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INTRODUCTION

According to the American Society of Plastic Surgeons, 245,138 liposuction procedures were performed in 2008. Of these, 218,038 were done in women and 27,100 were done in men, making it the third most common cosmetic procedure performed in 2008.

After some controversy regarding whether liposuction could be performed in a non-hospital setting, it has been shown that with proper patient selection and surgical team preparation, liposuction can be safely done in the office or surgical center setting using a choice of purely tumescent anesthesia, sedation, or general anesthesia.

COMPONENTS & DEVICES

TUMESCENCE DELIVERY

The administration of fluid that acts in both a hemostatic and anesthetic manner prior to lipoaspiration has been one of the fundamental steps in improving the safety profile of liposuction. Large syringes can be attached to an infusion cannula for fluid injection into small surgical sites. However, standard procedure now dictates the use of intravenous infusion devices for larger regions. These can range from a pressure cuff or air-filled bladder that applies positive pressure to a liter bag of solution, with a roll lock or stop-cock to allow the surgeon control of flow, to a motorized, pedal driven pump. The preferred method of tumescent delivery is through a peristaltic pump machine. These devices allow control of speed and rate of delivery in addition to precise on and off control. They may deliver flow upwards of 200 mL/min, but this rate is controlled to ensure maximal patient comfort. Long 27–32 cm cannulae allow infusion over large areas, while shorter 17–20 cm devices offer greater control and precision. Two 3.0 mm diameter cannulae can infuse tumescent solution at rates over 200 mL/min and are useful for large-volume infusion. In smaller cases, such as submental liposuction, better control is afforded by 18–20 gauge spinal needles attached to syringes.

SUCTION-ASSISTED LIPOSUCTION

Suction-assisted liposuction (SAL) evolved from subcutaneous lipectomy techniques that were originally performed using uterine curettes. Schrudde and others found these early techniques to be successful in removing subcutaneous fat, but the high rates of hematoma and lymphatic collections in the resulting dead space lead to a flurry of innovations. Fischer, Kesselring, and Teimourian each developed modifications of suction cannula. In 1978, Illouz described the tunneling lipoplasty technique that has become the current standard from which all further advancements in suction-assisted liposuction have developed.

The negative pressure in suction-assisted liposuction is typically generated from an external mechanical aspirator. Optimal aspiration rates are generally reached at 1 atmosphere of negative pressure (29 inches or 74 cm of mercury) but lower levels are typically preferred when performing liposuction of more delicate regions. For subtle contouring and in areas around the head and neck, manual suction may be performed with the use of a 60 mL syringe. A locking device offers the surgeon complete control of the strength of negative pull through ...

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