treatment gUIde |
treatment guide Lipoplasty & body contouring
anaesthesia. the patient is put to sleep in the operating room, and fat is then rapidly suctioned. the patient is subjected to the side-effects of general anaesthesia and the associated recovery. The second type of liposuction,
I
tumescent liposuction, is performed on awake patients using tumescent local anesthesia (TLA). This breakthrough technique,
first described by
dermatologist Jeffrey Klein in 1987, is performed safely and efficiently in the office surgical setting 1
. The TLA solution
is used to infiltrate the areas of subcutaneous fat that have been targeted for removal. TLA comprises dilute lidocaine (to anaesthetise the fat layer), adrenaline (to constrict blood vessels and slow the absorption of lidocaine), sodium bicarbonate (for more comfortable infiltration), and normal saline. The subcutaneous fat can then be suctioned painlessly and with very little blood loss2–3
.
In that the patient is totally awake, they can be repositioned at any time during the procedure to achieve optimum fat removal. The ideal liposuction candidate is in
good health and within 20% of his/her ideal body weight. They have localised fat deposits that are resistant to diet and exercise. The most common areas for liposuction
are the neck (men and women), hips/ outer thighs (women), abdomen (men and women), love handles (men), and inner knees (women).
76 ❚ July 2011 |
prime-journal.com
n my vIew, there are two distinct types of liposuction with different safety profiles. the first type of liposuction, performed in the US since the early 1980s, is liposuction under general
Post-procedure care Following the procedure, the small liposuction incisions will drain TLA fluid for 18 hours. A compression garment is worn under the patient’s clothing for 7–14 days. Patients usually return to work within a few days, and aerobic exercise in 7 days.
Safety profile The safety profile of liposuction using TLA is unprecedented. A 1995 survey of 15 336 patients who underwent tumescent liposuction revealed no fatalities or significant complications4
. No patients
required hospitalisation for the treatment of complications. Another survey in 2002 reported on 66 570 liposuction procedures performed under TLA5
. There were no
fatalities, and the adverse event rate was 0.68/1000 cases. Additional studies have revealed very low complication rates and high levels of patient satisfaction6–7
.
New advances There have been many advances in the tumescent liposuction technique. Some of these advances can also be used to obtain safer and better results with liposuction under general anaesthesia. Recent advances include: ■ The use of sharp needle infiltration of TLA whenever possible. Needle infiltration provides complete anaesthesia compared with blunt cannula infiltration ■ Suctioning of fat should be performed parallel to the long axis of the body whenever possible. This technique minimises tissue trauma and surface irregularities ■ The use of manual stretching of the skin surface allows for more precise
C. William Hanke Medical Director, Laser and Skin Surgery Center of Indiana, Carmel, Indiana, USA
References
1. Klein JA. The tumescent technique for liposuction surgery. Am J Cosm. Surg 1987; 4: 263–7
2. Klein JA. Tumescent technique for regional anesthesia permits lidocaine doses of 35 mg/kg for liposuction. J Dermatol Surg Oncol 1990; 16(3): 248–63
3. Ostad A, Kageyama N, Moy RL. Tumescent anesthesia with lidocaine dose of 55mg/kg is safe for liposuction. J Dermatol Surg 1996; 22(11): 921–7
4. Hanke CW, Bernstein G, Bullock S. Safety of tumescent liposuction in 15,336 patients. Dermatol Surg 1995. 21(5): 459–62
5. Housman TS, Lawrence N, Mellen BG, et al. The safety of liposuction: results of a national survey. Dermatol Surg 2002; 28: 971–8
6. Habbema L. Safety of liposuction using exclusively tumescent local anesthesia in 3,240 consecutive cases. Dermatol Surg 2009; 35(11): 1728–35
7. Hanke W, Cox SE, Kuznets N, Coleman WP 3rd. Tumescent liposuction report performance measurement initiative: national survey results. Dermatol Surg 2004; 30(7): 967–77
tunnelling and minimises patient discomfort ■ The development of powered cannulas has led to less patient and surgeon fatigue, enhanced patient comfort, and better results ■ Multiple end points allow the surgeon to determine when enough suction has been done (e.g. how the skin surface looks, how it feels, how much time has been spent suctioning a particular area, and the volume of fat that has been removed).
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