Liposuction and Surgical Recontouring of the Neck: A Retrospective Analysis

BACKGROUND: With the advent of tumescent liposuction, many advances in cosmetic surgery have occurred. Liposuction of excess adipose tissue from the submental area, jowls, and neck, along with cold steel surgery, has become an attractive alternative to the facelift for cervicomental aesthetic surgery. OBJECTIVE: To describe new techniques for tumescent neck liposuction, platysma repair, and subcutaneous musculoaponeurotic system plication, evaluate results, and assess complications with the procedures. METHODS: We reviewed the results of the last 35 patients who underwent neck liposuction, simultaneous platysma plication, subdermal CO2 laser resurfacing, and/or subcutaneous musculoaponeurotic system plication at our institution. RESULTS: Three of 35 patients (9%) experienced mild complications from the procedure. Two of the three complications (66%) were in patients who underwent subdermal and/or platysma laser resurfacing at the time of liposuction. Good to excellent results were achieved in 91% of patients and fair to good results were achieved in 9%. No major complications such as nerve injury occurred. CONCLUSION: Neck liposuction can be a safe method for facial rejuvenation when performed properly. Platysma repair, and in some cases subcutaneous musculoaponeurotic system plication, can further improve results when combined with the liposuction procedure.     

Liposuction of Neck and Jowls: Five-Incision Method Combining Machine-Assisted and Syringe Aspiration

BACKGROUND: Liposuction of the jowl region is difficult from a single submental incision and must be done conservatively in order to avoid overresection of fat. The neck region may be suctioned much more completely. OBJECTIVE: A new method for liposuction of the neck and jowls that uses five incisions and that combines syringe suctioning of the jowls and machine-assisted suctioning of the neck has been developed. METHODS: The neck was suctioned from submental and infra-auricular incisions. The jowls were suctioned from the infra-auricular and additional infrajowl incisions. RESULTS: This method has been used on 68 patients over a 3-year period. Three additional patients underwent syringe liposuction of only the jowls. Volumes of fat aspirated from bilateral jowls were consistently nearly equal. The incidence of adverse events was low. CONCLUSION: This method enables conservative removal of jowl fat and thorough removal of neck fat, with a low incidence of adverse sequalae.     

Rhytidectomy Assisted with Ultrasound Techniques: The Ultra-Lipo-Lift Technique

Ultrasound-assisted liposuction has been practiced in Europe and South America for more than 10 years. This method was clinically introduced in 1989 for removal of fat by Dr. Zocchi, who developed the concept of applying ultrasound energy to adipose tissue [13,14]. Since 1992, we have been using ultrasound lipoplasty, first in body remodeling, then in face and neck surgery, after establishing working and safety rules in a study of 300 patients. In the beginning we were only looking to eliminate deposits of fat in oval faces with acne-scars, subdermal fibrosis, and thick skin, as these types of cases are not good candidates for rithidectomy. We found good skin retraction when we adjusted the superficial movements of the canula and had adequate machine power to avoid complications beneath the skin. Afterwards, we can break and release the adhesion zones of scarring and fibrosis, consequences of subdermic infiltrations or thread implants. Now we report our technique of rithidectomy assisted with ultrasound, which we have called ultra-lipo-lift (ULL). During the two last years we used this technique on 67 patients (48 females and 19 males) with good results and very few complications.     

New Indications in the Approach to the Pendulous Abdomen

The appearance of the superficial liposuction technique has permitted the surgeon to advance in his indications for treating localized lipodystrophy, without skin resection. With the cutaneous retraction phenomenon that follows superficial liposuction, pendulous abdomen, which was once treated by classical dermolipectomies, can now be treated with liposuction alone, obtaining satisfactory results. The authors recommend this form of treatment for patients with pendulous abdomen and with good skin quality, with few or no stretch marks, and with little or no diastasis of the rectoabdominal musculature.     

External Ultrasound-Assisted Lipoplasty from Our Own Experience

External ultrasound-assisted liposuction (XUAL) is a new technique that requires traditional aspirative liposuction after the application of high frequency ultrasonic fields delivered through the skin into a wetted tissue. Initial data suggest that it has some advantages over the traditional procedure, especially regarding the achievement of less traumatic surgery with superior clinical outcome. This preliminary report describes a comparative study between conventional liposuction and the external ultrasound-assisted technique as the modality of treatment for fat deposits in 65 bilateral anatomical areas. The results showed considerable superiority of the ultrasound-assisted series. We found less resistance to the canulla with more rapid removal of fat and the aspirated tissue showed less blood content with intact viable fat cells. Patients report less pain and discomfort on the ultrasound-treated sides and we found less swelling and bruising, with superior skin shrinkage. Clinical recovery was also enhanced by the external ultrasound and no complications were reported with the technique.     

Large-Volume Liposuction in 181 Patients

Liposuction is a commonly performed cosmetic surgery procedure that is associated with complications, including fatalities. Many of these have been associated with large-volume liposuction. During 1998 the American Society of Plastic Surgery Task Force on Lipoplasty and the Plastic/Cosmetic Surgery Committee of the Medical Board of California have both arbitrarily defined large-volume liposuction as greater than 5000 cc and asked that surgeons not remove any more than this volume except in specific circumstances such as a hospital-type setting [1]. This study includes 181 patients who have had greater than this amount of total aspirate removed in a single procedure. From January 1, 1996, to February 11, 1997, we used tumescent liposuction only (31 patients). From February 12, 1997, to June 30, 1998, we used a combination of ultrasonic liposuction using the Lysonix 2000 Ultrasonic Liposuction Unit and tumescent liposuction (150 patients). During the last part of the latter series we calculated the blood loss of 45 patients derived from preop and 5-day postop hematocrits. The results show that (1) there is no correlation between the aspirate volume and the calculated blood loss; (2) the majority of the calculated blood loss is not in the cannister; and (3) no deaths occurred, but one patient suffered a deep venous thrombosis and two patients suffered pulmonary emboli. As others have pointed out [2–6] large-volume liposuction can be performed relatively safely if this procedure is treated with the respect it deserves and the practitioner exercises sound surgical judgment, uses appropriate technique, and does not try to cut corners to save money for the patient by performing this surgery in minimal settings.     

Liposuction Breast Reduction

All breast reductions since 1996 have been performed with only liposuction. Removal of up to 2250 ml per breast has been obtained in 45 patients, without any complications. Significant skin retraction results from a very superficial subcutaneous liposuction, with a significant volume reduction of the gland. One bilateral mastopexy was performed subsequently.     

Adjunctive Tumescent Technique in Massive Resections

Tumescent technique for liposuction is a widely used technique. Four cases are reported here in which this technique was used to aid in the resection of massive neuromatous lesions with good postoperative results and minimal morbidity. Review of the relevant literature is done.     

CAST Liposuction of the Arm Improves Aesthetic Results

Lipocontouring the arm has a lower degree of patient satisfaction compared to other regions since untoward sequelae such as sagging and wrinkled skin may result. Circumferential para-Axillary Superficial Tumescent (CAST) liposuction was offered as an alternative to traditional arm liposuction or brachioplasty to 59 patients. Fifty-three of 59 patients (89.9%) were satisfied or very satisfied with the procedure; six patients (10.2%) requested secondary procedures; four, further liposuction (6.8%); two, brachioplasty (3.4%). Although temporary untoward sequelae (15.3%) and minor complications (8.5%) were not infrequent and more vigorous postoperative care necessary, the final aesthetic result was rarely compromised and patient satisfaction was high.     

Very Superficial Ultrasound-Assisted Lipoplasty for the Treatment of Axillary Osmidrosis

Treatment of axillary osmidrosis has been mainly concerned with surgical excision of glandular tissues and involved major surgical procedures with high morbidities and many complications. Search for a less invasive procedure for axillary osmidrosis resulted in the use of liposuction. However, there have been controversies over the efficacy of this method. The problem was that liposuction could not effectively remove the apocrine gland located in the dermis and dermosubcutaneous junction. A high rate of residual malodor and dissatisfaction were reported. The author used ultrasound-assisted lipoplasty (UAL) in the very superficial plane to remove the apocrine gland located in the dermis and dermosubcutaneous junction. The purpose of this study was to prove the efficacy of the very superficial UAL (VSUAL) for the treatment of axillary osmidrosis. From December 1998 to December 1999, 21 consecutive patients underwent UAL in their axilla for axillary osmidrosis. The follow-up period ranged from 2 to 12 months (mean: 8 months). UAL was performed in the very superficial plane with an amplitude of 40%. The very superficial UAL (VSUAL) was done mainly in a withdrawing manner with the tip of the cannula against the skin. The UAL (VSUAL) was done aggressively until the skin changed slightly erythematous. The results were assessed subjectively and objectively, and classified as excellent, good, fair, and poor. Nineteen patients were graded as excellent and one patient as good. The total satisfaction rate was 95.2%. One patient complained of residual malodor in her left axilla. There were no cases of skin necrosis, hematoma, or seroma. Histology showed partial removal of the subcutaneous layer and deep dermis, and degenerative epithelial changes in the apocrine glands in the residual deep dermis. These microscopic findings meant near-total functional ablation of the apocrine gland in the axilla comparable to ``flap-to-graft conversion' or surgical excision of axillary skin. The UAL (VSUAL) for axillary osmidrosis has the advantages of a high success rate with minimal complications. Rapid recovery, less restriction of movement, and tiny scars were other major benefits of this technique. Therefore, UAL (VSUAL) is a viable option for treatment of axillary osmidrosis.     

Submentoplasty as an isolated rejuvenative procedure for the neck

As facial cosmetic surgery has become more popular, patients' desires for minimally invasive surgery and brief healing times have increased. Submentoplasty has been described as an isolated procedure, but it is more commonly incorporated into a face-lift for rejuvenation of the cheeks, jowls, and neck. However, many patients considering submentoplasty do not need or desire face-lift surgery. Submentoplasty, in combination with liposuction, wide undermining, and platysma plications, has proven to be an effective way to rejuvenate the neck by restoring the cervicomental angle without large-incision surgery such as a face-lift. Presented here is a technique for performing submentoplasty developed over experience with more than 100 patients of widely varying ages. Recovery time is shorter than with standard face-lift techniques, and complications have been few. Submentoplasty is a viable option for patients who desire rejuvenation of the neck as a solo procedure or in combination with other facial cosmetic surgery.     

Comparative Evaluation of Traditional, Ultrasonic, and Pneumatic Assisted Lipoplasty: Analysis of Local and Systemic Effects, Efficacy, and Costs of These Methods

Recently ultrasound assisted liposuction (UAL) and pneumatic assisted liposuction (PAL) have been introduced as an attempt to improve the results and reduce the pitfalls of standard liposuction (SAL). Until now no studies comparing, at the same time, UAL, PAL, and SAL have been published. The aim of this study was to analyze these methods from the surgeon's point of view, focusing not only on aesthetic results but also on local and systemic trauma, efficacy, handling, and cost. Forty-five cosmetic patients affected by local lipodystrophy, divided into three equal groups, have undergone liposuction with the three above-mentioned techniques. Quantitative and qualitative analysis of lipoaspirates, together with blood chemistry, local and systemic complications, time to aspirate 100 cm³, distress, fatigue, and costs of the procedures, has been recorded. Our results showed bloodier lipoaspirates in SAL and a higher percentage of triglycerides in UAL lipoaspirates. Blood tests revealed a slight decrease in the postoperative Hb in SAL only. Early complications observed were four erythemas in PAL, three ecchymoses in SAL, and one long-lasting edema in UAL. Aesthetic results rated by independent viewers were similar for all methods. Efficacy was higher in the PAL group (4 min × 100 cm³ fat aspirated) than in SAL (7 min × 100 cm³ fat) and UAL (10 min × 100 cm³ fat). Surgeon's distress was higher in PAL than in SAL and UAL. Surgeon's fatigue was much lower in the PAL group than in the others. Costs expressed as multiples of 1 unit (1 unit = $500 U.S.) were highest for UAL, low for PAL, and lowest for SAL. In conclusion, PAL and UAL caused reduced vascular injury, UAL being more selective for adipocyte removal. Complications of UAL and PAL were mostly related to the longer learning curve of these methods. The UAL procedure was much more expensive than PAL and, especially, SAL. PAL proved to be a handy technique, with the most favorable cost/benefit ratio, and seems to be the best option for busy liposuction practices or fast office procedures, even though the choice of the ideal technique always depends on the surgeon's preference.     

Abdominal Etching

The development of blunt liposuction by Illouz [1] in 1978 ushered in a new era in body sculpting. For the first time it had become possible to dependably remove large amounts of subcutaneous fat and decrease saddlebags and bulges to provide a smoother contour. Refinements in liposuction techniques have made it possible to dramatically resculpt the subsurface plane and improve body contour virtually from head to toe [2–4]. Mark Gilliland first performed abdominal etching by removing specific grooves of subcutaneous fat to accentuate the appearance of the abdominal musculature [5–8]. We have developed a new cannula for precision etching. This technique has been used in 25 patients with good results and has resulted in only one complication, which was the result of placing one of the horizontal etching lines at the level of the umbilicus. This created an unseemly fold that is best avoided.     

CAST Liposuction: An Alternative to Brachioplasty

The aging female with excess arm fat and poor skin tone frequently refuses a brachioplasty scar due to permanent detectability. Traditional deep liposuction localized to the posterolateral aspect of the arm frequently leaves sagging, wrinkled skin. Circumferential para-Axillary Superficial Tumescent (CAST) liposuction was developed to maximize skin retraction and create regional harmony by preparatory compartment magnification with dilute lidocaine and epinephrine followed by circumferential treatment of the arm and adjacent areas utilizing superficial and/or subdermal liposuction. Early CAST liposuction results in patients with moderate fat and excess skin revealed excellent skin retraction. CAST liposuction was then offered as the first of two stages to patients with excess fat and poor skin tone to avoid or shorten the brachioplasty scar. Twenty-six patients underwent CAST liposuction with 9–22 months follow up. Only two patients (7.7%) eventually required brachioplasty. Although postoperative seromas were frequent (38.5%) and preexisting skin wrinkling usually returned, the final result is acceptable to the vast majority of patients (84.6%) who refuse a brachioplasty scar.     

External Ultrasound Used in Conjunction with Superficial Subdermal Liposuction: A Safe and Effective Technique

The authors present their experience with the external ultrasound (EU) used in conjunction with superficial subdermal liposuction (SSL) to achieve better results in a safe, predictable, and reproducible way, and discuss the safety of liposuction and the related methods of anesthesiology.     

Endoscopic Facelift: Two Years' Experience

In the upcoming Twenty-first Century, we will find many surgical methods and devices that come to fulfill one of the main objectives of the aesthetic plastic surgery: to reduce scars, especially in facial surgery. Endoscopy is one of those methods. In my experience of the last two years, I have used this technique, sometimes combined with CO₂ laser to partially remove glabellar muscles and the platysma fibers of the middle part of the neck. This work shows the results from 160 patients undergoing endoscopic forehead lift and neck contouring, using specially designed instruments. The results are highly significant and satisfactory.     

Ultrasound-assisted lipoplasty: Is it really safe?

During the last decade liposuction has become the most common aesthetic procedure. It has also become the most common aesthetic procedure performed by physicians not trained in plastic surgery. New developments such as the tumescent technique, finer cannulas, and, finally, the technique of ultrasound-assisted lipoplasty (UAL) have been paralleled by reports of larger amounts of extracted fat. At the same time we see an increasing number of fatal complications. I have undertaken an investigation of 28 patients during 16 months, undergoing liposuction with UAL, to find out how the procedure affected them in terms of blood loss. I found that, while undergoing UAL, our patients lost up to 53% of their blood volume on postoperative day 1, and the average patient still had a loss of 20% of the blood volume 1 week postoperatively.     

Does Liposuction Influence Lipidogram in Females: In Vivo Study

Suction lipectomy is one of the most commonly performed cosmetic procedures that is ideally indicated for the treatment of minimal to moderate localized fat deposits. The safety of the procedure has been addressed regarding patient selection, complications and results. Little is known about the impact of liposuction on lipid metabolism during and immediately after the procedure. Ten consecutive patients operated on for moderate volume liposuction (mean 1470 cc, range 500–2800 cc) were included in the present study. Blood samples analysis were obtained preoperatively (T1), 20 minutes after the beginning of the procedure (T2), one hour (T3), and four hours postoperatively (T4). The levels of total cholesterol, HDL cholesterol, LDL cholesterol,triglycerides, lipoprotein lipase, A1 lipoprotein, and B lipoprotein were measured from T1 to T4. All the values were increased at T2 and T3, but remained under upper normal values and nearly complete return to baseline was observed at T4, underlining the safety of the procedure on a metabolic basis.     

The Thigh's Lateral Skin (Saddle Bags): Histomorphometric Study of Interest to Liposuction

Study of the thigh's lateral skin (``saddle bags') in cadavers made it possible to evaluate its regional characteristics. Sex or race were not reported but the age group most appropriate to liposuction was considered. In this way, authors believed that as per standards established at the time, results as to the skin retraction in liposuction, will be able to be analyzed in a comparative way in the future.     

Liposuction of the Kneecap Area Under Tourniquet: A Superdry Procedure

In this paper, we report our experience and describe the technique of liposuction under tourniquet. This technique facilitates liposuction in the kneecap area and makes it bloodless. The approach described is effective and necessitates a relatively brief intraoperative and postoperative period, with inherently less morbidity. We obtained satisfactory results using this simple procedure.