Chapter 41: Liposuction

INTRODUCTION

The popularity of liposuction has increased dramatically over the past two decades, with liposuction constituting 10% of all ambulatory cosmetic procedures performed in the United States between 1995 and 2010.¹ This interest, particularly among dermatologists and non-core cosmetic practitioners, has grown in large part due to Klein’s introduction of the tumescent technique, allowing this procedure to be performed comfortably and less invasively under local anesthesia with minimal postoperative downtime, unparalleled patient safety, and improved aesthetic results.^2,3

INDICATIONS

Diet- or exercise-resistant subcutaneous fat in virtually any area of the body can now be treated safely and effectively with tumescent liposuction, from excessively full jowls to thick ankles. Potential non-cosmetic indications for liposuction, such as breast reduction in women and the treatment of gynecomastia in men, are listed in Table 41-1.^4–11

PATIENT SELECTION

Consultation

Patients presenting for a liposuction consultation often have preconceived notions about the procedure, having heard both positive and negative reports from friends or via the internet. Although the advent of social media now connects individuals en masse, this may only potentiate the spread of biased and unreliable information.¹² Potential patients need to be properly informed and educated regarding tumescent liposuction, including the risks, benefits, alternatives, and a realistic appraisal of the postoperative course and expected results. The physician utilizes the consultation visit to determine whether the patient is mentally and physically healthy, has no contraindications to surgery, and has fatty deposits that are amenable to treatment. Once both the patient and the physician have adequate information, the decision to proceed can be made.

Patient Selection and Contraindications

The ideal patient is in excellent health, is not overweight, and has fatty deposits out of proportion to overall body shape, with otherwise normal skin tone and elasticity. These fatty deposit areas are primarily genetic in origin, gender specific, and resistant to diet and exercise. The ideal patient also has reasonable and realistic expectations. The ideal patient age range is 30 to 55 years old, as this group is generally mature enough to undergo this procedure and more likely to be free of underlying illnesses, with less risk of excessive skin ...