Facial rejuvenation surgery in all its forms-from the browlift to simple liposuction-strives to create a more refreshed appearance. The desire for a younger appearance has its beginning in the youthful facial features immortalized in ancient Grecian and Romanesque statues. Evaluation of the idealized statue of Venus or David, for example, shows acute angles and crisp facial structure.
Surgeons have manipulated the ptotic orbicularis oculi muscle, resuspended the falling buccal fat pad, and tightened the hypertrophied and weakened platysmal sling for many years. All of these maneuvers are an attempt to redefine the natural facial angles through resuspension or removal of the ptotic or excessive soft tissue envelope. Facial adiposity is a significant hurdle that over the years has thwarted achievement of the ideal surgical result. In the early 1970s, Schrudde1 discussed the concept of "lipoexeresis." Manipulation of fatty deposits was first performed as an adjunctive procedure to facelift and was designed to improve aesthetic outcomes of primary rejuvenation surgeries.
The concept of fat removal continued to evolve with Fischer and Fischer2 and Kesselring's3 suggestion of placing a tube connected to a suction device through small incisions in a covered field to access fat deposits. Illouz described the technique of lipolysis in which he injected hypotonic saline in the proposed surgical site and then used a blunt-tipped cannula with a high vacuum for fat aspiration.1 Today facial liposuction is used as a primary facial sculpting or rejuvenating procedure and in combination with other regional aesthetic operations. In contrast to earlier methods, suction lipectomy offers important advantages of minimal scarring, reduced tissue trauma, shorter recuperative periods, and hidden incisions. Some feel that liposuction has revolutionized aesthetic surgery.1 The advent of smaller cannulas, the use of tumescence of the adipose tissue, the application of ultrasonographic techniques, and the use of the liposhaver are the latest advances in this field.
