Rationale of subdermal superficial liposuction related to the anatomy of subcutaneous fat and the superficial fascial system

Abstract

The liposuction technique has changed greatly over the years. In 1989, the authors presented subdermal superficial liposuction which treats the superficial fat layer and yields better skin retraction. With this technique the surgeon can treat thin adipose layers to obtain better results in more cases than the traditional liposuction technique. The technique can be used in cases with difficult skin adjustment and in secondary cases when "deep only" liposuction has been performed and there were residual adiposities. Subdermal superficial liposuction evolved so that one could obtain good skin retraction by performing massive liposuction of all the fat layers. The authors named this technique MALL (Massive All Layer Liposuction). The technique is applied in body areas where the fat layer is very thick and stretches the skin because of its volume and weight such as in the abdomen, posterior arms, and internal surface of the upper third of the thighs. MALL liposuction drastically reduces the indications for abdominoplasty and inner thigh and arm dermolipectomies. Knowledge of the anatomy of the subcutaneous fat and the superficial fascial system allows one to explain the subdermal superficial liposuction from an anatomical point of view, to perform a more rational and effective procedure, and to differentiate the technique depending on the area of the body.

Anatomical, Histological And Metabolic Differences Between Hypodermis And Subcutaneous Adipose Tissue

“…With the weight gain and the resultant adipocyte hypertrophy in adulthood, the hypodermis uniformly thickens throughout the tegument whereas the subcutaneous adipose tissue proportionally increases in volume, thus being responsible for the located accumulations [5]. Therefore, the meaning of "located body fat: first to gain, last to lose" can be more easily understood.…”

“…Its thickness varied in adipose content and mechanical strength among the studied individuals. The oblique distribution of the septa, its limited elastic properties when stretched and its low resistance to compression explain the sliding of this tissue over the deep fascia [3,5].…”

“…As shown by studies on the anatomy of the abdominal wall, the superficial adipose tissue is organized below the epidermis and the dermis as follows: hypodermis or areolar adipose tissue (AAT), a fibrous horizontal layer of connective tissue (fascia superficialis), and subcutaneous adipose tissue or lamellar adipose tissue (LAT) [2,3,4,5]. Owing to the fact there is no unanimity among the authors concerning nomenclature in the literature, these will be the adopted terms to describe the layers in the current review [4].…”

“…The fascia superficialis is a membranous layer formed by multiple sublayers of fibroelastic tissue, which is composed of collagen bands distributed in different directions, with intersection points between them and fine irregular adipose cells islets located between the collagen fibers, resembling lamellae [3,5].…”

Radiofrequency-assisted Liposuction for Arm Contouring

“…3 Some have found good skin retraction with aggressive SAL of all layers of the arm. 4,5 It is postulated that energy-assisted liposuction may improve skin retraction 6 and the overall aesthetic result in nonexcisional upper extremity contouring procedures. For example, increased retraction was observed in the inferior portion of the arm skin in patients treated with ultrasonic-assisted liposuction.…”