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At least 865 records · Page 48Linked to original sources
PubMed1999

Does the location of the surgery or the specialty of the physician affect malpractice claims in liposuction?

BACKGROUND: There is increasing national dialogue on who should perform liposuction and where it should be performed. OBJECTIVE: To determine the effect of the location of liposuction surgery and the specialty of the physician on the incidence of malpractice claims. METHODS: Physicians Insurance Association of America malpractice data from 1995-1997 was analyzed. RESULTS: Hospital-based liposuction had more than 3 times the rate of malpractice settlements than office-based liposuction. Dermatologists accounted for less than 1% of malpractice claim settlements in liposuction. CONCLUSION: Dermatologic liposuction education has emphasized small volume cases performed under local anesthesia using the tumescent technique. The safety of this approach appears to be validated in terms of decreased malpractice settlements.

Ambulatory Surgical Procedures↗
PubMed1999

Sociodemographic profile and satisfaction with treatment of patients undergoing liposuction in tumescent local anesthesia.

OBJECTIVE: To assess patient satisfaction with liposuction in tumescent local anesthesia (TLA) and to define a patient profile regarding sociodemographic data. METHODS: Three hundred randomly selected patients were asked by mail to complete a standardized questionnaire on aesthetic dermatology and cosmetic surgery 3-25 months after liposuction. The 64 items addressed treatment satisfaction, treatment effects on body, social, and professional life as well as self-confidence, body feeling, and social contacts. RESULTS: One hundred fifty-nine (53.0%) of 300 patients returned complete questionnaires. Ninety-two percent of the patients were female and the mean age was 45.3 +/- 11.8 years. The mean body mass index (BMI) was 24.5 +/- 3.7, and 61.7% of the patients had a normal BMI. Satisfaction with the liposuction was high (about 85% mostly or completely satisfied). The procedure was regarded by most patients as a nonstressful event (>80%). About 40% reported positive effects on social life, about 91% on body feeling, 57% on attractiveness, and 20% on their profession. CONCLUSION: Liposuction in TLA is a satisfying and well-tolerated treatment for most patients.

Adult↗
PubMed1999

Lidocaine levels during the first two hours of infiltration of dilute anesthetic solution for tumescent liposuction: rapid versus slow delivery.

BACKGROUND: Tumescent anesthesia for liposuction with dilute lidocaine has been well documented to result in peak serum levels 4-14 hours after infiltration. Pharmacokinetic studies have shown that the rate of lidocaine absorption is related not only to dilution, but also to the speed of subcutaneous infiltration. Early studies with a more concentrated solution of lidocaine (1.0%) have shown that with rapid infusion, peak plasma levels may occur within 30 minutes. OBJECTIVE: To determine whether rapid absorption of lidocaine may occur during infusion of tumescent solution by varying the rate of infusion of dilute lidocaine solution (0.05% or 0.1%) and observing serum levels of lidocaine within the first 2 hours of the procedure. METHODS: Eighteen patients participated in this study and were infused with a standard liposuction tumescent formula consisting of lidocaine either 0.05% or 0.1%. The rates of infusion of tumescent anesthesia ranged from 27.1 mg/min up to 200 mg/min infused over a period of 5 minutes to 2 hours. Total lidocaine infused ranged from 7.4 to 57.7 mg/kg. Serum levels of lidocaine were taken every 15 minutes during the first hour of the procedure and repeated at 2 hours. RESULTS: In all 18 patients, lidocaine levels remained significantly below the toxic range and were always less than 2.0 microgram/ml. In 11 patients, lidocaine levels at all time intervals were less than 0.5 microgram/ml. In seven patients, the lidocaine levels ranged from 0.6 to 1.9 microgram/ml at varying intervals. There was no correlation between the maximum dose of lidocaine (mg/kg) or rate of lidocaine delivered (mg/ml) with plasma levels of lidocaine. CONCLUSION: Despite variability, the serum levels of lidocaine remained well within safety limits during infusion of tumescent solution and the first hours of the procedure when infused in rates up to 200 mg/min with spinal needles and/or small diameter multiholed infusion cannulas.

Adult↗
PubMed1999

Modified tumescent liposuction.

BACKGROUND: Tumescent liposuction has been found to be safe and effective. However, there are still many refinements that may be possible, such as varying the size and tips of the cannulas, varying the types of infiltrate and associated anesthesia, and the method of compression. OBJECTIVE: To examine possible variables in tumescent liposuction techniques such as the most efficient liposuction cannulas, to determine an effective tumescent fluid, and to examine the extent of compression provided by different garments. METHODS: Patient markings, tumescent fluid formulas, methods of infiltration, types of cannulas, skin incisions, and compression garments were compared between the pure tumescent technique and modified tumescent liposuction. RESULTS: The most efficient cannulas were those with three staggered ports, such as the Mercedes, Cobra-keel, Giorgio Fischer, and Accelerator II tips. When these are combined with modified tumescent fluids and sedation, it is possible to perform total body liposuction in a safe and efficient manner. Multiple ports and compression garments are beneficial to reduce bruising and focal areas of inflammation. CONCLUSION: The tumescent liposuction technique will continue to be improved. So far, with more efficient cannulas and more efficient tumescent fluids, combined with sedation, it has been possible to increase the yield and decrease the required time for the technique. We call this modified tumescent liposuction.

Humans↗
PubMed1999

Stromal progenitor cells present within liposuction and reduction abdominoplasty fat for autologous transfer to aged skin.

BACKGROUND: Autologous fat is used for direct transfer to locally replace fat, as well as for use intradermally in the treatment of rhytids in aged skin. OBJECTIVE: To determine if the components of the autologous fat could be separated to produce a better agent for the treatment of rhytids. METHODS: Liposuction material from four patients and fat from abdominoplasty from five patients was processed by homogenization and centrifugation to separate mature lipocytes from other stromal cell populations in its associated extracellular matrix, and then to separate this from the blood and cellular debris. The cellular layer was evaluated histologically and with the immunohistochemical antibodies for CD34, SM-actin, S-100 protein, MIB-1, Bcl-2, and factor XIIIa. RESULTS: The cellular layer showed spindle cells, some small vascular structures, a small amount of mature fat, and extracellular matrix. CD34 showed diffuse staining of most spindle and endothelial cells in all sections, factor XIIIa showed only focal staining of spindle and dendritic cells, and Bcl-2 showed light to moderate staining in scattered cells within the cellular component. S-100 protein, SM-actin, and MIB-1 were negative. CONCLUSION: Processed liposuction and abdominoplasty processed fat may be ideal for the treatment of wrinkles in aged skin because it contains progenitor stromal cells that are known to be present within the fat and which may be concentrated by processing methods.

Abdomen↗
PubMed1999

Skin retraction after liposuction in patients over the age of 40.

BACKGROUND: A commonly held misperception regarding liposuction in patients over 40 years of age is that the skin will not retract and redrape following removal of the fat. OBJECTIVE: In order to evaluate tissue retraction in the abdomen, neck, and arms in patients undergoing liposuction after 40 years of age, the following study was conducted. METHOD: A total of 58 patients ranging in age from 40 to 75 years underwent liposuction. Thirty had liposuction of the abdomen, 20 had liposuction of the neck, and 8 had liposuction of the arms. Measurements in inches and weight in pounds were recorded before and at 1, 3, and 6 months after the procedure. RESULTS: Ninety percent of the patients were women. The rest of the patients were men. The average age of the patients undergoing liposuction of the abdomen was 55 years old. The average supranatant fat extracted from these patients was 1725 ml, with an average lidocaine dose of 36 mg/kg of body weight. The patients who had liposuction of the abdomen demonstrated an average weight loss of 5 lb and a decrease of 3 inches in waistline 6 months after the procedure. For those patients who had liposuction of the neck, the average age was 57 years old. The average supranatant fat extracted from these patients was 75 ml, with an average lidocaine dose of 4 mg/kg of body weight. The patients who had liposuction of the neck decreased an average of 1.3 inches in circumference without any weight change 6 months after the procedure. For those patients having liposuction of the arms, the average age was 44 years. The average supranatant fat extracted from these patients was 525 ml, with an average lidocaine dose of 16 mg/kg of body weight. The patients who had liposuction of the arms had an average of 0.5 inch decrease in circumference without any weight change 6 months after the procedure. The cosmetic results were good to excellent. Our highest lidocaine dose occurred in a patient having suction of the abdomen and was 71 mg/kg of body weight. No patients experienced any objective or subjective signs of lidocaine toxicity. CONCLUSION: Tumescent liposuction of the abdomen, neck, and arms is a safe alternative for contour improvement with good cosmetic results in patients over 40 years of age.

Adult↗
PubMed2000

Liposuction and surgical recontouring of the neck: a retrospective analysis.

BACKGROUND: With the advent of tumescent liposuction, many advances in cosmetic surgery have occurred. Liposuction of excess adipose tissue from the submental area, jowls, and neck, along with cold steel surgery, has become an attractive alternative to the facelift for cervicomental aesthetic surgery. OBJECTIVE: To describe new techniques for tumescent neck liposuction, platysma repair, and subcutaneous musculoaponeurotic system plication, evaluate results, and assess complications with the procedures. METHODS: We reviewed the results of the last 35 patients who underwent neck liposuction, simultaneous platysma plication, subdermal CO2 laser resurfacing, and/or subcutaneous musculoaponeurotic system plication at our institution. RESULTS: Three of 35 patients (9%) experienced mild complications from the procedure. Two of the three complications (66%) were in patients who underwent subdermal and/or platysma laser resurfacing at the time of liposuction. Good to excellent results were achieved in 91% of patients and fair to good results were achieved in 9%. No major complications such as nerve injury occurred. CONCLUSION: Neck liposuction can be a safe method for facial rejuvenation when performed properly. Platysma repair, and in some cases subcutaneous musculoaponeurotic system plication, can further improve results when combined with the liposuction procedure.

Adult↗
PubMed2000

Treatment of axillary hyperhidrosis: combination of the starch-iodine test with the tumescent liposuction technique.

OBJECTIVE: To evaluate and permanently improve axillary hyperhidrosis. BACKGROUND: Excessive sweating of the axillae is a common problem for which patients frequently seek dermatologic advice and therapy. Many treatments, including aluminum chloride, topical and systemic anticholinergic agents, tranquilizers, iontophoresis, direct surgical excision, botulinum toxin injection, and thoracic sympathectomy, have been employed to control this problem. All have drawbacks of one sort or another. METHODS: The starch-iodine technique for delineation of preoperative and postoperative axillary sweating is described in detail. A method of sweat gland removal utilizing tumescent liposuction is discussed. RESULTS AND CONCLUSION: The combination of the starch-iodine technique and tumescent liposuction is safe and effective for therapy of axillary hyperhidrosis.

Axilla↗
PubMed2000

When one liter does not equal 1000 milliliters: implications for the tumescent technique.

BACKGROUND: Tumescent anesthesia has revolutionized the practice of liposuction. Inherent to the tumescent technique is the use of large volumes of dilute solutions of lidocaine with epinephrine instilled into subcutaneous fat deposits. Precise formulation of the tumescent anesthesia is essential to liposuction technique. OBJECTIVES: To determine the actual volumes of fluids contained in intravenous (IV) 1 L bags of saline used for tumescent anesthesia, to calculate volumes supplied in 50 cc stock solutions of 1% lidocaine, and to measure the amount of fluid retained by peristalic pump tubing used for infiltration. METHODS: The amount of saline contained in fifteen 1 L saline bags from three different manufacturers was calculated using graduated cylinder methodology. The volume of tumescent anesthesia retained by peristaltic pump tubing was calculated by expelling the contents of the filler tubing and measuring it. The actual amount of 1% lidocaine contained within fifteen 50 ml "stock" 1% lidocaine bottles from different manufacturers and with different lot numbers was calculated by transferring the contents into graduated cylinders. RESULTS: One liter IV bags of physiologic saline contained an average volume of 1051 ml (range 1033-1069 ml). The 50 ml bottles of 1% lidocaine with epinephrine contain an average of 54 ml of anesthetic (range 52.5-55 ml). Infusion tubing for use with peristaltic pumps may retain 46-146 ml of tumescent anesthesia. CONCLUSION: One liter IV bags of normal saline contain more than 1 L, having an average volume of 1051 ml. Common methods of preparation of 0.05% lidocaine with 1:1,000,000 epinephrine and sodium bicarbonate can increase the total amount of fluid in the tumescent anesthesia to 1112 ml for 0.05% solutions and preparation of a 0.1% solution contains an average volume of 1162 ml. The fluid contained in each bag may be increased over labeling by as much as 11-16%. Final concentrations of lidocaine in tumescent anesthesia may be reduced due to extra fluids. A 0.05% lidocaine solution may have a final lidocaine concentration of 0.045% and a 0.1% lidocaine solution may have an actual concentration of 0.086%. Lidocaine concentrations may be reduced by as much as 10-14%. Extra anesthesia fluid is also contained within stock 50 ml bottles of 1% lidocaine. Dermatologic surgeons should be aware of extra fluid possibly contained within tumescent anesthetic preparation, be aware of the extra anesthesia supplied in standard 1% lidocaine bottles, and possible decreased concentration of lidocaine within the final tumescent anesthesia.

Anesthesia, Local↗
PubMed2000

Liposuction surgery for the treatment of large hematomas on the leg.

BACKGROUND: Post-traumatic hematomas overlying the muscular fascia on the lateral aspect of the leg are common in elderly patients, particularly those receiving oral anticoagulant therapy. When large collections of blood accumulate within this region, the pressure within the hematomas may exceed the blood pressure in the dermal and subdermal vessels. Large areas of necrosis of the overlying skin may then result. OBJECTIVE: To decrease the pressure of evolving and long-standing hematomas, thereby reducing inflammation and pain. METHODS: Liposuction surgery was employed as a means of decompressing both evolving and long-standing hematomas. RESULTS: Liposuction surgery has been found to be useful in the treatment of hematomas on the leg, and has the added benefit of producing cosmetically elegant results. An elastic compression bandage placed postoperatively reduces the risk of relapse. CONCLUSION: Liposuction surgery may be used to remove large leg hematomas without producing long and cosmetically unacceptable scars. The technique is easy to perform and permits rapid evacuation of hematomas, thereby minimizing patient discomfort.

Bandages↗