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Liposuction: Can it be applied to management of lipedema?
Published in Byung-Boong Lee, Peter Gloviczki, Francine Blei, Jovan N. Markovic, Vascular Malformations, 2019
Robert J. Damstra, Tobias Bertsch
According to the Dutch guidelines,1 liposuction in lipedema is considered a way to reduce fat in very specific cases. Liposuction has to be performed as super tumescent liposuction in an ambulatory setting as part of an integrated therapeutic armamentarium. Before using liposuction, the associated deteriorating components, such as edema, obesity, unhealthy lifestyle, lack of physical activity, lack of knowledge about the disease, and psychosocial distress, should be addressed using the CCM and the ICF method.
Surgical Rejuvenation of the Ageing Face
Published in John C Watkinson, Raymond W Clarke, Terry M Jones, Vinidh Paleri, Nicholas White, Tim Woolford, Head & Neck Surgery Plastic Surgery, 2018
Gregory S. Dibelius, John M. Hilinski, Dean M. Toriumi
A tumescent liposuction technique is used to harvest the fat for transfer. Tumescent solution containing 20 mL of 1% lidocaine and 1 amp of epinephrine in 1 L of isotonic saline is infiltrated into the subcutaneous fat plane using a blunt-tip cannula. The tumescent solution is permitted to stand for a period of time prior to liposuction to allow for adequate vasoconstriction. Fat is then harvested using a liposuction technique similar to that described above. A 2–3 mm blunt multihole cheese grater type cannula is preferred for the harvest. Careful attention is paid to the plane of harvest to avoid irregular scarring of the dermis or entry into the abdominal cavity. The non-dominant hand continuously palpates the depth of the cannula and controls its movement. The amount of fat required for facial injections is typically well below the volume performed in a standard liposuction procedure, which decreases the morbidity of the technique substantially. Patients should be counselled not to expect a significant aesthetic improvement at the donor site.
Body Contouring
Published in M. Sandra Wood, Internet Guide to Cosmetic Surgery for Women, 2013
This AAD online pamphlet describes liposuction, focusing specifically on tumescent liposuction. The pamphlet describes the procedure and its benefits, indications for the surgery, and why a patient would choose a dermatologic surgeon for this procedure. Postsurgery and safety information are included.
Liposuction for large facial involuted infantile hemangiomas in children: clinical evaluation and management strategies
Published in Journal of Dermatological Treatment, 2021
Wei Gao, Yajing Qiu, Yunbo Jin, Xiaoxi Lin
Compared to the direct open surgical resection, liposuction for large facial involuted IH is less aggressive with little violation of skin. The most common sequela of the open surgery is the scarring. Although modified surgical methods, such as the circular excision and purse string (11), are created to minimize the possible scars, there are, however, certain patients in whom the postoperative scar is still obvious and unacceptable. Thus, based on our experience and research of IH in past years (6,12–15), liposuction is a fast and definitive solution to volumetric sequelae after involution. For superficial subcutaneous lesions, the cannula could be flexibly adjusted to achieve an optimal facial symmetry. For lesions penetrating the SMAS and deeper tissue, liposuction prior to lipectomy could remove most of the superficial fibrofatty tissue, minimizing the incision of following surgical resection. Regarding the safety, we agree with Berenguer et al. (3) that the tumescent liposuction is not inferior to ultrasound-assisted liposuction. The limitation of the technique is that liposuction can only solve the problem of volumetric residue, cannot solve the poor skin texture, and telangiectasis irresponsive to laser therapy. The limitation is the lack of validation of our results through randomized control trials.
Anterior Ischaemic Optic Neuropathy following Liposuction in a Patient with Optic Disc Drusen
Published in Neuro-Ophthalmology, 2021
Kaveh Abri Aghdam, Ali Aghajani, Mostafa Soltan Sanjari, Azadeh Yavari
IONs are the most frequently reported conditions associated with perioperative visual loss; 73% of them occurring in the setting of spine surgery. Other associated procedures are mostly major cardiovascular and orthopaedic surgeries.1 Tumescent liposuction is usually considered a safe procedure for the removal of nearly 1500 ml of localised fat, but when large amounts of fat are aspirated fluid shifts to third spaces, which may cause haemodynamic complications.7 ION after liposuction surgery was first reported by Minagar et al.8 Since then, a few cases have been reported with a similar clinical history. Foroozan et al.9 reported a case of bilateral AION after liposuction surgery and suggested that large volume fat removal and the haemodynamic instability that ensued was the causative factor. However, haemodynamic instability and hypotension occur in many surgical and nonsurgical conditions, yet ION happens rarely. Individual predisposing factors or a constellation of multiple factors are possible explanations.10 Optic disc perfusion vulnerability due to elevated CSF pressure was the proposed predisposing factor in another case reported by Monteiro et al.11 Since the demographics of patients with IIH and the patients who choose cosmetic abdominal surgery are close, they suggested general screening for the presence of optic disc swelling before performing liposuction procedures. Moura et al.4 proposed that a small crowded optic disc in the setting of perioperative blood loss and overhydration was the predisposing factor for ION in their patient. The methylenetetrahydrofolate reductase (MTHFR) homozygous and heterozygous to prothrombin II variant mutation was suggested to be the underlying cause of optic nerve infarction in a patient with post-liposuction bilateral posterior ION reported by Rath et al.5
Liposuction-assisted circumferential trimming in treatment of axillary osmidrosis (AO)
Published in Journal of Dermatological Treatment, 2018
Xiaogen Hu, Bo Chen, Dingquan Yang
Based on the studies above, the technique of tumescent liposuction combined with circumferential trimming is compatible with traditional surgery in effect but offers fewer complications. In our technique, several advantages are stressed. (1) An 1.5 cm long incision is made, as a result, there is no noticeable scar and the appearance is perfect after recovery. (2) Tumescent anesthesia is used in favor of subcutaneous undermining and hemostasia. The tumescent anesthesia expands the soft tissue of the axillae, which minimize the risk of injury to the brachial plexus and facilitated dissection of the flap. Furthermore, the surgical area is anesthetized by tumescent solution in which the epinephrine can constrict blood vessels to decrease the possibility of blood loss and formation of hematoma. (3) Liposuction is performed before circumferential trimming. It has advantage over direct excision in that liposuction helps elevate the skin flap by suctioning to and fro. The blunt tip of the cannula minimizes injury to surrounding tissues as compared with direct excision during skin flap elevation. In addition, liposuction not only helps elevate skin flap but also eliminate apocrine glands in the primary stage, which increases chance of successful treatment of AO. (4) Then glandular tissue attached to the dermis of the flap is removed manually by scissors. The procedure ensures that apocrine glands are removed by using the ‘pinch and evert’ technique under direct vision, so that subcutaneous tissue attaching to the dermis can be removed safely and completely. Another reason is that the undersurface scar of the skin can also block out the remnant glands, which decreases the possibility of recurrence. (5) The sub-dermal vascular plexus is maintained in the process of meticulous trimming, so that circulation of the flap is not compromised. The blood circulation of the flap is well protected; therefore, the complication of skin necrosis is reduced. (6) In addition, when the subcutaneous tissue is trimmed with a pair of scissors, glandular tissue is dropped directly on the wound surface which can be washed away by physiological saline flush.