BODY CONTOURING:

Liposuction

dr. Irena Sakura Rini, MARS, Sp.BP-RE(K)

 statistics

America Society Of Plastic Surgery

TOP from 2016 to 2017 major causes

procedure
5 5 % OBESITY
&
increase
done in America AGING
in procedure

https://www.plasticsurgery.org/documents/News/Statistics/2017/cosmetic-procedure-trends-2017.pdf
 history

1921 1927 1975 1976 1987

dr. Charles Dujarrier Schrudde Arpad & Giorgio Fischer Kesseling & Meyer Jeffrey Klein

Performed New less invasive Modern technique Using double blade Demonstrated
liposuction of a technique using of liposuction. cutting curettage liposuction in large
dancer patient uterine curettage Introducing connected to volumes of dilute
↓ blunt hollow cannula aspirator anesthesia
necrosis and attached to aspirator & (tumescent)
amputation of foot criss cross methods
procedure

Aspiration of subcutaneous fat using cannulas

connected to high vacuum in order to reduce fat volume.

Effective in changing contour of the body.

 devices
ultrasound-assisted power-assisted laser-assisted water-assisted
liposuction liposuction liposuction liposuction
local complications

edema
& seromas haematomas infection
ecchymosis

surface
over-correction under-correction asymmetry
irregularities

scar-related neurological umbilical

skin necrosis
problems sequel deviation
 local complications

Excessive Edema Over-correction in thigh

after abdominal liposuction left : pre-operation right : post-operation
 local complications

Under-correction in abdomen
left : pre-operative
middle : under-corrected arena shown in red area
right : touch-up liposuction
local complications

Umbilical Deviation
after abdominal liposuction
 local complications

Surface irregularities Surface irregularities

after abdominal liposuction after thigh liposuction
local complications

Skin necrosis
 systemic complications

DVT or visceral
blood loss hypothermia
thromboembolism perforation

fulminant fat embolism pulmonary dissatisfied

infection syndrome edema patient

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3901919/
 systemic complications

Liposuction sepsis
Left: at time of presentation Middle: debrided wound Right: 6 months after sepsis
safe procedures to reduce complications
PRE-OPERATIVE

1. Time from gastric bypass to body contouring procedures

2. Stable patients weight (BMI)
3. Medical comorbidities
4. Nutritional assessment
5. Social history – smoking cessation
6. Medications
7. Unrealistic expectations in patients:
body dysmorphic, eating disorder, psychiatric history
safe procedures to reduce complications
PERI-OPERATIVE

Completion of
Right patient, Critical event instrument,
site & procedure anticipation sponge &
needle counts
safe procedures to reduce complications
POST-OPERATIVE

1. patient positioning
2. pain management
3. thromboembolic prophylaxis
4. bleeding control from catheter
5. prevention of other complications
references
1. Naghshineh N, Rubin JP. Preoperative evaluation of the body contouring patient: the cornerstone of patient safety.
Clin Plastic Surg. 2014;41(4):637-43
2. Ellsworth WA, Basu CB, Iverson RE. Perioperative considerations for patient safety during cosmetic surgery-
preventing complications. Can J Plast Surg. 2009;17(1):9-16.
3. Surgical safety checklist. World Health Organization; 2009 [cited 7 December 2018]. Available from:
https://www.who.int/patientsafety/safesurgery/checklist/en/
4. Postoperative care. World Health Organization; 2003 [cited 7 December 2018]. Available from:
https://www.who.int/surgery/publications/Postoperativecare.pdf
5. Shridhrani SM. Liposuction Devices : Technology Update. Med Devices (auckl).2014;7:241-251
6. DDixit VV, Wagh MS. Unfavourable outcomes of liposuction and their management. Indian J Plast Surg.
2013;46(2):377-92.
7. Dhami LD. Liposuction. Indian J Plast Surg. 2008;41(Suppl):S27-40.
8. Christodoulos Kaoutzanis. Cosmetic Liposuction: Preoperative Risk Factors, Major Complication Rates, and Safety of
Combined Procedures, Aesthetic Surgery Journal, Volume 37, Issue 6, 1 June 2017, Pages 680–694
9. Bell MSG, Doherty GP, Gutauskas A. Liposuction sepsis – be alert. Can J Plast Surg 2009;17(4):e29-e32.