Liposuction in cosmetic dermatology

A journey through liposuction and liposculture: Review

INTRODUCTION

Nowadays, liposuction is the most frequently performed aesthetic surgery procedure in Western Countries. This technique has had rapid development since the 1970s, when it was experimented for the first time by A. and G. Fischer. It is currently widely used in clinical practice for many different situations in aesthetic, reconstructive and functional fields.

MATERIALS AND METHODS

This review aims to describe the historical evolution of liposuction by analyzing the transformation of the method in function of the introduction of innovative ideas or instruments. We have also focused on reporting the major clinical applications of this surgical technique, applicable to almost the entire body surface. We finally analyzed the complications, both major and minor, associated with this surgical technique.

RESULTS

Liposuction is mainly used to correct deep and superficial fat accumulations and remodel the body contour. It has become an essential complementary technique to enhance the aesthetic result of many other aesthetic procedures such as reduction mammoplasty, abdominoplasty, brachioplasty, thigh lift and post bariatric body contouring. However, it can be largely used for the treatment of innumerable pathologies in reconstructive surgery such as lipomas, lipedema, lipodystrophies, pneudogynecomastia and gynecomastia, macromastia e gigantomastia, lymphedema and many others. The complication rate is very low, especially when compared with conventional excisional surgery and the major, complications are generally associated with improper performance of the technique and poor patient management before and after surgery.

CONCLUSION

Liposuction is a safe, simple and effective method of body contouring. It has enormous potential for its application in ablative and reconstructive surgery, far from the most common aesthetic processes with a very low complication rate.

The body as art

For millennia people have altered the appearance of their bodies with cosmetics, jewellery, tattoos, piercings, and other surgical procedures. It would appear that they wish to conform to a perceived 'ideal body', although the actual appearance of such a body is subject to temporal, cultural and geographical change. In contemporary society the media are largely responsible for providing the yardsticks against which individual body shape is measured. Today the desired form is generally young, slim, tanned and blemish-free. Sadly, dissatisfaction with body image can be the source of great unhappiness and may even lead to suicide. Interested scholars have debated the meaning of beauty for centuries but it seems that every human society has its own standards. At the simplest it would appear that youth and symmetry are the most highly prized ingredients. There is no doubt that those who fit the conventional standards of attractiveness are treated better by society. Individuals have an inalienable right to their own body appearance, and to alter it as they see fit, however such modifications may not always be in their own best interests. Practitioners of cosmetic procedures must be alert to clients with histories of weight fluctuation, unrealistic body image, or low self-esteem. Psychological disorders may present with dysmorphophobic symptoms. Doctors providing cosmetic services need to be adept at diagnosing psychological illness.

Implantation of primary cultured adipocytes that secrete insulin modifies blood glucose levels in diabetic mice

AIM/HYPOTHESIS

In type 1 diabetic patients, basal insulin supplementation plays a central role in tight glycaemic control. Therefore, safe and steady supplementation of basal insulin is strongly desirable, despite the need for multiple injections. The aim of this study was to investigate a procedure for supplementation using genetically engineered, primary-cultured adipocytes in diabetic mice.

METHODS

Furin-cleavable human proinsulin cDNA was transferred into murine primary-cultured adipocytes using a retroviral vector. The cells were implanted subcutaneously into streptozotocin-induced diabetic mice.

RESULTS

The transfected cells secreted substantial amounts of mature insulin, as well as C-peptide, into conditioned medium. Syngeneic implantation of the cells significantly improved hyperglycaemia and blood HbA(1)c concentrations in a manner that was dependent on cell number, without causing hypoglycaemia. The plasma insulin concentration was dependent on the implanted cell number, and the systemic effect of the circulating insulin was confirmed by marked improvement of body weight reduction and liver glycogen content. Additionally, surgical resection of the implants, in which the insulin secretion was immunologically confirmed after transplantation, diminished the glucose-lowering effect, suggesting that in vivo expression could be eliminated if necessary.

CONCLUSIONS/INTERPRETATION

These results indicate that the autotransplantation of functionalised adipocytes may lead to a clinical application in the treatment of diabetes.

Liposuction for axillary hyperhidrosis

Excessive axillary sweating is a common problem for which many patients frequently seek dermatological advice. The removal of axillary sweat glands using liposuction with tumescent anaesthesia in an outpatient setting is a relatively short and simple procedure with few complications, as seen in this case series. We present 10 patients treated with axillary liposuction under tumescent anaesthesia. Of the 10 patients treated, four relapsed with axillary hyperhidrosis and required additional liposuction to the same area. The longest time to relapse was 15 months, with 4 months being the shortest time. Six patients have not required additional liposuction, with 7 years being the longest time of remission. The complications reported were bruising in the axillae of two patients and relapse of hyperhidrosis in four patients.