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Liposuction

  • Eric Swanson
Chapter

Abstract

Ideal body proportions call for a low (0.70) waist-to-hip ratio in women. Liposuction remains the gold standard for treatment of body disproportion and provides a lasting improvement in body contours. On average, the fat thickness is reduced 45.6% after liposuction and two-thirds of the swelling is gone in 1 month. It takes about 3 months for the swelling to completely resolve. Today, many patients elect to have buttock fat transfer, reducing the role of thermal systems to dissolve fat cells.

Ultrasound scans are used to detect abdominal wall defects and avoid penetration of the abdominal wall with the cannula. A superwet infusion (1:1 infusion-to-aspirate ratio) is recommended to avoid overhydration. Patients are positioned supine and then turned from side to side to perform the infusion, avoiding prone positioning. The sequence is repeated for liposuction. The number of incisions is minimized. The abdomen is cross-hatched, while the patient is on her side to most effectively treat the upper abdomen. The arms and axillary areas are frequently included. Many patients (30%) undergo simultaneous facial or breast cosmetic surgery. Aspirate volumes rarely exceed 5 L.

Women drop an average of 1.7 dress sizes after liposuction. Men lose, on average, 1.4 in. at the waist. The average time off work after liposuction is 5.7 days. The mean pain rating is 6.1 on a scale of 1–10. Patients feel “back to normal” and return to exercising 1 month after liposuction, on average. Patient satisfaction is 82.5%, and 93.5% of patients would recommend liposuction to others.

Keywords

Liposuction Ultrasonic Superwet Tumescent Infusion Aspirate Contours Cannulae 

References

  1. 1.
    Singh D. Adaptive significance of female physical attractiveness: role of waist-to-hip ratio. J Pers Soc Psychol. 1993;65:293–307.CrossRefPubMedGoogle Scholar
  2. 2.
    Singh D. Body fat distribution and perception of desirable female body shape by young black men and women. Int J Eat Disord. 1994;16:289–94.CrossRefPubMedGoogle Scholar
  3. 3.
    Singh D, Luis S. Ethnic and gender consensus for the effect of waist-to-hip ratio on judgment of women’s attractiveness. Hum Nat. 1995;6:51–65.CrossRefPubMedGoogle Scholar
  4. 4.
    Etcoff N. Survival of the prettiest. The science of beauty. New York, NY: Anchor Books; 2000. p. 192.Google Scholar
  5. 5.
    Tovee MJ, Mason SM, Emery JL, McClusky SE, Cohen-Tovee EM. Supermodels: stick insects or hour-glasses? Lancet. 1997;350:1474–5.CrossRefPubMedGoogle Scholar
  6. 6.
    National Institute of Diabetes and Digestive and Kidney Diseases. Overweight & obesity statistics. https://www.niddk.nih.gov/health-information/health-statistics/overweight-obesity. Accessed August 28, 2017.
  7. 7.
    2016. Cosmetic plastic surgery statistics. American Society of Plastic Surgeons website. https://www.plasticsurgery.org/documents/News/Statistics/2016/plastic-surgery-statistics-full-report-2016.pdf. Accessed August 28, 2017.
  8. 8.
    Giese SY, Bulan EJ, Commons GW, Spear SL, Yanovski JA. Improvements in cardiovascular risk profile with large-volume liposuction: a pilot study. Plast Reconstr Surg. 2001;108:510–9.CrossRefPubMedGoogle Scholar
  9. 9.
    Swanson E. Assessment of reduction in subcutaneous fat thickness after liposuction using magnetic resonance imaging. J Plast Reconstr Aesthet Surg. 2012;65:128–30.CrossRefPubMedGoogle Scholar
  10. 10.
    Stevens WG, Bachelor EP. Cryolipolysis conformable-surface applicator for nonsurgical fat reduction in lateral thighs. Aesthet Surg J. 2015;35:66–71.CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Swanson E. Cryolipolysis: the importance of scientific evaluation of a new technique. Aesthet Surg J. 2015;35:NP116–9.CrossRefPubMedGoogle Scholar
  12. 12.
    Prado A, Andrades P, Danilla S, Leniz P, Castillo P, Gaete F. A prospective, randomized, double-blind, controlled clinical trial comparing laser-assisted lipoplasty with suction-assisted lipoplasty. Plast Reconstr Surg. 2006;118:1032–45.CrossRefPubMedGoogle Scholar
  13. 13.
    Apfelberg D. Results of a multicenter study of laser-assisted liposuction. Clin Plast Surg. 1996;23:713–9.PubMedGoogle Scholar
  14. 14.
    Swanson E. Does laser assistance reduce blood loss after liposuction? Aesthet Surg J. 2015;35:NP38–9.CrossRefPubMedGoogle Scholar
  15. 15.
    Illouz YG. Body contouring by lipolysis: a 5-year experience with over 3,000 cases. Plast Reconstr Surg. 1983;72:591–7.CrossRefPubMedGoogle Scholar
  16. 16.
    Zocchi M. Ultrasonic liposculpting. Aesthetic Plast Surg. 1992;16:287–98.CrossRefPubMedGoogle Scholar
  17. 17.
    Rohrich RJ, Ha RY, Kenkel JM, Adams WP. Classification and management of gynecomastia: defining the role of ultrasound-assisted liposuction. Plast Reconstr Surg. 2003;111:909–23. discussion, 924–925.CrossRefPubMedGoogle Scholar
  18. 18.
    Zocchi ML. Ultrasound-assisted lipoplasty: technical refinements and clinical evaluations. Clin Plast Surg. 1996;23:575–98.PubMedGoogle Scholar
  19. 19.
    Rohrich RJ, Morales DE, Krueger JE, et al. Comparative lipoplasty analysis of in vivo-treated adipose tissue. Plast Reconstr Surg. 2000;105:2152–8. discussion 2159–2160.CrossRefPubMedGoogle Scholar
  20. 20.
    Wall SH, Lee MR. Separation, aspiration, and fat equalization: SAFE liposuction concepts for comprehensive body contouring. Plast Reconstr Surg. 2016;138:1192–201.CrossRefPubMedGoogle Scholar
  21. 21.
    Swanson E. Prospective clinical study reveals significant reduction in triglyceride level and white cell count after liposuction and abdominoplasty and no change in cholesterol levels. Plast Reconstr Surg. 2011;128:182e–97e.CrossRefPubMedGoogle Scholar
  22. 22.
    Bylaws of the American Society of Plastic Surgeons. https://www.plasticsurgery.org/documents/Governance/asps-bylaws.pdf. Accessed August 28, 2017.
  23. 23.
    Bylaws of the American Society for Aesthetic Plastic Surgery. https://www.surgery.org/sites/default/files/ASAPS-2014-Bylaws.pdf. Accessed August 28, 2017.
  24. 24.
    Swanson E. The case against chemoprophylaxis for venous thromboembolism prevention and the rationale for SAFE anesthesia. Plast Reconstr Surg Glob Open. 2014;2:e160.CrossRefPubMedPubMedCentralGoogle Scholar
  25. 25.
    Swanson E, Gordon R. Comparing a propofol infusion with general endotracheal anesthesia in plastic surgery patients. Aesthet Surg J. 2017;37:NP48–50.CrossRefPubMedGoogle Scholar
  26. 26.
    Swanson E. Prospective outcome study of 360 patients treated with liposuction, lipoabdominoplasty, and abdominoplasty. Plast Reconstr Surg. 2012;129:965–78. discussion 979–980.CrossRefPubMedGoogle Scholar
  27. 27.
    Swanson E. Prospective study of lidocaine, bupivacaine and epinephrine levels and blood loss in patients undergoing liposuction and abdominoplasty. Plast Reconstr Surg. 2012;130:702–22. discussion 723–725.CrossRefPubMedGoogle Scholar
  28. 28.
    Connors J. Abdominal wall high definition lipo-sculpting video. Presented at ASPS Aesthetica Symposium. New Orleans; March 2-4, 2017.Google Scholar
  29. 29.
    Kosowski TR, McCarthy C, Reavey PL, et al. A systematic review of patient-reported outcome measures after facial cosmetic surgery and/or nonsurgical facial rejuvenation. Plast Reconstr Surg. 2009;123:1819–27.CrossRefPubMedGoogle Scholar
  30. 30.
    Claphan PJ, Pushman AG, Chung KC. A systematic review of applying patient satisfaction outcomes in plastic surgery. Plast Reconstr Surg. 2010;125:1826–33.CrossRefGoogle Scholar
  31. 31.
    Ching S, Thoma A, McCabe RE, Antony MM. Measuring outcomes in aesthetic surgery: a comprehensive review of the literature. Plast Reconstr Surg. 2003;111:469–80.CrossRefPubMedGoogle Scholar
  32. 32.
    Sackett DL, Straus SE, Richardson WS, Rosenberg W, Haynes RB. Evidence-based Medicine. 2nd ed. Churchill Livingstone: Toronto, ON; 2000. p. 109.Google Scholar
  33. 33.
    Chung KC, Swanson JA, Schmitz D, Sullivan D, Rohrich RJ. Introducing evidence-based medicine to plastic and reconstructive surgery. Plast Reconstr Surg. 2009;123:1385–9.CrossRefPubMedPubMedCentralGoogle Scholar
  34. 34.
    Chung KC, Kalliainen LK, Spilson SV, Walters MR, Kim HM. The prevalence of negative studies with inadequate statistical power: an analysis of the plastic surgery literature. Plast Reconstr Surg. 2002;109:1–6. discussion 7–8.CrossRefPubMedGoogle Scholar
  35. 35.
    Sarwer DB, Wadden TA, Pertschuk MJ, Whitaker LA. Body image dissatisfaction and body dysmorphic disorder in 100 cosmetic surgery patients. Plast Reconstr Surg. 1998;101:1644–9.CrossRefPubMedGoogle Scholar
  36. 36.
    Augustin M, Zschocke I, Sommer B, Sattler C. Sociodemographic profile and satisfaction with treatment of patients undergoing liposuction in tumescent local anesthesia. Dermatol Surg. 1999;25:480–3.CrossRefPubMedGoogle Scholar
  37. 37.
    Broughton G, Horton B, Lipschitz A, Kenkel JM, Brown SA, Rohrich RJ. Lifestyle outcomes, satisfaction, and attitudes of patients after liposuction: a Dallas experience. Plast Reconstr Surg. 2006;117:1738–49.CrossRefPubMedGoogle Scholar
  38. 38.
    Momeni A, Heier M, Torio-Padron N, Penna V, Bannasch H, Stark BG. Correlation between complication rate and patient satisfaction in abdominoplasty. Ann Plast Surg. 2009;62:5–6.CrossRefPubMedGoogle Scholar
  39. 39.
    Masoumi Lari SJ, Roustaei N, Roshan SK, Chalian M, Chalian H, Honarbakhsh Y. Determinants of patient satisfaction with ultrasound-assisted liposuction. Aesthet Surg J. 2010;30:714–9.CrossRefPubMedGoogle Scholar
  40. 40.
    Hanke W, Cox SE, Kuznets N, Coleman WP III. Tumescent Liposuction Report Performance Measurement Initiative: national survey results. Dermatol Surg. 2004;30:967–78.PubMedGoogle Scholar
  41. 41.
    Dillerud E, Håheim LL. Long-term results of blunt suction lipectomy assessed by a patient questionnaire survey. Plast Reconstr Surg. 1993;92:35–42.CrossRefPubMedGoogle Scholar
  42. 42.
    Goyen MR. Lifestyle outcomes of tumescent liposuction surgery. Dermatol Surg. 2002;28:459–62.PubMedGoogle Scholar
  43. 43.
    Lari SJM, Roustaei N, Roshan SK, Chalian M, Chalian H, Honarbakhsh Y. Determinants of patient satisfaction with ultrasound-assisted liposuction. Aesthet Surg J. 2010;30:714–9.CrossRefGoogle Scholar
  44. 44.
    Swanson E. Prospective clinical study of 551 cases of liposuction and abdominoplasty performed individually and in combination. Plast Reconstr Surg Glob Open. 2013;1:e32.CrossRefPubMedPubMedCentralGoogle Scholar
  45. 45.
    Roustaei N, Lari SJM, Chalian M, Chalian H, Bakhshandeh H. Safety of ultrasound-assisted liposuction: a survey of 660 operations. Aesthetic Plast Surg. 2009;33:213–8.CrossRefPubMedGoogle Scholar
  46. 46.
    Zakine G, Baruch J, Dardour J-C, Flageul G. Perforation of viscera, a dramatic complication of liposuction: a review of 19 cases evaluated by experts in France between 2000 and 2012. Plast Reconstr Surg. 2015;135:743–50.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG 2018

Authors and Affiliations

  • Eric Swanson
    • 1
  1. 1.Swanson CenterLeawoodUSA

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