Liposuction Risks

Every surgical or medical procedure involves a certain amount of risk. To minimize potential liposuction side effects, risks, complications, or other problems, make sure you fully understand the procedures you wish to have done, and discuss your expectations and concerns with your physician.

DocShop can help you find a cosmetic surgeon in your area today.

Possible Liposuction Problems
With any type of cosmetic surgery, including liposuction, complications may arise, but they are rare. Some dangers of liposuction include infection, a reaction to the anesthesia, blood clotting, and fluid loss. Less severe liposuction risks include bruises and scars, a numbing of the skin, and moderate problems such as changes in skin pigmentation. Liposuction complications may include:

Infection
Extended healing time
Allergic reaction to medication or anesthesia
Fat or blood clots - clots can migrate to the lungs and lead to death
Excessive fluid loss - fluid loss can lead to shock and, in some cases, death
Fluid accumulation - fluid must be drained
Friction burns
Damage to the skin or nerves
Damage to vital organs

Dangers of Excessive Liposuction
The most common dangers of liposuction include risks associated with removing too much fat from targeted areas at once, as well as having too much liposuction performed in a single day. Excessive liposuction can cause problems including dents, lumps, and sagging skin. In order to minimize surgical complications and the side effects of overexposure to anesthesia, patients should schedule multiple liposuction procedures at least several days apart.

Minor Complications
Non-life-threatening liposuction complications include bruising, scars, a lumpy appearance, sagging or discolored skin, focal skin necrosis, fainting after surgery, numbness, and non-lethal drug interactions. All liposuction problems should be discussed with your doctor, as some may become serious if left untreated.

Severe Liposuction Complications
Severe complications associated with liposuction are rare, but should be taken into consideration when deciding whether liposuction is right for you. Severe complications include adverse reactions to anesthesia, cardiac arrest, cardiac arrhythmia, internal blood clots, excessive bleeding, severe drug interactions, allergic reactions to medication, permanent nerve damage, seizures, and brain damage from anesthesia.

Minimizing Complications
Minor liposuction complications, problems, and general dissatisfaction can be minimized by fully understanding the risks and benefits associated with liposuction and having realistic expectations. It is extremely important to choose a cosmetic surgeon who will clearly and thoroughly explain potential liposuction side effects and risks. He or she should also have proper and extensive training, along with state-of-the-art facilities and a good standing in the field.

Severe complications can be minimized by disclosing your entire medical history to your doctor and discussing all prescription and over-the-counter medications you take on a regular basis. Patients should be good candidates for liposuction and fully understand what is involved in this procedure.

To maximize the success of liposuction surgery and minimize the risk of complications, always follow your cosmetic surgeon’s instructions for surgical preparation and postoperative care. If you smoke, your cosmetic surgeon will advise you to stop two weeks prior to and following liposuction surgery. You may also choose another avenue for fat removal. There are non-surgical liposuction alternatives available to patients who are not good candidates for liposuction or simply prefer other methods.

Talk to a Doctor about the Dangers of Liposuction
The best place to find out about potential dangers of liposuction is from your physician. It is important to understand that there are risks, problems, and complications associated with any cosmetic surgery procedure. However, doing your homework and asking all of the pertinent questions will minimize the risk of side effects that may occur as a result of the surgery. Let DocShop help you find a cosmetic surgeon in your area.

Tumescent Anesthesia Not Just for Liposuction

Physicians should think outside the liposuction box when it comes to using tumescent anesthesia in dermatologic surgery practices, Dr. Jeffrey A. Klein said at the annual meeting of the California Society of Dermatology and Dermatologic Surgery.
Excisions, Mohs surgery, lipoma removal, breast reduction, and intravascular vein ablation all lend themselves well to the use of tumescent anesthesia, according to the discoverer of the technique.
Besides providing long-lasting and profound local anesthesia, bactericidal protection, and elevation of tissues for delicate procedures, the tumescent technique offers "exquisite hemostasis," said Dr. Klein, a dermatologic surgeon in San Juan Capistrano, Calif., who is credited with revolutionizing the safety of liposuction anesthesia by pioneering the use of dilute concentrations of lidocaine and epinephrine in saline with sodium bicarbonate.
"I'm really impressed at how little blood loss there is," he said.
In laser and radiofrequency procedures, tumescent liposuction acts as a heat sink. For excisions or Mohs surgery on the neck or face, it can lift lesions safely away from superficial nerve branches, he pointed out.
It can be used in conjunction with dissection with blunt liposuction cannulas to separate fibrous, multilobular lipomas from surrounding tissue so they can be easily excised. In Germany, it is being used to perform sentinel lymph node biopsies on melanoma patients.
Dr. Klein outlined examples of numerous dermatologic procedures he has performed with tumescent liposuction, from the extraction of excess glandular tissue through the nipple of a patient with male gynecomastia to the excision of a large melanoma down to fascia.
Mohs surgery of a large, recurrent basal cell carcinoma can be accomplished as "essentially a painless procedure" during which the patient remains awake, he said.
The lack of infections seen following liposuction--just 1 in more than 6,000 procedures performed by Dr. Klein--suggests that "there must be a very substantial bacteriocidal effect" of tumescent solution, he said.
Obviously, much smaller volumes of tumescent fluid are utilized in these other procedures than are needed in large liposuction cases, but the ratio of the ingredients in the formula remains the same. (See "Small-Volume Tumescent Recipe".) Once the area is infiltrated, "you need to allow time for detumescence to occur," said Dr. Klein.
In large abdominal liposuction cases, this process ideally should occur over the course of an hour. For smaller dermatologic surgery cases, the procedure should be delayed for at least 15-30 minutes for fluids to drain away and the architecture of the lesion to be restored.
Recovery following cases in which tumescent anesthesia is used is remarkably quick, with patients most likely able to return to work within a day, even following large excisions.
Dr. Klein noted that tumescent anesthesia has been widely adopted by other specialties and is commonly used in stem cell harvesting and vein, breast, burn, craniofacial, and rectal surgery.
BY BETSY BATES
Los Angeles Bureau
Small-Volume Tumescent Recipe
A 100-mL formulation of tumescent local anesthesia (TLA) consists of approximately 0.25% lidocaine and epinephrine 1:400,000. To prepare this formulation, use:
* 100-mL bag of sodium chloride 0.9%.
* 300 mg lidocaine and 0.3 mg epinephrine (30 mL of 1% lidocaine with epinephrine 1:100,000).
* 3 mEq sodium bicarbonate (3 mL of 8.4% sodium bicarbonate).
On the day of surgery, a nurse prepares and labels the bag of TLA immediately after the patient arrives. For safety reasons, TLA should never be mixed 1 or more days before the day of surgery. Every bag of TLA should be well labeled at the time of its preparation.

Tumescent Liposuction Pharmacology

Tumescent Liposuction Pharmacology
The word tumescent means swollen and firm. With the tumescent technique such a large volume of dilute lidocaine is injected into the targeted fatty tissues that those areas become tumescent (swollen and firm). The tumescent technique produces profound local anesthesia of the skin and subcutaneous fat that lasts for many hours.


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Safety of the Tumescent Technique
Safety of the tumescent technique is remarkable. No deaths have ever been reported in association with the tumescent technique for liposuction totally by local anesthesia. Most serious liposuction complications seem to be associated with excessive liposuction or multiple simultaneous unrelated surgeries, and the use of general anesthesia or narcotic analgesics. The amazing safety record of liposuction totally by local anesthesia was surprising because the technique uses dosages of lidocaine (local anesthetic) that were considered potentially toxic. The mystery of this unexpected safety was solved by studying the pharmacokinetics of tumescent lidocaine.


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Pharmacokinetics
This is the science that studies the concentration, pathway and fate of drugs as they travel through the body. For example, the pharmacokinetics of tumescent lidocaine is concerned with measuring the concentration of lidocaine in the blood, and how this concentration changes over time. The toxicity of a local anesthetic is a function of its peak plasma concentration which in turn depends on several factors including the total milligram per kilogram dose, and the rates of systemic absorption and elimination.


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Safe Dose
A safe dose of tumescent lidocaine is estimated to be 45 mg/kg for thin patients, and 50 mg/kg for average to overweight patients. (Tumescent Technique, by J. Klein, Mosby Publishers, 2000).

Lidocaine Can Be Toxic
Lidocaine can be toxic if its concentration in the blood exceeds a threshold of 6 milligrams/liter. The most extraordinary aspect of the tumescent technique is its unprecedented safety record when used as directed. Most liposuction surgeons know that it can be dangerous to give a patient a dosage of tumescent lidocaine that exceeds 50 mg/kg. All liposuction-related deaths have been associated with either the use of general anesthesia, or IV sedation, or grossly excessive lidocaine doses in excess of 75 mg/kg. The tumescent technique is dangerous in the hands of surgeons or anesthesiologists who have not had specific training in the technique. There has never been a reported death associated with tumescent liposuction totally by local anesthesia.

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Total Dosage of Lidocaine Affects Safety
The total amount of lidocaine, measured in terms of milligrams of lidocaine per kilogram of body weight (mg/kg), that is given to a patient directly determines the risk of lidocaine toxicity. Following an injection of lidocaine, the concentration of lidocaine in the blood gradually increases, eventually reaching a peak, and then declines. The risk of toxicity depends on the peak concentration of lidocaine. Lower peak plasma lidocaine concentrations reduce the risk of lidocaine toxicity. The fundamental reason for the great safety of tumescent local anesthesia is its exceptionally slow rate of lidocaine absorption.

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Drug Interactions Affect Safety
Certain drugs such as the SSRI antidepressant Zoloft), the antibiotic erythromycin, the antifungal drugs ketoconazole (Nizoral) and Fluconazole (Diflucan) can impair the enzyme in the liver (cytochrome P450 3A4) that is required to metabolize lidocaine. Such drugs slow the rate of metabolism, and thus increase the amount of lidocaine in the body and the peak lidocaine concentration in the blood, which in turn increases the risk of lidocaine toxicity. It is important that patients and liposuction surgeons be aware this type of drug interaction, and either discontinue all such drugs at least 10 days before surgery or reduce the dosage of lidocaine to less than 35 mg/kg. (See Drugs that Inhibit CYP3A4)

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Lidocaine Absorption Rate Affects Safety
For any given milligram per kilogram (mg/kg) dose of lidocaine, anything that slows the rate of lidocaine absorption, will reduce the peak lidocaine plasma level, and thus reduce the risk of lidocaine toxicity. There are three factors that cause tumescent lidocaine to be absorbed from fat at an exceptionally slow rate: 1) subcutaneous fat has a relatively low volume of blood flow, 2) dilute epinephrine produces a prolonged and profound degree of vasoconstriction, and 3) lidocaine is lipophilic and is readily sequestered in fat cells. When lidocaine is injected into muscle, through a vein directly into the blood, or in the gums (for dental anesthesia) the rate of absorption into the blood is much more rapid than when lidocaine is injected into fat. Different rates of lidocaine absorption require different lidocaine dosage limits.

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Tumescent Anesthesia is Local Anesthesia
When the tumescent technique is performed properly, the effects of tumescent lidocaine are local and not systemic. However, there are surgeons who do very large volume liposuction surgeries; these surgeons may use large amounts of tumescent anesthesia and expose their patients to potentially excessive amounts of injected fluids or excessive amounts of lidocaine.

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Definition of Dosage and Dose
There is a distinction between the words dosage and dose.
The word dosage describes the amount of drug given to a patient expressed in units of mg/kg where mg = the weight of the drug expressed in milligrams, and kg = the patients weight expressed in kilograms. The word dose describes the amount of drug expressed in mg units where mg = total milligrams of drug given to a patient. The word dose does not take into account the patients total body weight. By using the mg/kg dosage to determine the amount of drug given to a patient, a physician can more accurately predict equivalent effects among patients whose weights are considerably different.

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Reduced Discomfort Upon Injection
Commercially available solutions of lidocaine are made acidic in order to increase the solubility of lidocaine. If the lidocaine solution also contains epinephrine, then an acidic solution is necessary to increase the shelf-life of epinephrine. Unfortunately, acidic solutions produce a slightly painful stinging sensation upon injection into the skin or into subcutaneous fat. The stinging discomfort of an injection of lidocaine can be reduced by the addition of sodium bicarbonate into the solution to neutralize the pH of commercially available solutions.

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Effect on Nerve Fibers Types
Local anesthetics tend to block small nerve fibers sooner than larger fibers. Clinically this is manifested by the observation that small fibers that mediate pain and temperature, are blocked more easily than the larger sensory nerve fibers that mediate pressure, and vibrations, or motor nerves that mediate muscle function. Tumescent local anesthesia in adipose tissue produces a rapid blockade of pain and temperature sensation, while local anesthesia has less effect on pressure and vibratory sensation. Thus, with adequate infiltration of tumescent local anesthesia, patients should not feel pain during tumescent liposuction, however they will often be aware of vibrations, and a peculiar rasping sensation.

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Antibacterial Effects of Lidocaine
Tumescent liposuction is associated with a remarkably low risk of postoperative infections. This enviable clinical record provides strong evidence that in-vivo tumescent local anesthesia is bacteriostatic (prevents the growth of bacteria) and bacteriocidal (kills bacteria). There are few, if any, extensive surgical procedures with a lower incidence of infection than that of tumescent liposuction.

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Lidocaine Reduces the Risk of Infections
Two recent reports have found that dilute lidocaine in a concentration of 500 mg per liter of solution (0.05%) does have in-vitro antibacterial activity. Another study found this lidocaine dilution to be bacteriostatic for Staphylococcus aureus. Another in-vitro study, using suspensions of bacteria containing approximately 105 bacteria per ml found that all gram-positive organisms tested, including S. aureus, had significantly lower colony counts in 0.05% or higher concentrations of lidocaine diluted by the IV anesthetic propofol. There is in-vitro evidence that lidocaine is not just bacteriostatic but actually bacteriocidal for organisms isolated from skin lesions. Recently it has been shown that when sodium bicarbonate is added to lidocaine, this in-vitro bacteriocidal activity is increased.

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Doing Too Much Liposuction is Dangerous
Common sense is still necessary. The enviable record of tumescent liposuction is attributable to 1) moderation in terms of the amount surgical trauma inflicted during a single surgical procedure, and 2) a wise selection of healthy patients. If surgeons disregard common sense and moderation in liposuction, and attempt to do too much liposuction on a single day, then the record of postoperative complications is no longer enviable.

Liposuction Information

What is Liposuction?
Liposuction is defined as the removal of fat from deposits beneath the skin using a hollow stainless steel tube (called a cannula) with the assistance of a powerful vacuum. Liposuction can be accomplished either with the use of general anesthesia, or with heavy IV sedation, or totally by local anesthesia. Newport Beach liposuction considers both the benefits and the potential dangers of local anesthesia and of systemic anesthesia.

Tumescent Liposuction Invented by Dr. Klein
Tumescent liposuction refers to a technique that uses large volumes of very dilute local anesthesia that is injected into the body fat causing the targeted areas to be come tumescent, or swollen and firm. Local anesthesia is widely regarded as the safest form of anesthesia. Because local anesthesia persists for many hours there is no need for narcotic pain medications after tumescent liposuction surgery.

Modified Tumescent Liposuction
Modified tumescent liposuction refers to a combination of tumescent local anesthesia plus some form of systemic anesthesia (general anesthesia or heavy IV sedation). Because general anesthesia or heavy IV sedation can be dangerous to the patient, these types of anesthesia must be administered by an anesthesiologist.

The Different Newport Beach Liposuction Techniques
There are many types of liposuction, for example liposuction can be done painlessly either totally by local anesthesia or with general anesthesia. In the realm of liposuction, speed and volume of aspirate are not a basis for excellence. Ultimately, Newport Beach liposuction excellence is measured in terms of patient happiness which is a function of safety, patient comfort, finesse, and quality of results. The important distinction between Newport Beach liposuction surgeons who are board certified is the liposuction technique that they employ. The liposuction surgeon's specialty is not as important as the surgeon's liposuction technique, experience and attitude toward patient safety.

Liposuction Complications
Liposuction complications are often the direct result of lack of caution, poor judgment, over confidence, ignorance about pharmacology, or adherence to faulty dogma. The Newport Beach liposuction site discusses these traits, and explains how to reduce the risk of liposuction surgical complications.
The "Art of Liposuction Surgery" by Dr. Klein
Liposuction surgery is a medium of artistic expression that displays itself in (1) a practical application of scientific knowledge, (2) the production of what is beautiful, (3) a perfection of workmanship, (4) a perpetual quest for improvement in technique, and (5) a skill attained through clinical experience, and above all (6) making people feel happy about what they see in the mirror.
Artistry and Safety are Related
Newport Beach liposuction asserts that artistry and safety depend on each other. The word "art" implies skill and mastery of a technique. In order to master an artistic liposuction technique, the surgeon must have the skill and intelligence to avoid exposing patients to unnecessary dangers. The true artist provides better results, and uses the safest liposuction technique and never forgets the duty to "first, do no harm." For example, even if a patient wants to have a large volume of liposuction surgery accomplished in one session, the artist convinces the patient that serial liposuction procedures are safer and ultimately yield better results. It is not artistry to take unnecessary risks or push liposuction surgery to the limits of safety.
Risks of Liposuction
Risks of Liposuction must be well understood by all prospective liposuction patients. Newport Beach liposuction emphasizes the need to constantly be aware of patient safety issues. In order to minimize the risk of liposuction surgery, the patient must be aware of the following facts :
Too much liposuction is an excessive volume of aspirated fat, or an excessive number of areas treated. Excessive surgical trauma (excessive liposuction) is dangerous and is an important cause for serious liposuction surgery complications.
Unrelated surgical procedures on the same day as liposuction surgery are unnecessary. Prolonged exposure to anesthesia is dangerous and is an important cause for serious liposuction complications.
Disfiguring skin irregularities and depressions are frequently the result of the liposuction surgeon�s inattention to detail. For example, if a liposuction surgeon attempts to do too much on a single day, and becomes fatigued, the result may be an inattention to detail, and undesirable cosmetic results. A liposuction cannula is a stainless steel tube inserted through an incision in the skin that is employed to suction the fat. The size of the liposuction cannula can influence the smoothness of the skin after liposuction. The use of large cannulas tends to create irregularities more commonly than microcannulas (outside diameter less than 3 millimeters). Surgeons who do total-body liposuction tend to use larger cannulas.

Tumescent Liposuction Technique is Safest
The tumescent technique for liposuction is unquestionably the safest form of liposuction. When tumescent liposuction is done correctly (not excessively), it is a very safe procedure. For example, there have been no reported deaths associated with tumescent liposuction totally by local anesthesia. Even when general anesthesia is combined with the tumescent technique, liposuction is quite safe provided the volume of fat removed and the number of areas treated during a single surgery is not excessive. The dilute epinephrine contained in the tumescent anesthetic solution profoundly shrinks capillaries and thus virtually eliminates surgical blood loss.
Tumescent Liposuction Yields Smoother Cosmetic Results
The tumescent technique permits the use of microcannulas which in turn yields smoother cosmetic results. Traditional liposuction cannulas (stainless steel tubes) have a relatively large diameter and remove fat rather quickly. However, with the use of large cannulas (diameter greater than 3 millimeters) there is an increased risk of irregularities and depressions in the skin. Tumescent liposuction performed by Dr. Klein using microcannulas with a diameter less than 3 millimeters, allow fat to be removed in a smoother and more uniform fashion. Some surgeons prefer larger cannulas because it allows liposuction to be done more quickly.
Rapid Healing after Tumescent Liposuction
After tumescent liposuction, there is a certain amount of blood-tinged local anesthetic solution that remains under the skin. This excess fluid is either slowly absorbed over several weeks into the blood stream, or it can be rapidly removed by drainage through skin incisions and absorbed by special absorptive pads (HK Pads).
Rapid Drainage
Rapid drainage of blood-tinged anesthetic solution out of incision sites, accelerates the rate of healing, and reduces post-operative pain swelling, and bruising. Post-liposuction drainage of blood-tinged anesthetic solution can be maximized by 1) leaving incision sites open and not closed with sutures, 2) placing several adits (1.5 mm tiny round holes) in the skin to encourage drainage, 3) placing HK Pads on the skin to absorb the drainage, and 4) wearing spandex compression garments to encourage drainage.

The KleinLipo Technique of Liposuction

Liposuction in Newport Beach


The tumescent technique, which permits liposuction totally by local anesthesia, is the brainchild of Dr. Jeffrey Klein. In developing the KleinLipo technique, Dr. Klein placed patient safety as his top priority followed by excellent cosmetic surgery results and rapid post-operative return to normal activities. Since the invention of the KleinLipo procedure in 1985, Dr. Klein has taught numerous classes in Orange County on the tumescent liposuction technique to cosmetic surgeons and it has become the worldwide standard of care for maximizing the safety of liposuction.


The advent of tumescent liposuction permitted liposuction to be done totally by local anesthesia with virtually no blood loss. Within a few years tumescent liposuction became the worldwide standard of care. Today in Newport Beach, the KleinLipo technique of tumescent liposuction continues to be the safest and most comfortable form of liposuction with the quickest recovery. Patient safety is Dr. Klein's top priority.

History of Liposuction

Introduction


Liposuction has become one of the most commonly performed cosmetic surgeries in the United States. In 1974, Dr. Giorgio Fischer, a gynecologist from Italy invented the original form of liposuction. French physicians Illouz and Fournier further developed liposuction around 1978. By 1980, liposuction was extremely popular in the United States but was confronting negative publicity due to patients experiencing excessive bleeding and undesirable rippling of the skin after surgery. In 1985, Dr. Jeffrey A. Klein, a California Dermatologist, invented the tumescent technique for liposuction, revolutionizing liposuction surgery. His “Tumescent Technique” allowed patients to have liposuction performed totally by local anesthesia using much smaller cannulas. Patients could now have liposuction surgery without the fear of excessive bleeding and undesirable skin depressions. Follow the links above to read more extensive information about the history of liposuction.

Tumescent superficial liposuction with curettage for treatment of axillary bromhidrosis

Backgrounds Axillary bromhidrosis is a common but unpleasant and distressing problem faced by many societies, particularly in Asia, where malodour is reflected as a social handicap. Currently, local surgery is the treatment of choice among various non-surgical and surgical treatment. Objectives To evaluate the clinical efficacy and safety of tumescent superficial liposuction and curettage in treating axillary bromhidrosis. Methods Forty-three patients (25 females and 18 males, average age 24.5 years) have undergone tumescent superficial liposuction and curettage. Local anaesthesia, tumescent solution, was injected into the hair-bearing area of the axilla. Two tiny incisions were made for Fatemi cannule, and subcutaneous tissue was removed by stroke movement under negative pressure. Subsequently, additional curettage was done around the incision sites. We evaluated the clinical efficacy (excellent, good, fair and poor) and complications. In addition, preoperative and postoperative histologic findings were reviewed in 15 patients. Results The follow-up evaluation started 3 months after the surgery, and mean follow-up period was 15.8 months, ranging from 3 to 54 months. Among 43 patients, 31 patients (72.1%) showed excellent to good results. The most common postoperative complication was transient ecchymosis which spontaneously regressed in 1 to 2 weeks. Focal skin necrosis, induration, and haematoma or seroma were each noted in four, three, and one patients, respectively, but resolved after proper dressing. The preoperative histological findings included increase in size and number of apocrine glands in cross-section view, and the postoperative specimen evidently showed removal of subcutaneous tissue, including apocrine and eccrine glands, and remnant sweat glands were severely destructed. Conclusion Tumescent superficial liposuction with curettage for axillary bromhidrosis is an effective and safe treatment method for axillary bromhidrosis.

Rationale of subdermal superficial liposuction related to the anatomy of subcutaneous fat and the superficial fascial system

The liposuction technique has changed greatly over the years. In 1989, the authors presented subdermal superficial liposuction which treats the superficial fat layer and yields better skin retraction. With this technique the surgeon can treat thin adipose layers to obtain better results in more cases than the traditional liposuction technique. The technique can be used in cases with difficult skin adjustment and in secondary cases when "deep only" liposuction has been performed and there were residual adiposities. Subdermal superficial liposuction evolved so that one could obtain good skin retraction by performing massive liposuction of all the fat layers. The authors named this technique MALL (Massive All Layer Liposuction). The technique is applied in body areas where the fat layer is very thick and stretches the skin because of its volume and weight such as in the abdomen, posterior arms, and internal surface of the upper third of the thighs. MALL liposuction drastically reduces the indications for abdominoplasty and inner thigh and arm dermolipectomies. Knowledge of the anatomy of the subcutaneous fat and the superficial fascial system allows one to explain the subdermal superficial liposuction from an anatomical point of view, to perform a more rational and effective procedure, and to differentiate the technique depending on the area of the body.

Superficial Liposuction Exposed In 2010

Patients have been made aware by advertisements of the technique called superficial liposuction since the mid to late 1990's. The face and neck have a blood supply that is totally different from that of the rest of the body. Surgeons specializing in facelifts realize, that in many instances, its possible to snip and cut very close to the undersurface of the skin of the face and yet not end up with patches of blood vessels or pigment after the face-lift is done. However imperfect, this is the way the majority of standard face-lifting procedures are done. Damage too high or close to the skin in non-facial tissues can cause scarring or other unwanted visible changes in the overlying tissues or skin.

Many surgeons became unhappy with their liposuction results in patients who were a bit older (many over 50 years of age). This was because the patient's skin became even sager or remained saggy following the removal of deeper fat. If a surgeon were to remove all the fat pushing out against the skin in older patients, the skin would usually not contract well after liposuction. Wrinkles and bruises more commonly form in older patients following typical liposuction procedures. Doctors have long known that by damaging the dermis, or leather layer of the skin, that the skin layer would tighten and contract in response.


The superficial liposuction was heavily marketed, as opposed to liposuction that involved removal of fat from the traditional location, which is in the lower to mid-fatty layers. Superficial liposuction near the surface of the skin may damage small blood vessels and nerves leading to the dermis (leather layer adjacent to the surface epidermis of the skin). The initial results of the contraction on some patients may have looked good, and the skin may have appeared "tighter." However, in many cases, the superficial liposuctions caused the overlying skin to die, leaving holes and ulcers that eventually scar. Quite commonly, patients receiving superficial liposuction had developed net-like congregations of blood vessels under the surface of the skin, with associated pigment discolorations. Like it or not, they most probably will stay with you forever

Many times the unwanted changes do not arise right away. Some of the problems associated with superficial liposuction are the result of stripping the nerves that control the blood vessels that feed the surface skin. This is followed by new blood vessel formation in irregular, net-like patterns, as well as by the loss of the nerve control that governs whether the remaining blood vessels will be properly closed or opened (dilated).

Some of the cases of surface skin death (necrosis) and scarring may have been caused by surgeons who suctioned and rasped too close to the dermis (leather layer) of the skin. It appears that the tiny blood vessels feeding the dermis may be cut or damaged by the tearing effect caused by turning the suction hole of the cannula upside-down and applying a vacuum on the delicate underside of the dermis. Bad results are mounting, but some doctors, are still performing the procedure.

Eventually, the use of a flawed procedure should naturally decline (to zero), unless there is an improvement in the procedure. Many of todays lifesaving procedures are improvisations of what started out to be risky procedures; take triple coronary bypass surgery, for example, which is now one of the greatest lifesavers. The problem is how to decrease the bad effects of "cosmetic experimentation" on the public.

Excessive Superficial Liposuction

Excessive Superficial Liposuction



Excessive superficial liposuction can produce significant cosmetic complications. The use of the tumescent technique and microcannulas allows the surgeon to do liposuction more superficially and to produce smoother results than could be done with old-fashioned techniques that used larger cannulas. Some surgeons mistakenly believe that scraping the undersurface of the skin with the liposuction cannula will cause the skin to contract. There is no scientific evidence to support the theory that intentional injury to the skin by doing excessive superficial liposuction produces improved cosmetic results. Excessive superficial liposuction can injure the superficial blood and lymphatic vessels located on the immediate undersurface of the skin resulting in significant complications including scars, lumpiness, permanent irregular coloration, and full thickness necrosis (death) of the overlying skin. Skin naturally contracts after liposuction because 1) skin naturally contains elastic fibers, 2) skin is relieved of the gravitational effect of subcutaneous fat, and 3) liposuction naturally results in contraction of the collagen in subcutaneous fat. Surgeons who advocate superficial liposuction must be careful to avoid excessively superficial liposuction.
 
Focal Excessive Liposuction
 
Focal Excessive Liposuction is the removal of an excessive amount of fat from localized area of the body. Removing too much fat yields an unnatural and unattractive appearance. If uneven or irregular excessive liposuction of a single area occurs, it produces depressions (lipotrops) or lumps and bumps (liponots). If smooth or uniform, focal excessive liposuction can appear abnormal and disproportionate. The goal of liposuction is not to remove the maximum amount of fat, but rather to produce an optimal cosmetic improvement and maximize patient happiness. The normal female body has subcutaneous fat. Thus, the complete lack of subcutaneous fat on part of the female body appears abnormal, and feels peculiar to the touch. Patients should not ask for or expect "maximum fat removal". Dr. Pierre Fournier has said, "It is not the fat that is removed, but the fat that remains after liposuction that determines success."



Focal excessive liposuction can cause unsightly depressions and irregularities of the skin. The use of large liposuction cannulas contributed to a permanent depression in this woman's outer thigh.

Erythema Ab Liporaspiration
 
Erythema Ab Liporaspiration is a permanent blotchy (net-like pattern) pink-brown discoloration of the skin resulting from rasping the undersurface of the skin during superficial liposuction. Inadvertent or intentional rasping of the undersurface of the skin will injure the superficial vascular network. Unfortunately, there is no treatment for this chronic discoloration. It does not seem to improve with time.







Erythema Ab Liporaspiration seen on this patient's thighs is a permanent blotchy pink-brown discoloration of the overlying skin as a result of excessively superficial liposuction that injured the small blood vessels on the undersurface of the skin.

Hematomas and Seromas
 
Whole blood consists of red blood cells plus serum (clear yellow fluid). A hematoma is a lake-like collection of whole blood that has leaked out of injured blood vessels and become trapped inside the body. The vasoconstriction produced by the tumescent technique for liposuction has virtually eliminated the occurrence of hematomas. A seroma is a volume of serum that has leaked out of blood vessels and collected as a "lake" of fluid within some part of the body.







Seroma under the skin on the inner knee is a collection of serum (clear yellow fluid) that accumulated after liposuction when the tiny incision sites were closed with stitches. Allowing the incisions to remain open after liposuction and thus encouraging drainage of tumescent fluid and serum can prevent such seromas. HK Pads are placed over the open incisions to absorb the otherwise messy drainage.

Minor Complications



A surgical complication is defined as any undesirable result of surgery. Minor complication has little risk that the patient will die. The causes for minor complications include unpredictable factors such as a patient's wound healing ability, misjudgment by the surgeon, patients' failure to follow instructions, or just bad luck such as an unexpected allergic reaction to a drug. Ultimately any result that produces an unhappy patient, is a complication.



Unrealistic Expectations


Unrealistic Expectations are the most frequent source of disappointing liposuction results.



If a patient has unrealistic expectations before surgery, then it is almost impossible for the surgeon to achieve results that will make the patient happy. To avoid unrealistic expectations surgeons must ask what the patient expects to achieve with liposuction. Surgeons must clearly state how much improvement is likely to be achieved. Patients must honestly state their hopes and expectations with the surgeon. Patients must not expect perfection. It is realistic to expect a significant improvement, but it is unrealistic to expect perfect results. This entire web site is dedicated to providing patients with information so that they can make a well-informed decision about having liposuction.






Skin Irregularities and Depressions


Significant irregularities and depressions of the skin are frequently the result of the surgeon's inattention to detail. For example, if a liposuction surgeon attempts to do too much on a single day, and becomes fatigued, then the result may be inattention to detail, and undesirable cosmetic results. A liposuction cannula is stainless steel tube inserted through an incision in the skin that is employed to suction the fat. The size of the liposuction cannula can influences the smoothness of the skin after liposuction. The use of large cannulas tends to create irregularities more commonly than microcannulas (outside diameter less than 3 millimeters). Surgeons who do total-body liposuctions tend to use larger cannulas.




Too much fat removed from a localized area of the lateral buttock has resulted in a permanent irregularity of the skin.

Full Thickness Skin Necrosis



Full Thickness Skin Necrosis (death of the affected skin) can result from excessive superficial liposuction that injures the vascular supply of the overlying skin. Deliberate trauma to the undersurface of the skin can injure the vascular supply to the skin and cause partial or full thickness necrosis of the skin. A partial thickness dermal necrosis may become a full thickness necrosis if it is complicated by an infection. Other causes of full thickness dermal necrosis following liposuction include infection (necrotizing fasciitis) , blood vessel thrombosis (clotting inside a blood vessel), injury to blood vessels, and vasculitis (blood vessel inflammation). For example, in patients who have a disease known as cryoglobulinemia (cold-induced blood clots), the application of ice-packs to the skin after liposuction can produce clotting in blood vessels of the skin and full thickness skin necrosis.
 
Blisters from Reston Foam



Reston foam is an adhesive-backed 3/8 inch thick foam that some surgeons apply to patients' skin to reduce bruising after liposuction. The manufacturer of Reston foam, 3M Corp., has warned against the use of Reston foam for liposuction. Reston foam is not intended to be applied to patients' skin. An allergic reaction to the adhesive on the foam (similar to an allergic reaction to poison oak or poison ivy) can cause blisters and an increased the risk of necrotizing fasciitis, a potentially lethal infection. An allergic reaction of this type can also cause a prolonged discoloration of the affected skin.






Hyperpigmentation of Incision Sites


Any inflammatory injury of the skin can cause rupture of skin cells containing pigment with release of melanin pigment granules into the surrounding skin. Escaped pigment is regarded as a foreign substance by the body. Scavenger (macrophage) cells ingest this pigment where it can persist a long time causing prolonged hyperpigmentation. In most individuals who have little natural pigmentation in their skin, post-inflammatory hyperpigmentation resolves in less than a 4 to 6 months. In people who naturally have darkly pigmented skin, the hyperpigmentation can last for a number of years. Trauma from the friction of a liposuction cannula moving in and out of a skin incision can cause inflammation and hyperpigmentation. Prospective liposuction patients who naturally have darkly pigmented skin must be informed of their increased risk of such pigmentation. In darkly pigmented patients, the surgeon must take extra care to minimizing the number of incisions, and to choose incision sites that are easily covered by clothing or bathing suits.






Fainting (Vasovagal Syncope)


Fainting or vasovagal syncope is a reflex reaction involving the brain and the heart that produces a sudden brief reduction of blood flow to the brain and loss of consciousness that resolves spontaneously. When a person faints it is usually when they are sitting or standing upright. Events that can trigger a fainting episode include anxiety, pain, or even the sight of blood. Fainting can occur before, or after any surgical procedure, and even during surgery if the surgery is done under local anesthesia. For example one patient fainted prior to liposuction while the surgeon was taking preoperative photographs. Another example involved the husband of a liposuction patient. While helping his wife change her dressing the morning after liposuction, the husband fainted at the mere sight of the blood-tinged absorptive pads, and immediately afterwards, the wife also fainted at the sight of her fainted husband. Head or neck trauma resulting from a fall is the greatest risk associated with fainting.






Vasovagal Symptoms


Vasovagal Symptoms in the O.R. Fainting (loss of consciousness) is unusual in the operating room (O.R.) when the patient lying flat. Instead, an awake patients who starts to faint will linger on the verge of fainting with vasovagal symptoms that include lightheadedness, cold sweats, and nausea or vomiting. Vasovagal symptoms typically occur in predisposed individuals who have a history of fainting or becoming dizzy or lightheaded at the sight of blood or at the thought of a medical procedure.
 
Vasovagal Near-Syncope Syndrome



In the operating room setting during tumescent liposuction totally by local anesthesia, true syncope is unusual. However, the syndrome of vasovagal near-syncope (light-headedness, cold-sweats with nausea or vomiting) is not uncommon and represents the early phase of fainting that simply stops short of the complete loss of consciousness. The first hint of the syndrome is typically a vague sensation of feeling queasy and lightheaded. Shortly thereafter, the patient's skin will appear ashen or pale, with damp, moist, clammy skin, perhaps with visible beaded perspiration, and dilation of pupils. Within a few brief moments, the patient experiences a slow heart rate and low blood pressure. Although vasovagal near-syncope is not dangerous, it is unpleasant. Treatment consists of a small intravenous dose of atropine (0.5 mg) after which the patient soon feels dramatically better.






Preventing Vasovagal Syndrome in the Operating Room


If a patient has previously experienced sudden lightheadedness or fainting for any reason, for example when having blood taken for a laboratory test, then he or she has a predisposition for the vasovagal syndrome. The vasovagal syndrome in the operating room can be prevented by giving 0.3 mg of atropine intravenously immediately prior to surgery. Every patient who is scheduled to have liposuction totally by local anesthesia should be asked the question, "Have you ever fainted or suddenly become light-headed for any reason?"






Post-Liposuction Syncope at Home


Post-liposuction lightheadedness and fainting most commonly occurs after urinating the morning after liposuction. Fainting after urination is called post-micturition syncope that occurs commonly in postpartum women the morning after childbirth upon standing up immediately after urination. Other stimuli that can trigger a fainting episode after liposuction include: 1) the sight of the blood-tinged anesthetic drainage on the absorptive pads, and 2) decompression of the lower extremities upon removal of postoperative compression garments. For at least 24 hours after tumescent liposuction, patients are generally in a state of mild fluid overload due to all the tumescent fluid remaining in the patient's system. Except in cases of excessive liposuction, it is unlikely that post-liposuction syncope is caused by a deficiency of intra-vascular fluids.






Preventing Post-Liposuction Syncope


Liposuction patients should be aware that fainting can occur at home after liposuction. A few suggestions may help patients prevent injury:






Remove postoperative compression garments slowly, if possible, with someone's assistance. If wearing more than one garment or elastic binder, take garments off one at a time, waiting a minute or two between removing successive garments.


Stand up slowly after urinating.


It is reasonable to have someone in the bathroom for assistance when showering for the first time after liposuction.


If feeling dizzy or lightheaded, immediately sit down or lie down in the shower or on the floor until feeling better.


Do not be alarmed by a large amount of blood-tinged drainage on the absorptive pads; the more drainage, the less bruising and swelling there will be.


Do not remove the garments with a completely empty stomach. To avoid hypoglycemia, which may increase the risk of this post-liposuction fainting, a patient should eat something before removing the garments to take a shower and change the dressings.


Do not lock the bathroom door when showering or urinating.
 
Wrong Areas Treated



Miscommunication between patient and surgeon may lead to confusion about which areas are to be treated. It is important that the patient and surgeon agree on which areas are to be treated by liposuction, and that this agreement be put in writing so that there is no confusion. This is especially important if the surgeon who does the consultation is not the same surgeon who does the liposuction. It is also important if liposuction is done under general anesthesia, because the patient will not be able to alert the surgeon who is about to treat the wrong area. Patients must insist that the areas to be treated are listed in writing.



Insufficient Volume of Fat Removed can be a complaint after liposuction. Among the reasons for insufficient removal of fat by liposuction are:





Patient had unrealistic expectations. It is unrealistic for a patient to expect perfection. On the other hand, it is reasonable to expect a significant improvement.


Surgeon wanted to avoid doing too much liposuction. If too much fat has been removed, it is very difficult to repair the situation. Other the other hand, if the initial liposuction was insufficient, it is relatively easy to return to have a little more liposuction.


Surgeon is in a hurry, and does not spend enough time to carefully complete each area. This unacceptable situation might be avoided by not attempting to do an excessive amount of liposuction on a single day, and by not doing other unrelated surgical procedures on the same day as liposuction.


Surgeon did not use microcannulas and is fearful of causing irregularities. It is more difficult to get smooth results when large cannulas are used. Using microcannulas (less than 3 mm in outside diameter) for liposuction can require a little more time than using larger cannulas, but microcannulas permit both the removal of more fat and smoother results.


Minor Superficial Irregularities


Dents, waviness, lumpiness and furrows can occur after any liposuction. These can usually be repaired with a minor "touch-up" liposuction procedure. Although perfectly smooth results can be achieved in some patients, it is not realist for every patient to expect absolute smoothness. It is reasonable for every patient to expect that liposuction will provide both a significant cosmetic improvement, and that eventually there will be almost no visible scars or irregularities that provide evidence that the patient has had liposuction. A lipotrop is the excessive and uneven removal of fat that results in depressions, dimples, and grooves in the skin. The lipotrop is the most common undesirable effect of liposuction. A liponot is a focal area of insufficient or uneven liposuction (note to web master: hyperlink to Glossary of Terms).






Temporary Lumpiness


Temporary lumpiness and bumpiness is common after liposuction. This condition becomes noticeable within one to two weeks after surgery and becomes most pronounced between two to four weeks after surgery. This temporary lumpiness is the result of the normal healing process after liposuction. The intensity and duration of this condition can be minimized using open-drainage and bimodal-compression.

Post-Liposuction Panniculitis



Post-Liposuction Panniculitis is a manifestation of postoperative inflammation due to incomplete drainage of blood-tinged tumescent anesthetic solution and the formation of small seromas. Seromas have become rare with the use of open-drainage and bimodal-compression. Patients typically complain of localized warmth, swelling and tenderness. There is often visible redness overlying the affected area. The onset occurs after the drainage of blood-tinged anesthetic solution has ceased. It is important that the surgeon distinguish between Post-liposuction panniculitis and an infection. Post-liposuction panniculitis is often preventable by using adits, open-drainage and bimodal-compression. Post-liposuction panniculitis is more common when incisions are closed with sutures thus preventing complete drainage and entrapping the inflammatory blood-tinged anesthetic solution beneath the skin.






Swelling


Swelling of the Legs and Ankles can occur following liposuction on any part of the lower extremity. This swelling is usually mild to moderate in degree. There is an increased risk of prolonged swelling when liposuction of the entire circumference of either the leg or the thigh is attempted on a single day. Placing sutures in liposuction incision sites promotes and prolongs this swelling. The incidence of distal edema is greatly reduced by using open-drainage and bimodal-compression, and avoiding circumferential liposuction of the thigh or leg.



Bruising


Bruising and Swelling of the Genitals in both males and females can occur following liposuction of the abdomen and is the result of blood-tinged fluid percolating downward under the effect of gravity. This bruising and swelling of the genitals is common after abdominal liposuction, and it usually resolves within two to three days. The use of 2 mm adits placed along the inferior border of the abdomen and the use of a good elastic compression garment can reduce the risk of this condition.






Postoperative Bruising


Postoperative bruising is a common result of liposuction. The use of the tumescent technique for liposuction has dramatically reduced the amount of bruising and the duration of bruising. The degree of bruising can vary between patients due to a number of factors including genetic differences in the coagulation system and exposure to substances that affect platelet function such as aspirin, ibuprofen, Nuprin, red wine, large quantities of garlic, or vitamin E taken with 7 to 10 days before surgery. Bruising, swelling, discomfort, and tenderness after liposuction can be minimized by using postoperative care techniques that include open-drainage and bimodal-compression.

Rapid Heart Rate



Rapid heart rate can occur during or after liposuction as a result of the epinephrine (adrenalin) that is an essential ingredient of the tumescent local anesthetic solution. Rapid heart rate can also be caused by medications containing ephedrine-like drugs often found in nasal decongestants such as Sudafed or pseudoephedrine. Patients should avoid ephedrine-like drugs before tumescent liposuction. The anti-hypertension medication clonidine, 0.1 mg by mouth, given immediately preoperatively, reduces the risk of rapid heart rate and also provides a degree of sedation without the risk of respiratory depression.


Vascular Injury and Excessive Bleeding


Vascular injury and excessive bleeding are rarely caused by liposuction with the use of microcannulas. Good postoperative compression for the first 24 hours postoperatively should preclude any significant bleeding from veins. Exceptions may be the result of drugs that impair blood clotting mechanisms by interfering with platelet function. Drugs that increase bleeding include aspirin, ibuprofen, other NSAIDS, vitamin E, red wines, large doses of garlic supplements. Diabetic patients are known to have an increased incidence of small vessel insufficiency that might predispose them to local tissue or skin necrosis following an otherwise insignificant injury to a blood vessel. Ultrasonic liposuction has been known to cause dangerous injury to major arteries. See Risks of Ultrasonic Liposuction.




Worry About Blood-Tinged Drainage


Patients are told that open-drainage and bimodal-compression are specifically designed to encourage copious postoperative drainage. The larger the volume of postoperative drainage, the shorter will be the duration of postoperative healing and soreness. Despite these careful explanations, some patients will inevitably become overly concerned that the drainage of very dilute blood-tinged anesthetic solution is actually a hemorrhage of whole blood. The resulting telephone call from a concerned patient or spouse requires careful evaluation and consideration. Usually careful questioning, evaluation and reassurance will be sufficient. Nevertheless, some patients will require an examination by either the surgeon or an experienced staff nurse. Another source of worry for liposuction patients is the concern that there is not enough drainage. In this case, the patient is worried that insufficient drainage of blood-tinged anesthetic solution will result in excessive swelling or delayed healing. This concern is usually unfounded. In any case, there is no serious long-term consequence of less-than-maximal drainage. Simple reassurance should calm the patient's concerns.

superficial liposuction

There are certain individuals who may not meet a medical procedure such as liposuction. For example, pregnant women have nothing going for liposuction until have given birth to their babies. Another is, ff you have a blood condition or circulatory, liposuction can not be a good option for you to lose weight because their condition can lead to some complications.

Well, one must know that, aside from liposuction or abdominoplasty, there are other safer ways to lose weight and includes natural methods. Instead of going to medical procedure, why not enroll in the program of summer weight loss available in your community? Or, have a do-it-(yourslef address) exercise program?

Back to liposuction, the success of a liposuction surgery does not lie alone in the skills and strategies of a plastic surgeon. There are a number of things you can do to help make a liposuction procedure easier for your surgeon. Before liposuction surgery, you need to steer clear of anti-inflammatory and anticoagulant drugs to prevent complications.

The Abdominal fat covering both shallow and deep fat. When is a abdominalplasty, is the superficial fat that accumulates over the abdominal muscles is removed. Deep fat includes fat that accumulates around the gut and can not be treated with liposuction because of the high risk of complications or organ damage.

People with inelastic body are not good candidates for the surgical procedure such as liposuction. If liposuction is performed in the areas of these people will remain being operated freely. Reports have shown that it is mainly elderly people who have this problem
The incisions created in the course of the cause of liposuction scare. The effect depends on the degree of fat, left his body. The number of incisions of the body determines the severity of the surgery. The scars are not permanent. Vanishes, Naturally, after some weeks or months.
Tumescent liposuction is the best form of surgery for the removal of body fat. Surgery in this part of the body is a bit difficult and this is because this body part is fibrous.

Liposuction involves breaking and draining the fat cells of the body and it is not possible to do int the absence of body fluid. In some cases, this fluid is excessively drained which leads to dehydration. It could also lead to death in some severe cases.

In fact, it is best to choose a natural method of weight loss a medical procedure such as liposuction, putting their own risk.

Fettabsaugung Superficial Liposuction bei Dr. Pullmann in Hamburg