Without realizing it, shortly after starting liposuction, I naturally adopted a way of working described in a magnificent book titled: “Superficial liposculpture“, co-written by an American, a Brazilian, and an Italian. The latter is Dr. Marco Gasparotti, whom I have mentioned before, and who welcomed me at his clinic in Rome.
One day, a colleague asked for permission to observe my work as a liposculptor, and he said to me: “Are you working with Gasparotti’s method?” I clarified: “No, what you are observing is my method; I have always worked this way!”
He then brought me the mentioned book, a work I devoured and which allowed me to get to know Dr. Gasparotti.
For me, from the start, this method had become so natural that I couldn’t imagine working any other way. There is a cleavage plane just under the dermis where the cannula moves naturally and with great ease. This way of proceeding was identical to that of the eminent clinician.
Without planning it, thanks to this superficial technique, I gained access to a much broader clientele, as all types of skin—healthy, sagging, or aged—could benefit from liposuction. Incidentally, I would like to clarify something very important. If the skin sags on its own, without the weight of fat being responsible, it will retain this characteristic after liposuction, as liposuction does not restore elasticity to skin that has lost it; however, it allows the remaining elasticity to express itself.
I specify this because if the skin sags due to the weight of fat, and you remove this weight through liposuction, the skin will often return to its place completely. If you tie a stone to an elastic band and let it stretch, the band will stretch according to the weight of the stone.
If you remove the stone, it will retract immediately. But if the elastic band was already stretched before attaching the stone, it will remain the same when you remove the stone. The same observation applies to the skin.
But what about cellulite, is it correctable? I’ll get to that. Everyone agrees that cellulite is that infamous orange peel skin so disliked by women. However, in popular language, cellulite is used as a catch-all term to describe anything unsightly on a woman’s body, such as bumps, dimples, folds, waves, irregularities, particularly the often “quilted” roundness. But if the roundness disappears thanks to the suction cannula, what will happen to the orange peel skin and the unsightly quilting?
Let’s listen to Dr. Gasparotti: Moreover, the phenomenon of cellulite is not addressed or corrected with the old technique (of deep liposuction with large cannulas). These issues, unsolvable with conventional liposuction, can now be successfully treated with the method called superficial liposuction. Gasparotti, Lewis, Toledo; Superficial Liposculpture, preface p. 1.
Indeed, cellulite owes its orange peel appearance to fibers called retinaculum cuti, which anchor the skin to deeper layers. If these fibers are under tension, they create irregularities on the skin, giving it a quilted appearance. Thus, cellulite could be defined as: “a special type of fat that gives the skin a quilted appearance. This appearance is due to fibrous adhesions pulling on the skin, producing the same effect as buttons on a mattress.“
Only stages 2 and 3 are treatable with liposuction. This does not mean that cellulite will disappear for sure, but the chances of improvement are high, thanks to superficial liposuction, as the cause of cellulite lies on the surface.
Dr. Toledo from Brazil invented a cannula that now bears his name and effectively breaks the fibers responsible for the orange peel appearance. When cellulite is significant, this cannula is moved under the skin at the end of liposuction, without aspirating fat, simply to cut the dermal fibers responsible for cellulite. However, this maneuver should not be overdone, as cutting too many fibers could lead to fluid accumulations called “seromas.” We will revisit this when discussing complications.
Why are men exempt from cellulite? It’s because, anatomically, they are built differently from women. Firstly, only 30% of their fat is subcutaneous, whereas women have 50%. Additionally, fat lobules are larger in women. I have already explained that the responsibility for cellulite lies with these fibers that anchor the skin to deeper layers. According to Dr. J.P. de l’Estang in his book: Liposculpture in Practice, p. 13, “in women, these fibers are perpendicular to the skin, causing the quilted appearance; in men, the fibers crisscross, allowing the skin to remain smooth.” From this perspective, it’s fair to say that men are privileged… one could even add that cellulite is a physiological inheritance for women, a natural phenomenon in a way.
