© The Author • Journal compilation © Blackwell Verlag GmbH, Berlin • JDDG • 1610-0379/2012/1002 JDDG | 2˙2012 (Band 10)

JDDG; 2012 • 10:111–113 Submitted: 16.8.2011 | Accepted: 30.9.2011

Keywords• liposuction• Dermatology• tumescent local anesthesia• fat disorder• aesthetic

SummaryLiposuction is an integral part of the wide range of surgical procedures in der-matology. Dermatologists established tumescent local anesthesia in combina-tion with the use of micro-cannulas; especially dermatologists from Germanyand Austria actively designed and developed these new techniques. In thisposition paper, we discuss the history, various interdisciplinary aspects, the sig-nificance, and the treatment indications for this procedure as well as its rolewithin dermatologic training programs and research. For quality reasons, mem-bers of the Germany Society of Dermatologic Surgery and the Austrian Societyof Dermatologic Surgery discuss several fundamental professional aspects aswell as the historical development of liposuction.

Liposuction – a surgical procedure in dermatologyStefan Rapprich1, Josef Koller2, Gerhard Sattler3, Birgit Wörle3, Boris Sommer4, Falk G. Bechara5, Wolfgang Koenen6, Christian Kunte7, Doris Grablowitz8, Klaus Hoffmann5, Alina Fratila9, Guido Bruning10, Maurizio Podda1, Sanja Schuller-Petrovic11, Syrus Karsai12, Wilfried Schmeller13, Ilka Meier-Vollrath13, Jörg Faulhaber6, Jens Brodersen14, Kornelia Boehler15, Christoph Löser16

(1) Department of Dermatology, Darmstadt Hospital, Darmstadt, Germany(2) Department of Dermatology, Salzburg University Hospital, Salzburg, Austria(3) Rosenpark Clinic, Darmstadt, Germany(4) Dr. Boris Sommer, Frankfurt, Germany (5) Department of Dermatology, Venereology, and Allergology, Ruhr University, Bochum, Germany(6) Department of Dermatology, Venereology, and Allergology, Mannheim University, Mannheim Medical School at

the University of Heidelberg, Mannheim, Germany(7) Clinic and Polyclinic for Dermatology and Allergology, University of Munich, Germany(8) Center for Aesthetic Medicine, Vienna, Austria(9) Jungbrunnen Clinic Dr. Fratila, Bonn, Germany

(10) Tabea Hospital, Hamburg, Germany(11) VENEX Center, Vienna, Austria(12) Greifswald University Medical School, Clinic and Polyclinic for Skin Diseases, Greifswald, Germany(13) Hanse Clinic, Lübeck, Germany(14) Dr. Jens Brodersen, Berta Clinic, Hannover, Germany (15) Department of Dermatology, Vienna University, Vienna, Austria(16) Department of Dermatology, Ludwigshafen Hospital, Skin Cancer Center, Ludwigshafen, Germany

IntroductionLiposuction is an integral and well-devel-oped part of dermatologic surgery. Der-matologists developed the tumescent li-posuction technique with micro-cannulasmeasuring less than 4 mm. This tech-nique is now the method of choice and foryears has been one of the most frequentlyperformed surgical procedures world-wide. Dermatologists from Germany andAustria were especially closely involved inthese developments. Today liposuction isoffered at numerous dermatology clinicsin private dermatology practices in bothcountries. With a view to quality assur-ance, this joint position paper by the

German Society of Surgical Dermatol-ogy (DGDC) and the Austrian Society ofSurgical Dermatology (ÖGDC) discusseskey aspects of liposuction surgery and itshistorical development.

History of liposuction in dermatology[1–2]The modern history of liposuction be-gan in the mid-1970s with papers byGiorgio and Arpad Fischer. A milestonein the development of liposuction wasset by Yves-Gerard Illouz from Paris. His notion of a “wet technique” gave theimpetus for the development of tumes-cent liposuction by the American phar-

macologist and dermatologist JeffreyKlein [3–5]. The introduction of the tumescent tech-nique enabled even more extensive lipo-suction procedures to be performed onan outpatient basis. Those dermatolo-gists who were among the first to use thisnew surgical and anesthetic techniquebecame driving forces in the further de-velopment of liposuction (citation from[2]) [6–9].The extremely low risk profile of thetechnique was confirmed in a 1994study by the dermatologist C. WilliamHanke which included 15,336 patientswho were treated with liposuction by

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dermatologists [10]. A more recent studyby Roland Boeni with 4,380 patients,further confirmed the safety of the technique [11].From the beginning, dermatologists wereinvolved in establishing liposuction. TheAmerican Society of Liposuction Surgerywas founded in 1983. The 50 foundingmembers included plastic surgeons aswell as ENT specialists and 10 dermatol-ogists [12].Gerhard Sattler was one of the first German dermatologists to offer tumes-cent liposuction, beginning in 1989 atthe Department of Dermatology atDarmstadt Hospital [13–15]. The firstliposuction procedures in Austria wereperformed in 1985 at the Department ofDermatology at Vienna University, bySanja Schuller-Petrovic, and were used asaesthetic as well as curative measures.Even today, dermatologists continue towork intensely on further developmentand optimization the method, as demon-strated by the recently published study by Augustin and colleagues [16] on theeffectiveness of lidocaine and prilocainein tumescent anesthetic techniques.Liposuction was presented to a growingrange of German and Austrian physiciansfrom various areas of medicine in coursesand at scientific and medical congresses.These include the annual meeting of the German Society of Dermatology(DDG), the Austrian Society of Derma-tology (ÖGD), the DGDC, ÖGDC,and since 1992, at the internationalDarmstadt live symposia for dermato-logic surgery. Due to the international exchange at these and numerous otherevents, liposuction has achieved a highand internationally recognized standard.

Interdisciplinary aspectsExchange is not restricted to the field ofdermatology, but rather includes otherareas such as plastic surgery. Representa-tives of these and other areas, which alsoinvolve surgical procedures on cutaneousfat, are routinely invited as presentersand participants, for instance at theDarmstadt live symposia.

IndicationsCurrently, liposuction is primarily per-formed as an aesthetic procedure. Cos-metic indications include body contour-ing (saddle bags, double chin, abdomen,etc.) and correction of scars. Liposuctionmay be performed as a separate proce-

dure or in combination with liposhift-ing, subcision, or augmentation [17].Processing methods for the aspiratedfatty tissue with immediate use in tissueaugmentation were developed by derma-tologists and have been the subject of sci-entific studies [18–19].Dermatologists have been closely in-volved in expanding the surgical spectrumof liposuction to include non-cosmetic indications. Medical indications includelipedema [20–22], benign symmetricallipomatosis [23], large lipomas, lipodys-trophy in HIV patients (being treatedwith HAART), and Madelung disease.The use of liposuction in these diseaseshas been scientifically studied and evalu-ated by dermatologists. For instance, theeffectiveness of liposuction in patientswith lipedema has been confirmed bystudies [21] and has been followed in longitudinal investigations [24]. A paperby Schmeller and colleagues [24] has pre-sented the largest follow-up study at thispoint in time. No other field has compa-rable data over such an extended period oftime for this disease.In addition, guidelines have now beenpublished by dermatologists on lipedema[25].

Liposuction as part of continuingeducation in dermatologyDermatologic surgery is an establishedpart of medical training in dermatology.Courses include reconstructive proce-dures for the skin and cutaneous fattytissue as well as body contouring methods. Liposuction is included amongthe latter and thus is part of the generalcurriculum for continuing education indermatology.It should be emphasized that, as with anyother dermatologic surgery technique, liposuction is not limited to the manualperformance of the procedure but alsoinvolves knowledge of anatomy, indica-tions, differential diagnoses, and alterna-tive procedures. Dermatologists are notthe only qualified physicians, but in gen-eral are particularly well-trained andqualified in this field. This also applies tothe management of potential complica-tions (e.g., erysipelas, phlegmon) as wellas correct diagnosis, which is only taughtin dermatology.Liposuction is an established part of dermatology congresses where it is presented in the form of workshops,courses, live surgical procedures, and

lectures. Physicians can also attend lipo-suction procedures in detail at specializedcenters (hospitals and private practices).Liposuction is routinely performed athospital dermatology units (teaching and university hospitals) in Germanyand Austria, not only for cosmetic indications, but also for medical reasons(see above).

Quality assurance for liposuction bydermatologistsMany dermatological clinics and privatepractices in Germany and Austria are cer-tified. All surgical procedures, includingliposuction, are thus subject to qualitycontrol. One part of quality control is thedocumentation and reporting of compli-cations. A study on the analysis of thesedata has already been initiated.

Liposuction in dermatologytextbooks and literatureThe first comprehensive German text-book on liposuction was published in2003 by the dermatologists Sattler, Sommer, and Hanke [2]. In three stan-dard textbooks on dermatologic surgery,an entire chapter has been devoted to li-posuction [26–29]. Dermatologists haveestablished a curriculum on aesthetic andplastic surgery procedures in dermatol-ogy, which also includes a substantialamount of information on liposuction[30]. International dermatologic surgerytextbooks also contain exhaustive chap-ters on liposuction [31, 32]. Most of the scientific literature comes from dermatologists. Evidence-based medicine, which isbased on current clinical study results,has the aim of conscious and considereduse of the best possible information for making treatment decisions for indi-vidual patients. Dermatologists thusseem to be predestined for assessing theindications for liposuction and for itscareful use.

SummaryAs skin disease specialists, dermatologistsare also specialized in the prevention ofdermatological diseases and in variousaspects of maintaining healthy skinthroughout the ageing process. This alsoincludes aesthetic issues. Liposuction isnot the exclusive domain of dermatol-ogy, but rather dermatology is activelyinvolved in promoting interdisciplinaryexchange on the topic. Modern tumescent

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liposuction techniques were largely de-veloped by dermatologists. By virtue ofdermatology training as well as continu-ing education and training programs,dermatologists are especially qualified toperform liposuction.

Executive Committee of the German So-ciety of Surgical Dermatology (DGDC),www.dgdc.de: Gerhard Sattler, WolfgangKoenen, Christian Kunte, Falk G.Bechara, Christoph Löser

Executive Committee of the Austrian Society of Surgical Dermatology (DGDC),www.oegdc.at: Josef Koller, KorneliaBöhler, Sebastian Reischle, WernerSaxinger <<<

Conflict of interestNone.

Correspondence toDr. med. Stefan RapprichHautklinikKlinikum DarmstadtHeidelberger Landstraße 379D-64297 DarmstadtTel.: +49-6151-107-4101; 06151-107-9554133 (direkte Durchwahl)Fax: +49-6151-107-4150E-mail: stefan.rapprich@klinikum-darmstadt.de

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