Surgical Fat Reduction (liposuction) Part I.pptx

Liposuction and Cosmetic Surgery
10/21/2022
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email:
askprof@moawadskininstitute.com
Liposuction is the most performed
cosmetic surgery in the world.
• Furthermore, it has become an essential
complementary technique to enhance the
aesthetic result of many other procedures,
such as cervicoplasty, reduction or
augmentation mammoplasty, abdominoplasty,
brachioplasty, thigh lift, and post-bariatric
body contouring.

Surgical Fat Reduction (liposuction): The Need
• It corrects deep and superficial fat
accumulations and thus remodels
the face, neck, breast, and body
contour deformities.
• It should be carried out in the
lamellar layer if one desires long-
term results. results.
10/21/2022 email: askprof@moawadskininstitute.com 2

Liposuction and Cosmetic Surgery
• Areas amenable to liposuction
are:
• Face & neck
• Breast
• Arms
• Abdomen
• Mons pubis
• Flanks & Hips
• Back
• Buttocks
• Thighs
• Knees
• Calves and Ankles
Liposuction is the most performed aesthetic surgery in the world.

Liposuction and
Cosmetic Surgery
10/21/2022
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email:
• Liposuction is the initial surgical approach of
choice for pseudo-gynecomastia, gynecomastia
macromastia and gigantomastia.
• In true gynecomastia, and female breast
however, there is an increase in the gland volume
with a dense fibrous and vascular stroma, making
suction more difficult.
• Liposuction combined with traditional
resection mammoplasty allows gynecomastia and
gigantomastia volume reduction before excision.
• It will refine further the results after the
surgery, in a more effortless surgery, less
complication and better aesthetic results.

Liposuction and
Cosmetic Surgery
• Eccrine glands are located at the superficial
subcutaneous plane.
• At first, a starch-iodine test helps identify
the area of excessive sweating
• Liposuction has been safely and effectively
performed for many years
• There are several different treatment
techniques.

Liposuction and
Cosmetic
Surgery
• Mons pubis lipodystrophy and “Buried" penis” in fatty men
result in embarrassment and sexual dysfunction that can be
treated safely with liposuction

Liposuction and
Cosmetic Surgery
email: askprof@moawadskininstitute.com
• Lipedema is characterized by
bilateral symmetrical and
localized subcutaneous fat
deposits of the buttocks and
lower limbs.
• It causes significant physical
disability, fatigue, pain, and
difficulty wearing shoes and
boots.
• liposuction provides good
aesthetic results, improving
the proportion between the
upper and lower body and
reducing painful symptoms,
especially at the lower limb
articulations, ensuring better
mobility.
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Liposuction and
Cosmetic Surgery
• Lipodystrophies represent a group of rare
diseases characterized by selective body fat loss
with altered body fat amount and/or
repartition that can be either generalized or
partial, associated with insulin resistance, type
2 diabetes, dyslipidemia, liver steatosis,
polycystic ovaries, acanthosis nigricans, and
cardiovascular complications
• The excess adipose tissue from the chin, buffalo
hump, and vulvar region can be removed by
liposuction. Autologous adipose tissue
transplantation or implantation of dermal fillers
can improve facial appearance.

Liposuction and
Cosmetic Surgery
• Lymphedema consists of the
accumulation of lymphatic fluid
in dermis and subcutaneous
tissue
• The chronically accumulated
lymphatic fluid causes
cutaneous dermal thickening,
hypercellularity, and
progressive fibrosis.
• Lipids accumulate in adipocytes
and macrophages, secondary
to local lipid transport from
limited lymph flow, resulting in
increased adipose tissue.
• liposuction provides good
aesthetic and functional long-
term results with a minimum
complication rate.
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Lymphedema

Liposuction and
Reconstructive
Surgery
• One of the liposuction's first non-cosmetic clinical
applications was the aspiration of a giant lipoma
without leaving a visible scar.
• Simple surgical excision remains the primary and
most effective treatment. However, removing large
or multiple lesions may be problematic and result in
significant objectionable scars.
• Liposuction can also be a helpful solution for
treating multiple lipoma syndromes and multiple
familial lipomatosis associated with some genetic
pathology.

Liposuction and
Reconstructive
Surgery
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• Musculocutaneous or fasciocutaneous flaps
are widely used to reconstruct various defects
• Liposuction usually allows thinning of the
subcutaneous tissue without the risk of flap
necrosis and reduces the number of revision
procedures required to achieve optimal
aesthetic and functional results.
10/21/2022

Liposuction and
Reconstructive
Surgery
10/21/2022
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• Revision of surgical scars.
• Tracheostomy, colostomy, and
urostomy in great obese
patients, in which the stoma
could be occluded by excessive
fatty tissue surrounding it.
Scar Revision

Liposuction
and Obesity
• Liposuction in obesity is worthwhile to
consider as a reasonable alternative to
other medical and surgical slimming
methods offering immediate compliance to
lower caloric intake and higher physicality.
• It improves body contour and image.
• It reduces cardiovascular risk factors such
as obesity, systolic blood pressure, and
plasma insulin.

Liposuction and Obesity
• On the other hand, obesity is ASA III type; patients with B.M.I.> 35 impart a threefold to
fourfold risk from anesthesia, prone to sleeping apnea, infections, poor wound healing, and
deep vein thrombosis.
• The risk of complications increases as the volume of aspirate and the number of anatomical
sites treated increase.

Patient
Selection
email:
• Appropriate candidates
for liposuction are not
morbidly obese, are of
stable weight, and should
commit to the necessary
diet, exercise, and
lifestyle changes before
surgery.
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Patient
Selection
• Liposuction is contraindicated in pregnant patients or poor general
medical health, patients with morbid obesity, large pannus hanging
over the thigh, cardiopulmonary disease, body image perception
issues, unrealistic expectations, wound healing difficulties, or who
have extensive or poorly located scars.

Patient
Selection
• Liposuction patients often present with
different expectations, concerns, and
complaints.
• Some expectations are more than can be
delivered by the surgeon. For example, patients
interested in losing a few pounds overnight
without maintaining a proper diet and exercising
are not good candidates for liposuction surgery.
• Find out their reason for liposuction and if
they are doing it for themselves or others, such
as their spouse or boyfriend. The surgery must
purely be done for themselves.
• Liposuction surgery does not make a
depressed patient well, but it will bring
happiness to a healthy patient.
• Beware of the dysmorphic personality, where
the patient dwells on a problem that does not
exist, and the surgeon can never satisfy that
patient.

Medical History
• A detailed medical history should be
obtained, including allergies, tobacco
use, diabetes, massive weight loss,
previous surgery, previous liposuction,
and a complete detailed list of
medications and supplements.
• It would be best if you stopped;
aspirin, NSAIDs, hormonal therapy, oral
contraceptives, beta-blockers,
antidepressants, and calcium channel
blockers.
• Smoking should be discontinued at
least two weeks before surgery.
• Anyone older than fifty years of age or
with a significant medical history
should be referred for preoperative
clearance by an internist or
cardiologist.

The American Society of
Anesthesiologists’ (ASA)
Physical Status Classification
Class I A healthy patient without systemic medical or psychiatric illness, excluding the very young and
ancient fit with good exercise tolerance
Class II A patient with a mild systemic disease but no functional limitations; has a well-controlled disease of
one body system (i.e., controlled hypertension or diabetes without systemic effects, cigarette smoking
without chronic obstructive pulmonary disease, and mild obesity
Class III A patient with severe systemic disease that is not considered incapacitating (obesity) significantly
increases the risk of any form of anesthetic, poor wound healing, increased risk of infection, deep
vein thrombosis, sleep apnea, and occasional death. The risk of complications increases as the
volume of aspirate and the number of anatomical sites treated increase.
Elective surgery patient should be Class I or II

Laboratory Tests
• Laboratory tests will be based on medical history and
physical examination.
• A chemistry profile, a complete blood count, and a
platelet assessment are mandatory
• Some surgeons may wish to obtain screening for H.I.V.
and Hepatitis.
• Massive weight loss patients should evaluate as any
excisional-type body contouring procedure
• An ultrasound or computed tomography (C.T.) scan
may further clarify abdominal hernia and prevent
potential perforation of an organ during liposuction.

Physical Examination: Body Mass Index (BMI)
• Calculating body mass index (BMI) is paramount to patient safety and follow-up visits
• It is well known that morbid obesity (BMI > 35) imparts a threefold to fourfold risk from anesthesia.

Patient
Examination
• The physical exam is best performed
before a full-length mirror and requires the
physician to evaluate that area
circumferentially
• Findings may be challenging to interpret
in obese individuals, males, or patients with
multiple scars
• The importance of looking good without
clothing identifies the patients who will
mandate smooth skin as a critical
component of their procedure
• If this is less important, it may open up
other options for the patient to look better
in clothing.

Physical Examination
Using the BMI, the surgeon can
objectively classify a patient's
obesity as one of the following:
• Class I: Lean range (18.5–19.9)
• Class II: Optimal (average) (20–25)
• Class III: Overweight range (25.1–29.9)
• Class IV: Obese range (30–34.9)
• Class V: Morbidly obese range (35–39.9)
• Class VI: Extremely obese (40 or greater)

Physical
Examination
• Skin tone and quality should be
assessed, and differences between
excisional procedures and liposuction
should be discussed with the patients.

Physical Examination
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• The fact that cellulite will
not improve with
suctioning may worsen and
that no improvement in
superficial contour
irregularities is possible
with liposuction alone,
usually combined with fat
grafting.
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Physical
Examination
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• The patient should know
that the body is not
symmetric, and the
markings will be slightly
different on the two sides
of the body.
• The surgeon should pinch
the excess fat, and if the
patient has asymmetry, this
should be pointed out to
the patient and recorded
with good photographs.
10/21/2022 26

Physical
Examination
Findings may be
challenging to interpret in
obese individuals
• Symmetry and Scars
• Skin quality and
cellulite
• Fat, muscle, and Bone
• Gender Variations

Preoperative Markings
• I use a color-coded topographic
type of marking for areas of
lipodystrophy and contour
deformities. Transition areas are in
green color, and Zones of
adherence and places to avoid are
marked with red or hash marks.
• The central ring is the most area
to liposuctioned and at a deep
level; as I move to the peripheral
rings, I aspirate less and move
more superficial blinging nicely
with the surrounding areas.

Preoperative
Markings
• Access sites are used for both Infiltration
of local anesthesia and lipoaspiration.
• It must allow me to treat multiple areas ,
cross-hatched cannula patterns, and
passing at various directions and depths.
• Using extra sites decrease the risk of
access site is being over-sectioned.
• It should be in well-hidden places such
as hair and creases, skin folds, or a previous
scars.
Transition
zone
Access Site

Markings Male Vs. Female
Attention must be paid to "gender ideal" muscular shape/ mass and fat
distribution

Preoperative
Markings
• Mark Dynamic areas in the
full range of muscular
contraction to yield natural
results
email:
10/21/2022 31

Medical Photography is a Must
Imaging is An educational Tool
High Medical Photograph: anterior, posterior, oblige and lateral
Consent Form must be Signed

Patient
Education
• One of the essential parts of the preoperative
consultation is emphasizing to patients that
liposuction has two parts. Fat removal is easily
understood, the unpredictability of skin retraction far
less so, but vital for a result satisfactory to both
parties.
• Often questions are asked during the consultation
as to how many sizes of clothing will be reduced. Or
how many pounds would be lost after the liposuction
surgery? It should be explained to the patient that
there is no way that it can be predicted how many
sizes an individual will reduce in clothing or how many
pounds will be lost.

Patient
Education
• Often patients want many areas
liposuctioned in one session.
• It should be explained to the patient that
the maximum amount of liposuction that
can be performed in an outpatient surgical
facility at one time is 5 l. Patients will have
a faster recovery and minimal
complications.

Patient Education
• The patient must understand that surgery, on average, does not achieve perfect results, and
further refinement might be needed

Patient
Education
• The patient and physician should discuss
the procedure, alternative treatments,
financial obligations (including further
surgeries if required), and complications
and risks. It is crucial to have the informed
consent read and signed at the
preoperative visit.

Second
Preoperative
Visit
• A follow-up visit is typically
scheduled 2–3 weeks after the initial
consultation.
• The second visit allows for
addressing recovery time, pain control,
bruising, and postoperative changes,
which will help strengthen the patient's
confidence in the procedure and
decrease the likelihood of any
uncertainties or surprises within the
perioperative period.

Location of Liposuction
• Liposuction is performed in three outpatient settings: hospitals, free-
standing ambulatory surgery centers, or office-based surgery facilities. The
operative location is determined after careful patient evaluation,
assessment of the complexity of the operation, and the appropriate
evaluation of medical comorbidities.
• It is up to the surgeon to choose the optimal surgical setting for each
patient undergoing liposuction.
• Office-based surgery has several potential benefits over hospital-based
surgery, including cost containment, ease of scheduling, and convenience
for patients and surgeons.
• It was found that hospital-based liposuction had three times the rate of
malpractice settlements compared with office-based liposuction surgery

Location of
Liposuction
• Surgical procedures are associated with several
physiologic stressors, including the development of
hypothermia, blood loss, malignant hyperthermia,
and deep vein thrombosis.
• Taking precautions against such stressors will lead to
thoughtful decision-making regarding the type of
anesthesia used, the safety of combining multiple
procedures, and the duration of the procedure(s) to
maximize patient safety and enhance postoperative
recovery.

Perioperative Days
• Prophylactic antibiotics are recommended for all extensive volume
liposuction. A 5-day course (500 mg/d), one day preoperatively followed by
250 mg once daily for days 2–5) of Zithromax is user-friendly. Patients skip
the day of surgery if intravenous antibiotics are utilized.
• The patient will have a shower on the morning of surgery with antibacterial
soap.
• Patients are told to wear loose-fitting clothing and cover their bedcover
sheets with plastic sheets or bags because drainage should be expected for
the initial 24–36 h.
• If tumescent anesthesia only will be used by the patient, a light breakfast is
allowed on the morning of surgery.
• However, patients with sedation or general anesthesia are told to avoid
drinking or eating starting at midnight before surgery.

The Day of Surgery
• Surgical consent signed
• Preoperative pictures
• All clothing, jewelry, contact lens, and any dentures are
removed
• Areas of liposuction are appropriately marked.

The Day of Surgery
• Preventative measures against
hypothermia include warming the wetting
solutions and prep, increasing the room
temperature, and using warming devices.

The Day of
Surgery
• Pedal or calf compression devices are
also applied in the holding area to assist
DVT prophylaxis.
• It should be considered for longer body
contouring cases and those involving
multiple sites.

Intraoperative
Time
• It is helpful to have the circulating
nurse maintain an accurate liposuction
data sheet to facilitate consistent and
accurate communication between the
surgeon, the anesthesiologist, and the
operating room team.

Patient
Positioning
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• Patient positioning depends on the
area or areas that need to be treated,
other procedures the patient will be
undergoing, the patient's body
habitus/B.M.I., and surgeon
preference.
• It is better to have excellent and
efficient positioning allowing better
contouring of the areas from several
access points and directions to
achieve the most significant aesthetic
results and avoid serious
complications.
10/21/2022 45

Patient
Positioning
• Up to 70% of the contouring can be performed in the prone position,
including liposuction of the arms, back, hips/flanks, lateral, posterior, and
medial thighs.
• Patients in the prone position are subjected to pressure changes over
the forehead, malar areas, iliac crest, and bony prominences of the arms
and legs.

Patient
Positioning
• The remainder of the trunk and extremities can be addressed with the
patient in the supine position, including arms, abdomen, anterior medial
thighs, and knees.
• Pressure points in the supine position include the occiput, scapula,
posterior iliac crest, sacrum, and heels.
• This position does not have significant effects on the cardiopulmonary
systems.

Patient
Positioning
• The lateral decubitus position most closely resembles the normal standing
position, allowing contouring to match the position the patient sees
themselves in a mirror, accessing the flanks, lateral back, buttocks, thighs, and
lower legs.
• All pressure points should be well-padded. Brachial plexus injuries can
occur if the arm is abducted >90°.

Tumescent Local
Anesthesia (TLA)
• In 1985 Jeffrey Klein, a San Juan Capistrano,
California dermatologist, performed his first case
using the original tumescent local anesthesia (T.L.A.)
formula: short-acting lidocaine, epinephrine, and
bicarbonate, diluted in a physiologic saline solution.
• All liposuction solutions are kept at a temperature
of 38°C.; the epinephrine is added to the wetting
solution just before infiltration.
• Lidocaine and epinephrine total doses are varied
according to the anatomic site to be treated, e.g.,
neck, back, or breast, and the total volume of
anesthetic solution injected.

Tumescent Local Anesthesia (TLA)
email:
• The invention of tumescent local anesthesia (T.L.A.) was
to perform liposuction surgery on an outpatient basis since
most dermatologists in the United States did not have
hospital privileges to perform liposuction.
• It was a secondary observation to experience a
dramatically reduced rate of complications in liposuction.
• Local anesthesia constituents differ primarily according
to fluid volume and infiltration/aspiration ratios.
• The ratio of infiltration to aspiration is approximately
2:1—-1:1 for large-volume suctioning.
• For more minor procedures, the proportions are higher
up to 10:1, i.e., 1000 mL of infiltration to 100 mL of
aspirate.
10/21/2022 50

Tumescent Local
Anesthesia (TLA)
• The traditionally recommended maximum dose of lidocaine
with epinephrine is 7 mg/kg; however, in the liposuction setting,
the safety of lidocaine in concentrations >35 mg/kg and as high
as 55 mg/kg in large-volume cases. Later, Patrick Lillis published
data explaining that 55 to 90 mg/kg body weight would be safe.
• Medications that increase lidocaine levels include oral
contraceptives, beta-blockers, and tricyclic antidepressants.
• Lidocaine provides analgesia for up to 18 h postoperatively.
• Lidocaine may also contribute to the extremely low incidence
of infection seen in liposuction because of its bacteriostatic
effect.

• The epinephrine dosage used in infiltrating solutions varies and may range from 1:100,000 to
1:1,000,000, depending on the anatomic sites treated and the infused infiltrate volume.
• It is recommended that epinephrine doses not exceed 0.07 mg/kg, although doses as high as
10 mg/kg have been used safely. Most commonly, epinephrine in 1 mg with 1/1000 dilution is
injected into a 1-L bag.
• . Vasoconstriction also decreases the lidocaine absorption rate, potentiating the local
anesthetic effect.
• The epinephrine may also increase the cardiac output, which, in turn, hastens the hepatic
metabolism of the lidocaine.
• The blood-tinged infranatant of the true tumescent liposuction aspirate has a hematocrit of
less than 1%. Less than 12 mL of whole blood is lost per liter of fat extracted
• With its vasoconstrictive properties, epinephrine is the key to minimal blood loss during
liposuction.
• However, epinephrine should not be given to patients with cardiovascular diseases.

Tumescent Local
Anesthesia (TLA)
• Sodium bicarbonate is necessary to
neutralize the acidic pH of
commercially available lidocaine,
eliminating the stinging and burning
sensation and in return, the need for
narcotic analgesia or sedation.
• Ten milliequivalents of sodium
bicarbonate are added per liter of the
most tumescent formulation.

Tumescent
Local
Anesthesia (TLA)
• The lidocaine solution is first placed into the incision site through a sharp
25-gauge needle; incisions are then made with a No. 11 blade.
• The incisions for infiltration of anesthetic solutions are usually the same for
harvesting fatty tissue.
• These incisions are just large enough (usually 2 mm) to permit insertion of
the tip of the harvesting cannula.
1 2

Tumescent Local
Anesthesia (TLA)
• Tumescent fluid in prepared bags is delivered through the tubing with a
motor-driven pump at a slow infusion rate (<50 mL/min) attached to
infiltration cannula in large cases.
• Alternatively, tumescent fluid is delivered through a syringe attached to
multi holes infiltrating microcannula in minor cases.
Pump Infiltration
Syringe Infiltration

• The volume of fluid infiltration depends on the tissue characteristics. Lighter fat, such as the abdomen, is more distensible and
takes up more volume, while dense tissues, such as the back, are less distensible and fill more quickly with infiltration fluid.
• Rapid infusion is undesirable because it tends to be less uniform, resulting in suboptimal hemostasis and anesthesia.
Lighter fat, is more distensible and takes more volume
Dense fat is less distensible and takes less volume

Tumescent Local
Anesthesia (TLA)
• Infiltration is carried first into the
superficial subcutaneous fat in sensitive
areas.
• Later deep infiltration use is easily
tolerated, even in challenging fibrous areas.

Tumescent Local
Anesthesia
• The operating hand should move
forward slowly and deliberately to fill
between fat lobules at every level.
• The other hand palpates the tissue from
the surface, constantly aware of the
location of the tip of the cannula.

email:
• Clinically, TLA fluid will lead to
maximum firmness of the skin
surface, a" state of tumescence.
• Firmness, a slight "orange
peel," fountain sign, and tissue
blanching are considered clinical
endpoints of infiltration in the
accurate tumescent technique.
• The wetting solution should
be allowed 30 min before
suctioning to reach its maximum
effect.
10/21/2022 59

Tumescent Local
Anesthesia.
• Fluid infiltration will lead to the first step of an
"interseptal hydrodissection“
• Since these tissue planes offer the lowest resistance
for the T.L.A., fluid to spread; after a short time,
depending on the rising interstitial tissue pressure, the
T.L.A. fluid will penetrate the fascia. It will surround the
fat lobules called "paralobular distribution."
• Increasing amounts of fluid will cause the fat lobules to
absorb the T.L.A. fluid, leading to "intralobular
penetration."
• After more and more liquid is added, the full extent of
all the fat levels is flooded by the T.L.A. fluid, which after
30 minutes of diffusion, leads to a "homogenization" of
the fat tissue.

Tumescent Local
Anesthesia
• The tumescent fluid will compress the blood vessels,
facilitating the vasoconstrictive action of epinephrine, and
will make them a smaller target and less likely to be
traumatized by concurrent liposuction.
• The sensory nerves are also stretched, making the
accompanying lidocaine effective.
• Infiltrating the fat layer magnifies its volume and defects
so that the desired fat sculpting can be accomplished with
greater accuracy and better feathering of edges.
• Expanding the fat layer can also create a safety cushion,
elevating the target work area away from underlying vital
structures.

Tumescent Local
Anesthesia
• If the skin surface shows softness,
additional fluid infiltration is indicated to
stabilize tissue during the liposuction surgery.
• Alternatively, a well-trained assistant
stabilizes the tissue manually by horizontal
fixation.
• It is important not to distort the tissue or
change the correct anatomical conditions to
prevent over-suctioning specific areas.

Tumescent Local
Anesthesia
• This situation is advantageous where there
is little room for error, such as in medial thighs
and jowls.
• After withdrawing the cannula, a band-aid is
placed to stem the fluid flow from the incision
site.
Awake Patient

Tumescent Local
Anesthesia
• I prefer to use tumescent local anesthesia
alone (awake liposuction) for; minor cases,
single sites, revisions, touch-ups, and fat
extraction.
• The result is complete fat removal with
less traumatic injury to delicate structures
of fatty tissue; this is crucial for both
liposuction results (fat left) or the need for
it later, whether for immediate contour
correction or the next step in lipofilling.

Large Volume
Liposuction
• The AACS 2000 Guidelines for Liposuction
Surgery state that the maximal volume
extracted may rise to 5,000 ml of
supernatant fat in the ideal patient with no
comorbidities.
• Currently, conservative guidelines limit
the total volume of supernatant fat aspirate
to less than or equal to 4 l in liposuction
cases.
• The guidelines also state that the
recommended volumes aspirated should be
modified by the number of body areas
operated on, the percentage of body surface
area worked on, and the percentage of body
weight removed.

Large Volume
Liposuction
• The guidelines also state that
the recommended volumes
aspirated should be modified by
the number of body areas
operated on, the percentage of
body surface area worked on,
and the percentage of body
weight removed.
• The risk of perioperative
morbidity and mortality
increases with the increasing
time and size of the procedure.
Buttocks Lipofilling

Large Volume
Liposuction
• Two options are available to
decrease the risk of lidocaine toxicity
in large-volume liposuction cases.
• The first is to reduce the
concentration of lidocaine in the
wetting solution.
• The second is to use smaller volumes
of infiltrating by applying the superwet
technique rather than the tumescent
technique.

Large Volume
Liposuction
• Although lengthy operations are prone to complications, it is
safer to Inject by section, i.e., one area is infiltrated and
extracted while the other is injected.
Left Buttock is done

Large
Volume
Liposuction
Alternatively, anesthetic
solution is injected with
two infusions.
TLA Infiltration

Large Volume
Liposuction
• Alternatively, the
extraction is performed
using two suction machines
simultaneously.
Fat Extraction

Large Volume
Liposuction
• The patient's body mass index and the
potential physiologic consequences of
tissue loss should be considered to ensure
that the volume of aspirate removed is
proportional to the patient's overall size
and medical condition.
• A urine catheter is placed for the
expected liposuction volume greater than 4
liters.

Large Volume
Liposuction
The following formula aids in
fluid management for these
patients.
• Maintain fluid throughout the
procedure and manage it based on
vital signs and urine output.
• Employ the superwet infiltration
technique.
• Administer crystalloid replacements,
0.25 mL for each milliliter of
lipoaspirate over 5 L.

Large Volume
Liposuction
7
3
• For me, liposuction is "large" when it is over 5,000
mL.
• I try not to extract over 10,000 mL per session.
• I always stay below the 55 mg/kg body weight
range regarding lidocaine.
• Now the anesthesia has reached its peak.
• The skin looks blanched and firm.
10/21/2022

Adjunctive
Anesthesia
Several adjunctive types of anesthesia
are used during liposuction
procedures, including
• General anesthesia.
• Epidural anesthesia.
• Spinal anesthesia.
• Sedation/analgesia.

Adjunctive
Anesthesia
Many factors influence the usage of
adjunctive anesthesia decision
including:
• Expected lipoaspirate.
• Length and extent of the
procedure.
• Patient positioning.
• Surgeon preference.
• Anesthesiologist preference.
• Overall health of the patient.

Surgical Fat Reduction (liposuction) Part I.pptx

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Surgical Fat Reduction (liposuction) Part I.pptx

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