Liposuction

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Également appelée "lipoaspiration" ou "liposculpture", la liposuccion est une intervention chirurgicale qui consiste à extraire la masse graisseuse excédentaire d'un patient par une aspiration à l'aide de canules (3/4 millimètres), insérées sous la peau. Cette technique de liposuccion par canule a été mise au point dans les années 1980 par le chirurgien français Yves Gérard Illouz. Le maniement de la graisse sous-cutanée doit être doux et régulier afin d'éviter les ondulations inesthétiques.

Sommaire :

• Introduction

• Origine: maladie cellulitique

• Origine : anomalies histologiques

• Quels sont les facteurs constitutionnels ?

• Quels sont les facteurs acquis ?

• Quelle est la technique la plus adaptée ?

• Photos avant / après de liposuccion.

What are nasolabial folds?

intro

Liposuction or liposuction

Liposuction is the treatment of excess fat or localized lipodystrophy which mainly affects the following areas:

FOR WOMEN:

- the belly and especially its area under the umbilical;
- the flanks or love handles” and the lumbar regions or “hips”;
- the peri-trochanteric regions or “saddlebags”;
- the inner side of the thighs ;

- the neck, which will be studied in the chapter on cosmetic surgery of the face;
- knees ;
- calves and ankles ;
- the inner face of the arms and the sub-axillary extension of the breasts.

IN MAN:

- the belly ;
- the flanks and lumbar regions;
- the breasts or adipogynecomastia;

- the neck .

Ultimately, many areas of the body can be subject to a fat overload , of very variable volume and more or less embarrassing.
Sometimes the entire lower half of the body is affected and undergoes liposuction, especially in women.

You should know that after significant weight loss, the problem is no longer really the fat but the skin , the excess skin that hangs and is extremely embarrassing both physically and psychologically.

THE SKIN IS AN EXCESS ON:

- the stomach : abdominoplasty;

- the entire belt: body lift;

- the chest: breast reduction or sagging cure (ptosis);

- the arms: inner face lift;

- the thighs: lifting of the internal or external face;

- the knees: less often, especially after bariatric surgery and very significant weight loss.

What are nasolabial folds?

cellulite

Les lipodystrophies localisées représentent le stade ultime de la maladie cellulitique à laquelle on distingue 2 stades :

• les anomalies cutanées superficielles ou aspect de « peau d’orange » ;
• les déformations externes ou masses visibles, comme la « culotte de cheval » qui correspondent aux lipodystrophies localisées, profondes au contact du muscle.

Les anomalies cutanées superficielles :

L’apparition d’un aspect cutané de « peau d’orange » est progressif et seulement perceptible, au début, par le pincement superficiel de la peau puis cet aspect devient visible spontanément en positions debout puis couchée.

Ce stade n’est pas chirurgical :

la liposuccion n’améliore jamais l’aspect de « peau d’orange ». C’est ici le règne des diététiciens (règles hygiéno-diététiques), des endocrinologues (normalisation de dérèglements hormonaux (chez la femme comme chez l’homme,) des kinésithérapeutes et des médecins esthétiques, (drainage lymphatique manuel et endermologie ou LPG), des préparateurs physiques (activité sportive), plus rarement et moins surement, des mésothérapeutes. Il faut insister actuellement sur des traitements nouveaux, le plus prometteur étant, à mon son sens le suivant : section des travées fibreuses associée ou non à l'introduction de cellules souches ou autres produits dans l'espace libéré.

Les déformations externes du corps :

En l’absence de traitement, l’aspect cellulitique de la peau évolue fréquemment vers l’apparition progressive de masses graisseuses profondes, situées au contact des muscles et qui déforment le corps.
Les médecins parlent alors de lipodystrophies localisées qui représentent une excellente indication de la lipoaspiration ou liposuccion.

What are nasolabial folds?

hystologique

2. HISTOLOGICAL ABNORMALITIES

Under the skin, in the presence of localized lipodystrophy it is described as the " saddlebags”, 3 fatty layers:
   - superficial and medium: responsible for superficial skin changes such as the appearance of “orange peel skin” and cellulite;
   - deep: where fatty masses called localized lipodystrophies develop.

The superficial appearance of “orange peel skin” is caused by:
   - swelling of fat cells which are loaded with triglycerides but do not multiply and are organized in clusters;
  - an attraction towards the inside and in places of the deep layer of the epidermis exerted by the stiffened fibrous tracts which surround the clusters of fat cells.

What are nasolabial folds?

3. HISTOLOGICAL FACTORS

Many factors seem predisposed to cellulite disease but the exact etiology remains to be defined.

We talk about the constitutional factors and the acquired factors

Constitutional factors

Gender:
This is the main factor, with women seeming to be particularly predisposed to cellulite for two reasons:
- their superficial fatty layer is much thicker than in humans;
- the fatty lobules of this superficial layer are partitioned without mesh by connective tissue whose vertical partitions are hooked on the surface to the deep face of the dermis in a more toned way and responsible for the appearance of "orange peel".

In man , the cells are smaller, and are not united to the surface by these vertical fibrous partitions. Surface anomalies and irregularities cannot therefore be formed in the same way with a septa meshing system.

What are nasolabial folds?

acquis

Acquired factors

Food is an important factor:
- too rich in fat , it promotes the storage of triglycerides in the adipocytes;
- too abundant , especially during childhood, it increases the risk of cellulite in adolescence and adulthood by hyperplasia of adipocytes. It is necessary to point out the interest of the chrononutrition developed by Dr Alain Delabos in 1986 and which indicates the importance of ingesting carbohydrates with slow assimilation and fats in the morning (bread and cheese), in large quantities, meat the noon and fish in the evening. Also note the importance of chewing, each bite must be chewed at least 20 times before being swallowed.

Regional loco factors:

mechanical, temporary or permanent: physical inactivity, tight clothing, underlying joint pathologies, problems with muscle contractions.
They seem to promote tissue blockages and the installation of cellulitis disease.

Nervous factors and drugs:
Neurovegetative and psychological factors seem to influence storage in adipocytes as well as certain drugs such as cortisone and certain antidepressants.

What are nasolabial folds?

technique

Surgical technique

Liposuction is a cosmetic surgery technique that consists of removing excess fat between the skin and the muscle, and particularly the deep fatty layer adjoining and in contact with the muscles. This deep layer is responsible for the external deformations of the body.

The liposuction technique proceeds in a mechanical fragmentation of the fat by the end of a cannula assisted by a preliminary infiltration of this fat via a suitable liquid, then in an aspiration and therefore an evacuation of the fragmented fat.

The different techniques of liposuction

Liposuction is the excision of the deep fatty layer, located in contact with the muscles. The aspiration technique proceeds in a fragmentation of the fat and in an evacuation of this fragmented fat.

Fat fragmentation can be achieved in several ways:

- mechanically: by a cannula with a blunt end which, handled in crossed directions , allows a uniform and complete fragmentation. This is the classic liposuction, implemented by a Frenchman, Doctor Gérard Illouz, and whose results are excellent.

- rarely by ultrasound or even vibration , which is only of some interest in the difficult cases of patients who have already been operated on and who present very significant subcutaneous fibrous sequelae with superficial retraction of the skin.

The evacuation of the fragmented fat is done, in all cases, by aspiration thanks to the vacuum obtained in the cannula. Classical liposuction also gives magnificent results. The only problem: very “physical”, it is almost as tiring for the operator as jogging or a weight training session of the same duration!

The classic suction technique

The technique is simple but obtaining good results requires an experienced operator with a certain artistic sensitivity.

It is enough to introduce under the skin a cannula of 2 or 3 mm in diameter (rarely 4), by a discreet incision, 3 to 4 mm in length, often hidden in a fold. This cannula is connected by a flexible and transparent tube to a machine creating a vacuum and allowing the aspiration of the fragmented fatty cells which are responsible for the localized lipodystrophy and the external deformation.

When this deep fat is completely aspirated, it is possible, in some cases, to continue the aspiration towards the two more superficial fatty layers, but with caution, by carefully examining and evaluating the retraction capacities of the skin.

Thanks to its elasticity, it must be able, in the weeks which follow the operation, to retract in a harmonious way without keeping residual folds on its surface while it is deprived of its underlying fatty support eliminated by aspiration.