The tumescent technique for face lifts?
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Anesthetics, Local↗
Biomedical subjects
A A Mottura
Publications and source records attributed to A A Mottura.
Tumescent technique for liposuction.
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Anesthesia, Local↗
Local anesthesia for abdominoplasty, liposuction, and combined operations.
This article describes a procedure to perform abdominoplasty, liposuction, and combined operations under local anesthesia. With an anesthetic solution composed of 25 cc of 2% lidocaine, 25 cc of 0.5% bupivacaine, 1 cc of epinephrine or ornipresine, and 350 cc of saline solution, a satisfactory dilution with low concentration and lasting effects was obtained. After infiltration a large amount was lost in the incision, the dissection, and the resected dermofatty tissue. A small amount of anesthetic remained in the operated area to be metabolized by the liver. Low lidocaine levels were found in venous blood samples during surgery. This type of anesthesia is advised in minor, limited, and normal abdominoplasties in normal-sized patients, or major abdominoplasties in small patients. In liposuction procedures, it is possible to anesthetize the patient using the same procedure and operate in an equivalent area. As a high proportion of the infiltrated anesthesia was lost during the operation, a similar amount could be used to infiltrate and operate other areas so that an abdominoplasty might be combined with liposuction or mastoplasty. We have experience with 25 abdominoplasties and 21 liposuctions performed under local anesthesia. There were no complications related to local anesthesia and no one had unpleasant memories of intraoperative events.
Abdominal Muscles↗
Local anesthesia in reduction mastoplasty for out-patient surgery.
To perform a breast reduction under local anesthesia we need a large amount of anesthetic with lasting effects. For this I use a solution of 25 cc of lidocaine, 25 cc of bupivacaine, and 1 cc of epinephrine in 350 cc of saline solution. The bupivacaine allows a 4-6-hour operation. Once the breast is infiltrated, a great amount of anesthetic is lost in the incision, in the dissection, and in the resected tissue. Thus, a low dose remains subcutaneously to be metabolized by the liver. The serum lidocaine levels are low during these operations, as demonstrated by fluorescence polarization immunoassay. Under analgesic sedation the submammary sulcus and the retroglandular space are infiltrated, blocking the perforants of the intercostal nerves, under the areola, beneath the skin where the incision is made and where the areola is placed. This procedure has been applied to many techniques of breast reduction by modifying the infiltration under the incision lines. For hypertrophy up to 1000 g, 200-300 cc of anesthetic solution is used for both breasts at one stage, while for gigantomastia, about 400 cc of anesthetic is used, infiltrating and reducing one after the other. As the blood loss is minimal and the recovery very fast, with an appropriate adhesive bandage and a "soutien," the patient could be discharged in the afternoon. Our experience includes 94 reduction mastoplasties with local anesthesia, and also 74 other mastoplasties with equally good results. There were no patient complaints and, in general, they felt very comfortable, awakening without pain or side effects.
Adult↗
Liposuction: more curettage than aspiration.
After infiltration with epinephrine solution in each adipose area, an 8- or 10-mm cannula, without the suction tube connected, was introduced. With a curettage maneuver and by directing the cannula upward, the fat began to come out spontaneously. After obtaining a considerable amount of fat, the suction tube was connected and the remaining fat tissue aspirated at low suction power (250 mm Hg). With this curettage maneuver adiposity of the abdomen, knees, and trochanteric areas can be reduced. However, in the back, buttocks, or thighs, where adiposity is more fibrous, aspiration is needed from the start in almost every case, but always at low-power suction. This procedure is indicated in particular for the face and neck and for secondary liposuction. The fact that fat comes out easily through the cannula (without suction) demonstrates that the curettage maneuver is more important than the aspiration. Only with curettage can a considerable amount of fat be removed. No fat is removed when aspiration of 1 atm without a curettage maneuver is used. Suction only helps to remove fat already mobilized and free in the cannula. Our experience includes 34 patients.
Abdomen↗
Local infiltrative anesthesia for transaxillary subpectoral breast implants.
Breast augmentations using a transaxillary subpectoral approach are usually performed under general anesthesia. This article describes a technique that uses local infiltrative anesthesia in breast augmentation, adenomastectomies with immediate breast reconstruction, and when placing breast expansors. Large anesthetic solutions with vasoconstrictor and long-acting effects are prepared. The axila, the subpectoral space, and a surrounding area of 3 cm outside the demarcation limits are infiltrated. Minimal bleeding, long-lasting effects, and a considerable postoperative analgesic effect are some of the advantages of this procedure.
Adult↗
Short columella nasolabial complex in aesthetic rhinoplasty.
Many papers describe different approaches for short columella in cleft lip or Negroid noses. Very little has been found in international literature related to these aesthetic rhinoplasties. The scarce skin of the columella, the firm union between the nasal tip and the lip, due to the hypertrophy of the depressor septi nasi muscle, and the low projection of the nasal tip, consequence of the open position of the caudal part of the medial crura, are the cause of this problem. Therefore, the skin, muscle, and cartilage were treated simultaneously. Herein is described a VY composite advanced flap for projecting the tip, suturing both divergent medial crura together and adding the skin and muscle tissues of the lip to the columella. With this flap the tip was projected, the columella was narrowed, the nasolabial angle improved, and the upper lip elongated. Good results could be achieved without using any other cartilage graft or silastic strut. Standard rhinoplasty and septumplasty could be combined with this technique. Inconspicuous scars were observed.
Female↗
Cervical rhytidectomy.
Based on anatomical and clinical considerations, a new classification of the six most common neck problems is presented. In general there are three types of necks-lean, fatty, and medium-which can involve three kinds of tissue-skin, muscle, and fat-that develop wrinkles, laxities, and adiposities. Different magnitudes and combinations of these problems are observed in these three kinds of patients. Medial plication of the platysma is emphasized as a natural way to deal with neck bands.
Female↗