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PubMed1991

The effect of epinephrine on blood loss during suction lipectomy.

In a prospective, double-blind, controlled study on 26 consecutive patients who underwent suction lipectomy, the injection of epinephrine (1:250,000, 1:500,000, or 1:1,000,000) was not found to decrease fluid/blood loss when compared with saline injection or no injection at all. Since our study fails to support the use of epinephrine to lessen fluid/blood loss during suction lipectomy, we have abandoned its use in that procedure.

Adult↗

PubMed1994

Plasma lidocaine levels during suction-assisted lipectomy using large doses of dilute lidocaine with epinephrine.

Liposuction, like many other plastic surgical procedures, is often performed under local anesthesia. Drug toxicity is the most serious complication and the factor that limits the use of this form of anesthesia. Toxic effects are related to the peak concentration in plasma and depend on the type of local anesthetic, the drug concentration, total dose, site of injection, injection speed, and whether vasoconstrictors are used or not. This study evaluates the use of large volumes of subcutaneously injected 0.1% lidocaine with epinephrine 1:1,000,000 as the local anesthetic procedure in 12 patients undergoing suction-assisted lipectomy of the abdomen, flanks, and/or lower extremities. A total dose of 1260 to 2880 mg lidocaine corresponding to 10.5 to 34.4 mg/kg was administered with an injection speed of 60 to 78 ml/min. The peak concentration of lidocaine varied between 0.9 and 3.6 micrograms/ml and occurred between 6 and 12 hours postoperatively. For the given dose range, a linear correlation (r = 0.83) was found between the total dose of lidocaine and the peak concentration in plasma. A dose increase of 1 mg/kg raised the peak concentration approximately 0.1 microgram/ml. Our data clearly demonstrate that when using pH-adjusted 0.1% lidocaine with epinephrine subcutaneously for suction-assisted lipectomy, lidocaine can be administrated safely in significantly higher doses than recommended. When such high doses are used, the patient probably should be observed for at least 18 hours postoperatively.

Adult↗

PubMed1998

Limited incision submental lipectomy and platysmaplasty.

Thirty years ago, submental fat deposition and platysma band formation were inadequately addressed by surgeons attempting facial rejuvenation procedures. Simple skin envelope tightening as practiced commonly at that time resulted in reappearance of submental bands within months, disappointing both patient and surgeon. During each subsequent decade, existing techniques for aesthetic surgical treatment of the submental and neck areas were refined, and new techniques were introduced. The earliest in this evolution of surgical approaches to rejuvenate the aging submental region was direct excision of redundant anterior cervical skin and platysma muscle bands. Later, periauricular incision approaches without anterior skin excision were used to address platysma muscle bands and remove excess submental fat. Today, the standard approach for submental and anterior neck rejuvenation is some variation of "corset" platysmaplasty and suction-assisted lipectomy both superficial and deep to the platysma muscles. The introduction of endoscopy to plastic surgery has stimulated interest in performing many surgical procedures through limited-incision approaches. While endoscopic techniques may not have a clear application for the submental area, redundant submental soft tissues producing obliquity of the cervicomandibular angle may be treated through a single submental incision approach under direct vision. A technique practiced by the author since 1981 for performing submental lipectomy and platysmaplasty through a single limited anterior submental incision without skin excision is described and discussed. Postoperative compression of the submental area with an elastic garment facilitates smooth skin contraction and redraping for all patients except those with poor or no residual skin elasticity.

Adolescent↗

PubMed1999

The influence of permanent magnetic field therapy on wound healing in suction lipectomy patients: a double-blind study.

The authors present their experience with the healing influence of permanent magnets on postoperative wounds. The responses of 20 patients who underwent suction lipectomy and postoperative negative magnetic field therapy were studied in a double-blind fashion. Magnets in the form of patches (10 patients) or sham magnet patches (10 patients) were placed over the operative region in each of the patients. Pain, edema, and discoloration (ecchymosis) were evaluated at 1, 2, 3, 4, 7, and 14 days postoperatively. Our results show that the treatment group had significant reductions in pain on postoperative days 1 through 7, in edema on days 1 through 4, and in discoloration on days 1 through 3 when compared with the control group. These results demonstrated that commercially available magnets have a positive influence on the postoperative healing process in suction lipectomy patients.

Adolescent↗

PubMed2000

Toxic shock syndrome after suction lipectomy.

We present a case of toxic shock syndrome with necrotizing fasciitis after suction lipectomy. The patient underwent aesthetic suction lipectomy of the abdomen, buttocks, and thighs during an office procedure by a cosmetic surgeon. On postoperative day 2, the patient was referred to the emergency department of our hospital because of pain. On admission, the patient was in toxic shock. She required intensive medical treatment for about 1 month, along with psychiatric help to adapt after the illness. Although toxic shock syndrome is a rare postoperative complication, every plastic surgeon should be acquainted with it. A combination of early recognition, diagnosis, and aggressive supportive therapy is the only successful treatment.

Adult↗

PubMed2003

Suction lipectomy during flap reconstruction provides immediate and safe debulking of the skin island.

Immediate suction lipectomy combined with flap reconstruction has not been reported to date. Concern of skin island compromise has swayed clinicians from attempting synchronous debulking of generous skin island tissue during primary flap reconstruction. To date, several reports have documented the safe use of liposuction during mobilization of skin flaps as a minimally invasive, undermining tool in the cervical neck area. Additionally, liposuction has been used safely as an adjunct to rhytidectomy procedures over areas containing vital structures. The authors report 2 patients in whom generous skin island tissue prevented primary closure after transposition of the flap into its recipient site. Aspiration of subcutaneous tissue in a transverse rectus abdominis musculocutaneous flap and gluteus musculocutaneous rotational flap for breast and sacral ulcer reconstructions respectively resulted in appropriate debulking of the skin island without any flap skin compromise. The findings of this report may provide impetus for further clinical investigations establishing the utility of combined suction lipectomy and flap reconstruction.

Adult↗

PubMed2002

Compensation for partial lipectomy in mice with genetic alterations of leptin and its receptor subtypes.

One hypothesis for the regulation of total body fat suggests that leptin is a lipostatic feedback signal that acts at brain sites involved in regulation of energy balance. The importance of leptin in recovery from partial surgical lipectomy was tested by performing bilateral epididymal lipectomy or sham surgery on wild-type and leptin-deficient ob/ob mice. Eight weeks later, nonexcised pads of lipectomized mice were increased but total carcass fat was lower than in sham-operated ob/ob mice. In experiment 2, ob/ob mice, wild-type mice, and two db/db mutants, C57BL/6J db(Lepr)/db(Lepr) (BL/6J) mice possessing short-form and circulating leptin receptors and C57BL/6J db(3J)/db(3J) (BL/3J) mice expressing only circulating receptors, were lipectomized or sham operated. Sixteen weeks later, body mass and carcass lipid were not different between sham and lipectomized ob/ob mice, wild-type mice, or BL/6J db/db mice, whereas there was incomplete (decreased carcass fat) but suggestive recovery (increased retroperitoneal fat mass and cell number) in lipectomized BL/3J db/db mice. These data indicate that leptin is not required for the regulation of total body fat.

Adipocytes↗

PubMed1994

Body fat regulation after partial lipectomy in Siberian hamsters is photoperiod dependent and fat pad specific.

Siberian hamsters exhibit seasonal fluctuations in body weight (fat). Initial exposure to a short photoperiod results in body fat loss that reverses after approximately 22 wk of short-day exposure. The purpose of this study was to determine whether Siberian hamsters are able to recover body fat after surgical reduction of total lipid stores and if so, whether this ability is photoperiod dependent and fat pad specific. Either the largest pair of internal fat pads, the epididymal white adipose tissue (EWAT) or one pair of two large external depots, the inguinal (IWAT) fat pads, were removed from male hamsters housed for 22 wk in a long (LD) or short (SD) photoperiod. Retroperitoneal fat pad (RWAT) mass was increased in LD EWAT- and IWAT-lipectomized hamsters. IWAT mass also was increased in the LD EWAT-lipectomized hamsters. Neither SD-lipectomized group compensated for body fat loss in any of the measured fat pads. Increased food intake was not necessary for total body fat recovery, but undereating partially may be responsible for the lack of recovery in SDs. The results of these experiments demonstrate a photoperiod-dependent ability of male Siberian hamsters to regulate total body fat after partial lipectomy. In addition, recovery involves a fat pad-specific compensatory response to partial lipectomy, rather than a general increase in lipid deposition in all fat depots.

Adipose Tissue↗

PubMed2000

Subcutaneous lipectomy causes a metabolic syndrome in hamsters.

The insulin resistance syndrome X is related to excess intra-abdominal adipose tissue. With lipectomy of >50% of subcutaneous adipose tissue (SQAT) in nonhibernating, adult female Syrian hamsters on high-fat (HF; 50 calorie%) diet and measurements of oral glucose tolerance, oral [(14)C]oleic acid disposal, serum triglycerides, serum leptin, liver fat, perirenal (PR) adipose tissue cellularity, and body composition, we studied the role of SQAT. Sham-operated (S) animals on HF or low-fat (LF; 12.5 calorie%) diets served as controls. After 3 mo there was no visible regrowth of SQAT but HF diet led to similar levels of body weight and body fat in lipectomized and sham-operated animals. Lipectomized (L) animals had more intra-abdominal fat as a percentage of total body fat, higher insulinemic index, a strong trend toward increased liver fat content, and markedly elevated serum triglycerides compared with S-HF and S-LF. Liver and PR adipose tissue uptake of fatty acid were similar in L-HF and S-HF but reduced vs. S-LF, and were inversely correlated with liver fat content and insulin sums during the oral glucose tolerance test. In summary, lipectomy of SQAT led to compensatory fat accumulation implying regulation of total body fat mass. In conjunction with HF diet these lipectomized hamsters developed a metabolic syndrome with significant hypertriglyceridemia, relative increase in intra-abdominal fat, and insulin resistance. We propose that SQAT, via disposal and storage of excess ingested energy, acts as a metabolic sink and protects against the metabolic syndrome of obesity.

Adipose Tissue↗

PubMed1990

Fulminant adult respiratory distress syndrome after suction lipectomy. A case report.

The adult respiratory distress syndrome developing within 24 hours in a patient who underwent suction lipectomy for body contouring under general anaesthesia is reported. During surgery, in which a total of 1.3 l of suction matter was removed, the patient became haemodynamically unstable and mildly hyperthermic. Subsequently, clinical signs and symptoms of the fat embolism syndrome developed. Aggressive haemodynamic and respiratory support over an 8-day period resulted in patient survival. Malignant hyperthermia was excluded as cause for the clinical presentation on muscle biopsy and in vitro caffeine contracture studies. Although usually complication-free, suction lipectomy may be associated with life-threatening incidents. Even suction volumes as low as 1.3 l have potential hazards, therefore the procedure merits regular postoperative observation and re-assessment.

Adult↗

PubMedDate not supplied

Suction-assisted lipectomy--an adjunct to orthopaedic treatment.

Suction-assisted lipectomy was first performed in 1964 but did not become popular until 1981. Many thousands of patients are now so treated for cosmetic reasons each year, but no previous use of this technique as an adjunct to orthopaedic treatment has been reported. Two patients were successfully treated by suction-assisted lipectomy to reduce the circumferential measurement and shape of the residual limb so that prosthetic restoration could be more easily performed.

Adolescent↗

PubMed1989

A national survey of complications associated with suction lipectomy: a comparative study.

In March of 1988, a survey form was sent to all 2695 U.S. and Canadian members of the American Society of Plastic and Reconstructive Surgeons. Nine-hundred and thirty-five members responded, for a response rate of 34.7 percent. The purpose of the survey was to ascertain the total number of major liposuction, dermatolipectomy, and abdominoplasty procedures performed from January of 1984 to January of 1988 and to compare nine specific complications that are associated with these three procedures. The 935 surgeons reported a total of 112,756 procedures performed: major liposuction (75,591), dermatolipectomy (10,603), and abdominoplasty (26,562). Nine major complications were surveyed: mortality, myocardial infarction, cerebrovascular accident or transient ischemic attack, pulmonary thromboembolism, fat embolism, major skin loss, anesthesia complication, transfusion complications, and deep venous thrombosis. The findings in this survey showed, when comparing these three procedures and the nine types of complications, that the complication rate for major suction lipectomy was 0.1 percent, for dermatolipectomy 0.9 percent, and for abdominoplasty 2.0 percent. Fat emboli did not prove to be a significant factor associated with any of the three procedures. However, of the 15 reported deaths (major liposuction 2, dermatolipectomy 2, and abdominoplasty 11), pulmonary thromboembolism was the causative factor in 9 deaths (60 percent). Based on these analyzed data, we feel that major suction lipectomy has a low complication rate and is a reasonably safe procedure.

Abdominal Muscles↗

PubMed1989

Suction lipectomy in the management of limb lymphedema.

We have been pleased overall with the results achieved using suction lipectomy in lymphedema patients. In appropriately selected patients, it is predictable and well-tolerated. It is, however, only palliative and temporary. It may be performed on a periodic basis. Compressive stockings are essential for success. Based on our experiences, we recommend suction lipectomy for mild temporary cases, specifically involving the upper extremity, and liposuction plus excisional debulking for more severe cases and for the lower extremity.

Adolescent↗

PubMed1995

[Ultrasonic suction lipectomy. A mini-invasive treatment of obesity].

The safety of ultrasounds lipolysis in the treatment of local obesity and lipodystrophies versus suction lipectomy (less blood loss because of a lower impact on blood vessels network, and less mortality) induced us to combine these mini-invasive techniques in the treatment of obese patients. Between 1991 and 1994 we treated 205 patients (146 females, 59 males, 18-59 range age), affected by 1st degree obesity (44.4%), 2nd degree obesity (27.3%) and 3rd degree obesity (28.3%), accordingly to the following schedule: 1) general anesthesia; 2) subdermal infiltration of the operating sites of a cold sodium chloride (0.9%) epinephrine solution (1:10(5), 8 degrees C); 3) 0.5 cm cutaneous incisions; 4) introduction of titanium tips as ultrasounds source; 5) insertion of suction lipectomy probes to remove the adipose tissue destroyed by ultrasounds; 6) drainage of the wide subcutaneous space; 7) setting of elastic bandages. Mortality was zero and very low side effects have been observed. We report an improvement of blood glucose and triglycerides level and blood pressure 30 days after surgery. Fair late postoperative improvement of the blood glucose tolerance test have been seen in 3 cases.

Adolescent↗

PubMed1993

[Suction lipectomy for male gynecomastia].

This paper reports the application of the suction lipectomy to treat gynecomastia in 10 cases with excellent results. A 2-2. 5 cm incision was made on the lower areolar border at 5 to 7 o'clock. The suction power was adjusted to 67-93 kPa. The suction cannula was moved to and fro in radial direction rapidly. The diameter of the sucked area should be larger than desired size of the breast by 2 cm to avoid a saucer deformity. If gynecomastia is entirely due to fat accumulation, suction lipectomy only is enough. But, when gynecomastia is due partly to parenchymal hypertrophy, an additional excision of the parenchymatous tissue is required. After the operation, elastic garment must be worn at all time for 4 to 6 weeks to avoid hematoma and to achieve a flat appearance.

Adult↗

PubMed1983

Experience with "lipolysis": the Illouz technique of blunt suction lipectomy in North America.

"Lipolysis" or blunt suction lipectomy for modest to moderate deformities of localized fatty deposits has been carried out on a series of North American patients. The American patients were felt to be larger than the French patients with whom the procedure was developed, and thus required larger removals. Many patients showed a substantial drop in hematocrit levels following this procedure. Drains may add 400 ml to the blood loss. An obvious third space shift occurred into the operated area and can be of noteworthy magnitude. This often required hospitalization and colloid replacement. It should be anticipated that blood may have to be given. On the basis of our experience in North American patients, we have lowered our expectation for ambulatory discharge to patients undergoing removals of 650 ml or less. This may prove to be too optimistic on occasion. The "lipolysis" technique did not cause any seroma formation in patients as reported for other suction-assisted lipectomy techniques. All patients sensed early anxiety and then disappointment at the lack of "instant" results, and worry over uneven areas during weeks 2 through 6 and required constant reassurance. Prolonged massage therapy bridged this period both physically and psychologically, lightening the burden of both surgeon and patient.

Adipose Tissue↗

PubMed1988

Lipectomy influences white adipose tissue lipoprotein lipase activity and plasma triglyceride levels in ground squirrels.

Golden-mantled ground squirrels undergo marked fattening and fat depletion during the prehibernatory and hibernatory phases, respectively, of their annual body weight cycle. Fat regulation was studied by surgical removal (lipectomy) of most of the inguinal-subcutaneous, retroperitoneal, and parametrial fat depots from female squirrels during the weight-gain phase of the annual cycle. Seven weeks after surgery, body weights of lipectomized (Lipx) and Sham-Lipx squirrels were equivalent, although white adipose tissue was not completely recovered in Lipx animals. Lipoprotein lipase (LPL) activity was markedly elevated in subcutaneous adipose tissue of Lipx squirrels, but not in other depots. Plasma triglyceride (TG) levels also were higher in Lipx squirrels 7 weeks after surgery. Changes in LPL activity and plasma TG may contribute to body mass and lipid restoration following lipectomy.

Adipose Tissue↗

PubMed1988

Lipectomy does not impair fattening induced by short photoperiods or high-fat diets in female Syrian hamsters.

Syrian hamsters (Mesocricetus auratus) exhibit seasonal fluctuations in body fat that are triggered by changes in photoperiod and/or diet. Body fat accumulates when hamsters are switched to a short photoperiod or high-fat diet. The effects of surgical reduction of adipose tissue (lipectomy) on these responses were tested in adult female hamsters. Dorsal-inguinal subcutaneous, parametrial, and retroperitoneal white adipose tissues were removed bilaterally from some hamsters, while others received sham surgery. Hamsters from each surgical group were then fed a high-fat diet for the next 12 or 30 weeks, or were exposed to a short photoperiod for 13 weeks. Restoration of previously excised pads was for the most part incomplete, yet all lipectomized hamsters fully regained total body lipid, which suggests compensatory hypertrophy in other depots. Consistent with this, we found a significant increase in the weight of the previously undisturbed axillary subcutaneous pad, but this increase was small and not sufficient to offset the deficits remaining in the regenerated pads. Thus, restoration of total body lipid mass was achieved by a general increase in deposition over all depots rather than a specific renewal of removed tissue. This ability to recover completely from lipectomy is similar to that previously reported in ground squirrels. In contrast, rats and mice are frequently unable to replace lost adipose tissue. Both hamsters and squirrels adjust their levels of body fat according to season, which may afford them an enhanced ability to recover from surgical reductions of adipose tissue.

Adipose Tissue↗