liposuction Flashcards
describe ideal candidate for liposuction
already at ideal body weight though disporportionate adiposity causing contour deformity
realistic expectations
no body dysmorphia etc
no significant medical comorbidities
Areas to avoid with liposuction (to prevent contour irregularities)
lateral gluteal depression infragluteal fold inferolateral iliotibial tract mid medial thigh infragluteal triangle
absolute CI to tumescent liposuction
severe obesity hoping for weight loss effect body dysmorphia untreated psychiatric illness excess scarring in the target areas pregnancy
relative CI to tumescent liposuction
moderate obesity poor wound healing (eg Ehlers Danlos) hypertrophic / keloidal scarring coagulation/ bleeding disorders allergy to LA AE to adrenaline significant medical illness unstable psychiatric condition
indications for liposuction
contour irregularities lipohypertrophy lipomas Cushingoid buffalo hump gynaecomastia Dercum disease lipomas, familial multiple lipomas axillary hyperhidrosis/ bromhidrosis lymphoedema
Advantages of tumescent liposuction vs traditional liposuction
awake patient
minimal blood loss due to adrenaline
minimal bruising
minimal pain post proecdure (LA can last as long as 24H)
dressings/support garments for shorter period (1-3 wks vs 4-6 wks)
return to work earlier
lignocaine has bacteriostatic properties (less risk infection)
less risk of dimpling appearance
no reported deaths
Pre-procedure assessment - history + examination
Comorbidities (medical, psychological) RFs for complications (infection, scarring, AEs from the LA, clotting, bleeding) Medication history Allergies Smoking Social/return to work etc Examination factors - BMI, striae, cellulite, actinic damage, scars, loose/excess skin PHOTOGRAPHS
Pre-procedure Ix
FBC, ELFTs, coags, Hep B/C/HIV, HCG
Tumescent recipe
1L saline 50ml 1% lignocaine (500mg) 1ml 1:1000 adrenaline (1mg or 1:1000000) 2.5-10ml sodium bicarbonate (8.4%) OR 1L Ringer solution 50ml 1% lignocaine 1ml 1:1000 adrenaline
Maximum dose of lignocaine with tumescent anesthetic
55mg/kg if healthy
35mg/kg if RFs
Method
equipment + staff
ability to mx emergency
markings done while pt is standing (insertion sites)
equipment - infiltration + suction cannulae, tubing, blade, gauze, pump
IV access
Sterile prep + pt positioning
Warm tumescent solution
Incise access points (under usual LA)
insert cannula
infiltrate <100ml/min w slow advancement, fan approach looking for firm induration/blanching
leave for 15-20 mins
liposuction - aggressive thinner cannulae first then less aggressive, apperture away from dermis (leave superficial fat)
End point is increasing bloody aspirate, gritty feeling, flaccid appearance, lack of suctioned fat
cannulae differences
multiple holes at the tip = more aggressive (more fat but more trauma + bleeding)
smaller diameter + blunt ends + fewer proximal holes away from tip = less aggressive, less trauma
complications
- immediate - pain, blood loss, heart arrhythmias, vasovagal, tachycardia, hypothermia
- acute - prolonged oedema (normal response), ecchymoses
- short term - infection, necrosis, pigmentary changes, scarring, skin necrosis, paraesthesia, neuroma, asymmetry, skin laxity, surface irregularities, haematoma, seroma
- longterm - suboptimal result, weight gain, scarring, over-correction, under-correction, asymmetry, sensory nerve impairment
- serious - DVT, visceral perforation, fulminant infection, fat embolism (usually 24-72H), pulmonary oedema
What temparature does cryolipolysis use
- 10 deg for 35-60 mins
- need 1-3 sessions, 2 months apart
how does cryolipolysis work?
triggers a panniculitis - apoptosis of adipocytes –> destroyed fat cleared by macrophages
- inflammation peaks at 2 weeks, lasts 3 months
