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Liposuction Techniques
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Question: Why do bariatic surgeons only seem to offer gastric
banding whilst plastic surgeons don't want to know about large volume
liposuction?
I have been doing some research to understand my
options for the treatmentof obesity
I am male, mid-forties and I have had a number of
related treatments:
- Olistat
- CPAP for sleep apnoea
- exercise
- consultation with diatician
Malaria - this worked well, but I was back to my
normal weight in about a year
A number of studies
suggest that large volume liposuction has fewer
unpleasant side effects,
and results in long term stable weight loss.
Are there any rational reasons for the plastic
surgeon's objections? Or are they
just motivated by the documented antipathy to fat
people (another article in medline)?
Why is gastric band (or other gastric bypass) surgery
so favoured when it seems to
have so many unpleasant side effects?
Since we seem to be having a worldwide (rich world
anyway) epidemice of obesity,
why is this debate not going on?
Answer: Since the advent of epinephrine-containing wetting
solutions and sophisticated fluid management
techniques, increasingly larger and larger volumes of
liposuction aspirations have been reported.
Unfortunately, with these larger volumes of
liposuction being routinely performed, greater rates
of complications have also been reported, with the
worst of these resulting in deaths. In a response to
the increasing concerns over the safety of
large-volume liposuction, a critical review of the
senior author's own series has been performed to
evaluate risks and benefits and to recommend
guidelines for safe and effective large-volume
liposuction. A retrospective chart review was
performed on 631 consecutive patients who underwent
liposuction procedures of at least 3000 cc total
aspirate. All procedures were performed by the same
senior surgeon between January of 1986 and March of
1998. Before September of 1996, traditional
liposuction techniques were used. After September of
1996, ultrasound-assisted liposuction was performed.
The superwet technique of fluid management was
employed for all procedures performed after 1991. The
particulars of the surgical and anesthetic techniques
used are reviewed in the article. Data collection
included preoperative patient demographics,
preoperative and postoperative weights and
measurements, and preoperative and postoperative
photographs. Total aspirate volumes, fluid intakes,
and fluid outputs were measured, and all complications
were tallied. Average follow-up was 1 year.Results
showed the majority of patients to be women, aged 17
to 74 years old. Of the preoperative weights, 98.7
percent were within 50 pounds of ideal chart weight.
Total aspirate volumes ranged from 3 to 17 liters,
with 94.5 percent of these under 10 liters. Fluid
balance measurements showed an average of 120 cc/kg
positive fluid balance at the end of the procedure,
with none of these patients experiencing any
significant fluid balance abnormalities. Cosmetic
results were good, with a 2- to 6-inch drop from
preoperative measurements, depending on the area
treated. Ten percent of patients experienced minor
skin contour irregularities, with most of these
patients not requiring any additional surgical
procedures. One year after surgery, 80 percent of
patients maintained stable postoperative weights. No
serious complications were experienced in this series.
The majority of the complications consisted of minor
skin injuries and burns, allergic reactions to
garments, and postoperative seromas.
These patients were treated
appropriately and went on to have uneventful
recoveries. The results show that large-volume
liposuction can be a safe and effective procedure when
patients are carefully selected and when anesthetic
and surgical techniques are properly performed.
Meticulous fluid balance calculations are necessary to
avoid volume abnormalities, and experience is
mandatory when performing the largest aspirations.
Cosmetic benefits are excellent, and overall
complication rates are low.
Comment:
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