Liposuction, Abdominoplasty, and Belt Lipectomy Flashcards
Liposuction should not be offered as a treatment for global obesity
or cellulite
T
patients should be within 30% or their ideal
body weight
T
Women typically have a gynoid pattern of fat distribution with accumulation in the lower trunk, hips, upper thighs, and
buttocks
T
Men often exhibit an android fat accumulation pattern with
increased abdominal girth, thickened torso, and upper abdomen.
T
Liposuction
should be avoided in Zones of adherence or used with extreme caution in these areas as the
risk of contour irregularities is high
T
Body contouring operations such as liposuction and abdominoplasty have a higher incidence of venous thrombotic complications than other plastic surgery procedures
T
The use of chemoprophylaxis will depend on the preoperative risk
stratification
T
use of wetting solution
has greatly improved the safety of liposuction.
T
Wetting solutions
can be a variable composition but usually include
saline or lactated
Ringer’s, lidocaine, epinephrine, and sometimes sodium bicarbonate.
evolution of wetting solution techniques that have helped
decrease blood loss
T
SAL is the most
frequently utilized modality among plastic surgeons
T
Because PAL can break up fibrous fat more readily, this modality can significantly cut down on physician fatigue
due to shorter procedure times and employing less physical labor
to use
T
How you can aviod the compilaction of the UAL?
With the use of smaller cannulas and conservative ultrasound
application times,
LAL uses a small laser fiber to emulsify fat and tighten skin
T
LAL has been proven to cuase skin tightness
F However, several well-designed studies have failed to
show a significant benefit over SAL
vThe aesthetic outcomes, patient satisfaction, and incidences of long-term complications appear to be more related TO technology
F to technique
Primary endpoints for SAL/PAL/UAL is the treatment time and volume
F Seconadary end piont treatment time and volume
Cryolipolysis is a noninvasive technique to destroy adipose cells through administration of
controlled thermal reduction via a specialized machine
T
Because
of their susceptibility, exposure ofadipose cells to below normal temperatures (+5° to -5°C) results in apoptosis-mediated cell death with
preservation of overlying skin integrity
T
The subsequent inflammatory cascade results in removal of the damaged cells over the course
of 3 months.
T
complication following cryolipolysis
hypoesthesia of the treatment area that usually resolves over
several months. Other less common complications include surface
contour irregularities, chronic pain, and rarely, paradoxical adipose
hyperplasia
The deep plane is suctioned first
T
Cross-hatching or cross-tunneling is the method of using the liposuction cannula via multiple access sites to create intersecting sets of
parallel lines over the treated area. This helps to ensure the tissue is
suctioned more symmetrically and evenly
T
separation step in SAFE tech uses an exploded-tip (basket-tip)
cannula with no suction to separate and mechanically emulsify the
fat. This step comprises 40% of the operating time and addresses
both the superficial and deep fat compartments
T
Maintenance IVF should be administered up to 5 L. Every 1 mL
of aspirate beyond 5 L should be replaced with 1 mL of IVE
ب Maintenance IVF should be administered up to 5 L. Every 1 mL
of aspirate beyond 5 L should be replaced with 0.25 mL of IVE
Adiposity is usually focused at the posterior third of the
arm and can be addressed through access points on the distal radial
side of the arm
T
the medial antebrachial nerve pierces the fascia of the arm approximately
14 cm proximal to the medial epicondyle and is susceptible to injury
in this area
T
Lipodystrophy of the back tends to result in folds, especially inferior to the bra line. Improved contour can be obtained when
the fibrous attachments creating the folds are disrupted
T
UAL is a commonly
employed technique for The buffalo
hump
T
Lipodystrophy in the abdomen is predominantly in the infraumbilical region
T
female
aesthetic having an hourglass figure defined by the flanks and a
slight supraumbilical concavity and infraumbilical convexity
T
Men
should have no flare at the iliac crest and the infraumbilical area
should be flat
T
In a leaner patient, improved body contour can be achieved with
high definition liposuction or etching
T
With this method, the fat in the
superficial plane is liposuctioned to improve or provide the appearance ofmuscular definition
T
This techniquecan be usedin conjunction
with focused fat transfer
T
In women, the adipose deposits are commonly in the hip overlying the iliac crest and extending down to the lateral thigh zone of
adherence. In contrast, the men tend to have adiposity in theflank or
lateral lumbar area.
T
The thigh is a difficult area for liposuction why?
because ofthe circumferential approach that is usually required.
In addition, zones of adherence and natural creases (gluteal crease)
need to be recognized and appreciated. Overzealous suctioning in the
buttock can result in ptosis and in the thigh can lead to unflattering
skin redundancy
The dressing can be changed as needed for drainage and the
compression garment should be worn at all times except during showering. post operatively
T
wear compression garments mosta dvocate a duration of 12 weeks
F duration of2 to 4 weeks
VTE is one of the early complication of the Liposuction
T the most common cause of death following liposuction.
Risk for this complication increases with large-volume aspirate
(>5 L), increased wetting solution infiltration
Late Complications
Neurapraxia Should resolve within 3 to 4 months
Contour irregularities
Contour irregularities : thisis the most common postoperative complication and can occur in up to 20% ofpatients.
Techniques to help
prevent include use ofsmall cannulas, multipleaccess incisions, and
cross-tunneling. Treatment of irregularities requires secondary fat
equalization and fat grafting to oversuctioned regions, ifneeded
The abdominal wall is composed ofseven layers
■ Skin
■ Subcutaneous fat (superficial layer offat-thicker and dense)
■ Scarpa fascia (superficial fascia! system)
■ Subscarpal layer (deep layer offat-less dense)
■ Anterior rectus sheath
■ Muscle
■ Posterior rectus sheath
The aponeurotic portion ofthe oblique muscles and the transversus abdominis envelope the rectus muscles forming the anterior and
posterior rectus sheaths
T
Huger zones
■ Zone I is the midabdomen, supplied by deep superficial and deep
inferior epigastric arcades.
■ Zone II is the lower abdomen and is supplied by the superficial
and deep circumflex arteries.
■ Zone III is the lateral abdomen and is supplied by the intercostal,
subcostal, and lumbar arteries.
Prior to abdominoplasty, the major blood supply to the abdomen
is from zone II
F Prior to abdominoplasty, the major blood supply to the abdomen
is from zone I
Following abdominoplasty, zone I blood supply is lost
and the abdominoplasty flap is predominantly supplied via zone III
segmental perforators with minor collateral flow from zone II
T
Which nerve at risk of injury in abdominoplasty
the lateral femoral cutaneous nerve
emerges into the superficial plane approximately 2 cm medial to the
anterior superior iliac spine (ASIS) and therefore, dissection in this
area should be superficial to reduce the risk of meralgia paresthetica,
a syndrome characterized by tingling, burning, and numbness in the
lateral thigh.
Ilioinguinal nerve injury
at Lateral aspect oflow horizontal incision near inguinal ligament
Numbness along the medial thigh and scrotum/labia
lntercostal injury at Plane between the internal oblique and transversus abdominis. Lateral branches penetrate fascia at midaxillary line and travel
in subcutaneous tissues
T Numbness in
abdominal/flank
dermatome
The blood supply to the umbilicus
The blood supply is based on the subdermal plexus, the ligamentum teres remnant, and perforators from the deep inferior epigastric system.
Patients should be
nicotine free for a minimum of4 weeks prior to and after an abdominoplasty to minimize postoperative complications.
T
The amount and location ofexcess fat and skin will aid in determining the best technique to address the abdomen.
T
striae will improve with abdimino plasty
F abdominoplasty will remove stria located
inferior to the umbilicus but those located supraumbilically may be
made worse by the procedure
Scars may limit the movement of the
abdominal skin flap and a subcostal scar has potential to compromise
the vascular supply to the skin flap
T
