WASHINGTON – Even Jane Fonda, Richard Simmons, and Phyllis George can’t diet or exercise away saddlebags – those localized fat deposits of unknown origin on he hips and thighs that can make a woman look like she’s wearing riding breeches. But a new surgical technique, the suction lipectomy, enables plastic surgeons to remove fat and melt away inches.
“This operation hit us like a bolt out of the blue when it arrives on our shores a few months ago,” says Dr. Mark Gorney, of Stanford University School of Medicine and president of the American Society of Plastic and reconstructive Surgeons. Although the stage was set in Europe, the United States is fast becoming the fat-suction capital of the world.
The “closed suction technique,” or “collapsing technique,” was developed by Dr. Yves Gerard Illouz in Paris six years ago. The plastic surgeon uses a blunt suction cannula to remodel the body contour, a rigid silicone tube and a powerful suction machine, like the one used for abortions, to ensure the steady flow of fat from the body. The technique can be used anywhere on the body where there’s a localized fatty deposit – most frequently thighs, buttocks, abdomen, knees and back (“love handles”).
“The key to the success of the procedure is not only the amount of fat removed, but the amount and distribution of tissues left in place,” says Washington, D.C. plastic surgeon Dr. Clyde Litton, who has helped popularize the technique in the United States.
The new method differs from less sophisticated surgical techniques to remove fat, since there is virtually no bleeding and the surgery involved rapid healing time, only a small half-inch-long scar, buried in the gluteal fold, and minimal risk of complications. Litton says the procedure is virtually painless because it’s “superficial.”
This technique eliminates bulges and inches rather than pounds, since fat weighs very little. “You can reduce bulges to a straight line or a nicer contour,” says Litton. “Most women want to be slim enough to wear tight jeans and look good in bathing suits or in the nude.” He notes that with today’s clothing styles, women have become more conscious of their bodies 12 months a year, rather than just from May through September.
“For the first time in my life I’m wearing jeans. You can’t imagine how it feels to wear clothes like most other people,” says one Rockville, Md. Woman.
“This is really a last-resort technique. Most have tried diet, exercise, massage – the whole gamut,” says Dr. Litton. “But once you see this trochanteric deformity (saddlebag thighs), you can see they’re wasting their time on other methods.”
The procedure is carried out in an operating room under general anesthesia. A small half-inch-long incision is made in each fold of the buttocks. A No. 10 cannula is inserted through the incision into the fatty layer, between the skin and the underlying muscle. With a gentle thrusting pressure, the blunt instrument pushes aside blood vessels and nerves and breaks up and ruptures the fat cells. A powerful suction machine pulls the fat out through a tube, often removing a pint or more of fat from each side, typically reducing the hips and thoughts by three inches. To complete the process, the surgeon smooths out any bulges.
Although the patient stays in the hospital only a night or two, suction drains remain in place for two days to prevent the collection of blood or serum under the skin.
A pressure dressing, acting as a mold for the future shape, is placed over the wounds for five days. The patient wears pressure garments for several weeks to prevent fluid accumulation.
Bicycling is recommended as exercise after a week. The patient is taught to do light massage, and then, after six weeks, a heavier massage, to break up any remaining lumps of fat. The bruising disappears after two to three weeks. Temporary building and depressions disappear in four to six months when the maximum improvement is revealed.
The procedure may be relatively painless, but the cost is not. In Washington, the base surgical fee for the hips and buttocks is $2,000. Each additional area, such as “love handles” or abdomen, adds another $500 to $1,000 to the bill. Anesthesia and hospital costs generally run another $2,000/ But “it’s worth it,” says one 53-year-old Washington woman. “It turned out beautifully.”
This is not an operation for everyone. “It’s an operation which is to be used on selected patients by selective surgeons,” warns Stanford’s Dr. Gorney. “Unfortunately, this country is full of unhappy neurotic people who will respond to an ad telling them they can be beautiful forever within minutes between sandwich bites at lunchtime if someone sticks a vacuum under their hips and sucks the fat out. This is simply not true.”
The procedure has some potential medical risks, with the most dangerous resulting from complications of general anesthesia. Bleeding, infections, hematomas or seromas (an accumulation of blood or serum under the skin) are rare, but are a concern. Another risk is that if a large amount of fat is removed in too short a time, it can lead to a drop in blood pressure and shock.
More women than men are candidates for the procedure, and younger women – those under 53 or 40 – are preferred. Their skin is more elastic. In older patients, some waves of puckering will remain after the bulge is removed.
“This is not an operation to obesity,” warns Gorney. “It is strictly limited to areas where there is localized fat, often gene-determined, which cannot be gotten rid of by exercise or diet.”
Litton says there’s no immobility and relatively little discomfort except for some temporary numbness.
But one patient views it differently: “It was a damn nuisance because you can’t bend where your legs connect to your hips. You try going to the john for a week or 10 days when you can’t bend…”
Unlike a facelift, in which the eyes get puffy and the jowls may begin to sag after a few years, this is a once-in-a-lifetime ordeal, says Dr. Litton and the other “fat-sucking czars.” “once that fat cell is removed,” he says, “it never grows back. We don’t leave any of them there to enlarge again, so it’s improbable that it would need to be repeated.”
“But that doesn’t mean it gives an individual carte blanche to gorge himself.”
“This is a new tool in surgery that will provide us with a better means of dealing with an old problem. This new procedure is here to stay,” says Dr. Jerome Adamson, professor of plastic surgery at the East Virginia Medical School and a former president of the surgical association.
But like many new procedures, this one is prone to abuse. Gorney compares it to the early days of the heart transplant business, when everybody was doing it.
“It was a glamorous procedure – it created headlines,” he says. “But physicians stopped doing it because people were dying. Now only a couple of centers are doing it. The same is true of this procedure.”
“Every surgeon who tries this will not necessarily be successful with it,” cautions Litton. “There are good sculptors and bad sculptors.”