214: Liposuction Flashcards
(44 cards)
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.
