214: Liposuction Flashcards
What are the patient selection criteria for tumescent liposuction?
A healthy patient near their ideal body weight with disproportionate, localized adipose deposits that are resistant to diet and exercise is suitable for tumescent liposuction.
What is the maximum safe dose of lidocaine for tumescent liposuction?
The maximum safe dose of lidocaine for tumescent liposuction is 55 mg/kg.
What are the key techniques for performing tumescent liposuction?
Key techniques include:
- Tunneling with the cannula in linear, even strokes.
- Suctioning parallel to the axis of lymphatic drainage to minimize trauma.
- Avoiding uneven or overly aggressive suctioning to prevent contour irregularities.
- Measuring end points by time spent, amount of fat suctioned, and patient discomfort.
- Waiting at least 6 months before judging the final cosmetic result.
- Deferring touchup procedures for at least 1 year.
What are some contraindications for tumescent liposuction?
Contraindications include:
- Severe cardiovascular disease
- Severe coagulation disorders, including hemophilia
- Pregnancy
- History of bleeding disorders, thrombophlebitis, or emboli
- History of infectious diseases (e.g., hepatitis, HIV)
- Poor wound healing
- Diabetes mellitus
- Immunosuppression
- Prior extensive abdominal surgery
- Hepatic disease
- Renal disease
- Morbid obesity
- Underlying systemic diseases with functional limitations
- Use of anticoagulant medications, vitamins, or herbal supplements
What are the other medical uses of liposuction?
Other medical uses of liposuction include:
- Symptomatic breast reduction
- Breast ptosis
- Pseudogynecomastia (enlarged breasts from excess fat)
- Gynecomastia (enlarged breasts from hypertrophic ductal and stromal tissue)
- Lipedema (chronic painful disorder of SC and lymphatics causing symmetrical fatty swelling of the waist, hips, and legs; cannot be reduced with diet and exercise)
What is lipedema and why is it resistant to diet and exercise?
Lipedema is a chronic painful disorder of subcutaneous and lymphatic tissues that manifests as symmetrical fatty swelling of the bilateral waist, hips, and legs. The adipose tissue in lipedema cannot be reduced with diet and exercise.
Why should suctioning during tumescent liposuction be aimed parallel to the axis of lymphatic drainage?
Suctioning parallel to the axis of lymphatic drainage minimizes tissue trauma.
What is the role of sodium bicarbonate in the lidocaine solution for tumescent liposuction?
Sodium bicarbonate is used as a buffer in the lidocaine solution.
What are the potential consequences of uneven or overly aggressive suctioning during tumescent liposuction?
Uneven or overly aggressive suctioning can lead to contour irregularities.
List the end points that can be used to measure the progress of tumescent liposuction.
End points include time spent in a given area, amount of fat suctioned, patient discomfort, assessment of the target area by palpation, and the transition from yellow adipocyte-rich aspirate into fat-sparse serosanguineous tumescent fluid.
How long should a surgeon wait before judging the final cosmetic result of tumescent liposuction?
The surgeon should wait at least 6 months before judging the final cosmetic result.
When should touchup procedures be performed after tumescent liposuction?
Touchup procedures should be deferred for at least 1 year after the initial procedure.
What are some other uses of tumescent liposuction besides fat removal?
Other uses include symptomatic breast reduction, addressing breast ptosis, treating pseudogynecomastia, gynecomastia, and lipedema.
What is pseudogynecomastia and how can tumescent liposuction help?
Pseudogynecomastia is the enlargement of breasts due to excess fat, and tumescent liposuction can help by removing the excess fat.
What is the difference between gynecomastia and pseudogynecomastia?
Gynecomastia involves enlarged breasts due to hypertrophic ductal and stromal tissue, while pseudogynecomastia is due to excess fat.
A patient undergoing tumescent liposuction is on anticoagulant therapy. What should be done to ensure safety?
Anticoagulant therapy is contraindicated for tumescent liposuction. The patient should discontinue anticoagulant therapy before the procedure.
How should lidocaine be adjusted for patients unable to interrupt medications that interfere with lidocaine metabolism?
For such patients, the maximum dose of lidocaine should be lowered to less than 35 mg/kg.
What is the preferred vehicle for lidocaine in tumescent liposuction?
The preferred vehicle for lidocaine in tumescent liposuction is normal saline (0.9% NaCl).
Why is epinephrine added to the lidocaine solution in tumescent liposuction?
Epinephrine is added to augment hemostasis and slow the absorption of lidocaine.
What concentration of lidocaine is recommended for small or sensitive areas during tumescent liposuction?
A concentration of 0.1% lidocaine is recommended for small or sensitive areas.
What concentration of lidocaine is used for treating large or multiple areas in tumescent liposuction?
A concentration of 0.075-0.05% lidocaine is used for treating large or multiple areas.
Describe the proper technique for cannula tunneling during tumescent liposuction.
Tunneling with the cannula is performed in linear, even strokes with the surgeon’s dominant hand, while the nondominant hand (or ‘smart hand’) controls the cannula tip position at all times.
What are the key factors to consider during preoperative evaluation for tumescent liposuction?
Key factors include ensuring the patient is not on anticoagulant therapy and adjusting lidocaine dosage for patients on medications that interfere with lidocaine metabolism.
What is the significance of the ‘smart hand’ during the tumescent liposuction procedure?
The ‘smart hand’ (nondominant hand) controls the cannula tip position at all times, ensuring precision and safety during the procedure.
A patient has undergone tumescent liposuction and is dissatisfied with the results after 3 months. What should the surgeon advise?
The surgeon should advise the patient to wait at least 6 months before judging the final cosmetic result, as the full effects may not yet be visible.
During tumescent liposuction, the aspirate transitions from yellow adipocyte-rich fluid to serosanguineous tumescent fluid. What does this indicate?
This transition indicates that the end point of fat removal in the treated area has been reached.
A patient with lipedema seeks treatment. Why might tumescent liposuction be recommended?
Tumescent liposuction is recommended because the adipose tissue in lipedema cannot be reduced with diet and exercise, and the procedure can alleviate symptoms.
What precautions should be taken when performing tumescent liposuction on multiple areas?
Use a lower concentration of lidocaine (0.075-0.05%) to ensure safety and minimize the risk of lidocaine toxicity.
How does the addition of epinephrine to the lidocaine solution benefit the tumescent liposuction procedure?
Epinephrine augments hemostasis and slows the absorption of lidocaine, reducing bleeding and prolonging the anesthetic effect.
What is the importance of using linear, even strokes during cannula tunneling in tumescent liposuction?
Linear, even strokes ensure uniform fat removal and reduce the risk of contour irregularities.
A patient undergoing tumescent liposuction reports discomfort during the procedure. What should the surgeon assess?
The surgeon should assess the target area by palpation and consider whether the lidocaine concentration or dosage needs adjustment.
Why should touchup procedures be deferred for at least 1 year after tumescent liposuction?
Deferring touchup procedures allows sufficient time for the body to heal and for the final cosmetic result to become apparent.
What is the role of the nondominant hand during the tumescent liposuction procedure?
The nondominant hand, or ‘smart hand,’ controls the cannula tip position to ensure precision and safety during the procedure.
A patient with gynecomastia is considering tumescent liposuction. What should they be informed about?
They should be informed that gynecomastia involves hypertrophic ductal and stromal tissue, and tumescent liposuction can help by removing excess fat and tissue.
What are the potential risks of overly aggressive suctioning during tumescent liposuction?
Overly aggressive suctioning can lead to contour irregularities and increased tissue trauma.
How can the surgeon minimize tissue trauma during tumescent liposuction?
The surgeon can minimize tissue trauma by suctioning parallel to the axis of lymphatic drainage.
What is the significance of using sodium bicarbonate in the lidocaine solution?
Sodium bicarbonate acts as a buffer, reducing the acidity of the solution and improving patient comfort.
A patient with pseudogynecomastia is considering tumescent liposuction. What should they know about the procedure?
They should know that tumescent liposuction can effectively remove the excess fat causing the breast enlargement.
What factors should be considered when determining the amount of fat to suction during tumescent liposuction?
Factors include the patient’s discomfort, the amount of fat suctioned, and the transition of aspirate from yellow adipocyte-rich fluid to serosanguineous tumescent fluid.
Why is it important to use a lower concentration of lidocaine for large treatment areas?
Using a lower concentration of lidocaine reduces the risk of toxicity while still providing effective anesthesia.
What is the recommended lidocaine concentration for treating small or sensitive areas?
The recommended concentration is 0.1% lidocaine for small or sensitive areas.
How does tumescent liposuction help in cases of breast ptosis?
Tumescent liposuction can remove excess fat and improve the contour of the breasts, addressing breast ptosis.
What is the primary goal of tumescent liposuction in patients with localized adipose deposits?
The primary goal is to remove disproportionate, localized adipose deposits that are resistant to diet and exercise.
What should be done if a patient is unable to interrupt medications that interfere with lidocaine metabolism?
The maximum dose of lidocaine should be reduced to less than 35 mg/kg to ensure safety.
