Since the middle of the 1990s, a revolutionary new technique named superficial liposuction has been widely advertised in the United States. This technique developed because some cosmetic surgeons were not entirely happy with the results they were getting with liposuction procedure, especially on patients older than 50. By this age, most people’s skin has lost much of its youthful elasticity, and begins to sag a bit. When deeper fat is removed from older patients during liposuction, the skin is not always able to contract to fit the new contours of the body tightly. Surgeons decided to try removing fat higher up, where the dermis meets a layer of subcutaneous fat, in an effort to prevent the wrinkles and bruising common in older patients who had gone through body liposuction.
The blood supply to the neck and face is quite different from that to other parts of the body. Cosmetic surgeons who had done many face-lifts realized that they could cut very close to the undersurface of facial skin without leaving visible patches of pigment or blood vessels after the surgery. Although this procedure is far from perfect, it is how most standard face-lifts are done. However, in the rest of the body, damage too close to the surface of non-facial skin often causes undesirable changes in the skin, like scarring or changes in pigmentation, that are visible sometime after surgery.
Superficial liposuction represented an extension of these surgeons’ observations, and their experimentation to see if facially-appropriate techniques might be useful in liposuction of the body. Traditional liposuction removes excess fat from the lower to middle layers of fat. Superficial liposuction removes fat much closer to the skin. The new procedure was heavily marketed, and many patients opted for it. Damage to nerves and blood vessels close to the dermis (the leather layer of skin just under the surface epidermis) was not always noted at first, and frequently, after the surgery, skin looked tighter. Unfortunately, the superficial liposuction often caused the death (necrosis) of the surface skin, with unsightly ulcers and holes that eventually became permanent scars. Patients who had received superficial liposuction commonly developed net-like patches of blood vessels visible under the skin, as well as permanent and widespread discolorations in pigment.
It appears that these results were probably caused by surgeons applying a vacuum to the fragile underside of the dermis by means of a cannula turned upside-down, thus tearing or cutting tiny blood vessels that feed the dermis. Although such bad results continue to be reported, some doctors are still recommending superficial liposuction. It is likely that if this procedure turns out to be permanently flawed, its use will eventually decline and disappear. However, cosmetic surgeons are looking for ways to improve the procedure and lessen its safety risks. Many of our modern lifesaving procedures started out as improvisations of risky procedures. Only one example is the triple coronary bypass – which is now one of our greatest lifesavers in the case of massive heart attack.
In summary, superficial liposuction may be unsuitable for use in areas of the body, with the exception of the face and neck. This is because the flow in blood vessels differs in the latter areas, and does allow an amount of superficial liposuction. You may wish to reconsider if you have been thinking about having superficial liposuction anywhere besides on your face or neck. Ask plenty of questions if your surgeon seems enthusiastic about this procedure, and do some research online as well. You don’t want to find yourself one of the “bad results” mentioned above!
