Aesthetic or functional indications for liposuction.

Liposuction to correct unaesthetic deposits of fatty tissue is the most commonly performed cosmetic surgical procedure worldwide. 1 Highly satisfactory silhouette contouring may be achieved when appropriately trained operators perform the procedure with properly selected technologies on well-selected patients and anatomical areas. The fundamental principles of the technique have evolved into the method of choice in the treatment of various entities; applications of liposuction have expanded beyond its original aesthetic indication to include the treatment of many pathological conditions. A frequently asked question , particularly when the procedure is performed for functional complaints, is whether liposuction should always be considered an aesthetic procedure or whether it should, in some situations, be deemed a therapeutic reconstructive procedure covered by national health plans and third-party payers. Liposuction can be defined as both a technique and a surgical tool, similar to the electric scalpel or the optical scalpel (CO 2 laser) or, more recently, the innovative tools used in endoscopic or robotic surgery. It can be advantageously applied for diverse pathologies and conditions, ushering in a new era of liposuction. The technique can be performed as a minimally invasive procedure and can be a better alternative to direct surgical lipectomy and debulk-ing, resulting in fewer complications such as hematoma formation, skin necrosis, wound infection, and dehiscence with delayed healing and prolonged hospital stay. In other words, liposuction is to surgical lipectomy what endoscopic cholecystectomy is to open surgical cholecystectomy. The term liposuction merits demystification and redefi-nition. The indication for which liposuction is being applied—not the biased general understanding that it is always a cosmetic procedure—should determine whether to classify liposuction as a cosmetic or functional procedure. In many situations, the line between aesthetic and reconstructive procedures is blurry, but when liposuction is used for debulking massive lymphedema or treating conditions such as Dercum disease, Madelung or Launois-Bensaude disease, or adiposis dolorosa, functional indications prevail. Liposuction ceases to be a cosmetic procedure in these instances, since the final aesthetic outcome is far from optimal for most of these conditions. Unfortunately, the boundary between aesthetic and functional indications is less clear when dealing with various lipodystrophy syndromes or debulking flaps because liposuction may result in obvious aesthetic improvements. Table 1 summarizes the conditions and pathologies for which liposuction may be indicated as a primary therapeutic procedure or as an ancillary procedure to facilitate the applied surgical technique or improve outcomes. It is becoming urgent that …