“Look at Greek sculptures. They idealized the human body. Their perfection of human form of male and female bodies remain as evidence of Greek civilization’s concept of beauty. In the past painters idealized the female body with portly attributes,” Dr. Manuel Moran said. Dr. Moran is an anesthesiologist and surgeon in Guatemala where he has participated in hundreds of body sculpting procedures.
In French slang the word ‘Boudin,’ is used to describe a portly woman. It comes from the famed artist’s conceptions of female bodies that are layered with fat. To that Dr. Moran responds, “Beauty is in the eye of the beholder. If beautiful is black skin or superman shape then that is considered ideal. Media influences affect social concepts of beauty. Some artists have seen the female body on the heavy side. This is not in vogue today,” Dr. Moran explained.
Responding to a surge in demand for body contouring or sculpting, a team of plastic surgeons have produced a new book offering state of the art surgical techniques. ‘Body Contouring and Liposuction’ by Drs. J. Peter Rubin, MD, Professor of Plastic Surgery at the University of Pittsburg, Mark L. Jewell, MD, Assistant Clinical Professor of Plastic Surgery at Oregon’s Health Sciences University, Dirk F. Richter, MD, PhD, Associate Professor, University of Bonn and Chief of the Department of Plastic and Reconstructive Surgery and Carlos O. Uebel, MD, PhD, Associate Professor of Plastic Surgery, University of Brazil, present years of research and operating techniques for the medical practitioner in this specialty to guide their practice and study.
The new book presents state of the art techniques for what is fast becoming an expanding practice not only in the United States but around the world. A preface by Dr. Ivo Pitanguy who has practiced plastic and reconstructive surgery for more than fifty years, offers a perspective that lay person and physician can understand and appreciate. Dr. Pitanguy writes, “Liposuction is a wonderfully challenging and constantly evolving field at the intersection of surgical skill, artistry and new technology. Through this highly impactful practice, we reshape the bodies and the lives of our patients.”
Dr. Pitanguy’s fifty-year perspective describes the techniques: “Body contouring surgery is a collection of procedures with the goal of volumetric manipulation of superficial tissue, usually adipose, with or without removal of excess skin (dermolipectomies).”
Dr. Pitanguy says the “Etiology of these deformities may be primary (i.e. congenital or constitutional) or secondary (i.e. weight gain or severe weight loss). In a broader sense this may include contouring of the face and breast.”
Ecoching Dr. Moran’s remarks, Dr. Pitanguy writes, “Concepts of beauty have been continually evolving throughout the history of mankind. The voluptuous figures that were idealized by artists in the past have been substituted by slimmer forms. Until the second half of the twentieth century, contour deformities were mostly hidden under heavy clothing and were reluctantly accepted. With fashion promoting body-revealing attire and outdoor exposure, and the emphasis on fitness and good health, people have sought to reflect these trends by demonstrating youthfulness and vitality in their bodies. The subliminal as well as overt message is that these are desirable requirements for maintaining sensuality, social acceptance and professional success.”
Dr. Pitanguy continues to describe some of the causes of issues that plague modern society. He writes, “On the other hand, sedentary lifestyle and dietary excesses, associated with factors such as genetic determination, pregnancy and the aging process, contribute to corporeal alterations that result in the loss of the individual’s body image. This creates strong psychological motivation for surgical correction.”
If ‘Body Contouring and Liposuction’ provided no more information than Dr. Pitanguy’s remarks it would be extraordinary insight into today’s society. The book is an encyclopedia of information for the practicing surgeon and an amazing reference tome for anyone interested in the subject whether patient, medical student or experienced practitioner. The book is an encyclopedia of informatin for surgeons, students and patients that are interested in the subject. The book contains image clips that can be activated with any mobile device that provide audio and visual presentations of techniques described.
Dr. Luis Porres, MD is one of the world’s foremost plastic surgeons actively using liposuction techniques for body contouring. Dr. Porres, is a graduate of the San Carlos Medical School in Guatemala. He practiced general surgery for several years. Dr. Porres came to the U.S. where he completed is studies in plastic surgery on a fellowship at John Hopkins Medical School. There he studied under Professor Oscar Ramires, MD, FACS, a distinguished member of the American Society of Plastic and Reconstructive Surgery.
Dr. Porres practiced under Dr. Ramires at his plastic surgery center in Maryland. Dr.Porres later went to Seville, Spain where he practiced under the mentorship of Dr. Michel Zocchi, MD where he was trained in ultrasonic liposuction. Today Dr. Porres specializes in innovative and improved plastic surgery techniques in Guatemala City operating his own clinic.
When asked to define liposuction, Dr. Porres replied, “It is the most modern technique of aspiration of adipose tissue (fat) from the human body. The technique is to aspirate fat with cannulas from specific areas and to mold them to the body structure. Infiltration of a saline solution is done previous to the procedure with vasoconstrictors since it decreases blood loss from fatty tissue. This technique is called ’tumescente.'”
“Historically liposuction, especially as practiced in the U.S., began with the use of a cold saline solution. This produced vasoconstriction. Later it was found to cause hypothermia. That practice has been stopped. It was observed that the use of local anesthesia also caused operatory problems. Use of too much anesthesia likewise caused problems. New techniques in the use of proper amounts anesthesia with saline solution at ambient temperature have been developed. These techniques proved successful with 90% of my patients. It is the technique we use today since it has the best post-operative results. The new technique allows us to work with greater volumes of adipose tissue extraction in one session. This makes the procedure simpler for the patient with less surgical interventions decreasing the cost. Important since it is elective surgery not covered by insurance,” Dr. Porres explained.
“Since it is aesthetic, the incisions are very small, less than ½ centimeter. They are made in occult areas like the axils, in between the umbilical wall, the pubis and in areas where the skin folds. The most commonly used anesthesia procedures are sedation and epidurals or Raquid blocks,” he added.
“The word is ‘liposculpture.’ Now we take fat from the back, hips, arms and legs. Not just from the abdomen anymore,” Dr. Porres explained. While Dr. Moran administers anesthesia Dr. Porres plans his body sculpting to take advantage of the time and accomplish as much work as possible at one surgical session.
“Some doctors do only one area then continue later on. This is very expensive for the patient. I try to accomplish everything at one time,” he said. Thus saving another surgical visit with its attendant costs.
When asked about dangers or complications from the procedure, Dr. Porres said “Just like any surgery the risk of any type of complications exists. In liposuction the major risk is to have a fat embolism. This falls in the 1 in 1000 percentage.” Dr. Porres says that he has not seen this complication in his practice since he follows a protocol of thorough pre-operative patient screening.
As part of the pre-operative protocol Dr. Porres obtains a thorough medical history, internist evaluation and examinations as well as psychological evaluation of the patient. Dr. Porres states that a thorough screening and health history is important to minimize risk.
Dr. Porres related that during most procedures he removed 5 to 10 liters of fat. Roma Canulas, long hollow probes, in different sizes from 25 to 30 centimeters in length, are used to literally suck out fat from the body. Dr. Porres has done some 8,000 TO 10,000 surgical procedures. These include liposuctions or combinations with bust augmentation and abdominoplastia. Of his cases some 3,000 have been liposuction and body contouring.
Statistically Dr. Porres reports that 99% of his patients are women between 19 and 80 years of age. Older persons in good health are candidates for the procedure. Only 1% of his patients have been men.
When asked why so many of his patients are women he replied, “Because hormonally women’s physiques suffer changes earlier than men and pregnancies also create body changes. Women’s metabolism is slower. Men are better able to get rid of fat faster.”
Women that seek the procedure are a wide societal mix: housewives, models, professional women and some that provide escort services.
In all of his experience, Dr. Porres has seen adverse results in two cases, one involving pancreatitis another heart disease. “The protocol requires that careful screening be done pre-operative and we must be sure the patient is healthy.”
Of the science, Dr. Porres explained “The advantage of liposuction is that when we extract the fat we also extract adiposities and they do not regenerate. We do not see the ricochet effect with liposuction.”
When asked if every obese person could be a candidate for liposuction, Dr. Moran said no. “Only people with 35% or less total body fat, according to a chart, are candidates for the procedure.
“Obesity is a family disease. That is the way we are taught to eat. Obese people need guidance. Some races are fat, some are thin. Genetics plays a role. Modern society emphasizes that thin is healthy and most importantly thin is beautiful. Truly the orientation should go hand and hand with a doctor and nutritionist. Cosmetic surgery is done by patient’s choice. Insurance companies do not pay for it. I like to point out that there is a psychological component of low self-esteem. If that is not improved then patients will feel it and it will affect them all their lives,” Dr. Porres said.
The birth of plastic surgery and liposuction was developed approximately 40 years ago. Protocols were created in Brazil 50 years ago by pioneer Dr. Ivo Pitanguy. Today techniques and equipment have improved. Liposuction was not popular until it turned out to be a surgical procedure with less risk and no trans-operatory pain due to the right combinations of anesthesia. Dr. Manuel Moran has created his own protocols with anesthetics for today’s techniques.
While bariatric surgery, or gastric bands, are alternative surgeries in some obese patients to reduce food intake and thus create weight loss, body contouring is aesthetic. Most people want to look their best. Aging, smoking, weight gain and hormonal changes can create body deformities.
What modern science offers patients are alternatives, though body contouring, to be accepted in their own eyes and by society. For the interested patient and, as a must for the practicing plastic surgeon, the book ‘Body Countouring and Liposuction’ published by Elsevier-Saunders, is an important treatise and guide. “One of the most actualized books of our times,” according to Dr. Luis Porres. For information about the book call Elsevier Publishers at 1-800-401-9962 or visit them at www.elsevier.com.
