In Focus: Fat Chance

LIPOSUCTION PRINCIPLES FOR PATIENT SAFETY AND GOOD OUTCOMES

The American Society of Plastic Surgeons (ASPS) annual statistics show that liposuction has become one of the most commonly performed plastic surgery procedures, with more than 202,000 procedures performed in 2012. A special topic paper publish in Plastic and Reconstructive Surgery-Global Open, a companion journal to the American Society of Plastic Surgeons' Plastic and Reconstructive Surgery publication, found that by following some key principles, it's possible to achieve consistently excellent cosmetic results with low risk of complications for patients undergoing liposuction.

Dr. Geo Nicolas Tabbal of University of Texas Southwestern Medical Center, Dallas, and coauthors outlined five principles for successful liposuction, focusing on the goals of patient safety and good outcomes.

Preoperative Evaluation and Planning. Patients selection is key to success. “Patients should be generally healthy and demonstrate a commitment to long-term lifestyle changes, including both healthy diet and exercise,” the authors write. They highlight the need to ensure “appropriate and realistic” expectations-promoted by good communication between the surgeon and patient. Key elements of surgical planning should be discussed, including the choice of suction-, ultrasound-, and power-assisted techniques.

Intraoperative Monitoring and Safety. Except for some limited procedures, liposuction is generally performed with general anesthesia. The anesthetist plays a critical role in monitoring the patient during surgery. Dr. Tabbal and colleagues outline principles of positioning to provide good access for the surgeon to perform liposuction while protecting patient safety. “As much as 75% of the body can be accessed from the prone position, including the arms, back, hips/flanks, the lateral/posterior areas, and a portion of the medial thigh,” the authors write, adding that remaining areas can be access with the patient in a supine position.

Wetting Solutions and Fluid Status. Techniques using various “wetting solutions” have been developed to allow larger-volume liposuction to be performed safely and with good results. With the use of these techniques, close monitoring of the patient's fluid status is essential. Most commonly used wetting solutions currently used combine a crystalloid with epinephrine and lidocaine, the authors note.

Body Contouring and Prevention of Complications. Dr. Tabbal and coauthors discuss key technical considerations in performing three-dimensional body contouring during liposuction. Immediate fat grafting—transferring some of the patient's own fat cells—can be performed as needed to correct any contour irregularities that develop during the procedure.

Postoperative Care and Outcomes Measurement. Patients should wear compression garments for the first two weeks after liposuction, and at night for a few weeks afterward. Routine steps are outlined to minimize complications, which can be broken down into “undesirable sequelae,” causing cosmetic issues; and various types of medical/surgical complications, some of which resolve with time.

Studies have found that patients' ratings of their cosmetic outcomes are the “pivotal determinant” of their satisfaction with liposuction. Patients who are dissatisfied with their liposuction treatment are also those with the lowest opinion of their appearance. In particular, weight gain has direct negative effects on patients' perceptions of their appearance and satisfaction with the results of liposuction.

Recognizing that fact, Dr. Tabbal and coauthors re-emphasize the need for proper patient selection and patient-physician dialogue. They highlight the importance of “educating patients on postoperative lifestyle changes, including continued exercise and health eating, which are tenets of successful liposuction treatment.”

The full text of the article can be accessed at http://bit. ly/1cNwhBY.