Last year, liposuction took the top spot as the number-one procedure performed around the world. It’s considered the gold standard of fat removal, and it’s a powerful tool for reshaping and contouring all areas of the body. The almost 100-year-old surgery may have had a sketchy start, but it’s come a long way. Modern-day advancements have made it a significantly safer experience capable of producing beautifully sculpted results.
A Scary Start
The first-ever surgical fat-removal surgery was performed by French surgeon Charles Dujarier. He operated on a young model and ballet dancer who wanted to slenderize her “unbecoming legs.” San Francisco plastic surgeon Steven Williams, MD says the procedure went “terribly wrong” and ended in an amputation. “He attempted to contour the lower body through skin and tissue excision, but the procedure resulted in significant tissue death.” Dr. Dujarier was sued and jailed for two years for performing an illegal surgery. “Interest in body contouring dwindled and no one did liposuction for about 30 or 40 years,” adds Dr. Williams.
Father and son Italian gynecologists Drs. Arpad and Giorgio Fischer developed a blunt tunneling technique that eventually evolved into the liposuction we know now. Using a blunt cannula with rotating scalpels attached to a vacuum device, their new method allowed for better results and fewer side effects. Early liposuction procedures were only performed on the thighs. “Prior to the development of liposuction, body contouring, especially of the buttocks, thighs and abdomen, left significant scarring behind,” says Fort Myers, FL plastic surgeon Ralph R. Garramone, MD. “This new technique presented an alternative body-contouring method without scarring. It allowed the treatment of relatively large areas with just one or two small incisions.”
It was so easy. It made me feel better in dresses; I felt more confident.Chrissy Teigen on arm lipo
Late ’70s—Early 80s
What really transformed the surgery was the introduction of using fluid to spread out the fat, and medication to constrict the blood vessels, says Dr. Williams. “This made liposuction much safer.” In 1978, French physicians Yves-Gerard Illouz and Pierre Fournier modified techniques to reduce the sedation and morbidity risks. Dr. Fournier pioneered the use of lidocaine as a local anesthetic during the treatment, and Dr. Illouz’s “Illouz Method” (also known as the “wet” technique) involved injecting a large amount of a saline solution to numb the area and swell the fat cells, making them easier to suction out. This helped reduce blood loss and damage to the nerves and blood vessels. “Using tumescent fluid improves efficiency and results with less bruising,” explains Dr. Garramone.
“In the early 1980s, liposuction went from a procedure primarily used in Europe and not generally accepted in the United States to the most commonly performed cosmetic procedure in the world,” recalls Dr. Garramone. Many American dermatologists made significant contributions, too. Denver dermatologist Joel Cohen, MD says, “Dr. Jeffrey Klein applied the tumescent technique to liposuction in 1985, which allowed it to be done safely on awake patients under local anesthesia.” Dr. Klein also used smaller cannulas and reduced the amount of saline solution injected. This technique became popular because it was less invasive, less painful and had fewer side effects. To safely remove larger volumes of fat, Dr. Fournier developed the “super-wet” technique, which calls for injecting a saline solution that is equal to the amount of fat removed.
The “Lipo” Boom
According to the American Society of Plastic Surgeons, there were 3,500 liposuction procedures performed in 1985. A decade later, that number jumped to more than 180,000, and by 2005, more than half a million fat-removal procedures were performed annually. In the mid-’90s, ultrasound-assisted liposuction using high-frequency sound waves was invented. In the early 2000s, the widely used power-assisted liposuction was introduced. It involves using a vibrating cannula to break up fat cells before suctioning them out. “Powered instruments allow for less surgeon fatigue and make the procedure less traumatic to the body, which leads to a quicker recovery,” says Dr. Garramone. In the 2000s, laser liposuction, which uses laser technology to liquefy the fat, was also developed.
Modern liposuction techniques have evolved to become less invasive, more precise, and more effective. New technologies have helped improve the accuracy, safety, pain management and recovery. There’s also less stigma attached to getting a little tune-up. Celebrities like Chrissy Teigen, Dwayne “The Rock” Johnson and Susan Sarandon have all openly talked about their treatments. Today, many body-contouring experts will also “stack energy” to help tighten skin to enhance results. “Stacking technologies with liposuction like laser, helium plasma, or radio-frequency energy can help with skin retraction, but can also increase the risk of skin burns,” says Eugene, OR plastic surgeon Mark Jewell, MD. No matter the technology used, Dr. Williams adds that it is the physician’s experience, skill and sculpting techniques that lead to the best results.