Atlas of Liposuction

243 Pages·2013·40.62 MB·English

by  Adrien E. Aiache

Adrien E Aiache MD
9884, Little Santa Monica Boulevard
Beverly Hills, California, USA
Email: [email protected]
Melvin A Shiffman MD JD
17501, Chatham Drive
Tustin, California, USA
Email: [email protected]
Foreword
Pierre F Fournier
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Atlas of Liposuction
First Edition : 2013
ISBN: 978-93-5090-345-2
Printed at Ajanta Offset
Foreword
It is with great pleasure that, I accepted the offer of Adrien E Aiache to write
a foreword to his book on liposculpturing. I consider this to be a privilege
and honor for two reasons, the quality of the author and the quality of the
book.
It was in Rio de Janeiro in February of 1972 at the first meeting of
Aesthetic Plastic Surgeons that I met Adrien and we became friends at once
for medical as well as social reasons; both of us had a similar professional
education, a double medical education consisting of basic medicine acquired
in France and specialization abroad. Throughout the years, Adrien has been
able to preserve and develop his French clinical education and associate it
with the exceptional theoretical and practical education offered to plastic
surgeons in the United States.
If his “graft” to California has fully succeeded, he has also maintained a cultural bridge with his
country of origin and it is because of this “French Connection” that he has been among the pioneers
of liposculpturing and been able to share this knowledge with his American colleagues.
In February 1982, as I was returning from Lake Tahoe, after my first presentation in North America
of a new defatting procedure in esthetic surgery of the head and neck, Adrien and I met in Los Angeles
and discussed the new possibilities offered by this procedure. Soon after, Adrien accompanied by some
other plastic surgeons, flew to Paris to attend the first course on liposculpturing, even in Paris, with
YG Illouz, the great simplifier and popularizer of the original technique of Giorgio Fischer. Upon his
return to California, he passed-on his experience with “surgery from within” and actively participated
in its development in the States, both solely and working with other surgical groups.
Although this new procedure of closed body contouring was a significant advance on the
conventional open techniques, in 1982, we were only at the stage of lipoextraction. It is only with
years of practice that we have advanced to the era of true liposculpturing. As a matter of fact, even
if we had all the proper instruments needed to extract the excess adipose tissue at that time, we did
not yet know (and had to develop) the procedures needed to perform this new surgery safely and with
as few complications as possible. In a word, the surgeon has to shift from the position of a miner
and become an architect.
Adrien has been a witness to an actor in all these improvements including the development of the
better understanding of the operation, the refinements which he describes today in his book,
miniaturization of the instruments, study of the static and dynamic morphology of the patient, patient
selection, external and internal cryoanesthesia, the routine use of vasoconstrictors, the accomplishment
of the peripheral mesh undermining, the direct approach, the combined procedures and cases of the
treatment of zones previously considered taboo, the first cases of circular lipoplasty, microlipoextraction
and injection, histological studies, etc.
Adrien is not only a winner but also a leader and, in 1986, he founded ASPER capably assisted
by his wife Sylvie. The first meeting of this group was very successful as were those following. By
carefully selecting his faculty members, the students were presented with the latest advances in esthetic
plastic surgery and in the field of liposculpturing. The lipoplastic surgeon was shown for the first time
such subjects as incremental liposculpturing, autologous collagen, microlipoextraction and injectable soft
tissue implants.
vi Atlas of Liposuction
This book of high quality, written by a highly qualified lipoplastic surgeon, describes step by step the history,
basic theory and a very thorough study of all special areas of the body and the different cases coming to the
lipoplastic surgeon.
Breast reduction with suction lipectomy, one of the author’s earlier contributions to liposculpturing is given
special attention as well as gynecomastia combined techniques, face-lift combination with suction lipectomy and
arm lipectomy.
Autologous fat re-implantation, which was at that time a very controversial subject, is evaluated and its goals
explained.
Complications are also described and the study of those chapters will properly educate the reader.
The book should be read not only by beginning lipoplastic surgeons but also by the well-trained operator. He
will learn many refinements, finesses, tricks and unusual procedures that Adrien has accumulated over the years,
through his own extensive experience and through the experience of visiting professionals, and is now sharing
with the surgical community.
Thank you, Adrien, for presenting such an insightful, useful and carefully written book to your colleagues,
who with you, are fighting in the battle of body contouring, modifying the human body without scars and with
a minimum of complications. Since you waited so many years before writing this book, the readers are assured
that it is a reliable one, the full experience of an experienced plastic surgeon who is also an outstanding lipoplastic
surgeon in the most recent and significant advances in esthetic plastic surgery. I praise you for your wonderful
contribution to liposculpturing, for your honesty and for your loyalty about this new exciting and difficult “surgery
from within” as well as for increasing the circulation of the cultural bridge connecting Europe to America, which
gave to your book its quality.
Finally, you demonstrate with the work, you have achieved that you are a living example of one of the famous
quotes of Mario Gonzales Ulloa:
“The essentials in life are:
Not in having but in giving,
Not in knowing but in teaching,
Not in being able but in accomplishing.”
Pierre F Fournier MD
Past President of the French National Society of Aesthetic Surgery
55 Boulevard de Strasbourg, 75010 Paris, France
Email: [email protected]
Preface
Atlas of Liposuction presents an exhaustive survey of the current techniques in suction lipectomy. This
new operation was devised for removal of localized fat deposits. After a short introduction covering
basic theory, preoperative procedures and general techniques, use of the liposuction on each specific
area of the body is discussed in detail. These discussions cover the exact modus operandi, including
such matters as incisions, positions and instruments. Many color photographs and illustrations showing
actual clinical cases are included as an integral part of the text.
Through these volumes, the reader will be completely apprised of the techniques involved in
liposuction and can then refer back to specific chapters for help in solving problems or reviewing any
areas of special interest. Because of the number of different cases presented and the various techniques
used, we feel that this book will be of interest to even the well-versed surgeon in this area, as well
as to the operating surgeon with relative modest experience in liposuction and the student wanting to
learn the entire procedure. For any practitioner, regardless of experience, this book will serve as a
complete guide to the full range of techniques used in liposuction.
Note that a significant new advance in the field—the re-introduction of fat into the depressed areas
and wrinkles—has been included at the end of the Atlas. While this technique took a while to be
accepted by the general plastic surgery practitioner, we feel that it is likely to become a precious and
effective tool in body and facial contouring.
Other significant improvements such as superficial liposuction, laser liposuction and ultrasound
liposuction are discussed in this book since they have been emerging as the last improvements in the
technique of liposuction.
Adrien E Aiache
Melvin A Shiffman

Contents
1. History of Liposuction 1
Melvin A Shiffman
2. Preliminaries 7
Adrien E Aiache
3. The Setup 17
Adrien E Aiache
4. Saddlebags 38
Adrien E Aiache
5. Suction Lipectomy of the Buttocks 52
Adrien E Aiache
6. Suction Lipectomy of the Thighs 61
Adrien E Aiache
7. Liposuction of the Inner Thighs 66
Adrien E Aiache
8. Combination of Techniques: Liposuction with
Trochanteric Lipectomy 72
Adrien E Aiache
9. Liposuction of the Knees 78
Adrien E Aiache
10. Abdominal Liposuction 85
Adrien E Aiache
11. Combination of Abdominal Liposuction and
Abdominal Lipectomy 97
Adrien E Aiache
12. Liposuction of the “Love Handles” 109
Adrien E Aiache
13. Iliac Crest Liposuction 115
Adrien E Aiache
14. Lumbar Bulge Liposuction 122
Adrien E Aiache