In Beverly Hills, Birnbaum, whose clients include a good portion of the rich and famous, suctions the flanks of a television superstar four times; in Palm Springs, the outspoken Dr. Vincent Forshan, who co-authored a text on liposuction with Illouz and retains a public relations agent, suctions a Pasadena couple in their 60s who have decided it is a nifty way to celebrate their 40th anniversary. When the technique was introduced, the general wisdom was to avoid the procedure for persons over 40, but Forshan, half of whose clients are "geriatric," disdains tradition: His oldest patient, after all, was his grandmother, whose belly he suctioned at the age of 80 so she could look good in Bermuda shorts.
Whatever happened to the concept of age as beauty?
"Wait till you're 80," Forshan says.
As most doctors will tell you, you have a finite number of fat cells that expand and shrink as you gain and lose weight, and when you suction them out, they are gone forever, never to return. Which is not to say that, after surgery, you will not gain weight. Eat like a horse, after you have had your tummy sucked, and even if you tend to gain less in your stomach, your body will find a place to store that fat.
There are other problems with the technique.
It is, first of all, a method for removing localized fatty deposits, not for overall weight loss. If a surgeon takes out too much fat or removes the fat unevenly, he may leave "divots" or "waves": indentations in the skin. Though some doctors have had success grafting fat from one part of the body to the other, in many cases damage cannot be repaired. A 32-year-old psychologist and self-described perfectionist reports she went back into psychotherapy after a suction lipectomy left deep ridges in her stomach and legs. The operation cost her $4,000. She spent another $4,000 on more surgery to get herself fixed.
There are still other problems: If the skin is inelastic, from aging or from having been stretched by weight gain and loss or pregnancy, after liposuction the patient may have loose, baggy skin, correctable only with additional surgery--which leaves scars.
And then there's the clincher: When a doctor suctions out fat, he is removing blood and body fluids as well, and if too much is removed--most doctors put a limit of 2,000 cubic centimeters or 4.4 pounds total per procedure--without replacing the blood supply, it can lead to death. There have been 14 deaths nationwide, according to San Francisco surgeon Mark Gorney, a former president of the American Society of Plastic and Reconstructive Surgeons, which have led to an ongoing battle among doctors regarding who should be allowed to perform suction lipectomy. (See accompanying article, previous page.)
There are also those plastic surgeons, who--while they use the technique--take a skeptical view of its current popularity.
"I was there that day in 1983, at the meeting of the American Society of Plastic and Reconstructive Surgeons in Honolulu, when liposuction burst forth upon us fully formed like some strange, alien beast," says an eminent California plastic surgeon, who asked not to be named. "Actually, we'd heard rumors that this kind of thing had been going on in France with good results, so this fellow Illouz was invited to present to us. The last day of a five-day surgical meeting you barely have one-third of the room full. It's probably the worst slot, but this was different. It was standing room only in the main ballroom. He presented this paper in heavily accented English and talked about the little waves and we didn't know what the hell he was talking about."
"I was doing plastic surgery a lot," Illouz himself explains, "and I was obliged when I wanted to modify the contour to leave a big scar, and I did not find this very aesthetic. I don't think this makes a very good improvement, except for the people who are dressed, and now women want to be beautiful not only dressed but undressed. They go to the beach, they have short skirts, they want to be happy in their private life. Then, one day, it was 10 years ago exactly, a girl, young and pretty, comes to me with a lymphoma, a fat tumor, on the shoulder. She wanted that removed with a minimum of scar, and an idea comes to me and I say, 'I am going to try on you something that may be working.' So I remove the fat with the suction machine."
"He showed a lot of pictures," says the California surgeon. "Many had excellent results, some of them had poor results, some I couldn't see the difference. But it certainly made an impression on the specialty. We were coming out of a recession, and in a recession the volume of elective surgery goes down. All of a sudden here was a procedure that many regarded as exciting enough to bring a lot of patients into the office. Of course, traditionally, most operations are developed in the anatomical laboratory or with animals, and then we try it on human beings."