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Large-Volume Liposuction for Obesity
Abstract
Liposuction surgery has generally been divided into volume liposuction and liposculpture [1]. In the former, large volumes of fat are aspirated in order to substantially improve the shape and contour of the body. This is a form of surgery directed towards the control of aesthetics and health in general and it can even be used in cases of true obesity. In liposculpture, small fat deposits are aspirated with the sole purpose of giving the body a better shape. This surgery is basically practiced for aesthetic reasons. However, a new technique has been developed in which large volumes of fat are aspirated and body contour is improved at the same time. Attention is paid to detail, especially in the flanks, back, waist, and hips [1]. The word sculpture come from the Latin sculpere, meaning to carve or scratch. It is a variant of scalpere, from which the English word scalpel is derived. Its past participle, sculptus, and the noun sculptura are other variants from which the word sculpture gets its origin [2]. The traditional volume liposuction implies performing large aspirations from specific sites of the body [3]. The authors' goal is to perform liposuction surgery for the whole body. In other words, the surgery is performed in different parts of the body at the same time. This is a combination of volume liposuction and liposculpture called volume liposculpture [1] (Table 63.1). Because of cultural, social, and ethnic reasons, most of the patients operated on are overweight. (Table presented).
... In addition to the obvious cosmetic effects, liposuction can change the body composition, as well as the hormonal balance and psychology of the consumers [25]. Findings have proven that liposuction treatment can minimize cardiovascular risks [29]. Nevertheless, consumers still need to control their daily diet after the treatment to maintain their body figure appearance. ...
Slimming centres are one of the popular places to reshape one’s body figure in Malaysia.
Technology innovations are being used by the slimming centres to provide slimming treatments. This
research looks at the preferred treatments that are commonly offered by slimming centres in Malaysia.
Primary data were collected through a survey questionnaire. The unit of analysis were those consumers who
had experienced consuming treatment in slimming centres. The data were collected based on a multiple
response questionnaire and analysed using Statistical Package for the Social Sciences (SPSS). It was found
that the majority of consumers had experience of consuming more than one treatment in slimming centres
since the majority of slimming centres offer slimming treatments in the form of a package. Those slimming
centres that offer more treatments within a package might appear more attractive to consumers. This
research highlights the most common treatments that are normally experienced by the consumers.
Entrepreneurship is a vital economic activity to support local communities. It is perceived as a significant avenue for influencing the youngsters to a start-up business. The growing number of graduates annually has become one of the main challenges for the Omani government. Therefore, entrepreneurship has become one of the essential measures for reducing the escalating unemployment rate due to the low national recruitment rate in the public and private sectors in Oman. This research aims to examine the extent of the entrepreneurial intention of youngsters, especially among 322 tertiary students from colleges of applied sciences in Oman, to venture into entrepreneurship through the flea market retailing by adopting the theory of planned behavior (TPB). The findings highlight the impact of education on entrepreneurial intentions, which will provide resources in the area of entrepreneurial education to online libraries for research students and also provides useful policy directions to the Oman government in its effort to actively promote entrepreneurship and business ventures through the Al Raffd Funds.
Advances in liposuction, primarily involving the tumescent technique of local anesthesia, have fostered the advent of large-volume liposuction. Such major alterations in the volume of an organ system must have physiologic implications. This paper attempts to describe fat metabolism as it relates to fat storage and expenditure and the possible effects of large-volume liposuction on fat metabolism.
The paper presents a refresher on the Ten Commandments of Liposuction, and safe techniques for superficial liposculpture are also presented. Recent litigation and unsafe practices are discussed. Goode v. Goodstein illustrates that superficial liposculpture using undermining and sharp instruments should be avoided because it can cause permanent vascular damage, nerve damage, and scarring. Superficial liposculpture using tunnels and thin cannulas can be safely performed.
The effect of liposuction on serum lipids is unknown. This study evaluated the reduction in lipid levels following suction-assisted lipectomy (SAL) in 23 patients with preoperative elevated serum lipids. Sixty-five percent (15 patients) had reduction in lipids following SAL. The mechanism of this change is unknown and further, better controlled, studies are necessary.
Technique, correct instruments, skin elasticity, consistency of the adipose tissue, muscular tone, force of gravity, and the surgeons' ability are factors that determine the quality of liposculpture. As liposuction has evolved, the instruments and techniques have been refined and complications have lessened. This paper discusses historical aspects of the development of liposculpture.
Over the past few years, accidents involving liposuction surgery (LS) have led to serious complications and death These outcomes have been well publicized, especially in the case of show-business people who suffered serious complications. This bad publicity has cast a shadow over the procedure and generated much tendentious information - that the surgery is extremely dangerous, that only plastic surgeons should perform it, and that it is safely earned out only in hospitals. Are these ideas facts, fearful notions, or products of a hostile campaign of misinformation? To clarify the situation, we review the history of LS and its advances, discuss the procedure as practiced in the United States and Latin America, and analyze the data on serious complications and mortality. Our findings are that (1) well-performed LS is safe; (2) most of the procedures that resulted in serious complications and deaths were performed by plastic surgeons, far fewer by cosmetic surgeons, and none by dermatologists; and (3) most accidents occurred in hospitals, not in "surgicenters.".
When compared to conventional tumescent liposuction (CTL), external ultrasonic tumescent liposuction (EUTL) has been presented as provoking less bleeding, giving improved aesthetic results, faster recovery of the patient, and less effort by the surgeon. CTL and EUTL were compared, with special attention to clinical, physical, chemical, and microscopic results. EUTL demonstrated higher amount of triglycerides in the aspirated fluid but lower amount of proteins than CTL. The percentage of damaged adipocytes was higher in EUTL, while in CTL the connective tissue and vessels were higher. Cosmetic results, recovery time, and complications were similar at both sides. The changes, observed were more microscopic, physical, and chemical than related to patients' cosmetic outcome. If the correct tumescence is used, EUTL is not better than CTL alone.
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Surgical removal of adipose tissue is a widely practised form of plastic surgery most often aimed at correcting cosmetic defects after extreme weight reduction such as a pendulous abdomen. However, it has not been proposed as a cure for obesity. Evidence for an interaction between the adipose tissue mass and regulation of food intake and energy balance might suggest that a reduction of body fat could favorably influence obesity. This study presents body composition data on five patients with a mean body weight of 136 kg with hyperplastic obesity who after a mean weight reduction of 46 kg by conventional therapy were subjected to extensive plastic surgery aimed at removing supernumerary fat cells. Analysis of adipose tissue cellularity revealed that 12-18% of the total number of fat cells were removed by combinations of abdominoplasty and lumbar and femoral adipectomy. There were no indications that this reduction of adipose tissue mass could prevent the recurrence of obesity in these patients, though there was no evidence for regeneration of adipose tissue in situ.
Since the importation of liposuction surgery into the United States more than a decade ago, we have witnessed a number of major technique changes and practice trends occur. One of us (L.M.F.) was the first dermatologic surgeon to undergo the "lipsuction experience" (Paris, 1977) under the tutelage of Giorgio and Arpad Fisher and Pierre Fournier, and another (R.S.N.) the first to undergo training with Yves Illouz (also Paris). All three co-workers have served on teaching faculties of both the International and American Societies for Dermatologic Surgery, the American Society of Liposuction Surgery, and the American Academy of Cosmetic Surgery, have performed many hundreds of procedures, and have lectured/published on this subject on repeated occasions. We recognize certain vital changes and expansions have occurred during the past decade, and share our impressions of these with you.
Diabetes mellitus is commonly associated with systolic/diastolic hypertension, and a wealth of epidemiological data suggest that this association is independent of age and obesity. Much evidence indicates that the link between diabetes and essential hypertension is hyperinsulinemia. Thus, when hypertensive patients, whether obese or of normal body weight, are compared with age- and weight-matched normotensive control subjects, a heightened plasma insulin response to a glucose challenge is consistently found. A state of cellular resistance to insulin action subtends the observed hyperinsulinism. With the insulin/glucose-clamp technique, in combination with tracer glucose infusion and indirect calorimetry, it has been demonstrated that the insulin resistance of essential hypertension is located in peripheral tissues (muscle), is limited to nonoxidative pathways of glucose disposal (glycogen synthesis), and correlates directly with the severity of hypertension. The reasons for the association of insulin resistance and essential hypertension can be sought in at least four general types of mechanisms: Na+ retention, sympathetic nervous system overactivity, disturbed membrane ion transport, and proliferation of vascular smooth muscle cells. Physiological maneuvers, such as calorie restriction (in the overweight patient) and regular physical exercise, can improve tissue sensitivity to insulin; evidence indicates that these maneuvers can also lower blood pressure in both normotensive and hypertensive individuals. Insulin resistance and hyperinsulinemia are also associated with an atherogenic plasma lipid profile. Elevated plasma insulin concentrations enhance very-low-density lipoprotein (VLDL) synthesis, leading to hypertriglyceridemia. Progressive elimination of lipid and apolipoproteins from the VLDL particle leads to an increased formation of intermediate-density and low-density lipoproteins, both of which are atherogenic. Last, insulin, independent of its effects on blood pressure and plasma lipids, is known to be atherogenic. The hormone enhances cholesterol transport into arteriolar smooth muscle cells and increases endogenous lipid synthesis by these cells. Insulin also stimulates the proliferation of arteriolar smooth muscle cells, augments collagen synthesis in the vascular wall, increases the formation of and decreases the regression of lipid plaques, and stimulates the production of various growth factors. In summary, insulin resistance appears to be a syndrome that is associated with a clustering of metabolic disorders, including non-insulin-dependent diabetes mellitus, obesity, hypertension, lipid abnormalities, and atherosclerotic cardiovascular disease.
The tumescent technique for local anesthesia permits regional local anesthesia of the skin and subcutaneous tissues by direct infiltration. The tumescent technique uses large volumes of a dilute anesthetic solution to produce swelling and firmness of targeted areas. This investigation examines the absorption pharmacokinetics of dilute solutions of lidocaine (0.1% or 0.05%) and epinephrine (1:1,000,000) in physiologic saline following infiltration into subcutaneous fat of liposuction surgery patients. Plasma lidocaine concentrations were measured repeatedly over more than 24 hours following the infiltration. Peak plasma lidocaine levels occurred 12-14 hours after beginning the infiltration. Clinical local anesthesia is apparent for up to 18 hours, obviating the need for postoperative analgesia. Dilution of lidocaine diminishes and delays the peak plasma lidocaine concentrations, thereby reducing potential toxicity. Liposuction reduces the total amount of lidocaine absorbed systemically, but does not dramatically reduce peak plasma lidocaine levels. A safe upper limit for lidocaine dosage using the tumescent technique is estimated to be 35 mg/kg. Infiltrating a large volume of dilute epinephrine assures diffusion throughout the entire targeted area while avoiding tachycardia and hypertension. The associated vasoconstriction is so complete that there is virtually no blood loss with liposuction. The tumescent technique can be used with general anesthesia or IV sedation. However, with appropriate instrumentation and surgical method, the tumescent technique permits liposuction of large volumes of fat totally by local anesthesia, without IV sedation or narcotic analgesia.
The tumescent technique, developed by dermatologists, has revolutionized the approach to liposuction. It has eliminated concerns about blood loss, fluid replacement and fluid shifts, and the risks and morbidity of general anesthesia. It has also significantly decreased the cost of liposuction by eliminating the need for general anesthesia, an anesthesiologist, a hospital or outpatient operating room, and the need for blood transfusion.
It is clear that central obesity is a strong predictor of multiple health risks. It appears likely that much of the influence for the preferential deposition of fat in these various stores is related to sex hormones, although other factors clearly play a role, including genetic, environmental, nutritional, and other factors. Whereas a great deal has been discovered about these relationships in the past 10 years, further study is necessary to clarify them and determine what role dietary and surgical interventions may play in the prevention and reversal of those risk factors.
Dermatologists have been involved in liposuction even before its introduction into the United States. Liposuction has rapidly become part of the dermatologic surgeon's armamentarium. Dermatologic surgeons have been innovators in teaching and research in liposuction. They have been largely responsible for developments in fat transfer surgery.
In March of 1988, a survey form was sent to all 2695 U.S. and Canadian members of the American Society of Plastic and Reconstructive Surgeons. Nine-hundred and thirty-five members responded, for a response rate of 34.7 percent. The purpose of the survey was to ascertain the total number of major liposuction, dermatolipectomy, and abdominoplasty procedures performed from January of 1984 to January of 1988 and to compare nine specific complications that are associated with these three procedures. The 935 surgeons reported a total of 112,756 procedures performed: major liposuction (75,591), dermatolipectomy (10,603), and abdominoplasty (26,562). Nine major complications were surveyed: mortality, myocardial infarction, cerebrovascular accident or transient ischemic attack, pulmonary thromboembolism, fat embolism, major skin loss, anesthesia complication, transfusion complications, and deep venous thrombosis. The findings in this survey showed, when comparing these three procedures and the nine types of complications, that the complication rate for major suction lipectomy was 0.1 percent, for dermatolipectomy 0.9 percent, and for abdominoplasty 2.0 percent. Fat emboli did not prove to be a significant factor associated with any of the three procedures. However, of the 15 reported deaths (major liposuction 2, dermatolipectomy 2, and abdominoplasty 11), pulmonary thromboembolism was the causative factor in 9 deaths (60 percent). Based on these analyzed data, we feel that major suction lipectomy has a low complication rate and is a reasonably safe procedure.
Cross-sectional studies have shown that a central distribution of adipose tissue is associated with increased risk of metabolic complications and cardiovascular morbidity. Four prospective studies in men are reviewed and they consistently indicate that central adipose tissue distribution is a risk factor for coronary heart disease (CHD) and its predictive contribution seems almost to be in the same order as for the major risk factors for CHD. In one study there is an indication of decreasing predictive power of central adipose tissue distribution for CHD with increasing age. Abdominal adipose tissue distribution is also a risk factor for stroke, diabetes and sickness absenteeism, and for all cause mortality. It seems, however, not to be a predictor of degree of well-being in general. The question of causality is not solved but indices of adipose tissue distribution should be included in future observational and experimental studies in this field.
The results presented in this paper concerning regional obesity as a health hazard in women refer to a 12-year longitudinal population study of 1,462 women, aged 38-60, which was carried out in Gothenburg, Sweden, in 1968-69. In univariate analysis the ratio of waist-to-hip circumference showed a significant positive association with the 12-year incidence of myocardial infarction, angina pectoris, stroke, diabetes mellitus and death. The association with incidence of myocardial infarction and diabetes mellitus remained in multivariate analysis. The relation between the ratio of waist-to-hip circumference and the end points studied was stronger than for any other anthropometric variable studied.
It is well establised that obesity is often associated with insulin resistance and type II diabetes. It was early shown that hyperinsulinemia accompanies obesity as a marker of the insulin resistance, and that fasting insulin levels in the plasma correlate with the degree of obesity. The existence of insulin resistance in obese subjects has also been documented in a number of studies in vivo. The fact that not all obese subjects suffer from impaired glucose tolerance is explained by the individual variation of capacity to increase insulin secretion. However, it is also evident that not all obese subjects are equally insulin resistant. The finding that the abdominal distribution of fat tissue in the individuals correlates with the various metabolic aberrations related with type II diabetes suggests that obese subjects with an abdominal fat distribution are more prone than others to develop insulin resistance. It has, in fact, been shown recently in several studies that abdominal, but not gluteal, obesity is correlated with insulin resistance and glucose intolerance. Furthermore, population studies have shown that a high waist/hip ratio as a marker for abdominal fat distributions a better predictor of glucose intolerance than the degree of obesity. In studies where selected obese subjects have been investigated, body fat and waist/hip ratio seem to be two independent factors correlating with glucose intolerance.
Recent research has shown the marked differences in association with disease between obesity localized to the abdominal respectively to the gluteal-femoral regions. In this review systematic analyses were performed of the associations between obesity (body mass index, BMI) or abdominal obesity (increased waist-over-hip circumference ratio, WHR) on the one hand, and a number of disease end points, and their risk factors, as well as other factors on the other, WHR was associated with cardiovascular disease, premature death, stroke, non-insulin-dependent diabetes mellitus and female carcinomas. In contrast, BMI tended to be negatively correlated to cardiovascular disease, premature death, and stroke, but positively to diabetes. The established risk factors for these end points were found to correlate to WHR, while this was often not the case with BMI. BMI was positively correlated only to insulin, triglycerides and blood pressure. Together with diabetes mellitus, this seems to constitute a metabolic group of conditions which are thus associated with BMI. Androgens (in women), and perhaps cortisol, seem to be positively, and progesterone negatively correlated to WHR. The WHR was also positively associated with sick leave, several psychological maladjustments, psychosomatic and psychiatric disease. Attempts were made to interpret these findings. In a first alternative an elevation of FFA concentration, produced from abdominal adipose tissue, was considered to be the trigger factor for the pathologic aberrations associated with abdominal distribution of body fat. When obesity is added, the metabolic aberrations may be exaggerated. In a second alternative adrenal cortex hyperactivity was tested as the cause. When combined with the FFA hypothesis, this might explain many but not all of the findings. It seems possible to produce an almost identical syndrome in primates by defined experimental stress. Women with high WHR were found to have a number of symptoms of poor coping to stress. It was therefore suggested that part of the background to this syndrome might be a hypothalamic arousal syndrome developing with stress. It was concluded that obesity and abdominal distribution of adipose tissue constitute two separate entities with different pathogenesis, clinical consequences and probably treatment.
In a prospective study of risk factors for ischaemic heart disease 792 54 year old men selected by year of birth (1913) and residence in Gothenburg agreed to attend for questioning and a battery of anthropometric and other measurements in 1967. Thirteen years later these baseline findings were reviewed in relation to the numbers of men who had subsequently suffered a stroke, ischaemic heart disease, or death from all causes. Neither quintiles nor deciles of initial indices of obesity (body mass index, sum of three skinfold thickness measurements, waist or hip circumference) showed a significant correlation with any of the three end points studied. Statistically significant associations were, however, found between the waist to hip circumference ratio and the occurrence of stroke (p = 0.002) and ischaemic heart disease (p = 0.04). When the confounding effect of body mass index or the sum of three skinfold thicknesses was accounted for the waist to hip circumference ratio was significantly associated with all three end points. This ratio, however, was not an independent long term predictor of these end points when smoking, systolic blood pressure, and serum cholesterol concentration were taken into account. These results indicate that in middle aged men the distribution of fat deposits may be a better predictor of cardiovascular disease and death than the degree of adiposity.
A longitudinal population study of 1462 women aged 38-60 was carried out in Gothenburg, Sweden, in 1968-9. In univariate analysis the ratio of waist to hip circumference showed a significant positive association with the 12 year incidence of myocardial infarction, angina pectoris, stroke, and death. The association with incidence of myocardial infarction remained in multivariate analysis and was independent of age, body mass index, smoking habit, serum cholesterol concentration, serum triglyceride concentration, and systolic blood pressure. The relation between the ratio of waist to hip circumference and the end points of myocardial infarction, angina pectoris, stroke, and death was stronger than for any other anthropometric variable studied.
Abdominal fat distribution has been compared in 25 men and 25 women by computed tomography (CT) at the level of the umbilicus. Men have significantly more fat within the abdominal cavity. Women have similar total fat, but store a greater proportion of it in their subcutaneous tissues. For this reason, abdominal CT may prove to be more accurate in males than in females.
Tumescent liposuction is a new method of liposuction under local anesthesia that has been developed by dermatologic surgeons.
To determine the safety of tumescent liposuction in a large group of patients treated by dermatologic surgeons.
A survey questionnaire was sent to 1,778 Fellows of the American Society for Dermatologic Surgery in February 1994. The comprehensive questionnaire requested information on numbers of patients treated with tumescent liposuction and complications that occurred.
Sixty-six dermatologic surgeons provided data on 15,336 patients. The complications that were reported were infrequent and minor. There were no serious complications such as death, embolism (pulmonary or fat), hypovolemic shock, perforation of peritoneum or thorax, or thrombophlebitis. Blood transfusions were not required in any of the 15,336 patients and there were no admissions to the hospital for treatment of complications.
Tumescent liposuction is an exceptionally safe method of liposuction under local anesthesia that eliminates the necessity of general anesthesia and blood transfusions. Tumescent liposuction is safer than liposuction under general anesthesia and results in fewer complications.
The tumescent technique for local anesthesia improves the safety of large-volume liposuction ( > or = 1500 ml of fat) by virtually eliminating surgical blood loss and by completely eliminating the risks of general anesthesia. Results of two prospective studies of large-volume liposuction using the tumescent technique are reported. In 112 patients, the mean lidocaine dosage was 33.3 mg/kg, the mean volume of aspirated material was 2657 ml, and the mean volume of supernatant fat was 1945 ml. The mean volume of whole blood aspirated by liposuction was 18.5 ml. For each 1000 ml of fat removed, 9.7 ml of whole blood was suctioned. In 31 large-volume liposuction patients treated in 1991, the mean difference between preoperative and 1-week postoperative hematocrits was -1.9 percent. The last 87 patients received no parenteral sedation. In a second study, a 75-kg woman received 35 mg/kg of lidocaine on two separate occasions, first without liposuction and 25 days later with liposuction; peak plasma lidocaine concentrations occurred at 14 and 11 hours after beginning the infiltration and were 2.37 and 1.86 micrograms/ml, respectively.
Purpose:
Vascular smooth muscle cell (VSMC) proliferation is an early event in the pathogenesis of atherosclerosis. Insulin and glucose are known to stimulate the growth of VSMC. Cell membrane receptors play an important role in the proliferation of VSMC in response to growth factors. Insulin and insulin-like growth factor-1 (IGF-1) have demonstrated a cross reactivity for receptor binding and function. By using monoclonal antibodies directed against insulin (IRA) and IGF-1 (IGF-1RA) receptors, we attempt to further delineate the mechanism for the proliferation of VSMC in response to insulin and glucose.
Methods:
Human infragenicular VSMC isolated from diabetic patients undergoing below-knee amputations were used. Cells from passages 3 to 6 were grown in serum-free media with a glucose concentrations of 0.1% or 0.2%, both with and without insulin (100 ng/mL). The baseline cell density was 4,635 +/- 329 cells/mL. IRA or IGF-1RA was added to the media, with the control group receiving neither antibody. Cells were grown in 5% CO2 at 37 degrees C for 6 days. Analysis of variance was used for statistical analysis, with P <0.05 considered significant. In addition, DNA synthesis was measured using thymidine incorporation assays in the same groups of cells receiving IRA, IGF-1RA, and no antibody.
Results:
IGF-1RA prevented the proliferation of VSMC in response to insulin and glucose, while IRA had no effect on cell growth. There was no significant growth when IGF-1RA was added to the media, while the control group and the group receiving IRA demonstrated significant growth compared with the baseline concentration of 4,635 +/- 329 cells/mL at all concentrations of insulin and glucose. [3H]thymidine incorporation assays confirmed the cell count results.
Conclusions:
These results suggest that the mitogenic effects of insulin and glucose on infragenicular VSMC are due to stimulation of the IGF-1 receptor. VSMC antiproliferative strategies employing receptor blockade should be directed against the IGF-1 receptor, not the insulin receptor.
There is evidence that intracellular insulin may carry out some insulin mediated actions, including glucose transport. As intracellular insulin has never been quantitatively assessed in human cells, we evaluated its concentrations in monocytes from normal subjects (n = 7) and obese patients without (n = 9) and with Type 2 diabetes mellitus (n = 10). After the incubation of cells with labeled insulin for 60 min at 37 degrees C, intracellular intact insulin concentrations were measured by HPLC and expressed as pmol x 10(-6). Insulin concentrations were higher (ANOVA P < 0.01) within cells from obese (115.4 +/- 26.4 pmol x 10(-6)/2 x 10(5) cells) and obese diabetic patients (93.2 +/- 36.3 pmol x 10(-6)/2 x 10(5) cells) compared with normal cells (28.5 +/- 13.1 pmol x 10(-6)/2 x 10(5) cells). Moreover, after insulin was removed from the incubation medium the decrease of intracellular insulin was significantly lower (P < 0.01) in cells from both obese and obese diabetic patients than in normal subjects. Intracellular undissociated insulin-insulin receptor complexes on average, increased 2-fold (P < 0.01) in cells from insulin resistant patients compared with normal cells. Finally, in downregulated cells from obese and obese diabetic patients, the recycling of the internalized insulin receptor was completely disrupted. In conclusion, monocytes from obese patients with and without Type 2 diabetes mellitus, present increased intracellular insulin concentrations and these conditions are associated with a significant impairment of insulin receptor processing. Increased intracellular insulin concentration in cells from these patients may be necessary in order to overcome insulin resistance.
Troubling reports of adverse outcomes after liposuction prompted a census survey of aesthetic plastic surgeons. All 1200 actively practicing North American board-certified ASAPS members were polled by facsimile, then mail, regarding deaths after liposuction. Patient initials together with case summaries precluded data replication yet assured patient anonymity and preserved surgeon privacy. Incomplete returns or ambiguous findings were authenticated, where feasible, by direct follow-up. Total number of lipoplasties performed by plastic surgeons was interpolated from the ASPRS procedure database for the survey time frame of 1994 to mid-1998. Lacking reliable annual case volume estimates, deaths from lipoplasties performed by non-ABPS surgeons were excluded from the actual mortality rate computation but were included in cause-of-death ranking statistics. Responding aesthetic plastic surgeons (917 of 1200) reported 95 uniquely authenticated fatalities in 496,245 lipoplasties. In this census survey, the mortality rate computed to 1 in 5224, or 19.1 per 100,000. A virtually identical 20.3 per 100,000 mortality rate was obtained in a 1997 random survey commissioned by the parent society. Pulmonary thromboembolism remains as the major killer (23.4+/-2.6 percent); lacking consistent medical examiners' toxicology data, the putative role of high-dose lidocaine cardiotoxicity could not be ascertained. Where so stated, many deaths occurred during the first night after discharge home; prudence suggests vigilant observation for residual "hangover" from sedative/anesthetic drugs after lengthy procedures. Taken together, these two independent surveys peg the late 1990s mortality rate from liposuction at about 20 per 100,000, or 1 in every 5000 procedures. Set beside the 16.4 per 100,000 fatality rates of U.S. motor vehicle accidents, liposuction is not an altogether benign procedure. We do not have comparable mortality data for lipoplasties performed by non-ABPS-certified physicians.
Body mass index (BMI; weight per unit surface area) is the scientific yardstick by which overweight is gauged relative to the population norm. The contrary association between obesity and diabetes or hypertension is only too well known. Less appreciated is the heightened sensitivity to respiratory depressants such as sedatives and analgesics in the obese (BMI >/= 30) and the increased incidence of sleep apnea in the morbidly obese (BMI >/= 35)-either or both of which raise the risk of cosmetic surgery when sedation or anesthesia is contemplated. Guided by the BMI, a gender-independent measure of fatness, the surgeon now can inform the patient of her or his relative operative risk and offer an objective rationale for advising overnight hospitalization rather than office-based day surgery. The BMI is readily calculated when height and weight are expressed in metric units, much less so when measured in foot-pound units. In fact, the calculations are sufficiently cumbersome that the BMI remains underused in U.S. office surgery. The author's complimentary "BMI Calculator"-an Excel workbook available on-line to society members-is designed so that office staff need enter only height (in feet and inches) and weight (in pounds) to print the BMI for the patient's permanent record. The BMI places patient weight relative to height in proper perspective for aesthetic surgery, whether with sedation or under general anesthesia. The BMI ought to be as routine a part of the preoperative assessment as blood pressure or hemoglobin content.
In this study, the authors investigated the physiologic effects of the altered body composition that results from surgical removal of large amounts of subcutaneous adipose tissue. Fourteen women with body mass indexes of greater than > 27 kg/m2 underwent measurements of fasting plasma insulin, triglycerides, cholesterol, body composition by dual-energy x-ray absorptiometry (DXA), resting energy expenditure, and blood pressure before and after undergoing large-volume ultrasound-assisted liposuction. There were no significant intraoperative complications. Body weight had decreased by 5.1 kg (p < 0.0001) by 6 weeks after liposuction, with an additional 1.3-kg weight loss (p < 0.05) observed between 6 weeks and 4 months after surgery, for a total weight loss of 6.5 kg (p < 0.00006). Body mass index decreased from (mean +/- SEM) 28.8 +/- 2.3 to 26.8 +/- 1.5 kg/m2 (p < 0.0001). This change in body weight was primarily the result of decreases in body fat mass: as assessed by DXA, lean body mass did not change (43.8 +/- 3.1 kg to 43.4 +/- 3.6 kg, p = 0.80), whereas DXA total body fat mass decreased from 35.7 +/- 6.3 to 30.1 +/- 6.5 kg (p < 0.0001). There were significant decreases in fasting plasma insulin levels (14.9 +/- 6.5 mIU/ml before liposuction versus 7.2 +/- 3.2 mIU/ml 4 months after liposuction, p < 0.007), and systolic blood pressure (132.1 +/- 7.2 versus 120.5 +/- 7.8 mmHg, p < 0.0002). Total cholesterol, high-density lipoprotein cholesterol, plasma triglycerides, and resting energy expenditure values were not significantly altered after liposuction. In conclusion, over a 4-month period, large-volume liposuction decreased weight, body fat mass, systolic blood pressure, and fasting insulin levels without detrimental effects on lean body mass, bone mass, resting energy expenditure, or lipid profiles. Should these improvements be maintained over time, liposuction may prove to be a valuable tool for reducing the comorbid conditions associated with obesity.
Volume liposculpture. Variations on a technique
- E Hernandez-Perez
- E Lozano
- E. Hernandez-Perez
Lipid and protein metabolism Human Physiology and Mechanisms of Disease
- A C Guyton
Body Sculpturing Through Syringe Liposuction and Autologouos Fat Re-Injection
- P Fournier
Potential role of adipose tissue for the development of insulin resistance in obesity
- P Lonroth
- P. Lonroth
Anestesia tumescente de Klein: Una opción segura en cirugía dermatológica
- J A Seijo-Cortes
- E Hernandez-Perez
- J.A. Seijo-Cortes
Clarifyng Concepts in Modern Liposuction
- E Hernandez-Perez
- A Henriquez
- J Gutierrez
- E. Hernandez-Perez
Dictionary of Word Origins
- J Ayto
- J. Ayto
Body Sculpturing Through Syringe Liposuction and Autologouos Fat Re-Injection. United States
- P Fournier
- P. Fournier
Human Physiology and Mechanisms of Disease
- A C Guyton
- A.C. Guyton
Tumescent liposuction with local anesthesia
- J A Klein