**1. Introduction**

The first and most important thing to know is that not all patients are candidates for liposuction as it is not a weight loss procedure rather is only for body contouring. The satisfaction of a good outcome for both the patient and the operating surgeon would come from selecting the right patient. Liposuction is most effective for treating localized adipose deposits, particularly combined with a targeted weight loss and lifestyle changes. The gender-specific distribution of typical subcutaneous adipose accumulation that are eminently amenable for removal through small incisions allowing the entry of small cannulae connected to constant suction have been taught to us through experience. One of the most groundbreaking medical developments of our time is liposuction.

The suction-based removal of excess fat – which is the most basic requirement of liposuction – is the simple part. The creative part includes determining how much fat to remove for an overall contouring, how much to leave behind for a smooth coverage, and how retractile the skin is.

We classify patients based on their BMI, and if the BMI is greater than 33, we recommend bariatric surgery, which is a SLEEVE GASTRECTOMY generally depending on assessment by the Bariatric Surgeon. Liposuction and skin removal may still be required in such cases to achieve the ideal shape for the person once the weight has been stable for more than a year.

At first glance, liposuction may be considered to be one of the simplest treatments especially for someone seeking to be a cosmetic surgeon however it requires an artistic skill and experience.

## **2. History**

Liposuction has its origin as a procedure involving subcutaneous scissor dissection with curettage and debris suctioning in the second step.

Modern fat extraction began approximately 40 years ago, initially as a closed technique, when the German physician Schrudde [1] first published his technique (called lipexeresis) using a uterine curette to remove subcutaneous fat. Several other surgeons, including Kesselring and Meyer, used this technique in the mid-1970s, and combined this with aspiration to remove more fat. Further stages of development included the intriguingly named 'cellulosuctiontome' [2] and 'aspiradeps' [3] that defined the second generation where sharp dissection and suction were combined as a single stage.

The prime originator of contemporary liposuction is Illouz [4], from France who ushered in the third generation by innovating a blunt-tipped cannula and the use of wetting solution to aspirate a lipoma from a patient's back. The latter aided aspiration and for the first time a procedure with acceptable morbidity and reproducibility was available to address fat deposits. Visiting Americans embraced liposuction with such a vigor and it was an US dermatologist Jeffery Klien [5] who first introduced the tumescent technique. Such direct infiltration of tumescent fluid produced regional anesthesia of both the skin and subcutaneous tissue allowing avoidance of general anesthesia and its use as ambulatory day care procedure thus could be done by Non-surgeons and/or those not having formal admitting rights to hospitals. Moreover, the combination of dilution and active removal as part of the lipoaspirate allowed higher doses of lignocaine to be used, but a safety limit of 35 mg/kg was proposed to limit toxicity [5, 6]. A firm structure for protection (especially for intra-abdominal viscera in those with abdominal laxity) and a more controlled harvest to reduce post-operative contour irregularities are two other advantages of the tumescent technique. Suction-assisted liposuction (SAL) is the general term for this method, and it is the gold standard by which all others are evaluated.

The fourth generation are the use of novel lipolysis technologies, the first of which was ultrasound-assisted liposuction (UAL) [7]. With less physical effort put into the aspiration and sound energy breaking down the adipocytes, more attention could be placed on the end product, a term known as "liposculpture." Unexpected cutaneous burns from the extra energy transmitted to the tissues specially the skin dampened the excitement, but the idea of 'assistance' was born nevertheless. This is well discussed in **Figure 1**.

Laser-assisted liposuction (LAL or Smart lipo) [8], power-assisted liposuction (PAL such as from MicroAire) [9], and, most recently, radiofrequency-assisted liposuction (RFAL) [10] are some of the other choices available for the Liposuction surgeon.

*Use of Technologies to Improve the Liposuction Outcome Including Skin Texture and Form DOI: http://dx.doi.org/10.5772/intechopen.99947*

**Figure 1.**

*The development of liposuction and the use of modern technologies for ease of fat removal.*
