With thorough fat removal, tumescent liposuction produces good cosmetic results as a sole procedure for those patients beyond 40 years old, David Bank, M.D., said at Academy '99.

Many plastic surgeons, fearing a lack of tissue retraction, discount liposuction as a sole procedure for body sculpting after age 40.

"It's a common misconception that the skin is not capable of redraping or retracting following liposuction alone in patients older than 40 years," said Dr. Bank, director, The Center for Dermatology, Cosmetic and Laser Surgery, Mt. Kisco, N.Y., and an instructor in clinical dermatology, Columbia University, New York.

"many plastic surgeons perpetuate the myth that patients older than 40 need to have a tummy tuck or face lift instead of just having the fat suctioned out of the neck or abdomen," he added.

THREE PRIMARY AREAS

Dr. Bank shared his experience in performing liposuction in different anatomic areas in patients older than 40 years. He presented results of a study in which tissue retraction was evaluated in the abdomen, neck, and arms in this age group.

"These are the three areas that have to defy gravity in terms of tissue retraction," he said.

Fifty-eight patients - from ages 40 to 75 years - had outpatient tumescent liposuction under local anesthesia. Thirty of the patients underwent liposuction of the abdomen, 20 of the neck, and eight of the arms. Measurements in inches and weight in pounds were recorded at one, three and six months after the procedure.

Ninety percent of the participants were women. The average age of patients undergoing liposuction of the abdomen was 55 years; the neck, 57 years; and the arms, 44 years.

Patients undergoing liposuction of the abdomen lost an average of five pounds and 2.8 inches in the waistline. The average reduction in circumference of the neck was 1.3 inches without weight change in patients having liposuction of the neck. Those who had the procedure performed on their arms lost 0.5 inches in circumference without weight change.

"By thoroughly removing the extra fat from these areas, the skin demostrated its own natural tendency to redrape and retract on its own," Dr. Bank said. "What we're seeing is the bulk and weight of the fat that tends to push the skin away from the underlying muscles, but if you thoroughly and evenly debulk and remove the extra fat, the skin will conform over the underlying muscular structures."

"Many lay people and physicians are under the impression that you have to cut out the extra skin or it will hang," he continued. Because of this misconception, many patients undergo more invasive and potentially riskier procedures, he said.

PLEASED PATIENTS

Ninety percent of the patients in the study considered the results to be excellent, and 10 percent rated the results as good. None of the patients expressed dissatisfaction.

"The overwhelming majority of these patients can be satisfied with outpatient liposuction under local anesthesia, which is extremely safe and quick with an easy recovery time," Dr. Bank said.