LIPOSUCTION

Laser Lipo

Liposuction is the most commonly performed cosmetic procedure in the United States. It can be done either using general anesthesia or with the tumescent liposuction technique using local infiltration of lidocaine (the anesthesia), combined with a small amount of epinephrine, which effectively decreases the blood flow to the area being treated, and thus, decreasing the amount of blood loss during the procedure. An ideal patient for the procedure is in good general health but who is unable to diminish, either through diet and exercise, deposits of fat that are localized in certain areas of the body.

With the advent of the tumescent liposuction technique some years ago, in which local anesthesia is infiltrated under the skin, the safety profile of liposuction has improved dramatically, in terms of complications, the need for post-operative blood transfusions, decreasing the volume of the fat removed at any one time, and in the general well-being of the patient.



THE TUMESCENT LIPOSUCTION PROCEDURE

Advantages

There are several advantages of the tumescent technique:

  • Less blood loss.
  • Intravenous fluid replacement is not usually needed.
  • Bacteriostatic lidocaine may decrease the risk of infections.
  • Lipid-soluble lidocaine is somewhat suctioned out with the aspirated fat.
  • Vasoconstriction caused by epinephrine minimizes absorption of lidocaine.
  • The epinephrine may increase the cardiac activity, which, in turn, increases the hepatic metabolism of the lidocaine.
  • The duration of anesthetic effect may last as long as 24 hours, so no pain medication after the procedure is required.
  • Use of small cannulas that will cause less injury to the tissues, and an easier recovery period.

Indications

Liposuction is generally performed for the reduction of fatty deposits that are well localized and resistant to other measures.

Other situations exist that may benefit from tumescent liposuction. These include lipoma removal, axillary hyperhidrosis, evacuation of hematomas, pseudogynecomastia, and others.

Contraindications

  • Unrealistic patient expectations. Patients need to understand that this is not a weight-loss program.
  • Poor physical health of patient
  • Morbid obesity (megaliposuction controversial due to higher risk of mortality).
  • Cardiac and hypertensive patients may be at risk because of the epinephrine and lidocaine used.
  • Patients who are taking medications that block the cytochrome P-450 enzyme system in the liver, in effect prolonging the time lidocaine stays in the body, and thus increasing the risk of lidocaine toxicity, which may cause seizures and may be cardiotoxic at high doses.

These are precautionary warnings in general terms. Studies on the metabolism of lidocaine in patients undergoing the tumescent liposuction procedure, done following the appropriate protocols, have shown that the levels of lidocaine in the blood are very much lower than those seen with toxic doses. And even though complications are very rare, one needs to be aware of them.

Technique

Once consent is obtained and the photographs taken, the skin is prepped with a disinfectant and the markings of the areas to be treated are drawn, the patient is placed on a sterile drape, insertion sites for the cannulas are marked and then entered after local anesthesia at the sites is given. Then the infiltration of the liposuction solution is done. After the infiltration comes a period of time that varies between practitioners, but usually about 30 minutes or so, to give the anesthetic enough time to work, before the actual liposuction procedure starts.

Please understand that these are simple guidelines for those who have not had any experience on the subject, and it is only given here to provide you with some information as to what to expect. The actual sequence of events are going to vary and your physician will "walk" you step-by-step as to how she/he does it.

Postoperative care

Liposuction is performed on an outpatient basis, requiring only several hours, and the patient can return to home that evening.

Return to a normal activity level can occur within a few days to a couple of weeks.



THE LASER LIPOSUCTION PROCEDURE

In the past few year, laser liposuction has received wide media attention as a procedure with similar efficacy but with less downtime than traditional liposuction. The procedure has been marketed as SmartLipo, which uses a pulsed 1064-nm Nd:YAG system to help heat and possibly liquefy fat. Coagulation produced by the laser has been suggested as a possible benefit.

When combined with traditional tumescent liposuction, the results appear to be similar to those achieved with tumescent liposuction. But the laser liposuction is, at present, not used by most physicians for the treatment of large areas because it is not practical and it is time consuming. It is however used for small areas such as the neck, with good results.

Complications

Complications of liposuction performed with a pure tumescent technique have been minimal. The most significant complications have been attributed to concurrent sedation or general anesthesia or fluid shifts secondary to large volume liposuction. Fatalities have been associated with other concurrent surgical procedures, for example abdominoplasty performed with abdominal liposuction.