Science

Over the years,  I have received numerous questions about the underlying scientific procedures and discoveries, methods and applications, of what is, in the most fundamental of schemes, art, not science. Sicence, however, is the inevitable basis, which we manipulate to produce Art. Here, I would like to acquaint the widest possible audience with the history, and purpose of this connection of Art and Science.

St. Luke’s Hospital Center in New York (my second Alma Mater – after Columbia) has a unique heritage of plastic surgery. The serene, gentlemanly Robert Abbe created his many surgical innovations there from 1874 to 1928. Then William F. Mac Fee, founding member of the American Board of Plastic and Reconstructive Surgery, performed his masterly head and neck surgery-cum-reconstruction while Director of Surgery at St. Luke’s. My mentor, Dr.Stark told me that it was Prof. Mac Fee who, with Dr. Harold A. Zintel, invited him in 1955 to come to St.Luke’s from the New York Hospital to start a new section of plastic surgery within the Department of Surgery. The first groundbreaking texts on plastic and reconstructive surgery, cleft palate  and  aeasthetic-cosmetic surgery, a field that only just began to emerge. I had the luck to stand at the conception of modern Plastic Surgery – to see it all, and learn from the best.

LIPOSUCTION

Liposuction, or as it was first named “suction assisted lipectomy,” is a surgical procedure, which was first performed in Europe, where it became known as “liposuction.” Liposuction was used sparingly at first in the 1950s. As word of liposuction spread, the procedure underwent expansion in the size of the areas treated.

Liposuction was first performed by gynecologists who had a D&C vacuum pump canulls that they adapted from abortion procedures. From that the procedure of liposuction had its roots in the hush-hush realm of European abortionists with self-contained procedure rooms, ready and willing to expand into the area of removing fat from wealthy women – even if the results of the liposuction were disappointing.

In 1979, a professor at Georgetown Medical School, who had studied in France, tried the liposuction procedure on a limited scale on a lower leg. His paper on liposuction of the leg was rejected by the Journal of Plastic and Reconstructive Surgery, and so he turned to his young resident to re-write it. Liposuction was unknown at the time in the United States. It only invited enmity among the professors.

Nevertheless, the young resident tried to write something. Finally, after he had exhausted his well of imagination, he asked for the help of his brother, Gregory T. Fisher, MD, who had become a published author and a contributor to a textbook on plastic surgery, and was regarded as an expert writer of scientific articles on plastic surgery. Dr. Gregory Fisher, although he had no great experience in the field at the time agreed to investigate and do research in the field, to see if any benefits could be derived from it.

Together, the brothers started basic research on liposuction. They went to the cadaver lab, with the permission of the chief pathologist. With the canulls they had obtained, they performed liposuction on various body areas in cadavers. After liposuction, they dissected those areas treated with liposuction, and found, amazingly, that those nerve and blood vessels arising from the deeper areas and body structures, running to the skin, were intact. Liposuction had spared these important anatomical structures. However, at the same time, liposuction was able to remove fat stored between these structures by either displacing or removing fat by liposuction.

This lead to the realization that in order to further prove the safety of liposuction and to demonstrate its ability to remove fat while sparing important blood vessels and nerve structures, further research was needed. The next step was to obtain permission to perform liposuction on cadavers that had not been preserved, which means those people who had died but had not been embalmed.

In order to obtain permission for access to morgue specimens, the modus operandi of liposuction had to be explained to the coroner and chief pathologist. Noting the importance that liposuction might have in being able to remove significant deposits of fat while sparing sensory and vascular structures, it was emphasized that liposuction might well be helpful in the treatment of diabetes, morbid obesity, and other conditions such as the iatrogenic “buffalo hump” or submental fad pad caused by overmedication.

Our theory was that liposuction could be carefully performed so as to move important structures laterally or medially to the canulae, thus focusing the force of the suction on the delicate fat cells that lay between these structures, and removing them permanently. Liposuction through canulae could derive a harvest of fat cells, which could be measured and could be powered by a vacuum pump. Vacuum cannot be greater than 29.9mm. of mercury, it was not necessary to obtain sophisticated pumps, which would be able to produce a perfect vacuum, thus enabling this treatment to be used by any qualified practitioner, and benefit patients who were afflicted by lipodystrophy.

After verifying our observations in the fresh specimens, liposuction gained proof of its effectiveness in the abdomen, legs, and facial areas. When dissected, we were able to find that following liposuction, the blood vessels and nerves retained a honey-comb, intact pattern, fully functioning in all respects. The next step was to proceed to living specimens. After lengthy ethical procedures and consents obtained, we performed liposuction in live people who were scheduled for abdominal lipectomies in the areas, which were going to be excised in the performance of the procedures, thus doing no harm to the patients.  We felt that this would be the true test of whether and to what extent liposuction was helpful or possibly harmful to the patients.

We were encouraged. We were elated! We found this procedure called “liposuction” not only was effective in removing fat cells, sparing nerves and arteries, but we could prove it all. A cathedral-like structural support of nerves and arteries remained intact after the liposuction removed all fat in the area.

Liposuction’s final test in live human beings was performed, and it proved to be effective and extremely helpful to all those who could not lose wait genetically or were otherwise predisposed to obesity.

As part of performing hundreds of tummy tucks operations, the area that was discarded from the abdominal wall showed no injury to the overlying tissues. Liposuction had removed fat from entire large sections of the abdomen, thighs, hips, and chin – without any injury to blood vessels, tissues, nerve, or skin. Where performed properly, it proved to be a great advance to body contouring surgery. 

 

 

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