2. Cosmetic Liposuction/Abdominoplasty Flashcards
For women undergoing abdominoplasty after massive weight loss, which of the following is the best position of the navel?
A) Along the line drawn between the iliac crests
B) At the horizontal level of the tenth ribs
C) Between the first and second tendinous inscriptions
D) In the midline 10 cm above the vulvar commissure
E) One-third of the distance from the xiphoid to the pubis
The correct response is Option A.
As a result of the rapid increase in the number of bariatric surgical procedures performed each year, the frequency of body contouring procedures has risen concomitantly over the past decade. Among the most popular of these is abdominoplasty for resection of redundant skin on the torso. When designing the outline of skin to be resected, among the preeminent concerns is maximizing the aesthetic result of the procedure. Removal of the redundant panniculus may involve a low transverse incision only or a more extensive resection such as the fleur-de-lis or corset pattern incisions. The length of the navel stalk may limit any transposition of this structure. Accordingly, one must plan for sitting the navel in an aesthetically pleasing location to complement the finished result. The umbilicus is typically inset along a horizontal line that spans the iliac crests. This will result in the most natural appearance for most individuals. A location 10 cm above the anterior vulvar commissure would result in a placement that is unnaturally low. The other options would yield a position of the umbilicus that is too high.
References
1. Leahy PJ, Shorten SM, Lawrence WT. Maximizing the aesthetic result in panniculectomy after massive weight loss. Plast Reconstr Surg. 2008 Oct:122(4):1214-1224. 2. [No authors listed]. Safety considerations and avoiding complications in the massive weight loss patient. Plast Reconstr Surg. 2006 Jan;117(1 Suppl):74S-81S. 3. Moya AP, Sharma D. A modified technique combining vertical and high lateral incisions for abdominal-to-hip contouring following massive weight loss in persistently obese patients. J Plast Reconstr Aesthet Surg. 2009 jan; 62(1):56-64. Epub 2007 Nov 26.
A 51-year-old woman comes to the office for consultation for abdominal and lower extremity liposuction. The procedure is expected to last approximately 2.5 hours. BMI is 30 kg/m2. The patient takes an oral contraceptive. The patient reports having had a small venous thromboembolism (VTE) during lumpectomy for breast cancer that took place in her early 40s. Which of the following factors increases the risk of VTE and Caprini risk assessment score most significantly?
A) Age B) History of malignancy C) History of VTE D) Length of surgery E) Use of an oral contraceptive
The correct response is Option C.
In this patient, the highest Caprini risk factor is the history of a VTE, which carries a score of 3. The length of surgery is greater than 45 minutes so it would be considered major and would carry a score of 2, as would her history of malignancy. Age, obesity, and contraceptive use all carry a score of 1. This gives the patient a Caprini score of 10.
References
1. Matarasso A, Levine SM. Evidence-based medicine: liposuction. Plast Reconstr Surg. 2013 Dec;132(6):1697-1705. 2. Murphy RX Jr, Alderman A, Gutowski K, et al. Evidence-based practices for thromboembolism prevention: summary of the ASPS Venous Thomboembolism Task Force Report. Plast Reconstr Surg. 2012 Jul;130(1):168e-175e.
Which of the following symptoms meet the current Medicare guidelines for approval of abdominal lipectomy/panniculectomy following massive weight loss?
A) Neck and back pain B) Psychological distress C) Unsatisfactory appearance D) Diastasis recti E) Recurrent intertrigo
The correct response is Option E.
Medically necessary criteria for Medicare approval of abdominal lipectomy/panniculectomy include:
Inability to walk normally Chronic pain and ulceration created by the abdominal skin fold When the panniculus hangs below the level of the pubis Intertrigo of the pannus that is persistent or recurrent over a 3-month period while receiving appropriate medical therapy Stable weight for at least 6 months and 18 months after gastric bypass surgery
According to Medicare guidelines, the other four options listed are not considered reasons that make this procedure medically necessary:
Treatment of neck and back pain Repairing abdominal wall laxity or diastasis recti Improving appearance Treating psychological symptomatology
References
1. CMS (Centers for Medicare and Medicaid Services); Local coverage determination (LCD) for Cosmetic and Reconstructive Surgery; Abdominal Lipectomy/Panniculectomy
A 48-year-old woman undergoes liposuction of the abdomen, flanks, and thighs. Liposuction is performed using 4 L of infiltration fluid. Each liter is mixed with 50 mL of 2% plain lidocaine and 1 mL of 1:1000 epinephrine. At which of the following times after infiltration are concentrations of lidocaine in the blood expected to be the highest in this patient?
A) Immediately after injection B) 1 hour after surgery C) 2 to 4 hours after surgery D) 8 to 18 hours after surgery E) 24 to 48 hours after surgery
The correct response is Option D.
The safe dosage of lidocaine in liposuction is 35 to 55 mg/kg. Peak lidocaine levels are reported to be 8 to 18 hours after infiltration. Oftentimes, patients are discharged to home when peak levels occur. Surgeons should keep this in mind when calculating lidocaine dosage.
References
1. Gutowski KA. Tumescent analgesia in plastic surgery. Plast Reconstr Surg. 2014 Oct;134(4 Suppl 2):50S-57S. 2. Swanson E. Prospective study of lidocaine, bupivacaine, and epinephrine levels and blood loss in patients undergoing liposuction and abdominoplasty. Plast Reconstr Surg. 2012 Sep;130(3):702-722.
A 35-year-old woman comes to the office for consultation regarding a tummy tuck. She wants the scar as low as possible, but she does not want a lower vertical midline scar. Physical examination shows mild upper and lower abdominal skin excess and rectus abdominis diastasis. BMI is 27 kg/m2. Abdominoplasty and repair of diastasis are planned. Intraoperatively, there is marked tension on the lower central abdominal flap closure. Which of the following is the most appropriate maneuver to decrease the tension on the repair?
A) Creation of a 3-cm transverse umbilical opening
B) Liposuction of the upper abdomen
C) Relaxing incision of the external oblique fascia
D) Scoring of Scarpa fascia to the dermis
E) Use of progressive tension sutures
The correct response is Option E.
Progressive tension sutures are placed from Scarpa’s fascia to the abdominal wall fascia. This helps close the dead space, minimize flap movement, and minimize seroma rate. When placing these sutures with progressive tension, final tension on the abdominal suture line can be lessened. In so doing, healing complications can be reduced.
The more common method for reducing tension on flap closure is to close the native umbilical skin opening in a vertical direction. This technique leaves a vertical incision in the midline of the abdominal flap. The need for revision of this scar is not infrequent. Further, most patients want to avoid this scar.
Creating a 3-cm transverse incision for the umbilicus would decrease the tension on the flap; however, the appearance of the umbilicus would be aesthetically unacceptable.
Relaxing incision of the external oblique fascia is used for closure of ventral herniorrhaphy and would not lessen skin flap tension.
Scoring Scarpa’s fascia to the dermis would injure the subdermal vascular plexus, on which the vascularity of the abdominal flap depends.
Upper abdominal liposuction can be performed at the same time as abdominoplasty, provided care is taken to maximize preservation of the lateral rectus perforators. It would not be a solution to minimize skin tension.
References
1. Hurvitz KA, Olaya WA, Nguyen A, et al. Evidence-based medicine: Abdominoplasty. Plast Reconstr Surg. 2014 May;133(5):1214-1221. 2. Pollock TA, Pollock H. Progressive tension sutures in abdominoplasty: a review of 597 consecutive cases. Aesthet Surg J. 2012 Aug;32(6):729-742. Epub 2012 Jun 29.
Compared with liposuction, which of the following is the greatest advantage of cryolipolysis?
A) No procedural discomfort B) No risk of bruising C) No risk of posttreatment swelling D) No surgical intervention E) Shorter duration of treatment time
The correct response is Option D.
Nonsurgical fat freezing treatment (CoolSculpting) is a method of noninvasive fat reduction that occurs via the use of cryolipolysis. It is a noninvasive technique that takes place in an office setting and does not involve the use of surgery. Following CoolSculpting treatment, patients have some aspect of bruising and swelling, which can last for up to several weeks. Results of CoolSculpting treatments typically take 3 to 4 months to develop. Results are additive, however, with multiple treatments. CoolSculpting involves the utilization of different applicators that have been developed to treat various parts of the body effectively. Each actual treatment is for 1 hour; however, most areas of the body may require multiple treatments to be effectively managed. Treatment times for an abdomen can range from 2 to 6 hours alone, whereas outer thighs are treated for at least 2 hours per side and inner thighs at least 1 hour per side. Although not all of these treatments need to be performed in one sitting, the total time for CoolSculpting treatments for most areas of the body are much longer than it would take to surgically perform liposuction. In general, however, CoolSculpting is a less expensive treatment option compared with liposuction as there is no fee necessary for anesthesia or operating-room costs.
References
1. Avram MM, Harry RS. Cryolipolysis for subcutaneous fat layer reduction. Lasers Surg Med. 2009 Dec;41(10):703-708. 2. Stevens WG, Pietrzak LK, Spring MA. Broad overview of a clinical and commercial experience with CoolSculpting. Aesthet Surg J. 2013 Aug 1;33(6):835-846. Epub 2013 Jul 15.
During routine brachioplasty, which of the following nerves is/are most likely at risk during typical dissection?
A) Lateral antebrachial cutaneous nerve
B) Medial antebrachial cutaneous nerve
C) Sensory branches of the axillary nerve
D) Sensory branches of the radial nerve
The correct response is Option B.
The medial antebrachial nerve is most at risk for injury during routine brachioplasty surgery secondary to its superficial location within the subcutaneous tissue within the area of typical skin and soft-tissue excision. This nerve arises from the medial cord of the brachial plexus 78% of the time and from the lower trunk in 22%. After emerging from the axilla, the medial antebrachial cutaneous nerve travels medial to the brachial artery and lies adjacent to the basilic vein at the distal upper arm. In the distal or mid brachium, this nerve pierces the deep fascia to become very superficial running above the deep fascia at an average of 14 cm proximal to the medial epicondyle. Despite some minor anatomical variability, this nerve has been found to be consistently present in the deep plane of dissection for the standard brachioplasty technique.
References
1. Knoetgen J 3rd, Moran SL. Long-term outcomes and complications associated with brachioplasty: a retrospective review and cadaveric study. Plast Reconstr Surg. 2006 Jun;117(7):2219-2223. 2. Gusenoff JA, Coon D, Rubin JP. Brachioplasty and concomitant procedures after massive weight loss: a statistical analysis from a prospective registry. Plast Reconstr Surg. 2008 Aug;122(2):595-603.
A 34-year-old woman is evaluated for body contouring after Roux-en-y gastric bypass surgery 6 months ago. There is no evidence of malabsorption. BMI is 36.3 kg/m2. She had a 75-lb (34-kg) weight loss and is actively losing weight. The patient reports low back pain. Which of the following is the most appropriate next step in management?
A) Liposuction B) Panniculectomy C) Revision of the gastric bypass surgery D) Upper GI series E) Observation
The correct response is Option E.
After bariatric surgery, patients can continue to lose weight as a result of the surgical procedure for approximately 2 years. Thus, most recommendations call for waiting until patients are 12 to 18 months out from their bariatric surgery and at a stable weight for 3 to 6 months. Ideally, patients should be within 10 to 15% of their goal weight.
In this case, the patient is still within the time frame of active weight loss, and notes that she is actively losing weight. Thus, the appropriate answer is to wait until weight loss has stabilized.
Because this patient is actively losing weight and there are no clinical findings of any issues such as malabsorption, there is no indication currently to evaluate her with an upper GI series or revise her bypass.
In addition, as noted above, the risks for surgery are increased at this patient’s BMI. Thus, elective liposuction or panniculectomy is not appropriate at this time. Furthermore, because the patient is actively losing weight, the risk for revision surgery to address additional skin laxity that may develop with further weight loss makes undertaking these procedures not appropriate at this point in time.
References
1. Hng KN, Ang YS. Overview of bariatric surgery for the physician. Clin Med. 2012 Oct;12(5):435-440. 2. Michaels J 5th, Coon D, Rupin JP. Complications in postbariatric body contouring: strategies for assessment and prevention. Plast Reconstr Surg. 2011 Mar;127(3):1352-1357. 3. Toy JW, Rubin JP. Post-bariatric reconstruction. In: Neligan PC, Gurtner GC, eds. Plastic Surgery. 3rd ed. Philadelphia: Elsevier-Saunders; 2013:634-654. 4. van der Beek ES, van der Molen AM, van Ramshorst B. Complications after body contouring surgery in post-bariatric patients: the importance of a stable weight close to normal. Obes Facts. 2011;4(1):61-66. Epub 2011 Feb 16.
Compared with standard suction-assisted lipectomy, laser-assisted liposuction has been shown to decrease which of the following?
A) Contour irregularities B) Ecchymosis C) Postoperative pain D) Skin necrosis E) Swelling
The correct response is Option C.
A prospective, randomized, double-blind study involving human subjects compared the effects of laser-assisted lipoplasty with suction-assisted lipoplasty. No significant difference was noted between the two groups with respect to cosmetic outcome, ecchymosis, edema, skin retraction, or surgical time. The only measured potential benefit of the laser-assisted technique was an overall decrease in postoperative pain.
References
1. Prado A, Andrades P, Danilla S, et al. A prospective, randomized, double-blind, controlled clinical trial comparing laser-assisted lipoplasty with suction-assisted lipoplasty. Plast Reconstr Surg. 2006 Sep 15;118(4):1032-1045. 2. Gingrass MK. Liposuction. In: Thorne CH, Chung KC, Gosain AK, et al., eds. Grabb and Smith’s Plastic Surgery. 7th ed. Philadelphia: Lippincott Williams & Wilkins; 2013:679-687.
A 35-year-old woman comes to the office for lipodystrophy of the upper arms. Physical examination shows negligible skin laxity; pinch test shows a thickness of 3 cm of the entire upper arm and the chest wall. Which of the following is the most appropriate surgical intervention?
A) Extended brachioplasty B) Limited medial brachioplasty C) Mini brachioplasty D) Suction-assisted lipectomy E) Traditional brachioplasty
The correct response is Option D.
Skin laxity is the single greatest determinant of whether liposuction is an appropriate modality in an algorithmic approach to upper arm lipodystrophy. The determination of excessive fat can be made by the pinch test, and patients with greater than 1.5 cm of fat on a pinch test may be candidates. The classification of lipodystrophy, described by Rohrich et al., includes skin excess, fat excess, and the location of skin excess.
Where there is skin excess, the skin must be excised for a favorable result. Liposuction alone can exacerbate the appearance and presence of excess skin. Similarly, skin laxity is a predictor of liposuction success. With marked laxity, the skin is unlikely to have enough elastic properties to retract. Although there are some papers that show increased retraction of skin with laser liposuction, this has not been shown to be a consistent result in large-scale studies.
References
1. Appelt EA, Janis JE, Rohrich RJ. An algorithmic approach to upper arm contouring. Plast Reconstr Surg. 2006 Jul;118(1):237-246. 2. Rohrich RJ, Beran SJ, Kenkel JM. Back and Arms. In: Rohrich RJ, Beran SJ, Kenkel JM, eds. Ultrasound-Assisted Liposuction. St. Louis, MO: Quality Medical Publishing; 1998:231-252.
A 37-year-old woman reports nontender swelling of the lumbar area after undergoing lower body lift following massive weight loss. Examination shows tense swelling and a positive fluid wave test. Percutaneous needle aspiration is performed on a weekly basis, and fluid is still present after three aspirations of 150 mL each of a clear, yellowish serum. Which of the following is the most appropriate next step in management?
A) Compression
B) Operative incision and drainage
C) Placement of a closed suction drain tube
D) Use of an ipsilateral gluteus maximus muscle advancement flap
The correct response is Option C.
Among the most common complications following body contouring for post-massive weight loss-induced skin laxity is seroma, occurring in up to 35 to 50% of patients. To minimize the risk for seroma, preoperative nutritional repletion, especially for protein, and intraoperative use of closed suction drains, aggressive minimization of dead space, limited degree of skin flap undermining, and use of well-fitted elastic compression garments are among the techniques that are commonly recommended. None of these, even in combination, can completely guarantee the elimination of this complication. After several ineffective aspirations, compression garments alone are not likely to eliminate a seroma for this patient. The most appropriate next management measure for this patient’s seroma is ultrasound-directed percutaneous closed suction drain placement. Operative incision and drainage is not indicated unless the closed drain fails, following failed sclerosant therapy, or if the seroma is shown to be infected. A muscle flap is not indicated in this setting.
References
1. Shermak MA, Rotellini-Coltvet LA, Chang D. Seroma development following body contouring surgery for massive weight loss: patient risk factors and treatment strategies. Plast Reconstr Surg. 2008 Jul;122(1):280-8. 2. Michaels J 5th, Coon D, Rubin JP. Complications in postbariatric body contouring: postoperative management and treatment. Plast Reconstr Surg. 2011 Apr;127(4):1693-1700.
A 35-year-old woman with a history of hypertension is evaluated for body contouring. Physical examination shows generalized abdominal adiposity and moderate infraumbilical pannus. The patient undergoes abdominoplasty and large-volume liposuction after induction of epidural anesthesia. A super-wet technique is used and a total volume of 5500 mL is removed. Which of the following factors poses the greatest risk of death for this patient?
A) Abdominoplasty B) Epidural anesthesia C) Hypertension D) Liposuction volume E) Super-wet technique
The correct response is Option A.
The cumulative effect of multiple procedures performed during a single operation increases the potential that complications may develop. Large-volume liposuction, combined with other procedures such as abdominoplasty, can cause serious complications. Death associated with isolated lipoplasty is rare (0.0021%, or one per 47,415), but mortality increases significantly when lipoplasty is combined with other procedures. When combined with non-abdominoplasty procedures, lipoplasty mortality increases to one per 7314; when combined with abdominoplasty, with or without other procedures, the lipoplasty mortality increases to one per 3281. The presumed benefits of combined procedures must thus be weighed against potential untoward events.
Studies indicate that epidural anesthesia combined with the infusion of anesthetic infiltrate provides patients with a consistent intraoperative comfort level. Data from the few anesthesia studies that have specifically assessed patients undergoing liposuction confirm the safety of general anesthesia, epidural anesthesia, spinal anesthesia, moderate sedation, and local anesthesia for this procedure. It should be noted, however, that epidural anesthesia and spinal anesthesia can cause vasodilation and hypotension, thereby necessitating the administration of excess fluid and increasing the risk of fluid overload.
Based on the patient’s history, physical examination, review of systems, laboratory testing, and/or a medical specialist’s evaluation, the physician should select the patient’s American Society of Anesthesiologists (ASA) physical classification rating:
Type 1: A normal healthy patient; Type 2: A patient with mild systemic disease; Type 3: A patient with severe systemic disease; Type 4: A patient with severe systemic disease that is a constant threat to life.
ASA Type 1 and Type 2 patients are candidates for ambulatory and office-based surgery. The patient described is a Type 2 patient, a classification rating that represents patients who have any of the following conditions that are under control without systemic compromise: diabetes mellitus, hypertension, asthma, gastroesophageal reflux disease, peptic ulcer disease, hematologic disorders, arthritis, and neuropathy.
Large-volume liposuction is defined as the removal of 5000 mL or greater of total aspirate during a single procedure. A review of the scientific literature shows that there are no scientific data available to support a specific volume maximum at which point liposuction is no longer safe.
The super-wet technique, introduced in the mid-1980s, uses larger volumes of subcutaneous infiltrate, whereby 1 to 2 mL of solution is infused for each 1 mL of fat to be removed. The infiltrate solution consists of saline or Ringer’s lactate with epinephrine and, in some cases, lidocaine. Using this method, blood loss generally decreases to less than 1 to 2% of the aspirate volume.
References
1. Iverson RE, Lynch DJ; American Society of Plastic Surgeons Committee on Patient Safety. Practice advisory on liposuction. Plast Reconstr Surg. 2004 Apr 15;113(5):1478-1490. 2. Horton JB, Janis JE, Rohrich RJ. MOC-PS(SM) CME article: patient safety in the office-based setting. Plast Reconstr Surg. 2008 Sep;122(3 Suppl):1-21. 3. Haeck PC, Swanson JA, Gutowski KA, et al. Evidence-based patient safety advisory: liposuction. Plast Reconstr Surg. 2009 Oct;124(4 Suppl):28S-44S.
An otherwise healthy 41-year-old woman who underwent Roux-en-Y gastric bypass surgery 24 months ago, followed by a 120-lb (54-kg) weight loss that she maintained for 6 months, undergoes plastic surgery evaluation for a panniculectomy. Medical history includes hypothyroidism that is controlled with levothyroxine. Preoperative cardiovascular examination shows no abnormalities, and results of a pregnancy test on the day of surgery are negative. She undergoes panniculectomy and thigh lift, and on extubation, the patient is lethargic and confused. ECG shows sinus tachycardia, and she remains somnolent and confused. Analysis of thyroid-stimulating hormone and cardiac enzymes, chest x-ray study, and ventilation-perfusion scan show no abnormalities. Which of the following is the most likely diagnosis?
A) Acute thyroiditis B) Diabetic ketosis C) Pulmonary embolism D) Undiagnosed pregnancy E) Vitamin B1 (thiamine) deficiency
The correct response is Option E.
Thiamine deficiency is most often identified shortly after bariatric surgery but can be diagnosed later. Some patients can develop Wernicke-Korsakoff encephalopathy (WKE). Body stores of thiamine can last from 3 to 6 weeks, and thiamine deficiency is more associated with decreased dietary intake. Although clinical manifestations are very uncommon, and WKE is considered a rare complication, approximately 11% of patients who have undergone Roux-en-Y gastric bypass surgery and take vitamin supplementation show evidence of thiamine deficiency 2 years postoperatively.
The hallmark of thiamine deficiency is neurologic symptoms, but in contrast to WKE, patients rarely exhibit confusion, ataxia, and oculomotor abnormalities. If thiamine deficiency is not recognized and treated, it can have devastating results, including irreversible brain damage and death.
Full nutritional workup of patients is critical.
Confusion is a symptom of diabetic ketosis, but diabetic ketosis is notable for signs of dehydration and excessive thirst or urination, and is associated with Kussmaul respirations.
Acute thyroiditis has symptoms of pain and swelling of the anterior neck. Pulmonary embolism can have symptoms of respiratory distress and right-sided heart strain. Early pregnancy often results in nausea, but not lethargy and confusion.
References
1. Sebastian JL, V JM, Tang LW, et al. Thiamine deficiency in a gastric bypass patient leading to acute neurologic compromise after plastic surgery. Surg Obes Relat Dis. 2010 Jan-Feb;6(1):105-106. Epub 2009 May 18. 2. Agha-Mohammadi S, Hurwitz DJ. Potential impacts of nutritional deficiency of postbariatric patients on body contouring surgery. Plast Reconstr Surg. 2008 De;122(6):1901-1914. 3. Agha-Mohammadi S, Hurwitz DJ. Nutritional deficiency of post-bariatric surgery body contouring patients: what every plastic surgeon should know. Plast Reconstr Surg. 2008 Aug;122(2):604-613. 4. Bossert RP, Rubin JP. Evaluation of the weight loss patient presenting for plastic surgery consultation. Plast Reconstr Surg. 2012 Dec;130(6):1361-1369.
A 39-year-old woman is evaluated because she is dissatisfied with the appearance of her abdomen. She has had five pregnancies with two full-term deliveries and three second-trimester miscarriages. She takes no birth control pills. Physical examination shows wide diastasis with excess abdominal skin. BMI is 28 kg/m2. Abdominoplasty with translocation of the umbilicus is planned. This patient is at increased risk for which of the following complications?
A) Deep vein thrombosis B) Hematoma C) Infection D) Recurrent diastasis E) Wound dehiscence
The correct response is Option A.
A history of two late-term miscarriages stands out as a significant risk factor for thrombophilia (inherited and acquired) and subsequent deep vein thrombosis. It is imperative that these patients be identified and further evaluated. If abdominoplasty is performed, chemoprophylaxis is required.
The most common inherited thrombophilia is factor V Leiden, which is present in 3 to 7% of the Caucasian population. Multiple inherited thrombophilic conditions can be present in the same individual.
Studies have shown that complication rates in abdominoplasty increase in patients with a BMI greater than or equal to 30 kg/m2. Based upon history and physical examination alone, the other complications of hematoma, infection, recurrent diastasis, or wound dehiscence should not be significantly increased.
References
1. Davison SP, Venturi ML, Attinger CE, et al. Prevention of venous thromboembolism in the plastic surgery patient. Plast Reconstr Surg. 2004 Sep 1;114(3):43E-41E. 2. de Jong RH. Body mass index: risk predictor for cosmetic day surgery. Plast Reconstr Surg. 2001 Aug;108(2):556-561; discussion 562-563. 3. Ford HB, Schust DJ. Recurrent pregnancy loss: etiology, diagnosis, and therapy. Rev Obstet Gynecol. 2009 Spring;2(2):76-83. 4. D’Uva M, Di Micco P, Strina I, et al. Etiology of hypercoagulable state in women with recurrent fetal loss without other causes of miscarriage from Southern Italy: new clinical target for antithrombotic therapy. Biologics. 2008 Dec;2(4):897-902.
A 32-year-old woman is evaluated for lipodystrophy of the central abdomen with skin laxity. She desires volume reduction as well as improvement of the skin laxity. The patient is scheduled for superficial liposuction of the abdomen. Which of the following postoperative complications is most likely in this patient?
A) Contour irregularities B) Hyperpigmentation C) Infection D) Seroma E) Skin necrosis
The correct response is Option A.
The subcutaneous fat of the abdomen is anatomically arranged in two layers: superficial and deep. The superficial adipose layer is located 1 to 2 mm below the dermis and is dense and compact with numerous septations. The deep adipose layer is loose and areolar with few septa. Conventional or traditional liposuction is performed within the deep adipose layer with larger cannulas. Superficial liposuction or subdermal liposuction involves the removal of fat from the superficial compartment found 1 to 2 mm below the dermis, disrupting the extensive septations. Most complications following liposuction are minor and resolve without further surgical intervention. However, the most common complications following superficial liposuction are contour irregularities. Less common complications associated with superficial liposuction include seroma, hyperpigmentation, infection, hypertrophic scar, chronic induration, skin necrosis, and infection.
References
1. Kim YH, Cha SM, Naidu S, et al. Analysis of postoperative complications for superficial liposuction: a review of 2398 cases. Plast Reconstr Surg. 2011 Feb;127(2):863-871. 2. Matarasso A, Levine SM. Evidence-based medicine: liposuction. Plast Reconstr Surg. 2013 Dec;132(6):1697-1705. 3. Stephan PJ, Kenkel JM. Updates and advances in liposuction. Aesthet Surg J. 2010 Jan;30(1):83-97; quiz 98-100.
