8 - Liposuction and fat grafting

Abstract

■Incorporation of a diet and exercise program in conjunction with liposuction will allow patients to achieve their optimal shape and contour. Patients who do not adhere to diet and exercise are least happy with their results.■A thorough history and physical exam should be performed and a preoperative clearance obtained, especially for large-volume or long, combined cases.■Marking the patient in front of a mirror allows both the surgeon and patient to see and understand the areas of concern and intended treatment. Cellulite and other contour irregularities can be pointed out preoperatively to the patient.■Over-the-counter herbal and diet medications may have unfavorable interaction with surgery and/or anesthesia and should be discontinued 3 weeks prior to surgery.■Knowledge of the differing thickness and consistency of fat throughout the body is crucial to determining proper depth and technique for each region of the body.■Superficial liposuction should be reserved for significant superficial irregularities and be performed by those experienced in liposuction techniques.■Wetting solutions should always be used, and a strict record of volume infused and aspirated should be kept by the operating room personnel.■Surgical access sites should be concealed, often asymmetric, and utilized to allow the best access and treatment results. Excessive use of a single access incision may result in a deformity.■Patients with surgical scars on their abdomen must be thoroughly examined to rule out the presence of a hernia.■There are many tools one can use to perform liposuction. Physician experience and judgment supersedes any technology.■Contour irregularities are best diagnosed at the time of the surgical procedure. If noted, strong consideration for immediate fat grafting should be considered.■Postoperative contour deformities should be clinically evaluated and, if mild, can respond to lymphatic massage or other non-invasive methods. A systematic approach should be used to correct contour deformities when they occur.