Liposculpture was developed in Paris and Brazil concurrently, but refined in Rome. I was fortunate to have spent weeks with the innovators and to share ideas. Over time, I have added what I regard as critical refinements.
Liposuction involves removing volumes of bulk (not weight loss) fat from body sites that are genetically mediated (arms, abdomen, buttock, thighs, knees, etc.). There are many ways to do this. The fastest entails a laser to liquefy fat, causing easy removal. I have abandoned this as I have seen major unrepairable skin burns and injury to nerve and blood vessels. All procedures entail suction of fat at the operative sites.
My technique has evolved into a high powered pneumatic suction with multiple ports. Let me explain. The speed of removal or speed of the procedure depends on the diameter square of a canula. A 4mm canula moves four times the speed of a 2mm canula. I have opted to use only SMALL canulas. Though certainly slower; it is much more precise and has eliminated the concavities and depression of large canulas
It is not enough to remove fat, as the overlying skin must be able to contract as if it were a stretched rubber membrane. This is achieved by first removing almost all of the adherent fat beneath the skin which prevents shrinkage. Despite this, I noticed residual cellulite depressions. As cellulite represents vertical bands which package the skin into small checkerboards; they must be released. I mark every dimple and depression of my patients while standing. Using a specially designed instrument, each cellulite site is released to allow skin adaptation.
Every area of bulk requires two perpendicular suctions so fat can be evacuated both vertically and horizontally. Therefore, each area is done twice and is than checked both visually and manually.
I have never over thousands of procedures had a complication. I do not believe that this is because I am uniquely qualified or lucky. It is rather that the surgery requires being done slowly and cautiously in a hospital environment with expert monitoring.
Patients do have modest pain for approximately six to eight hours which we can easily control in a hospital environment. This is generally an outpatient procedure. Patients can aggressively exercise in 4 to 5 days.
Compression is a vital key and critical. All of the operative areas need to be compressed so that tissue memory and fluid fill does not recreate the defect removed. My experience, stretching over 30 years, is, about 6 weeks of compression is needed.
While fat is readily removed, it can be reinjected into different sites as a sole operative procedure. Fat can also be moulded into depressed body sites without removal at the time of surgery; that is, you can fill a hollow with fat from a bulge.
Liposuction is not a technique for weight loss. Fat is bulky, but not overly heavy. What is interesting is that patients within the first one to two years tend to lose weight without dieting or exercise. I believe that without the old fat deposits, patients have reduced the hormonal mechanisms driving them to eat.