2018 09 12
Liposuction: an interesting secret about our bodies unveiled
Plastic Surgery, Cosmetic Procedures
To make history easier to understand, a certain background explanation is required. This discovery is from the field of human anatomy, i.e. science about the human body’s structure. Anatomy is divided into macro-anatomy (what can be seen with the naked eye) and microanatomy, where optical help is necessary. What amazes is the fact that this discovery is from the field of macro-anatomy. Here, the last discovery was made in the middle of the last century. It’s also surprising that the structures discovered were all the time visible to us with the naked eye, but nobody realized that they were a separate unit.
Even more exciting is the fact that they (there’s not just one of them in our bodies) determine our appearance. Possibly, this was not discovered earlier because we are talking about the fatty tissue structure and more specifically about the subcutaneous fatty layer formations. In spoken language, that would be just fat – the same thing that deposits itself so unkindly around the trunk, thighs and buttocks and causes so much frustration to both sexes. Nobody expected to find something else in this “speck”. It has always looked like humanity was more interested in ways of getting rid of this good stuff. However, life disregards our interests and simply flows its own way.
In the eighties, the world was rocked by a new disease – acquired immunodeficiency syndrome (AIDS), which is caused by the human immunodeficiency virus (HIV). The hardest the disease hit was in American cities, where the “sexual revolution” was enduring and which had the largest concentration of gay men – in this group of the population the disease spread the fastest and affected the largest proportion. In advanced stages of AIDS, strong lipodystrophy (atrophying of the adipose tissue) manifests, and so ill people acquire the appearance of skin-sheathed skeletons, which isolates them socially and destroys them spiritually even more, not to mention the stigma of the disease itself.
While searching for a solution to this problem, an essentially new branch of pharmacology emerged – companies started looking for substances that could be injected under the skin to replace the lacking layers of fat. In this way, fillers appeared that are now widely used in aesthetic medicine to rejuvenate the face and correct unsatisfactory features or defects after traumas and tumour excision operations, although they are best known for their use to plump up the lips and smooth down face wrinkles. A young plastic surgeon, David Teplica, a pupil and surgery partner of the world-renown plastic surgeon and academician Gary Burget, who went on to become a tutor of the author of this paper, at that time worked at the St Joseph Hospital in Chicago which is in the heart of one of the most popular districts in the gay community and, as the AIDS pandemic started, the majority of the Chicago’s AIDS patients would be taken to the hospital. It became the main centre for help and research against AIDS in the state of Illinois.
Dr Teplica got an idea that the patients whose bodies and faces were particularly mutilated by lipodystrophy could be helped by moving (auto transplanting) the adipose tissue from places where it still remained to the face. At that time, vast experience of auto transplanting other organs and tissues existed, including the use of the great saphenous vein to bypass the cardiac and peripheral blood vessels and the bone tissue widely used in places where it was lacking. Incidentally, his teacher Gary Burget created numerous auto transplantation procedures for nose reconstruction and the auto transplantation of fat had been tried before, but the results had not matched expectations.
Liposuction (the removal of fat by suction) was also already known. Dr Teplica started taking the adipose tissue from places where it remained on the patients’ bodies and planting it in the hypoderma of the face using the technology he had developed. To the surprise of sceptics, this fat would attach and the body did not resorb it.
However, it was not his discovery. Similar attempts had been made earlier but for different purposes and the results were not particularly gratifying. Interacting with thousands of AIDS patients suffering from lipodystrophy, he noticed that fat does not atrophy evenly over the body. Initially, he paid attention to the fact that in both male and female breasts (breast tissue is a type of adipose tissue) it atrophies insignificantly. However, besides the breasts, starting with the underarm to the upper inside thigh, all patients had nine pairs of mammary glands along the so-called embryologic mammary ridge. After examining it more thoroughly, the skin above these glands was more supple; often, more hairiness could be observed in these areas as well as moles, which, if looked closer at, resembled nipples. After performing more tests, it turned out that the 18 breasts of our mammal forebears did not go anywhere; they just atrophied and transformed. Their situation and size now determines the appearance of our trunk; these mounds now cover and hide our pectoral and abdominal muscles. He termed these embryogenetic breasts vestigial breast mounds, which would approximate in Lithuanian the saying ‘non-functioning breast mounds’. Dr Teplica published the discovery and its application in numerous articles in such prestigious publications as Annals of Plastic Surgery and Journal of Plastic and Reconstructive Surgery as well as in presentations for the American Society of Plastic Surgeons.
Since then, liposuction and the transplantation of the adipose tissue has developed significantly and gained in popularity, with such terms as liposculpting, body-sculpting, and Brazilian buttocks appearing. Just the transformation of the Kardashian family and uncountable lip and bust rejuvenations and augmentations for many stars have electrified a large part of the global audience. Quite recently, fat was an unloved atrocity, and now, under suitable conditions and circumstances, it is a desirable phenomenon (for instance, in liposculpting, abdominal fat is desirable, and sometimes surgeons recommend their patients to grow a belly), because a six-pack effect can be created from it by using liposuction or the fat can be auto-transplanted, transferred to an ageing face, deformed breasts or simply used to augment the breasts or buttocks. The subcutaneous fatty tissue has become an object of intense research. Now we know about these mounds and white, yellow and so-desired brown fat (the last one burns white and yellow fat, which is why it is desirable, and the more the body has of it, the lower the risk is of obesity). However, this is not the end – fat transplantation was soon applied in reconstructive surgery, especially for the face and breasts, where the possibility appeared, for example, after removing part of the face or breast tissues due to cancer, to replace them by autologous (one’s own) fat – the body does not reject it. Furthermore, it turns out that fat contains a lot of stem cells and, selectively sampling the fat from specific places, stem cells can be separated and planted on the affected places. This not only looks more aesthetic but also helps to revive the nervous and other tissues. Aesthetic aspects should not be forgotten; after all, breast, buttocks, face and other implants can be replaced by fat implantation from places that have too much of it to the places where it is desired.
Certainly, it has to be mentioned that this is not as simple as it might look. After the first wave of fat auto-transplantation, great disappointment arose, because the body used to absorb its fat, as it actually represented just the injection of fat obtained by liposuction to the required placed rather than lipotransfer, which was developed by such innovators as Dr Teplica by test and trial, failure analysis and retrial.
One interesting coincidence in the history of this discovery should be mentioned. AIDS looked so threatening that developed countries and pharmacological giants contributed vast funds and efforts to overcome this malady and created powerful means helping to neutralise the agent within an unbelievably short period of time compared to the nature of the problem. Within five years, the first effective drug was created, and within 15 years a therapy system that, if complied with, the virus could no longer be detected in the patient’s sample under normal conditions. Because of this, lipodystrophic patients soon became a rarity. Non-functional breast mounds again hid themselves from the “non-observant” human eye. So, the window for discovery was opened for a very short period of time. Here, we can do nothing more than recall the saying that reflects the American soul: to find yourself in the right place at the right time.