Trunk subcutaneous fat is constituted by two layers: superficial and deep. The first is dense and compact with many fibrous septa, the second is looser, with fewer walls and located mainly around the navel, lower back, buttocks and inner thighs.

In cellulite fat is not different from the common skin fat. The different appearance of cellulite is due to the architecture of the superficial fat in those areas. Dense vertical walls separate fat in pouches. At this hypertrophy (increase in size) or relaxing of the skin with age the walls act as an anchor to the skin. This results in the accordion appearance of cellulite.

The body creates fat cells into three periods: in utero, in childhood and early adolescence. In general, after reaching maturity, the total number of these cells will not increase. If they are removed by liposuction they will not be replaced by others. However, the remaining cells can increase in size and the mass of total fat in the area will increase again with an excessive intake, so it is advisable to maintain a fairly stable weight. The only exception to this is morbid obesity in which fat cells may be able to multiply.

Liposuction, also known as lipoplasty or liposculpture, is surgical removal of the adipose tissue with the use of small metal cannulas. Although the first attempt took place in 1921, modern techniques were developed by surgeons as Schrudde, Fisher, Meyer and Illouz in the 1970s and 1980s.

Liposuction works best in the case of localized fat deposits that do not respond to diet or exercise. Treated areas tend to keep the new contour unless the patient gains too much weight. This procedure is not indicated for obesity. Patients with significant medical problems, those whose vascular tone or elasticity are deficient and those taking anticoagulants should not undergo liposuction.

This solution is infiltrated subcutaneously before liposuction. It is a mixture of cold physiological serum with adrenaline, lidocaine, and bicarbonate. It has two advantages: a secondary anesthetic effect by the use of lidocaine and a hemostatic effect (reduces bleeding) by adrenaline. In this way blood loss is drastically reduced during surgery.

Overall, despite large amounts of fat being removed, the skin has good elasticity and it will conform to the new underlying volume. However, in patients with inelastic skin or older, maybe it wil not be able to withdraw and it maybe necessary to associate another procedure to dry the skin such as thigh lift.

There are two procedures. In cases of mild to moderate degree, traditional or ultrasonic assisted liposuction can be effective. If the deformity is moderate to severe or if the patient has inelastic skin, direct excision or brachioplasty or can be performed.