Computerized suction lipectomy aspirator monitor for improved results in suction lipectomy

A new computerized suction aspirator monitor is described. This device offers the benefits of instantaneous and concurrent scientifically accurate readout of aspirate contents in five separate bodily areas. Thus knowledge of amounts of blood versus fat can be immediately known without resorting to guess, estimate, or cumbersome lipocrit determination by centrifuging. Advantages of such a device include better accuracy in determination of fat removal from each area, with improvement of symmetrical fat removal. More exact determination of blood loss with improved hemodynamic replacement is also more easily and safely accomplished. In an area of mystique, experience, artistry, and aesthetic appreciation which has cloaked the initial enthusiasm for suction lipectomy, a new generation of scientific accuracy is now possible. Thus accurate determination of aspirate content vis-a-vis fat and blood can now transform this procedure into a more sophisticated and scientifically accurate operation which traditionally is desired by most practitioners of suction lipectomy.     

En bloc cervical lipectomy for treatment of the problem neck in facial rejuvenation surgery

The treatment of cervical fat in facial aesthetic surgery has received much attention in recent years. Suction lipectomy has become a very popular technique for removing cervical fat because it is easy to perform and results in few complications. This paper describes the en bloc excision of cervical fat in conjunction with rhytidectomy. The senior author has treated 1,000 patients over 17 years using this technique with a high degree of patient satisfaction and minimal morbidity. Although suction lipectomy alone may be indicated for the younger patient, our experience suggests that the en bloc excisional technique is the treatment of choice in the older patient in whom a rhytidectomy is also indicated. In contrast with suction lipectomy, we have found that the en bloc excision of cervical fat allows for more anatomic dissection and facilitates removal of greater amounts of fat and better redraping of the cervical skin.     

Gynecomastia: analysis of 159 patients and current recommendations for treatment

Gynecomastia has been treated surgically in 159 patients during the past 22 1/2 years. Prior to 1980, all patients had traditional excision, which was followed by a high incidence of complications and undesired sequelae, not the least of which was that the results of this aesthetic operation were often unaesthetic. Since 1980, when suction lipectomy became the cornerstone of treatment, the results have been much better. As a result, current recommendations for treatment are as follows: If the gynecomastia is entirely due to fat, suction lipectomy alone is sufficient treatment. However, since suction will not remove breast parenchyma, those patients whose gynecomastia is due to parenchymal hypertrophy also require local excision of the parenchyma. Skin excision is rarely, if ever, necessary.     

Suction lipectomy of the neck

Suction lipectomy of the neck has been advocated in other reports. However, because of skin laxity, a simultaneous face/neck lift has been performed usually. In this series of 49 patients, ages 18 to 73, removal of submandibular fat was performed by suction lipectomy. A simultaneous face/neck lift was not done. In addition, no skin was excised. On the contrary, the apparent excess skin was found to be required for contouring. Approximately one-third of the patients had a simultaneous chin implant. Others had different aesthetic surgical procedures performed during the same operation. The removal of neck fat by suction has proven to be more efficacious than excisional methods of lipectomy. The risks of operation have been found comparable to suction lipectomy performed in other anatomic locations.     

Regional fat aspiration for body contouring

Our experience with the original suction lipectomy is presented. The fat removal, done with a specially designed suction tube, is performed layerwise, creating a continuous, regular cavity that is transformed into a virtual space by compressive dressings. The main indication being excessive peritrochanteric fat pads, the operation is done under either epidural or general anesthesia. No antibiotics or anticoagulants are administered, and the patients are mobilized as soon as fully awake. Practicing suction-assisted lipectomy for more than seven years, we have never observed an infection, thrombosis, or fat embolism. In experienced hands, good results can be expected in about 80 percent of patients. Complications are almost always of an aesthetic nature as a result of bad indications. The method is not a surgical treatment for severe obesity.     

TRAM flap breast reconstruction: tumescent technique reduces blood loss and transfusion requirement

The tumescent technique has been shown to be efficacious in reducing both operative and postoperative bleeding without significant deleterious side effects in suction lipectomy. In this study, the effects of the tumescent technique on postoperative complications in transverse rectus abdominis myocutaneous (TRAM) flap breast reconstruction are investigated. All women who underwent a TRAM flap breast reconstruction by the senior author (J.B.) at the Emory Clinic during the years 1990 to 1996 were pooled (n = 386). Any woman who had a preincision infiltration of 0.25% epinephrine-containing saline solution (>200 cc) around the donor site was included in the tumescent group (n = 59). Medical records were reviewed, and rates of partial flap loss, fat necrosis (> or =10 percent flap volume), flap full-thickness skin loss, donor-site complication (skin loss, hernia, or infection), and blood transfusion were determined. Group rates were compared. The infiltrated group had a significantly lower transfusion rate as compared with the control group (0.34 units versus 1.32 units, p < 0.001). The rates of partial flap loss and fat necrosis were less in the tumescent group, but not significantly (0 percent versus 4 percent, p = 0.232; and 1.7 percent versus 10.4 percent, p = 0.058). There were no significant differences in the incidence of full-thickness skin loss or donor-site complications. Donor-site infiltration before incision with a 0.25% epinephrine-containing saline solution significantly reduced the transfusion requirement in TRAM flap breast reconstruction patients without adversely affecting either breast mound or abdominal donor-site complication rates.     

Suction lipectomy: complications and results by survey

In October of 1983, we sent a questionnaire on suction lipectomy to 2524 U.S. and Canadian members of the American Society of Plastic and Reconstructive Surgeons. Six-hundred and twelve plastic surgeons returned questionnaires (24.2 percent response rate). One-hundred and seven responding surgeons reported 1573 operations in which suction lipectomy with or without skin excision was used for 2685 procedures on various parts of the body. In the subset of 1249 operations in which suction lipectomy only was used to treat 2261 anatomic areas, surgeons reported greater than 80 percent good or excellent aesthetic results. The overall complication rate was 9.3 percent. The most frequent complications were persistent hypesthesia (2.6 percent), seroma (1.6 percent), and persistent edema (1.4 percent). Skin pigmentation, pain, hematoma, infection, and slough each occurred with an incidence of 1.0 percent or less. Based on the results of this survey, suction lipectomy is a valuable new modality for surgical improvement of body contour.     

Skin retraction following suction lipectomy by treatment site: a study of 500 procedures in 458 selected subjects

I identified 500 suction lipectomy procedures involving sites on the body and in the cervicofacial region in 458 selected patients and studied the influence of treatment site on postoperative skin retraction by comparing preoperative and postoperative skin condition. Postoperative skin condition was evaluated first in the immediate postoperative period (second or third day); then at a more remote date (after at least 2 months of follow-up). On the body, restoration of the preoperative condition of the skin was obtained in 94.6 percent of treatment sites in the immediate postoperative period; after a longer follow-up, this proportion was 87.9 percent because of delayed development of modifications. The time interval needed to obtain a stable result increased with increasing age, regardless of the nature of this result, as well as with the total amount of fat removed. On the neck, liposuction improved or even eliminated preexisting skin looseness, and this improvement was even more noticeable as follow-up increased. The neck thus appears as the site of choice for suction lipectomy. On the face, in contrast, favorable results deteriorated over time, a finding that leads me to advocate combination with a face-lift whenever ptosis is present. Thus treatment site obviously has a substantial impact on the potential of the skin for retracting postoperatively.     

The effect of epinephrine on blood loss during suction lipectomy

In a prospective, double-blind, controlled study on 26 consecutive patients who underwent suction lipectomy, the injection of epinephrine (1:250,000, 1:500,000, or 1:1,000,000) was not found to decrease fluid/blood loss when compared with saline injection or no injection at all. Since our study fails to support the use of epinephrine to lessen fluid/blood loss during suction lipectomy, we have abandoned its use in that procedure.     

Quantitative analysis of blood and fat in suction lipectomy aspirates

This study of suction lipectomy aspirates from 15 consecutive patients was undertaken to biochemically quantitate the blood-to-fat ratios of the aspirates. A wide variation in the blood-to-fat ratios (8 to 54 percent) was noted, but the authors failed to demonstrate any relationship between the blood-to-fat ratios and the suction lipectomy operative site. Prophylactic measures to allow treatment of patients in a consistently safe manner include carefully screening of patients to exclude those with bleeding disorders or significant illnesses, perioperative oral iron therapy, infiltrating the operation site with a dilute epinephrine solution, hydrating the patients adequately perioperatively, using smaller-diameter cannulas for the aspiration, minimizing aspiration once the aspirate turns grossly bloody, and limiting the aspirate to a volume of less than 1750 ml for any operative procedure.     

A national survey of complications associated with suction lipectomy: a comparative study

In March of 1988, a survey form was sent to all 2695 U.S. and Canadian members of the American Society of Plastic and Reconstructive Surgeons. Nine-hundred and thirty-five members responded, for a response rate of 34.7 percent. The purpose of the survey was to ascertain the total number of major liposuction, dermatolipectomy, and abdominoplasty procedures performed from January of 1984 to January of 1988 and to compare nine specific complications that are associated with these three procedures. The 935 surgeons reported a total of 112,756 procedures performed: major liposuction (75,591), dermatolipectomy (10,603), and abdominoplasty (26,562). Nine major complications were surveyed: mortality, myocardial infarction, cerebrovascular accident or transient ischemic attack, pulmonary thromboembolism, fat embolism, major skin loss, anesthesia complication, transfusion complications, and deep venous thrombosis. The findings in this survey showed, when comparing these three procedures and the nine types of complications, that the complication rate for major suction lipectomy was 0.1 percent, for dermatolipectomy 0.9 percent, and for abdominoplasty 2.0 percent. Fat emboli did not prove to be a significant factor associated with any of the three procedures. However, of the 15 reported deaths (major liposuction 2, dermatolipectomy 2, and abdominoplasty 11), pulmonary thromboembolism was the causative factor in 9 deaths (60 percent). Based on these analyzed data, we feel that major suction lipectomy has a low complication rate and is a reasonably safe procedure.     

Subcutaneous pseudobursa secondary to suction and surgery

Suction lipectomy has been used throughout the regions of the body to remove vast amounts of subcutaneous fat. The blunt technique allows for a multiplicity of small (4 to 6 mm) channels to be created and the fat removed by suction with little disturbance of the overlying skin, the supporting septa, vessels, or nerves. Abdominolipectomy has been successfully performed for decades, in which large amounts of skin and subcutaneous fat are removed by sharp dissection. The undermining involved in an adbominolipectomy extending from the xiphoid to pubis and laterally to the level of the iliac crest and then supplemented by the suction technique has led to the formation, in some cases, of chronic seromas not relieved by multiple aspirations. Healing and contractions of these seromas causes a deformity of the overlying skin, because it is puckered and drawn upon itself. This results in the formation of a subcutaneous pseudobursa lined by collagen sheets but no epithelial cells. We present 9 patients who have demonstrated this phenomenon. We suggest that in the largest resections, safety is best served by waiting a period of at least 6 weeks between suction and subsequent resection.     

Skin sensation after suction lipectomy: a prospective study of 50 consecutive patients

Using a reproducible pain stimulus, skin sensation was evaluated in a prospective study of 50 consecutive patients who underwent suction lipectomy. A total of 294 anatomic areas were evaluated and treated. Before operation, many patients were found to have patchy areas of decreased sensation, a condition that was unknown to them. Initially after surgery, all patients had decreased sensation in the treated areas. However, sensation usually returned to normal in 6 to 8 months. In some patients, sensory return to preoperative levels took as long as 1 year, and in a few, patchy areas of decreased sensation were present even longer. In general, the larger the treated area, the larger are the area and degree of sensory loss and the slower is the return of sensation.     

The influence of permanent magnetic field therapy on wound healing in suction lipectomy patients: a double-blind study

The authors present their experience with the healing influence of permanent magnets on postoperative wounds. The responses of 20 patients who underwent suction lipectomy and postoperative negative magnetic field therapy were studied in a double-blind fashion. Magnets in the form of patches (10 patients) or sham magnet patches (10 patients) were placed over the operative region in each of the patients. Pain, edema, and discoloration (ecchymosis) were evaluated at 1, 2, 3, 4, 7, and 14 days postoperatively. Our results show that the treatment group had significant reductions in pain on postoperative days 1 through 7, in edema on days 1 through 4, and in discoloration on days 1 through 3 when compared with the control group. These results demonstrated that commercially available magnets have a positive influence on the postoperative healing process in suction lipectomy patients.     

Buried penis release in adults with suction lipectomy and abdominoplasty

The buried penis in adults who had substantial weight gain was treated with a combination of suction lipectomy of the abdomen and pubic area and the release of the suspensory ligament of the penis and with abdominoplasty with suture anchoring of the pubic and penile skin base dermis to the rectus fascia superiorly. This procedure was performed in 11 patients over the past 10 years with satisfactory results. One patient required additional excess skin excision from the side of the pubic and scrotal area to improve the results.     

Gynecomastia: suction lipectomy as a contemporary solution

Suction lipectomy is adapted for the correction of gynecomastia. Previous attempts using suction lipectomy for gynecomastia still required the use of sharp dissection for removal of the glandular breast tissue as well as excision of redundant skin. With this new technique, gynecomastia is corrected solely with the use of suction lipectomy. The technique is successful if the gynecomastia is due to excess fat or parenchymal hypertrophy. A 7-mm cannula is inserted first, to remove the adipose tissue. Then a 2.4-mm cannula is used to remove the glandular and ductal tissue. The 7-mm cannula is then reinserted to remove subareolar parenchyma and to make final contour adjustments. The surrounding subcutaneous tissue is easily undermined to avoid a saucer deformity and to allow for skin contraction. Patients return to full activities in 48 hours. A compressive garment is worn for 4 to 6 weeks. The results of 10 patients are discussed.     

The tumescent technique: the effect of high tissue pressure and dilute epinephrine on absorption of lidocaine

Injection of lidocaine into the subcutaneous tissues by the tumescent technique results in a delayed absorption of the local anesthetic and has allowed clinicians to exceed the maximum recommended dose of lidocaine without reported complications. However, little knowledge exists about the mechanisms that permit such high doses of lidocaine to be used safely with this technique. The presence of low concentration epinephrine and the increased tissue pressure resulting from the tumescent injection have both been implicated as important factors, but neither has been studied in patients whose results were not altered by the variability of the suction procedure. The purpose of this work was to determine the effect of tissue pressure during tumescent injection and presence of low concentration epinephrine on the absorption of lidocaine from subcutaneous tissues in human volunteers. Twenty healthy female human volunteers were randomized into four study groups. After body fat measurements, all subjects received an injection of 7 mg/kg of lidocaine into the subcutaneous tissues of both lateral thighs. The injected solution consisted of 0.1% lidocaine and 12.5 meq/liter sodium bicarbonate in normal saline with or without 1:1,000,000 epinephrine. Tissue pressure was recorded during injection using a specially designed double-barreled needle. The time required for injection was also recorded. Subjects in group 1 received lidocaine with epinephrine injected by a high-pressure technique. Group 2 subjects received lidocaine with epinephrine injected by a low-pressure technique. Group 3 subjects received lidocaine without epinephrine injected under high pressure. Group 4 subjects received lidocaine without epinephrine injected under low pressure. Following injection, sequential blood samples were drawn over a 14-hour period, and plasma lidocaine concentrations were determined by gas chromatography. No suction lipectomy was performed. Maximum tissue pressure during injection was 339 +/- 63 mmHg and 27 +/- 9 mmHg using high- and low-pressure techniques, respectively. Addition of 1:1,000,000 epinephrine, regardless of the pressure of injected fluid, significantly delayed the time to peak plasma concentration by over 7 hours. There was no significant difference in the peak plasma concentration of lidocaine among the four groups. Peak plasma concentrations greater than 1 mcg/ml were seen in 11 subjects. Epinephrine (1:1,000,000) significantly delays the absorption of lidocaine administered by the tumescent technique. High pressure generated in the subcutaneous tissues during injection of the solution does not affect lidocaine absorption. The delay in absorption may allow time for some lidocaine to be removed from the tissues by suction lipectomy. In addition, the slow rise to peak lidocaine concentration in the epinephrine groups may allow the development of systemic tolerance to high lidocaine plasma levels.     

Lipodissection in body sculpturing: the dry procedure

We have used the honeycombed suction lipectomy (wet and/or dry) in over 700 patients. It represents a major advancement in the treatment of the localized adiposities of the body. Its advantages are eliminating the need for long, unsightly scars and reducing operating time and morbidity. Selection of appropriate patients is of paramount importance for reliable results because this technique is truly sculpting of the soft tissues. Results improve also with the proper training and experience of the surgeon. The indications and complications have been discussed. This technique (honeycombed suction lipectomy) appears more reliable than suction curettage that employs sharp dissection.     

Fat redistribution following suction lipectomy: defense of body fat and patterns of restoration

No randomized studies in humans have examined whether fat returns after removal or where it returns. We undertook a prospective, randomized-controlled trial of suction lipectomy in nonobese women to determine if adipose tissue (AT) is defended and if so, the anatomic pattern of redistribution. Healthy women with disproportionate AT depots (lower abdomen, hips, or thighs) were enrolled. Baseline body composition measurements included dual-energy X-ray absorptiometry (DXA) (a priori primary outcome), abdominal/limb circumferences, subcutaneous skinfold thickness, and magnetic resonance imaging (MRI) (torso/thighs). Participants (n = 32; 36 ± 1 year) were randomized to small-volume liposuction (n = 14, mean BMI: 24 ± 2 kg/m(2)) or control (n=18, mean BMI: 25 ± 2) following baseline. Surgery group participants underwent liposuction within 2-4 weeks. Identical measurements were repeated at 6 weeks, 6 months, and 1 year later. Participants agreed not to make lifestyle changes while enrolled. Between-group differences were adjusted for baseline level of the outcome variable. After 6 weeks, percent body fat (%BF) by DXA was decreased by 2.1% in the lipectomy group and by 0.28% in the control group (adjusted difference (AD): -1.82%; 95% confidence interval (CI): -2.79% to -0.85%; P = 0.0002). This difference was smaller at 6 months, and by 1 year was no longer significant (0.59% (control) vs. -0.41% (lipectomy); AD: -1.00%; CI: -2.65 to 0.64; P = 0.23). AT reaccumulated differently across various sites. After 1 year the thigh region remained reduced (0.77% (control) vs. -1.83% (lipectomy); AD: -2.59%; CI: -3.91 to -1.28; P = 0.0001), but AT reaccumulated in the abdominal region (0.64% (control) vs. 0.42% (lipectomy); AD: -0.22; CI: -2.35 to 1.91; P = 0.84). Following suction lipectomy, BF was restored and redistributed from the thigh to the abdomen.     

Toxic shock syndrome after suction lipectomy

We present a case of toxic shock syndrome with necrotizing fasciitis after suction lipectomy. The patient underwent aesthetic suction lipectomy of the abdomen, buttocks, and thighs during an office procedure by a cosmetic surgeon. On postoperative day 2, the patient was referred to the emergency department of our hospital because of pain. On admission, the patient was in toxic shock. She required intensive medical treatment for about 1 month, along with psychiatric help to adapt after the illness. Although toxic shock syndrome is a rare postoperative complication, every plastic surgeon should be acquainted with it. A combination of early recognition, diagnosis, and aggressive supportive therapy is the only successful treatment.