Sixteen months' experience with the Illouz technique of lipolysis

Pituitary apoplexy occurring during large volume liposuction surgery

A 50-year-old woman developed headache and right-sided ophthalmoplegia upon awakening from general anesthesia after liposuction surgery on her abdomen, hips, and thighs. Neuroimaging showed hemorrhage within a previously undiagnosed pituitary adenoma. The confirmatory surgical specimen contained areas of gross infarction and hemorrhage. The anesthesia record revealed intraoperative reduction of systolic blood pressure to 90 mm Hg for 30 minutes from a baseline of 120 mm Hg. This first reported case of pituitary apoplexy during liposuction surgery probably resulted from intraoperative hypotension attributed to a combination of general anesthesia, the use of subcutaneous lidocaine, sequestration of plasma in injured tissues, and blood loss.

Classification and management of gynecomastia: defining the role of ultrasound-assisted liposuction

Gynecomastia, or excessive male breast development, has an incidence of 32 to 65 percent in the male population. This condition has important physical and psychological impacts. Advances in elucidating the pathophysiology of gynecomastia have been made, though understanding remains limited. Recommendations for evaluation and workup have varied and are often arbitrary. A diagnostic algorithm is suggested, with emphasis on a comprehensive history, physical examination, and minimizing unnecessary diagnostic testing. Medical management has had limited success; surgical therapy, primarily through excisional techniques, has been the accepted standard. Although effective, excisional techniques subject patients to large, visible scars. Ultrasound-assisted liposuction has recently emerged as a safe and effective method for the treatment of gynecomastia. It is particularly efficient in the removal of the dense, fibrous male breast tissue while offering advantages in minimal external scarring. A new system of classification and graduated treatment is proposed, based on glandular versus fibrous hypertrophy and degree of breast ptosis (skin excess). The authors' series of 61 patients with gynecomastia from 1987 to 2000 at the University of Texas Southwestern Department of Plastic Surgery demonstrated an overall success rate of 86.9 percent using suction-assisted lipectomy (1987 to 1997) and ultrasound-assisted liposuction (1997 to 2000). The authors have found ultrasound-assisted liposuction to be effective in treating most grades of gynecomastia. Excisional techniques are reserved for severe gynecomastia with significant skin excess after attempted ultrasound-assisted liposuction.

Analysis of methods for reporting severe and mortal lipoplasty complications

During the past 2 years, media attention has focused on catastrophic outcomes associated with liposuction. A critical review of the lipoplasty literature was undertaken to determine the incidence of severe and mortal complications. Reported lipoplasty complications and patient outcome studies published in the English literature through January 1, 1999, were reviewed. From these and from ASPRS questionnaire surveys of experienced, board-certified plastic surgeons, it is apparent that (1) plastic surgeons do not often voluntarily report severe and mortal complications (either as case reports or in self-reported series), and (2) while survey studies provide the most accurate estimate of complications due to lipoplasty, they are subject to an underreporting bias because they exclude complications occurring in the hands of residents and junior attendings. The mortality from lipoplasty procedures is higher than the 0.003 to 0.02% reported in the literature and may be as high as 0.1%.

Evaluation of blood loss during tumescent liposuction in Orientals

BACKGROUND

There are high risks from general anesthesia and excessive bleeding associated with traditional liposuction using the dry or wet method. The blood loss has been estimated to be between 15% and 45%. The tumescent technique permits liposuction of more than 3,000 ml of fat totally by local anesthesia without sedation. The blood loss is reported to be less than 1% of aspirate.

OBJECTIVE

To examine the blood loss during liposuction using tumescent technique in Chinese patients compared with that of Caucasians as published in the literature.

METHODS

Hemoglobin values of patient's preoperative venous blood and infranatant of aspirate were measured in 45 consecutive cases of liposuction using the tumescent technique from May 1996 to June 1997.

RESULTS

A total of 30 patients completed the study. The average blood loss was estimated to be 1.08% of aspirate.

CONCLUSION

From this study, we found the blood loss in Chinese patients is comparable with that in Caucasians. Tumescent liposuction is a safe dermatologic cosmetic surgical procedure without the need of blood transfusion and general anesthesia.

Blood loss during suction-assisted lipectomy with large volumes of dilute adrenaline

The amount of blood lost during liposuction with the "dry" or classic "wet" techniques has been a cause for concern. In the present study 26 consecutive patients who underwent syringe-assisted liposuction with the "superwet" or "tumescent" technique had their blood loss recorded prospectively. The mean (SD) volume aspirated was 2448 (1368) ml and the mean (SD) drop in haemoglobin concentration was 11 (7) g/l. The haemoglobin concentration was measured in both the fluid and the fat fraction of the aspirate, and the mean (SD) amount of whole blood was 16.5 (9.3) ml/litre of aspirate. The present study shows that blood loss is considerably reduced when the "super-wet" or "tumescent" technique is used, compared with the reported amount lost by authors who used the "dry" or classic "wet" techniques.

Progress report on multicenter study of laser-assisted liposuction

Fifty-one patients underwent an FDA-approved study of laser-assisted liposuction in five plastic surgery centers. The YAG laser fiber is contained within the cannula and shears off the fat cleanly and coagulates blood vessels as the fat is drawn into the cannula. The drop in hemoglobin was relatively modest after surgery. Patients were able to return to work at six days and to light exercise at seven days. Contralateral studies showed a slight benefit for the laser side at both one and eight weeks for ecchymosis, pain/discomfort, and edema. Lipocrit studies were inconsistent.

Circumferential "intermediate" lipoplasty of the legs

Circumferential intermediate lipoplasty of the thighs and lower legs is an expansion of the traditional lipoplasty technique. Rather than limiting the correction to defined bulges, the goal is to thin the thigh or the calves and ankles circumferentially. This procedure is not indicated for all patients. In selected patients with extremely heavy thighs, medial and lateral bulges, full anterior thighs, and a full posterior thigh in the upper third, circumferential liposuction improves the results and produces a slimmer thigh. In the calves and ankles, circumferential lipoplasty reduces the entire lower leg giving a more attractive result rather than just reducing the medial and lateral ankle bulges. The concept of intermediate lipoplasty is introduced. This technique has advantages over the superficial technique and the traditional deep lipoplasty. No special equipment, incisions, drains, or change in technique is needed. Using circumferential intermediate lipoplasty to contour the entire lower leg results in a slimmer looking leg. There has been no increase in complications. The author reviews his experience with this technique.

Blood loss during liposuction using the tumescent technique

Blood loss during liposuction has been a concern when more than 1500 mL of material are removed during one session. Several authors have claimed that blood loss is dramatically reduced when the targeted area is infiltrated with large amounts of dilute lidocaine with epinephrine ("tumescent" or "superwet" technique). Using this technique, 25 consecutive cases in which the liposuction aspirate was expected to be 1000 mL or more were investigated with pre- and postoperative measurements of hemoglobin. In addition, hemoglobin was also measured in the fluid fraction of the aspirate. The mean +/- SD aspirated volume was 1658 +/- 518 mL and the mean +/- SD fall in postoperative hemoglobin was 0.7 +/- 0.6 g/100 mL (5.4% +/- 4.9%). The mean amount of blood per liter of aspirate was calculated to be 10.5 +/- 5.2 mL. These results clearly demonstrate that the blood loss when using the tumescent or superwet technique is dramatically reduced compared with the dry or classical "wet" technique.

Liposuction. What it will and won't do

Liposuction is used most often to contour the body. Usually, it is done on an outpatient basis under general or regional anesthesia. Results are better in patients who have good skin turgor and are at or near their ideal weight. The recovery period is short and relatively pain-free. While there have been serious complications in a few cases, the procedure is safe when done by experienced physicians who are careful in selecting patients and cautious about the magnitude of the procedure they perform. Patient satisfaction is high, particularly when patients are selected carefully and are well-informed concerning the expected outcome.

Determining safe limits for untransfused, outpatient liposuction: personal experience and review of the literature

Limiting liposuction volumes to avoid transfusion is sound surgical practice. Although the plastic surgery literature reports frequent use of transfusions in liposuction surgery, dermatologists almost never use blood replacement after liposuction. Techniques which favor less bleeding include sufficient use of fresh epinephrine, cryoanesthesia, use of smaller cannulas, fluid preloading, proper preoperative evaluation, serial liposuction, intramuscular steroids, and rapid application of pressure garments. A review of the literature and personal experience are detailed.

Outpatient anesthesia

More complex methods of outpatient anesthesia, including I.V. sedation and general anesthesia, have become commonplace. Patient selection and preoperative evaluation are discussed, as well as the choice of who will deliver anesthesia. Appropriate outpatient facilities and monitoring are reviewed. The authors' favorite methods of anesthesia, caveats, and suggestions are presented, as well as prevention and treatment of anesthesia problems and emergencies.