Significant, diffuse lipodystrophy noted bilaterally in “saddlebag” regions of upper lateral thighs.
Skin redundancy and residual adiposity noted on the central trunk.
Patient concerns, expectations, and goals of treatment.
Evaluate regions of suboptimal contour, asymmetry, lipodystrophy.
Evaluate skin quality and tone (thickness and elasticity): Pinch test.
Examine for hernias, diastasis.
Liposuction is a contouring procedure.
Best in areas of thick, elastic skin with underlying contour irregularity of fat.
Does NOT address cellulite or obesity.
Does NOT resect skin.
Perform preoperative markings with patient upright to determine treatment areas and asymmetries, and outline zones of adherence.
Target deep fat layer and cross-tunnel to prevent contour irregularities.
Wetting solution technique (Table 33.1)
Lidocaine, epinephrine, and bicarbonate solution added to saline or lactated Ringer solution.
Provides anesthesia and hemostasis.
Maximum lidocaine with epinephrine: 35 mg/kg.
Suction-assisted liposuction (SAL): Traditional liposuction technique.
Power-assisted liposuction (PAL): Motorized oscillating hand piece.
Ultrasound-assisted liposuction (UAL): Ultrasonic energy is applied after wetting solution to emulsify fat before aspiration.
Ideal for fibrous regions: Buttocks, lumbar region, gynecomastia.
Precautions to avoid cutaneous thermal injury.
Laser-assisted liposuction (LAL).
Fluid management for large-volume liposuction (critical safety issue)
Replace preoperative deficits.
Employ superwet or tumescent technique.
Administer maintenance intravenous fluid (IVF) + IVF replacement of 0.25 mL/1 mL of aspirate over 5 L.
Titrate IVF to patient′s clinical picture (e.g., urine output, vital signs).
Maintain intraoperative fluid ratio: (IVF + infiltrate)/aspirate = 1.2.
Older technique (Pitman): IVF + infiltrate = 2 × aspirate.
25 to 30% of infiltrate is removed with aspirate.
If large-volume liposuction (≥ 4 to 5 L) is performed, it must be done in an acute-care hospital or accredited facility.
Monitor vital signs and fluid balance with Foley catheter. Overnight inpatient observation.
Warm patient, fluids, and operating room to avoid hypothermia.
Dilute lidocaine further if greater volume of infiltration is necessary.
Deep venous thrombosis (DVT) prophylaxis
Mechanical: sequential compression devices.
Ambulate day of surgery.
Chemoprophylaxis not standardly required.
Compression garments for 4 to 6 weeks.