012 ). Better
known as the tumescent technique, this type of liposuction involves infusion of a
saline solution containing a local anesthetic agent and/or epinephrine (adrenaline)
into the subcutaneous tissue that allows for regional anesthesia and vasoconstriction
before removing both the liquid and tissue using suction. This technique improves
on the safety of large-volume liposuction (>1500 ml of adipose tissue) by decreas-
ing blood loss at donor site (Klein 1993 ). The initial dry technique only involves
suction or assisted suction (by mechanical pump) of adipose tissue without prior
infusion of the tumescent or Klein solution and is therefore known to harvest virgin
lipoaspirate (Gimble et al. 2007 ; Herold et al. 2011 ; Klein 1987 ; Coleman 2001 ;
Tommaso et al. 2012 ). Finely minced tissue fragments are produced by both tech-
niques, where the size of the fragments is dependent on the dimensions of the can-
nula used (Gimble et al. 2007 ).
Over the past three decades, liposuction techniques have become more refi ned
with improved patient safety. The emergence of new technologies however demands
critical evaluation of basic science and clinical outcomes of these modalities, and
these include the super-wet technique , ultrasound-assisted liposuction , power-
assisted liposuction , laser-assisted liposuction , and water-assisted liposuction
(Ahmad et al. 2011 ). Most ASAPS members currently in practice, with experience
in different types of liposuction techniques, prefer suction-assisted liposuction to
ultrasound-assisted liposuction and power-assisted liposuction (Ahmad et al. 2011 ).
The difference between a wet and super-wet technique is in the amount of wetting
solution injected prior to lipoaspiration. Fodor expanded the wet/tumescent tech-
nique concept to the super-wet technique, by introducing large volumes of wetting
solution in a 1:1 infi ltration-to-aspiration ratio, prior to aspiration (Fodor 1995 ).
It was confi rmed that laser-assisted liposuction negatively impacts the biology of
ASCs and is therefore not preferable for tissue engineering purposes with
suction- assisted liposuction being the preferable technique (Chung et al. 2013 ).
Recently it was shown that water-jet-assisted liposuction yields more viable ASCs
in the SVF compared to tumescent- and ultrasound-assisted liposuction, but less
viable ASCs compared to the Coleman harvesting technique (Meyer et al. 2015 ).
F.A. van Vollenstee et al.