Liposuction at a Glance
- Liposuction is one of the most commonly performed cosmetic procedures and is widely practiced by dermatologic surgeons.
- The tumescent technique of local anesthesia is one of the most important innovations in liposuction surgery.1
- Liposuction performed with tumescent local anesthesia allows for the removal of large volumes of fat safely and effectively.
- Liposuction is characterized by unparalleled safety, rapid patient recovery, and low postoperative morbidity.
- Importantly, liposuction has been demonstrated to be very safe to perform in the office setting, the preferred venue for the procedure when carried out by dermatologic surgeons.
Liposuction should be regarded not as a method of weight reduction or an alternative to diet and exercise, but as a body-contouring procedure. The ideal candidate is a healthy patient near his or her ideal body weight who has disproportionate, localized adipose deposits resistant to diet and exercise. Liposuction should be avoided in patients with unrealistic treatment goals and those with emotional or psychological instability (i.e., presence of an eating disorder or body dysmorphic disorder). A comprehensive preoperative consultation including a screening questionnaire is used to identify patients who are appropriate candidates. During the consultation, the risks, goals, anticipated results, and expected postoperative course are discussed.
Taking a thorough medical history will screen for patients who may be poor surgical candidates for liposuction (see Section “Risks and Precautions”). Patients at risk for complications should receive medical clearance before surgery.2,3 A careful review of all medications is essential. All anticoagulant medications, including vitamins and herbal supplements, should be discontinued 2 weeks before surgery. Use of medically necessary anticoagulant therapy is a contraindication for tumescent liposuction. Medications that are metabolized by the hepatic cytochrome P450 3A4 enzyme system should be identified. These medications may interfere with the hepatic metabolism of lidocaine, which leads to the potential for toxicity. They should be discontinued or tapered off 2 weeks before surgery if permitted by the prescribing physician. For patients who are unable to interrupt therapy, a lower maximum dose of lidocaine may be used (i.e., less than 35 mg/kg).
Preoperative laboratory testing includes complete blood count with differential and platelet count, prothrombin time, partial thromboplastin time, and chemistry panel (including liver function tests); serologic testing for human immunodeficiency virus and hepatitis B and C viruses; and serum pregnancy test (for females).2 An electrocardiogram may be considered when the patient is over the age of 60 or when indicated based on the patient's history or a review of systems.
Risks and precautions concerning liposuction are presented in Box 253-1.
Box 253-1 Risks and Precautions for Liposuction ||Download (.pdf)
Box 253-1 Risks and Precautions for Liposuction
CONTRAINDICATIONS TO LIPOSUCTION
- Severe cardiovascular disease
- Severe coagulation disorders, including hemophilia
CONDITIONS THAT PUT PATIENTS AT RISK FOR COMPLICATIONS
- History of bleeding diathesis, thrombophlebitis, or emboli (fat or thrombotic)
- History ...