The benefits of powered liposuction versus traditional liposuction: a paired comparison analysis

Outpatient-Based High-Volume Liposuction: A Retrospective Review of 310 Consecutive Patients

BACKGROUND

Currently, the definition of large-volume liposuction is the removal of 5 L or more of total aspirate. Higher volumes of lipoaspirate come into consideration with higher BMIs, because more than 5 L is often required to achieve a satisfactory aesthetic result. The boundaries of what lipoaspirate volume is considered safe are based on historical opinion and are constantly in question.

OBJECTIVES

Because to date there have been no scientific data available to support a specific safe maximum volume of lipoaspirate, the authors discuss necessary conditions for safe high-volume lipoaspirate extraction.

METHODS

This retrospective study included 310 patients who had liposuction of ≥5 L over a 30-month period. All patients had 360° liposuction alone or in combination with other procedures.

RESULTS

Patient ages ranged from 20 to 66 with a mean age of 38.5 (SD = 9.3). Average operative time was 202 minutes (SD = 83.1). Mean total aspirate was 7.5 L (SD = 1.9). An average of 1.84 L (SD = 0.69) of intravenous fluids and 8.99 L (SD = 1.47) of tumescent fluid were administered. Urine output was maintained above 0.5 mL/kg/hr. There were no major cardiopulmonary complications or cases requiring blood transfusion.

CONCLUSIONS

High-volume liposuction is safe if proper preoperative, intraoperative, and postoperative protocols and techniques are employed. The authors believe that this bias should be modified and that sharing their experience with high-volume liposuction may help guide other surgeons to incorporate this practice with confidence and safety for better patient outcomes.

LEVEL OF EVIDENCE: 3

Evidence-based medicine: liposuction

LEARNING OBJECTIVES

After reading this article, the participant should be able to: 1. Perform preoperative assessment and patient selection for liposuction surgeries. 2. Explain the differences among the various types of anesthesia and wetting solutions used in liposuction. 3. Identify the available literature about skin-tightening procedures. 4. Convey to patients the complication profile for various modalities of liposuction. 5. Recall important ASPS consensus guidelines when discussing liposuction.

SUMMARY

The article was prepared to feature recent evidence-based publications pertaining to liposuction. The authors placed special emphasis on the most clinically relevant data. In addition, they highlighted current data regarding liposuction-related fields, including autologous fat transfer and minimally invasive skin tightening.

1,000 consecutive cases of laser-assisted liposuction and suction-assisted lipectomy managed with local anesthesia

BACKGROUND

Advances in suction-assisted lipectomy (SAL) include improved instrumentation, better understanding of fluid dynamics, and an improved concept of appropriate indications. The tumescent technique uses subcutaneous injection of isotonic fluid containing vasoconstrictive and analgesic agents and is proved to be safe, with low morbidity and mortality rates. Laser-assisted liposuction (LAL) using local infiltration of an anesthetic and no general anesthesia or sedation has been developed, with claims of fat destruction and skin tightening. This study aimed to review 1,000 consecutive cases of LAL and SAL performed with the patient under local anesthesia and to determine whether this represents a safe technique with few complications.

METHODS

During a period of 22 months, 581 consecutive patients (486 females and 95 males) underwent 1,000 LAL/SAL operations, 545 of whom had multiple procedures performed. None of the patients had a body mass index (BMI) higher than 30 kg/m2. The patients ranged in age from 18 to 62 years. The fat aspirate ranged from 50 to 1,400 ml. Patients were given an oral sedative, an antibiotic, and an analgesic. Ringer's lactate solution containing lidocaine and epinephrine was injected into the subcutaneous space. The 1,064-nm and/or 1,320-nm neodymium:yttrium-aluminum-garnet (Nd:YAG) laser was used for laser lipolysis followed by SAL using standard and/or power-assisted liposuction (PAL) cannulas. The treated areas included the neck, triceps, male breast, midback, flanks, axilla, abdomen, mons pubis, thighs, presacrum, and knees. No patient was administered intravenous sedation or general anesthesia.

RESULTS

The average number of areas treated was 1.8, and no major complications or mortalities were observed. There were three burns, two infections, one hematoma, and one seroma. A total of 73 secondary procedures were performed (7.3%). No tertiary procedures were required.

CONCLUSION

For appropriately selected patients, comparable results can be obtained with an excellent safety profile and short recovery period using LAL and SAL with the patient under local anesthesia. The awake patient is able to participate in body positioning and to provide physiologic monitoring. No major complications occurred in this series. The burn and hematoma complications occurred in the first 25 cases and may have been related to a learning curve. One case of cellulitis occurred in the triceps region, and a second infection occurred in the abdomen. Both responded to antibiotics. Altogether, 73 touch-up procedures (7.3%) were performed. The amounts of fat removal were comparable with the volumes obtained using traditional liposuction. In conclusion, this series demonstrated that LAL/SAL using local anesthesia is a safe procedure for selected patients, with acceptably low morbidity and revision rates.

LEVEL OF EVIDENCE IV

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors at www.springer.com/00266.

Safety and efficacy of UltraShape Contour I treatments to improve the appearance of body contours: multiple treatments in shorter intervals

BACKGROUND

The UltraShape Contour I System (CE 0344; UltraShape Ltd., Yoqneam, Israel) is a noninvasive fat reduction and body contouring system currently approved for use outside the United States that utilizes focused ultrasound to selectively disrupt adipocytes.

OBJECTIVE

To evaluate the clinical safety and efficacy of the Contour I system when the intervals between treatments are shortened.

METHODS

Twenty-five healthy Caucasian women were selected from the patient population at two clinics in Paris, France, and received three 30- to 90-minute Contour I treatments in the abdominal region at two-week intervals. Safety parameters evaluated included adverse events, local skin reaction, and pain. Efficacy parameters evaluated included treatment area circumference, body weight, and comparison of before and after photos. Untreated thigh areas served as an internal control. Subjects were followed for 84 days after the last treatment (day 112).

RESULTS

No adverse events occurred. The majority of subjects (n = 23; approximately 90%) reported no pain. Mean midline circumference (2 cm below midline) was reduced by 2.47 cm (P < .001) on day 14 after the first Contour I treatment, 3.51 cm (P < .001) on day 56, and 3.58 cm (P < .001) on day 112. Peak midline circumference reduction was 3.12 cm on day 112. Most patients (n = 14; 63%) reported a positive change in body contour. Mean thigh circumference (the control area) was unchanged; the relative change between treated and untreated areas of the abdomen was significantly different at all time points. Circumference and weight reduction were significantly correlated (r = 0.42-0.71) at all time points; mean weight decrease was not statistically significant. Circumference reduction on day 112 positively correlated with patients' subjective satisfaction scores.

CONCLUSIONS

Our data showed that successive Contour I treatments at two-week intervals were safe and tolerable and also significantly reduced treatment area circumference.

New advances in liposuction technology

Although suction-assisted liposuction under tumescent anesthesia remains the traditional method for body sculpting, newer technologies promise to increase efficiency, decrease surgeon fatigue, and minimize complication. Power-, ultrasound-, and laser-assisted devices are ideal in large volume cases and in areas of fibrous tissues as an adjunct to traditional liposuction. Although skepticism remains chemical lipolysis, more commonly termed mesotherapy or lipodissolve may be an alternative to surgical treatment of localized fat. This article reviews the recent advancements in the field of liposuction and the current literature which support their use.

Power Liposuction

Power liposuction seems to be a significant advance in the evolution of the liposuction procedure. It allows for a faster, less painful recovery for the patient and is less of a strain on the surgeon, increasing the precision of the procedure. Complications are less than those seen with traditional liposuction performed under local tumescent anesthesia. Because it is performed under local anesthesia, power liposuction allows for fine tuning of the body contours with the patient in the standing position, reducing the number of postoperative touch-ups.

Lipoaspiration and Its Complications: A Safe Operation

Although lipoaspiration has been considered a safe surgical procedure for the last 30 years, reports indicate that this procedure has a high index of complications. This study was performed to analyze experience with patients in a clinical practice for the past 8 years who underwent lipoaspiration, either alone or in combination with another surgical procedure, and to compare the results with previous reports in the literature. The patients were divided into four groups: lipoaspiration alone of less than 5 liters, lipoaspiration alone of more than 5 liters, lipoaspiration combined with abdominoplasty, and lipoaspiration combined with another surgical procedure. Complications were divided into minor or major, depending on previous reports, and statistical analysis was used to determine any significant difference among the four groups. From January of 1994 to December of 2001, 1047 patients underwent lipoaspiration, either alone or in combination with another surgical procedure. A 21.7 percent incidence of minor complications was noted, as well as a 0.38 percent incidence of major complications. Minor complications included palpable and visible irregularities, seromas, cutaneous hyperpigmentation, overcorrection, cutaneous slough, and local infection. Major complications included fat embolism syndrome, cutaneous necrosis, and extended infection. No statistical difference was noted among the groups studied. The incidence of complications was similar to that in clinical reports in the world literature, being of a low percentage rate when compared with the reports of other types of surgical procedures. On the basis of these results, lipoaspiration continues to be a safe surgical procedure, but to maximally avoid complications, one should be mindful of all the factors that could predispose to them.

Power liposuction: a report on complications

BACKGROUND

Liposuction is the most commonly performed cosmetic surgical procedure in the United States. Traditional liposuction (TL) performed under general anesthesia has been associated with reports of major systemic complications, including death. When TL is performed using only tumescent anesthesia, there have been no reported deaths and few significant systemic complications. Power liposuction (PL), a newer procedure in which a reciprocating cannula is used to evacuate fat, has reported benefits over TL.

OBJECTIVE

To determine the complication rate associated with PL and to compare it with TL (regardless of the type of anesthesia).

METHODS

In this study, 207 consecutive PL cases performed with tumescent anesthesia between August 2000 and May 2002 by a dermatologic surgeon (B.K.) and a plastic surgeon (M.B.) were reviewed retrospectively to determine the number of complications associated with the PL procedure.

RESULTS

No systemic complications were identified, and only three local complications (all seromas) were found. This represents a complication rate of 1.4%.

CONCLUSION

Our results demonstrate fewer complications when performing PL using tumescent anesthesia compared with TL using general anesthesia. When compared with TL using tumescent anesthesia, the overall complication rate did not differ significantly. We conclude that in addition to PL previously demonstrated benefits, the complication profile compares favorably with TL under local tumescent anesthesia. Therefore, PL may assume a more prominent role in the armamentarium of the surgeon performing liposuction.