Tumescent Liposuction Research Articles

Safety of Ultrasonic-assisted Liposuction (UAL) Using a Non-Water-cooled Ultrasonic Cannula

There has been much medical investigation and much public relations in the media regarding ultrasonic liposuction. With different methodologies and instrumentation for applying ultrasonic energy to soft tissue in conjunction with liposuction, there is appropriate confusion and skepticism in the medical community. To present case reports that delineate the possible morbidities and/or safety of one method of application of ultrasonic energy to enhance liposuction--ultrasonic assisted Liposuction (UAL) performed with a non-water-cooled ultrasonic cannula. Description of six cases in which this procedure was performed and their follow-up over a 4-week period. Much of the morbidity described in these six cases was indistinguishable from that noted following standard tumescent liposuction with micro cannulas. There is a significant risk of heat necrosis of soft tissue with this procedure, which can be minimized with proper technique. UAL with a non-water-cooled cannula can be performed safely when proper education regarding its usage is followed. However, surgeons wishing to perform this technique must be willing to experience a significant learning curve.

Tumescent Infusion for Liposuction: A Practical Method and Pressure Delivery System

To facilitate tumescent liposuction, a pressure infusion technique is necessary. We have devised a new technique for anesthetic solution infusion—a pressure infusion bag along with an automatic low-pressure tourniquet pump—that can generate sustained and significant volume infusion. This system is readily available, requires a minimal capital outlay, and is economically advantageous to our patients.

Infusion rates and levels of premedication in tumescent liposuction.

Tumescent liposuction has proven to be an extremely safe and effective method of liposuction. However, the infusion of tumescent anesthesia can take 1 hour or more to complete. To document the types, dosages, and routes of administration of premedication utilized by four experienced tumescent liposuction surgeons. To determine if infusion rates for tumescent anesthesia are affected by types of premedication. Four experienced liposuction surgeons were asked to review their most recent 100 tumescent liposuction patients with respect to types and dosages of premedication and routes of administration. Data were also provided on corresponding infusion pump settings and infusion rates. Volumes of tumescent anesthesia and corresponding volumes of fat aspirated were also collected on the same 400 patients. Infusion of tumescent anesthesia could be performed more rapidly in patients who were given greater amounts of premedication. Volumes of tumescent anesthesia infused were generally two or more times the volume of fat aspirated. Patients could be infused with less premedication if slow infiltration was employed. Infusion rates for tumescent anesthesia can be increased of greater amounts of premedication are given. However, this must be balanced against the safety of the premedication.

Prevention of Epinephrine Reaction in Tumescent Liposuction with Atenolol (Tenormin)

Patients who receive more than 3000 cc of tumescent solution occasionally develop potentially dangerous tachycardia, and may develop a paniclike reaction of symptomatic overload about 12 hours postoperatively. This article describes how premedication with the beta-blocker tenormin (atenolol) prevents this complication of tumescent liposuction anesthesia.

Lidocaine Toxicity with Tumescent Liposuction

Lidocaine Toxicity with Tumescent Liposuction

CAST liposuction: an alternative to brachioplasty.

The aging female with excess arm fat and poor skin tone frequently refuses a brachioplasty scar due to permanent detectability. Traditional deep liposuction localized to the posterolateral aspect of the arm frequently leaves sagging, wrinkled skin. Circumferential para-Axillary Superficial Tumescent (CAST) liposuction was developed to maximize skin retraction and create regional harmony by preparatory compartment magnification with dilute lidocaine and epinephrine followed by circumferential treatment of the arm and adjacent areas utilizing superficial and/or subdermal liposuction. Early CAST liposuction results in patients with moderate fat and excess skin revealed excellent skin retraction. CAST liposuction was then offered as the first of two stages to patients with excess fat and poor skin tone to avoid or shorten the brachioplasty scar. Twenty-six patients underwent CAST liposuction with 9-22 months follow up. Only two patients (7.7%) eventually required brachioplasty. Although postoperative seromas were frequent (38.5%) and preexisting skin wrinkling usually returned, the final result is acceptable to the vast majority of patients (84.6%) who refuse a brachioplasty scar.

Splenic and Portal Vein Thrombosis following Liposuction

This article reports the first case of splenic and portal vein thrombosis evolving from tumescent liposuction. The patient was a 47-year-old white female. Within 48 hours of the surgery, the patient developed generalized abdominal cramping and discomfort without fever, diarrhea, or vomiting. Radiological analysis with ultrasound and CT could not differentiate between fat or blood emboli. Heparinization and hyaluronidase use are acknowledged as controversial measures, but surgeons should be alerted to the potential for a tumescent-liposuction-induced thromboembolic event and become sensitized to its signs and symptoms.

Didactic lectures

The safety of cosmetic procedures in patients who are pregnant and/or lactating is a complex clinical question surrounded by uncertainty. Our objective is to consolidate data on the safety of commonly requested cosmetic procedures during pregnancy and lactation after a systematic review of the current literature to guide evidence-based care in the future. A systematic search of the PubMed database was conducted for articles on cosmetic procedures during pregnancy and lactation. Due to a lack of controlled trials, case reports and series were considered. Minor procedures such as shave, punch, snipping, and electrocautery are considered safe. With respect to chemical peels, glycolic and lactic acid peels are deemed safe; however, trichloracetic and salicylic acid peels should be avoided or used with caution. Although safety data on botulinum toxin A is insufficient, the procedure may be safe because systemic absorption and placental transfer are negligible. Sclerotherapy can be safe during pregnancy but must be avoided during the first trimester and after week 36 of the pregnancy. Laser and light therapies have been considered generally safe for patients with granulomatous conditions and condylomata. Epilation should be limited to waxing, shaving, and topical treatments instead of permanent procedures. In patients who are lactating, most therapies discussed above are safe but fat transfer, sclerotherapy, and tumescent liposuction are not recommended. Better evidence is needed to make concrete recommendations on the safety of cosmetic therapy during pregnancy and lactation but preliminary evidence suggests excellent safety profiles for many commonly requested cosmetic procedures.

CAST liposuction of the arm improves aesthetic results.

Lipocontouring the arm has a lower degree of patient satisfaction compared to other regions since untoward sequelae such as sagging and wrinkled skin may result. Circumferential para-Axillary Superficial Tumescent (CAST) liposuction was offered as an alternative to traditional arm liposuction or brachioplasty to 59 patients. Fifty-three of 59 patients (89.9%) were satisfied or very satisfied with the procedure; six patients (10.2%) requested secondary procedures; four, further liposuction (6.8%); two, brachioplasty (3.4%). Although temporary untoward sequelae (15.3%) and minor complications (8.5%) were not infrequent and more vigorous postoperative care necessary, the final aesthetic result was rarely compromised and patient satisfaction was high.

ADVANCES IN DERMATOLOGIC SURGERY

The major advances in dermatologic surgery for this period reside in the areas of diagnosis and management of cutaneous melanoma, laser surgery, tumescent liposuction, and tumorigenesis. A closer look at these advances is presented.

Tumescent Liposuction: A Surgeon’s Perspective

The tumescent technique consists of injection of large amounts of dilute lidocaine and epinephrine into the subcutaneous fat prior to performing liposuction. This preinjection provides local anesthesia and reduction in postoperative pain. Blood loss, bruising, and swelling are significantly reduced. The large volume of injectate is a complete fluid replacement, eliminating the need for intravenous fluid support. In the authors' experience, patients are most comfortable when the tumescent technique is combined with monitored intravenous sedation.

Tumescent Liposuction: U.S. Survey

Liposuction is the most commonly performed cosmetic surgery procedure in the United States. Dermatologists have led the way in liposuction development

Comparison of Room Temperature and Warmed Local Anesthetic Solution for Tumescent Liposuction

The tumescent technique of local anesthesia has been accepted as the standard of care for liposuction surgery. Large volumes of a dilute solution of lidocaine, epinephrine, sodium bicarbonate, and triamcinolone are infused into the subcutaneous fat. The technique eliminates the need for general anesthesia and provides greater safety and improved esthetic results. A study was designed to evaluate the benefit of warming of the local anesthetic to 40 degrees C prior to infiltration and thus to determine whether warming provides improved patient comfort. A double-blind randomized cross-over study was performed in 16 patients undergoing outpatient tumescent liposuction. Pain scores were determined using a visual analog pain scale. The mean pain score was significantly lower for areas treated with the 40 degrees C warmed solution. Warming of local anesthetic solution for tumescent liposuction significantly reduces pain as perceived by the patient and is recommended in all tumescent liposuction surgery.

Current status of tumescent liposuction in the United States. National survey results.

Tumescent liposuction is an extremely safe method of liposuction that can be performed entirely under local anesthesia. To determine evolving trends in the current practice of tumescent liposuction in 15,336 patients treated by 66 dermatologic surgeons. A survey questionnaire was sent to 1,778 Fellows of the American Society for Dermatologic Surgery in February 1994. The comprehensive questionnaire requested information on the number of patients treated with tumescent liposuction, complications, and various practice issues. Sixty-six dermatologic surgeons provided data on 15,336 patients; 44,014 body areas were treated. The complications that developed were infrequent and minor and have been reported previously. The average amount of fat removed per patient was 1,276 cc. An average of 33 cc of blood was lost per patient per procedure. Cannulas of 4.0 mm or less in diameter were commonly used. The abdomen and outer thighs were the most common areas treated in women. The flanks/love handles and abdomen were the most common areas treated in men. Intraoperative monitoring of vital signs was common. Tumescent liposuction is an evolving technique that has virtually eliminated blood transfusions and the major complications of liposuction under general anesthesia. Large amounts of fat can be removed using small diameter cannulas. The fat can be safely removed with a minimum risk of minor complications.

Lidocaine and epinephrine levels in tumescent technique liposuction.

The safety of lidocaine dosing in the tumescent technique has been well documented, but there is little evidence regarding the safety of combining tumescent lidocaine infiltration with subcutaneous lidocaine infiltration required in other aesthetic surgery. The safety of lidocaine and epinephrine dosing was investigated in 10 patients undergoing tumescent technique liposuction alone and in 10 patients undergoing tumescent liposuction with concurrent facial and aesthetic breast surgery by determining serum lidocaine and epinephrine levels at 3, 12, and 23 hours following infiltration of the tumescent solution and the subcutaneous lidocaine. The mean lidocaine dose of all patients was 22.3 mg/kg. All patients demonstrated safe lidocaine levels at all intervals, with the highest levels occurring in patients who received intravenous lidocaine at the induction of anesthesia. The peak epinephrine levels occurred at the 3-hour blood draw and were approximately four times physiologic. No patient demonstrated any subjective or objective signs of lidocaine or epinephrine toxicity.

Tumescent liposuction: Operative technique

The tumescent technique for liposuction is a new and improved method for body sculpting. Although the technique allows liposuction under local anesthesia, its benefits extend beyond pain ablation. Tumescent liposuction results in negligible blood loss with diminished bruising, provides complete fluid replacement, and facilitates use of smaller cannulas.

Safety of tumescent liposuction in 15,336 patients. National survey results.

Tumescent liposuction is a new method of liposuction under local anesthesia that has been developed by dermatologic surgeons. To determine the safety of tumescent liposuction in a large group of patients treated by dermatologic surgeons. A survey questionnaire was sent to 1,778 Fellows of the American Society for Dermatologic Surgery in February 1994. The comprehensive questionnaire requested information on numbers of patients treated with tumescent liposuction and complications that occurred. Sixty-six dermatologic surgeons provided data on 15,336 patients. The complications that were reported were infrequent and minor. There were no serious complications such as death, embolism (pulmonary or fat), hypovolemic shock, perforation of peritoneum or thorax, or thrombophlebitis. Blood transfusions were not required in any of the 15,336 patients and there were no admissions to the hospital for treatment of complications. Tumescent liposuction is an exceptionally safe method of liposuction under local anesthesia that eliminates the necessity of general anesthesia and blood transfusions. Tumescent liposuction is safer than liposuction under general anesthesia and results in fewer complications.

Tumescent Liposuction and Improved Postoperative Care Using Tumescent Liposuction Garments™

The tumescent technique for liposuction, using large volumes of dilute lidocaine and epinephrine infiltrated into subcutaneous fat, has improved safety by eliminating the risks of general anesthesia and the massive blood loss associated with older techniques. This article describes the results of the author's search for ways to optimize patient care after tumescent liposuction. The tumescent technique has dramatically improved postoperative comfort and accelerated recovery time. Using microcannulas and multiple incisions for cannula access, leaving the incisions open without sutures, and wearing a specially designed Tumescent Liposuction (TLG) Garment for compression, patients return to work in 1 to 2 days, and the first postoperative follow-up office visit is 5 to 6 weeks after surgery.

Tumescent Liposuction under General Anesthesia

Tumescent liposuction has been recently established as a technique of infiltration of dilute concentrations of lidocaine and adrenalin, which appears to drastically limit the amount of blood loss during liposuction surgery. Previous reports focused on its use under local anesthesia. I have found that it is equally applicable to patients undergoing liposuction surgery under general anesthesia and have also found that the concentration of adrenalin can be reduced from 1: 1,000,000 to 1: 4,000,000 without compromising the hemostatic effects. The technique allows relatively large amounts of fat to be aspirated safely without autologous transfusion.