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How Liposuction Works
Conceptually, liposuction (or lipoplasty) is a straightforward technique in which excess fatty tissue is suctioned from beneath the skin. Prior to surgery, doctors flush the targeted area or areas with a solution composed of lidocaine (a local anesthetic similar in its numbing effects to novocaine), saline, and epinephrine (a drug that constricts blood vessels and thus reduces bleeding during surgery).
Then doctors insert a hollow wand-like device called a cannula through incisions in the skin. They push and pull the cannula around through fatty deposits, breaking up the cells, which, along with other body fluids, are suctioned out by an attached vacuuming device.
It's a simple system, says Stephen Rhodes, chief of the plastic and reconstructive surgery devices branch in FDA's CDRH. "It's essentially just a cannula and a vacuum." However, these products have only been approved for body contouring, and are not intended for large-scale fat removal, an increasingly popular use of liposuction.
There are several liposuction techniques available today. The amount of injected fluid determines the technique used, explains Peter B. Fodor, M.D., chief of plastic surgery at Century City Hospital in Los Angeles and spokesman for the American Society for Aesthetic Plastic Surgery.
In the "dry" technique, which few doctors use anymore, no fluid is injected into the targeted area.
For "wet" liposuction, the surgeon injects only a small amount of fluid, about six to eight ounces and usually containing small amounts of ephinephrine, regardless of how much tissue is subsequently removed.
The "superwet" technique evolved, says Fodor, because doctors found that the more fluid they injected--up to a point--the less blood was lost. "We found that by injecting one cc of solution for each cc of aspirate [amount of tissue and fluid removed], the blood loss was negligible." Although lidocaine is sometimes added when performing wet or superwet liposuction, patients will also receive general or epidural anesthesia.
In the tumescent technique, doctors inject up to five times as much fluid as aspirate. Because the injected fluid also contains large amounts of lidocaine, tumescent liposuction is generally performed with only a local anesthetic.
Many doctors are offering a modified version of the procedure that calls for using ultrasound in addition to the injected solution and the suctioning. Rhodes and others at the FDA are especially concerned about this practice, which calls for using devices not approved for liposuction--that is, special cannulas that vibrate at high rates and emulsify fat tissue before its removal. The wand generates a great deal of heat, and if doctors don't move it constantly, it can cause severe burns. As Roxolana Horbowyj, M.D., senior medical officer in CDRH, points out, a temperature increase of 20 degrees Celsius (about 36 degrees Fahrenheit) may encourage cell death. And, as FDA epidemiologist Brown notes, "We don't really know the long-term effects of ultrasound on tissues."
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