by Liz Finch
Plastic Surgery Products Magazine, February 2001, pages 66-68
edited by Dean P Kane, MD, FACS
Fifteen years ago, the purpose of liposuction was to get rid of fat pads in areas where they could not be removed naturally. Liposuction is still the number one procedure done in the United States, but the technique is now being used by some surgeons less for simple fat removal and more for sculpting areas of the body. Called body contouring, this focused approach allows surgeons to create a detailed, overall effect on the physique rather than approaching surgery body part by body part.
Body contouring is a higher level of liposurgery," says Lauri Kane, RD, MPD, ScD, who is in charge of patient education at The Center for Anti-Aging Medicine and Cosmetic Surgery, Baltimore, where her husband, Dean Kane, MD, FACS, CWS, performs a lot of body contouring work. "There is a new generation of people who work out and want to see the muscle structure. With body contouring, we create lines so the patient can see that muscular definition. It's amazing."
"We do body contouring on people from a size zero to a size 24. The size zeros have these little tiny pockets that they can't get rid of, and that's where body contouring came from," Lauri Kane says. "You're not just removing fat, you're contouring muscle. It's a detail, and that's an art."
The tumescent technique is preferred in body contouring, and involves administering a combination of vasoconstrictors, local anesthesia, and large amounts of intravenous saline solution. The mixture is infused into unwanted fatty areas, expanding the fat cells off the underlying muscles and vital organs to allow for a smoother passage of the cannulas through the tissues. The vasoconstrictor also decreases bleeding so almost no blood is lost, even when large amounts of far are removed at once.
Dr. Kane opts for smaller cannulas as well, but prefers syringe lipoplasty, especially on smaller body contours and on smaller women.
"The syringe is used on areas that are more delicate in definition, such as the pectoralis muscle and around the neck," Lauri Kane says. "He uses the power vacuum in combination with that for larger areas. He also uses a multiple stab incision approach, which reduces waviness and means less soreness for the patient."
Body contouring techniques are used on all areas of the body, and can supplement liposurgery to achieve more specific results. During breast reductions and breast lifts, Dr. Kane usually contours the side of the breast under the armpit, where it tends to be full in both men and women. This helps create a balanced breast appearance on the torso.
"When he does a full trunk liposuction, he will contour that armpit area as well, even if he is not doing anything for the breasts," Lauri Kane says.
For men, body contouring can be used to outline the pectoral muscles, giving the muscle look that men like. In cases of gynecomastia, the breast tissue is removed and liposuction gives the breast and pectoral muscles a defined, detailed form. Lauri Kane says contouring techniques also work especially well on the triceps and biceps.
"I had my arms done in May, and I had been working on my upper body for years and couldn't get that definition," she says. "Now it's beautiful and natural, and I can see the contour."
Contouring work also is done on the face, where Dr. Kane uses tiny cannulas to reinsert fat back into the face and the jawline.
"We can liposuction the area right below the cheek to the jawline to maintain a high, full cheek, but contour the face down so it is more tapered in a way that accents the cheeks," Lauri Kane says. "We also can define the neck using the same cannulas.
It is important to have a good liposurgeon for this work, however, and for the surgeon to not overdo it," she adds. "You see those results. Once you contour too much, it can create an indent. You can try to refill that with far, but fat dissipates after about a year."
A controversial facet of body contouring concerns the amount of fat removed at any one time. Dr. Kane is known for his large volume liposuction, and he will do up to 10 liters of fat removal on a complete body. Such high-volume candidates have to be in generally good health. Dr. Kane does not do high-volume liposuctions on patients with risk factors such as diabetes or cardiovascular disease.
"So far, we have not had a complication, and one reason why we have not is our safety precautions," Lauri Kane says. "We take two pints of the patient's blood prior to the procedure, and we only do procedures in a hospital setting. We keep an IV of fluid in their arm, and a catheter, and we monitor fluids for 24 hours. Then we give the patient back their blood the evening after the procedure.
"That has really been amazing, because it allows the patients to recover really well," she says. "The first time we did a high-volume procedure without doing that, the patient's hematocrit just dropped and it took several weeks to get back to normal. Now they bounce back generally equal to any other liposuction patient."
Another controversial aspect of body contouring is the relatively new use of ultrasound-assisted lipoplasty, commonly known as "UAL," a technique that uses sound waves to liquefy unwanted fat. UAL was developed in Europe in the 1970s by an Italian surgeon, Michael Zocchi, and American plastic surgeons began using it in the early 1980s. Although it is used by many surgeons, UAL is not without its detractors.
Dr. Kane agrees that a high level of training is needed for ultrasonic, because it can burn the skin, but says the technique is valid. A panel developed by the American Society of Aesthetic Plastic Surgery has even been formed to study the use of UAL in order to reduce complications.
"There are complications, but those who have not properly been trained or don't have experience are the ones who get complications," Dr. Kane says.
"It vibrates at a high degree to liquefy the fat," Lauri Kane says. "It works great when the fat is intertwined with fibrous tissue, like back area, particularly for men, because male fat is more intertwined than most female fat, which is a softer type of fat. The traditional tumescent technique doesn't soften the fat around muscle as well for men, so ultrasonic works like a charm. It has made the procedure easier."
Dr. Kane uses the ultrasonic method only in areas of high-density fibrous tissue, like the back, upper abdomen, chest wall and lateral thigh. He typically uses the syringe technique instead of the vacuum machine pump.
"It is more work, and it is harder to do, but Dr. Kane feels he has better control when doing it all by hand," she says.
No matter what the chosen technique for body contouring, surgeons who practice this art agree on the important role of Post-Operative care.
"Post-op care is almost as important as liposurgery," Lauri Kane says. Dr. Kane is very strict about the use of compression garments, and requires his patients to wear them 24 hours a day for six to eight weeks.
Light exercise can be resumed in three weeks and full exercise can continue in four weeks. Lauri Kane says a change in eating habits and exercise also improves results.
Liz Finch is a contributing writer for Plastic Surgery Products.