Re: Liposuction of giant lipoma and the treatment of gynecomastia without sharp excision.
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Biomedical subjects
Publications and source records attributed to R L Dolsky.
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Gynecomastia is a common finding in both adolescents and mature adult males. The previous surgical techniques of direct subcutaneous mastectomy were associated with high frequency of complications and unsatisfactory aesthetic results. Application of liposuction techniques to the prepectoral region has provided an effective and safe technique for reliably contouring and reducing the prepectoral region. The technique described in this article includes proper placement of the incision, the injection of low-dose Xylocaine and epinephrine, and the utilization of three different types of cannulas to significantly reduce the tissue mound. The author has operated upon 60 patients utilizing this technique without having a single operative complication.
1. For every 100 cc of aspirate, the average blood content in the aspirate is 18% for females and 23.6% for males. 2. For every 100 cc of aspirate, the average total body blood loss is 37.6 cc for females and 123.2 cc for males. 3. For every 100 cc of aspirate, the average blood loss into the wound (third space loss) is 19.6 cc for females and 99.6 cc for males. 4. For every 100 cc of aspirate, the average decrease in absolute hematocrit is 0.38 for females and 0.88 for males. 5. Males have 3.03 times as much blood loss as females during liposuction. 6. A delay of 15 minutes between the injection of local epinephrine and the onset of liposuction will decrease blood loss by 21.9%. 7. The traditional French Illouz cannula and the American cobra cannula cause approximately the same amount of blood loss. 8. There is no difference in the amount of blood loss when the concentration of epinephrine is diluted from 1:200,000 to 1:400,000. 9. The dry technique resulted in 3.4 times as much bleeding compared with the techniques utilizing epinephrine solutions. 10. The surgeon cannot predict the exact blood loss in an individual patient undergoing liposuction. The results are quite variable from one patient to the next.
Liposuction is a very safe and predictable means of contouring the body's adiposities. It is an effective surgical method for aesthetic sculpturing with minimal complications. Complications are rare and most commonly include waviness or irregularities of the skin from poor patient selection. We have had in the last 1200 patients one case of a hematoma that was attributed to preoperative ingestion of aspirin. No seromas have occurred in this group of patients. The procedure is relatively pain free, and propoxyphene is usually adequate for pain control. The results have been rewarding for both the surgeon and the patient. Liposuction surgery has arrived as a well-accepted, reliable, and safe procedure for treating unwanted adiposities and contouring the face, neck, and body.
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Facial profileplasty can include the removal of abnormal fat deposits in the face and neck as an individual begins to age and, in many cases, the correction of chin projection to achieve a better neck-chin contour line. In this report we retrospectively analyze the complications and results from 142 patients undergoing facial liposuction alone or in combination with chin augmentation or rhytidectomy during a follow-up period of 14 months. The liposuction technique offers very low morbidity and is superior to conventional excisional methods.
Liposuction techniques utilizing fat extraction sculpturing of the neck and simultaneous chin augmentation are described herein. In young persons, extraction is carried out in the submental areas. In older patients, who have diffuse fat accumulations and less skin tone, extraction includes the submental and submandibular areas, along with dry tunneling to the lateral borders of the sternocleidomastoid muscle and inferiorly to the suprasternal notch. When the skin tone is poor, with excessive redundancy, combined rhytidectomy with both open and closed liposuction is performed. With liposuction submental sculpturing , necessity for chin augmentation is critical to tauten the submental skin and to give a better neck-chin angle. Hard chin implants are preferred over the soft gelatinous types. We utilized a hard acrylic implant ( Rish ) in all cases. Results obtained by the dual approach of submental fat suction sculpturing and hard chin augmentation have been excellent.
Classical open surgical contouring and sculpturing of the body has required significant scarring with long incisions and wide depressed scars. During the last decade, a small number of European surgeons have pioneered techniques for suction lipectomy. Illouz introduced the concept of lipolysis and blunt cannula extraction. The method described herein, which is termed lipo-suction, is a dry technique. No lipolytic solutions or local anesthetic solutions are injected. The technique relies on mechanical disruption and suction extraction of adipose tissue. The instrument is a rigid blunt-ended extractor with dull apertures. Postoperative care is a significant factor in reducing the rate of seroma formation to less than 1%.
The argon laser is a useful instrument that, during the last 5 years, has become a widely accepted and available tool in cutaneous surgery. Its primary use is in the treatment of various cutaneous lesions, although it also produces very satisfactory results when applied to professional decorative tattoos. These procedures are described and illustrated.
The Même implant may result in fewer capsular contractures. However, difficulty with insertion of this prosthesis may discourage the surgeon and result in the abandonment of a useful prosthesis. A simple technique has been evolved which allows for easy insertion and placement of this implant.
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Cervical and submental deformities are the major complaints of many patients who have had rhytidectomies. Unfortunately, traditional rhytidectomy techniques have failed to provide satisfactory and lasting results in this region. During recent years, the superficial muscular aponeurotic system has been described and multiple platysma surgical techniques introduced. Our technique emphasizes a youthful cervical and submental region. It involves an anterior submental incision, total surgical excision of the anterior platysma bands, conservative submental lipectomy, routine rhytidectomy dissection, submandibular and mandibular fat contouring, and division and rotation of platysma flaps. This technique has been used for two years on 94 patients. There have been no complications specifically related to this technique.
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