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Shifting the Weight : New Techniques in Plastic Surgery To Move--or Remove--Fat

November 30, 1986|PADDY CALISTRO

For years, a certain 37-year-old woman bemoaned her heavy thighs and bulging belly, wishing that she could somehow move the excess fat to her flat chest. No amount of dieting or exercise seemed to help. She was one of the few for whom plastic surgery was the only hope. Surgery made her dream come true: Today she has smaller thighs, a flatter tummy and larger breasts.

Another woman, whose face was deeply wrinkled, had a plastic surgeon take fat from her double chin and use it to plump up her creases. Today she enjoys a more youthful appearance.

These are examples of the newest development in the world of body contouring: the combination of suction-assisted lipectomy (SAL), in which fat is vacuumed out of the body, and autologous fat grafting, in which fat is taken from one area and injected into a place that needs padding. Body contouring is not for overall weight reduction; its purpose is to remove unevenly distributed pockets of fat that can't be budged by exercise or diet.

The American Society of Plastic and Reconstructive Surgeons reports that in 1984, when plastic surgeons performed 477,700 procedures for strictly aesthetic reasons, 55,900 operations were SALs, making it one of the most popular forms of aesthetic surgery, despite the fact that the technique has only been used in the United States since 1981. (Fat grafting is such a recent development that it was not included in the 1984 survey.)

Fat has been removed surgically since before the turn of the century, but it was not until the mid-1970s that Dr. Yves-Gerard Illouz of Paris introduced new suction techniques that popularized this form of body contouring.

At a recent plastic-surgery conference in Los Angeles, Illouz and others reported on successful surgeries involving SALs used in conjunction with fat grafting. Besides its use in plumping wrinkles and augmenting breasts, fat grafting is employed to correct congenital deformities and other irregularities.

Dr. Frederick M. Grazer, a Newport Beach plastic surgeon, says: "It is a little too early to say that autologous fat grafting is here to stay. So far, we cannot determine the survivability of the (grafted) fat cells." When large amounts of fat are transferred from one area to another, many or all of the cells in these blocks are not properly nourished by the blood supply. Eventually they are absorbed by the body, and the desired effect is lost.

Dr. Mel Bircoll, a Beverly Hills plastic surgeon, developed a fat-transplant procedure that--unlike traditional grafting, which moves large blocks of fat--distributes extremely tiny globules over a relatively widespread area. Thus, it allows all of the transplanted fat to be in contact with the blood supply. Breast transplants that he performed more than three years ago, he says, have held up "with no real signs of absorption." Now Bircoll is using his procedure in cheek and chin implants and to improve the appearance of aged hands.

A word of caution: Fat suctioning, grafting and transplants may sound like easy solutions to facial and figure flaws, but, as Grazer points out, surgery should be considered "a last resort."

Complications--including massive infection and even death--have been associated with these surgeries. Researchers at the conference also emphasized that surgery must not be considered a quick fix for obesity. It is merely a way to correct disproportionate bulges such as saddlebags and love handles that cannot be reduced using traditional methods. If the post-plastic surgery patient wants to be slim all over, he or she must also change eating and exercise habits.

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