Twenty-one years ago, plastic surgeon Hans Lee brought a revolutionary new technique to Charleston, a surgical breakthrough in the fight against fat.In October 1983, the Gazette interviewed Lee about the long-awaited, much-heralded procedure that was developed in France and performed in the United States only in sophisticated metropolitan areas.He held up a long, slender metal tube with a blunt tip and a small hole on one side. He called it a cannula. “This is the future of plastic surgery,” he said. “Sooner or later, all plastic surgeons will have to learn how to handle it because there will be a big demand from the public.”Last year, the American Society of Plastic Surgeons ranked fat-suction surgery, formally known as lipoplasty or liposuction, as the most popular cosmetic procedure for women and the third most popular for men. It was the top choice for baby boomers, age 35 to 50.The 320,022 procedures performed nationally in 2003 represent a 13 percent increase over 2002. Only nose jobs (356,554) were performed more often.As predicted, virtually all plastic surgeons now learn liposuction as part of their training, Lee said.Improvements over the years have made the procedure safer and the results more consistent, he said, but the basic premise hasn’t changed. Simply put, lipoplasty sucks away fat.Aimed at specific stubborn fatty deposits that defy diet and exercise, the suctioning procedure can slim ankles and double chins, saddlebag thighs, love-handle hips, bull necks, blubbery bellies, bulging backsides and pudgy appendages.Surgeons now use it to enhance the results of facelifts, tummy tucks, breast reduction and other cosmetic and reconstructive procedures.Liposection can flatten a stomach without stretch marks, but patients with stretch marks, loose skin and loose muscles probably should choose a tummy tuck combined with some liposuctioning.The cannula fits into small incisions made in inconspicuous places. Flexible tubing connects the cannula to a vacuum pump that sucks out the fat. The surgeon shoves the cannula back and forth to loosen the fat, taking care to remove it evenly and to leave a protective upper layer of fat. The pump deposits the fat in a clear container. The skin retracts to fit smoothly over a smaller area.The original procedure, performed in the United States since 1982, was called suction-assisted liposuction or SAL, Lee said. “Then we got ultrasound-assisted liposuction, or UAL. That uses ultrasound energy, almost like a signal of water waves, to turn the fatty tissues into a thick liquid.”In power-assisted liposuction or POL, a surgeon uses a power tool to suck the fat instead of a manually operated cannula. A power tool works faster and removes fat more evenly, Lee said.“The original method is applied pretty much on every patient,” he said, “but we can combine that with UAL for areas where fat is dense and you want to soften it to make suctioning easier. The two methods augment each other.”In standard liposuction, a surgeon now injects a medicated saline fluid with local anesthetics to make suctioning easier, Lee said.Other improvements include smaller cannulas that allow more uniform suctioning.The going rate for liposuction in the area is about $1,500 to $2,000 for each area suctioned. Nationally, fees range from $2,000 to $10,000, with an average cost of $3,500 for one area.Removed fat cells don’t come back. At least not in the suctioned sites. But Charleston hairstylist Anthony Jarrell, a veteran of three liposuction surgeries, warns against complacency. Liposuction can’t replace diet and exercise, he said. “If you have fat cells removed and you continue to overeat, the body will find another place to store the excess fat, maybe the back of your arms or under your chin.”And liposuction shouldn’t be viewed as a form of weight reduction, he said. “It’s more like fine tuning, like having a suit taken in, but only half a size. Results are immediate, but it’s a three- or four-pound thing.”He had the surgery done on his abdomen, hips and back. Applauding improvements, he said the third procedure was easier than the first one. “I slept the first day, got up the second day and went back to work the third day.”One happy liposuction customer, a woman we will call Jenny, said she enjoys clothes shopping again, especially for jeans. “I always thought my thighs were too big,” she said. “And my lower stomach had that little pooch, so I had that done, too.“I’ve been wanting to do it for 20 years,” she said, “but making yourself go into surgery for something you don’t have to have is a little scary. And then, you have to think twice before you write a check for $4,000. But it was certainly worth it.”She stalled by telling herself she’d have surgery when she reached her ideal weight. Finally, she acknowledged that she might never reach her ideal weight and that results might be better at her “normal” weight.Now she chastises herself for waiting. “It was the easiest surgery ever,” she said. “Nothing to it.”Patients must wear a compression garment that fits much like a girdle through the recovery period to control swelling. Bruising and numbness are common. Both fade in time.Surgeons caution that the procedure works best on younger patients with firm, elastic skin.To contact staff writer Sandy Wells, use e-mail or call 348-5173.