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Fat layers

Fat under the skin lies in two layers, superficial and deep, separated by a membranous fascia that on the abdomen is called Scarpa fascia. Liposuction works in these layers, above the fascia of the muscle.

Techniques

Outside to inside

The layers under the skin

1. Skin

The skin has to shrink to fit the smaller shape. Illouz relied on skin retraction over many small tunnels instead of cutting away skin. Firm, elastic skin gives better results.[1][2][3]

2. Superficial fat

The superficial fat sits in compact, organized fibrous walls. Subdermal superficial liposuction, presented in 1989, treats this layer for better skin retraction. Illouz advised leaving at least 5 mm of fat under the skin.[1][2][3]

3. Scarpa fascia and the superficial fascial system

A membranous subcutaneous fascia separates the superficial and deep fat and fuses with the muscle fascia at set points. On the abdomen it is Scarpa fascia, deep to the fatty Camper fascia and superficial to the external oblique muscle, and it fuses with the fascia lata of the thigh. Lockwood described the superficial fascial system of the trunk and limbs in 1991.[1][2][3]

4. Deep fat

The deep fat sits in looser, widely spaced walls and varies by region. It forms deep compartments on both sides in the abdomen, the lower back and the buttock and thigh. Until the 1990s liposuction was done only in this layer. Deep subcutaneous fat behaves as a separate depot, closer to visceral fat in several proteins.[1][2][3]

5. Muscle fascia and visceral fat

The muscle fascia forms the floor of the deep fat. Liposuction removes subcutaneous fat. In one trial, visceral fat rose 10% six months after abdominal liposuction in women who did not exercise, and exercise prevented the rise.[1][2][3]