RESUMO
PURPOSE: The purpose of this quality improvement project was to improve perioperative management of patients undergoing tumescent liposuction (TL) through the development and implementation of a perioperative evidence-based protocol, educational course for perioperative staff, and patient discharge instructions. DESIGN: The TL protocol was validated using the modified Delphi process. The educational course and discharge instructions used a pre and postimplementation design. METHODS: An evidence-based protocol, an educational course for perioperative staff, and readable discharge instructions for patients undergoing TL were developed in accordance with best practice guidelines. The protocol was validated by subject matter experts at the facility and submitted for adoption. The evidence-based educational course was implemented, and the effectiveness of the course was evaluated for improving providers' knowledge and self-confidence. The evidence-based discharge instructions were implemented and evaluated for patient satisfaction and readability. FINDINGS: Three items were removed from the protocol, 2 items were modified, and 25 items were accepted with no change from modified Delphi analysis. Provider knowledge scores improved from 85.7% ± 16.18 to 97.1% ± 4.88; however, this was not statistically significant (P = .066). There was a trend toward improved confidence scores (P = .180). Overall patient satisfaction scores slightly improved postimplementation; results were not statistically significant (P > .05). CONCLUSIONS: All three phases of perioperative care in patients receiving TL were evaluated, reflecting best practice guidelines and successful adoption. There was no statistically significant improvement in provider knowledge, provider self-confidence, or patient satisfaction. A small sample size was a significant limiting factor.
Assuntos
Lipectomia , Alta do Paciente , Humanos , Lipectomia/métodos , Melhoria de Qualidade , Satisfação do Paciente , Assistência PerioperatóriaRESUMO
BACKGROUND AND OBJECTIVES: Cryolipolysis is a popular noninvasive lipolytic method that uses low temperature to induce apoptosis or necrosis of adipocytes to reduce local fat in the human body. Vacuum suction applicator is a commonly used cryolipolysis equipment, which suction human skin and fat into a chamber for cooling. The structure of vacuum suction applicator is usually irregular, its cooling characteristic is also complex, and unreasonable suction structure will cause human discomfort. Biological experiments and clinical studies are often used to study the structural design of applicators, whereas these methods are impossible to obtain the three-dimensional cooling characteristic of applicator comprehensively and require a lot of costs. This study aims to optimize the structure of applicator for lowering discomfort, evaluate the cooling characteristic and lipolytic effect of applicators, which could provide guidance for clinical application of applicators and reduce costs. MATERIALS AND METHODS: Cryolipolysis applicators models with four vacuum suction angles were established, and COMSOL was used to compare the cooling performance parameters, cooling kinetics, and lipolytic effects of the applicators. Specific evaluation indicators also include: cooling capacity analysis, temperature field analysis, lipolytic percentage, lipolytic volume, lipolytic weight, lipolytic thickness, lipolytic waistline, and lipolysis temperature threshold analysis. RESULTS: The applicator with a small suction angle has a greater cooling capacity to cool deeper level of fat. When the cooling temperature is -10°C, the temperature of skin layer is about -10°C at 60 minutes, the temperature of fat layer is -7.36 to 3.01°C at 10 mm, -3.67 to 5.91°C at 20 mm and 2.01-10.81°C at 30 mm. The percentage of lipolytic declined with the increase of suction angle, the final lipolytic percentage (35.81%) of the 90° applicator is the highest, the percentage (28.72%) of 150° applicator (28.72%) is the lowest. The lipolytic volume, weight, and average thickness of applicator constantly increased with the increase of the suction angle, the final lipolytic volume range of the four suction angle applicators is 171.88-310.18 cm3 , the lipolytic weight range is 160.11-288.93 g, and the lipolytic average thickness range is 1.21-1.36 cm. Lower lipolysis temperature threshold will reduce the lipolysis effect, but it may also lead to another lipolysis mechanism-cell necrosis. CONCLUSION: Different suction angles significantly affect the cooling characteristics and lipolytic effects of cryolipolysis applicator. A reasonable suction angle is one of the critical factors to improve the efficiency and comfort of cryolipolysis.
Assuntos
Crioterapia , Lipectomia , Humanos , Crioterapia/métodos , Resultado do Tratamento , Satisfação do Paciente , Lipectomia/métodos , Lipólise , Sucção , VácuoRESUMO
The aim of this study was to evaluate the safety and efficacy of combined 1060-nm diode laser and 635-nm low-level laser therapy (LLLT) device for non-invasive reduction of the abdominal and submental fat. Forty-two healthy subjects received single laser treatment on both the abdomen and submental area. Ultrasound images measuring the thickness of abdominal and submental fat were taken at baseline, follow-up at 4, 8, and 12 weeks after treatment. Waist circumference and body weight were also measured at all visits. Adverse events were recorded at all visits. Subjects completed a satisfaction questionnaire at the end of the trial. Twelve weeks after a single treatment with the investigational device, ultrasound images showed statistically significant (P < 0.0001) reductions in abdominal and submental fat by 18.62 and 26.4%, respectively. In addition, significant (P < 0.0001) reduction in waist circumference was observed. Ninety-six percent of subjects rated that they were satisfied. Noted side effects were transient mild to moderate tenderness which subsided within 1 to 3 weeks. No serious treatment-related adverse events were reported. The dual wavelength device combining 1060-nm diode laser with 635-nm LLLT was safe and effective for non-invasive reduction of both abdominal and submental fat.
Assuntos
Lasers Semicondutores , Lipectomia , Terapia com Luz de Baixa Intensidade , Terapia Combinada/efeitos adversos , Humanos , Lasers Semicondutores/efeitos adversos , Lipectomia/instrumentação , Terapia com Luz de Baixa Intensidade/instrumentação , Gordura Subcutânea/diagnóstico por imagem , Gordura Subcutânea/cirurgia , Gordura Subcutânea Abdominal/diagnóstico por imagem , Gordura Subcutânea Abdominal/cirurgia , Resultado do Tratamento , UltrassonografiaRESUMO
BACKGROUND: Subsurface radiofrequency (RF) treatments produce skin contraction by causing coagulation of the underlying subcutaneous fat. This method is marketed to fill a treatment gap for patients who do not wish to have surgery. A systematic review of this subject has not been previously published. METHODS: An electronic search was performed using PubMed to identify the literature describing subsurface RF treatments. RESULTS: Thirty articles were evaluated. An InMode device was used in 23 studies, and a Thermi device was used in 6 studies, with or without liposuction. Treatment areas included the face, neck, body, breasts, and labia. Most studies relied on patient satisfaction scores and physician review of photographs. The most frequent complications were induration and nodules. Most patients experienced prolonged swelling and numbness. Several studies reported marginal mandibular neuropraxias. The skin response after treatment of the abdomen was poor, and seromas were common. The incidence of burns improved after modification of the InMode device. Breast treatment did not appear to be effective in treating ptosis. Patient satisfaction scores were modest. Most studies (77%) were published by authors with a known conflict of interest. In some studies, the photographs did not accurately depict the treatment result. Institutional review board approval and disclosure of off-label regulatory status were often missing. DISCUSSION: Thermal treatment of the subcutaneous tissue introduces extra risks without a compensatory benefit. Comparisons in terms of safety, cost, recovery time, results, and complications do not favor energy-based devices. A treatment gap may be fictitious; properly informed patients may be treated with existing surgical procedures at all ages. CONCLUSIONS: Little evidence supports the efficacy and safety of subcutaneous RF treatments as an improvement over results that may be obtained using traditional surgical methods such as submental lipectomy, liposuction, and abdominoplasty. Photographic integrity is often lacking. Financial conflict of interest is pervasive. Marketing precedes the science. Plastic surgeons need to be aware of these serious limitations and the off-label regulatory status of these devices, before purchasing expensive equipment and recommending subsurface RF treatments to patients.
Assuntos
Ablação por Radiofrequência , Gordura Subcutânea , Cirurgia Plástica , Abdominoplastia , Humanos , Lipectomia , Ablação por Radiofrequência/efeitos adversos , Ablação por Radiofrequência/métodos , Gordura Subcutânea/cirurgia , Cirurgia Plástica/métodos , Resultado do TratamentoRESUMO
BACKGROUND: An ever-increasing demand for liposuction and fat transplantation procedures in the United States reflects their continued safety and clinical effectiveness. Technical breakthroughs, such as the utilization of tumescent infiltration and fat separation techniques, have been instrumental in optimizing outcomes but add time to the surgical procedure. Simultaneous separation and tumescence (SST) is a new technique combining these innovations to further improve safety and efficiency in liposuction. OBJECTIVES: The authors describe their technique for utilizing SST on more than 1200 patients spanning a 6-year period. A split abdomen study was designed to compare the vasoconstrictive effectiveness of SST with traditional Klein infiltration techniques. METHODS: A quantification perfusion analysis utilizing indocyanine green angiography was performed on 4 patients to illustrate the vasoconstrictive effectiveness of SST over traditional Klein infiltration techniques. A mean relative vasoconstriction score was calculated relative to the umbilicus for each technique. RESULTS: Compared with traditional Klein tumescence techniques, SST has a similar complication rate, utilizes similar infiltrative volumes, and increases vasoconstriction (mean 89.6% SST hemiabdomen vs 48.1% Klein hemiabdomen at 2 minutes, Pâ <â 0.0001). CONCLUSIONS: SST represents a novel, long-overdue departure from Klein tumescence, which has been a valuable mainstay for donor site preparation for over 3 decades. SST will pave the way for more efficient operative times and potentially higher volumes of fat being safely extracted.
Assuntos
Lipectomia , Humanos , Lipectomia/efeitos adversos , Lipectomia/métodos , Resultado do Tratamento , AbdomeRESUMO
BACKGROUND: Surgical excision remains the gold-standard therapy for arm skin laxity. However, many patients refuse surgical treatment for fear of the prominent long scars associated with brachioplasty. OBJECTIVES: The objective of the study was to compare the aesthetic outcome of 2 energy-assisted liposuction arm-contouring techniques, radiofrequency-assisted liposuction (RFAL; Group A) and Renuvion helium subdermal coagulation (Group B), with a control group treated with VASER-assisted liposuction (VAL) alone (Group C). METHODS: This is a randomized controlled study of 176 patients seeking arm contouring, who were treated between February 2017 and December 2020. All of the patients underwent VAL, followed by either RFAL (53 patients, Group A) with the BodyTite RF platform or subdermal coagulation (66 patients, Group B) with the Renuvion platform; 57 patients in the control group (Group C) received VAL alone. Patient data, marking techniques, operative details, complications (and tips and tricks to avoid them), and aesthetic outcomes were recorded and tabulated. Surgical team, third-party, and patient satisfaction surveys were conducted 6 months postoperatively. RESULTS: The study included 176 patients (153 female and 23 male) with a mean age of 32 years (range, 20-59 years). All patients were followed up for a minimum of 6 months. In total, 96 (80.6%) patients reported their satisfaction with the overall technique. An independent plastic surgeon considered the result good to excellent in 97 of 119 cases of the studied group. CONCLUSIONS: The umbrella of nonexcisional arm contouring can be extended to include treatment of difficult cases of arm laxity with energy-producing machines. The procedure can achieve a reduction in fat deposits and significant improvements in skin laxity.
Assuntos
Braço , Lipectomia , Adulto , Braço/cirurgia , Estética , Feminino , Humanos , Lipectomia/efeitos adversos , Lipectomia/métodos , Masculino , Satisfação do Paciente , Resultado do TratamentoRESUMO
Seromas are a common complication in plastic surgery. In this article, the authors describe their approach to the prevention and treatment of seromas and include a discussion of the evolution of their techniques. They provide specific technical details for many body contouring operations, including abdominoplasty, belt lipectomy, brachioplasty, and thighplasty. Many of the authors' techniques question the traditional dictums of plastic surgery, and they hope to encourage others to consider novel techniques for the treatment and prevention of seromas.
Assuntos
Abdominoplastia , Contorno Corporal , Lipectomia , Cirurgia Plástica , Abdominoplastia/efeitos adversos , Abdominoplastia/métodos , Humanos , Lipectomia/efeitos adversos , Lipectomia/métodos , Seroma/etiologia , Seroma/prevenção & controleRESUMO
Seromas are a common complication in plastic surgery. In this article, the authors describe their approach to the prevention and treatment of seromas and include a discussion of the evolution of their techniques. They provide specific technical details for many body contouring operations, including abdominoplasty, belt lipectomy, brachioplasty, and thighplasty. Many of the authors' techniques question the traditional dictums of plastic surgery, and they hope to encourage others to consider novel techniques for the treatment and prevention of seromas.
Assuntos
Abdominoplastia , Contorno Corporal , Lipectomia , Cirurgia Plástica , Humanos , Seroma/etiologia , Seroma/prevenção & controle , Lipectomia/efeitos adversos , Lipectomia/métodos , Abdominoplastia/efeitos adversos , Abdominoplastia/métodos , Contorno Corporal/efeitos adversosRESUMO
Axillary bromhidrosis is a widespread social problem in our society. Various modalities have been developed for the destruction or removal of the apocrine sweat glands to eliminate underarm odor. However, conventional surgical treatments often result in a high complication rate and frequent recurrence. In this study, we aimed to evaluate the effect of refined tumescent liposuction-curettage with pruning in small incisions as treatment for axillary bromhidrosis. Between July 2013 and April 2019, 110 patients (75 women and 35 men) with axillary bromhidrosis underwent refined tumescent liposuction-curettage with pruning. The results of eliminating underarm odor were evaluated by both the patients and doctors and rated as very satisfied (excellent), satisfied (good), slightly satisfied (fair), and not satisfied (poor). Postoperative complications, such as dehiscence, infection, wound contracture, cyst, subcutaneous hydrops, hematoma, or seroma, were also evaluated. Preoperative and postoperative histological examinations of axillary tissues were performed in two patients. In the subjective evaluation of 110 patients, 33 (30.0%) were very satisfied with the results, 70 (63.6%) were satisfied, and seven (6.4%) were slightly satisfied. The objective evaluation showed that 43 (39.1%) patients graded the results as excellent, whereas others graded the results as good. No serious complications occurred, except three patients with slight local subcutaneous hydrops and hematoma. Histologic examinations showed that the apocrine glands were significantly decreased or destroyed after the surgery. Refined tumescent liposuction-curettage with pruning in small incisions is an effective method for the treatment of axillary bromhidrosis.
Assuntos
Hiperidrose , Lipectomia , Axila/cirurgia , Curetagem , Feminino , Humanos , Hiperidrose/cirurgia , Lipectomia/efeitos adversos , Masculino , Recidiva Local de Neoplasia , Resultado do TratamentoRESUMO
BACKGROUND: Surgical interventions in patients with systemic sclerosis (SSc), in particular plastic procedures, might cause undesired consequences. Notably, liposuction seems to possess greater risk as adipose tissue has been shown to play an important role in treating wounds and ulcers in patients with SSc. While anticentromere antibodies were found to be correlated with vasculopathy in SSc, patients with SSc and anticentromere antibodies might be more vulnerable to surgical wound complications following liposuction. A 46-year-old female patient, who had been diagnosed with SSc at the age of 31 years, had antinuclear as well as anticentromere antibodies. She underwent abdominoplasty with liposuction and developed severe skin necrosis of the abdomen following the procedure and at the site of liposuction. The correlation with anticentromere and the role of liposuction in skin necrosis in SSc are presented.
Assuntos
Abdominoplastia , Tecido Adiposo/imunologia , Obesidade Abdominal/cirurgia , Escleroderma Sistêmico , Pele/patologia , Deiscência da Ferida Operatória , Abdominoplastia/efeitos adversos , Abdominoplastia/métodos , Anticorpos Antinucleares/sangue , Cicatriz/diagnóstico , Cicatriz/etiologia , Contraindicações de Procedimentos , Feminino , Humanos , Lipectomia/efeitos adversos , Lipectomia/métodos , Pessoa de Meia-Idade , Necrose/etiologia , Necrose/imunologia , Necrose/cirurgia , Obesidade Abdominal/complicações , Obesidade Abdominal/diagnóstico , Reoperação/efeitos adversos , Reoperação/métodos , Escleroderma Sistêmico/complicações , Escleroderma Sistêmico/imunologia , Escleroderma Sistêmico/cirurgia , Cirurgia Plástica/efeitos adversos , Cirurgia Plástica/métodos , Deiscência da Ferida Operatória/diagnóstico , Deiscência da Ferida Operatória/etiologia , Deiscência da Ferida Operatória/cirurgia , Resultado do TratamentoRESUMO
Being profitable procedures with little disposable costs, a number of noninvasive technologies have gained much popularity in recent years and are permeating the aesthetic marketplace. High-intensity focused ultrasound (HIFU) when focused at a targeted depth of 1.1 to 1.6 cm within subcutaneous tissue raises local tissue temperature at the focal point resulting in almost immediate cell death without damage to the surrounding tissues. Despite having gained popularity, little information is available regarding HIFU use for the treatment of localized fat and aesthetic body sculpturing. The current literature review is intended to investigate evidence-based efficacy of HIFU in aesthetic body contouring. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
Assuntos
Contorno Corporal , Lipectomia , Estética , Gordura Subcutânea , Resultado do TratamentoRESUMO
Liposuction is one of the most common procedures undertaken in plastic surgery with a steadily increasing trend over the years. Although usually performed as an aesthetic procedure for body contouring, it can also be utilized in specific patient groups for disease symptom reduction. One such disease entity is lipedema. The goal of this video to present the authors' technique in the surgical treatment of lipedema, and to offer the viewer a better understanding of the differences between an aesthetic liposuction and a functional liposuction as performed on a lipedema patient. Between July 2009 and July 2019, 106 lipedema patients have been treated in the authors' specialized lipedema clinic, with a total of 298 liposuction procedures and a median follow-up of 20 months. The mean amount of lipoaspirate was 6354.73 ml (± 2796.72 ml). The patients reported a significant reduction in lipedema-associated complaints and improvement in quality of life. The need for conservative therapy was significantly reduced. No serious complications were reported. The authors also present before and after photographs of three patients. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
Assuntos
Lipectomia , Lipedema , Estética , Humanos , Lipedema/cirurgia , Qualidade de Vida , Resultado do TratamentoRESUMO
BACKGROUND: Madelung disease is a rare lipid metabolic disorder, and most cases are sporadically reported. There are currently no systematic reviews summarizing the epidemiological and clinical characteristics of this disease. The purpose of the current article is to extract and analyze the existing evidence concerning Madelung disease derived from case series in order to provide adequate treatments for patients based on a more comprehensive understanding of the disease. METHODS: PubMed, Embase, and Web of Science databases were queried for relevant articles using the search terms "Madelung disease," "multiple symmetric lipomatosis," "Launois-Bensaude syndrome" and synonyms until Aug 31,2020. Data statistics of Madelung disease epidemiology and clinical characteristics are summarized in different tables or charts with Microsoft Office software. RESULTS: Patients exhibiting Madelung disease were mostly located in Europe, although some records existed in Asia as well. Average patient age was between 45 and 65 years old. Type I was the most common form of the disease, and the neck was the most common location for tumors. Madelung disease is associated with various metabolic disorders, and hematoma and seroma were the most common complications. Overall recurrence rate was 18.3%, with similar recurrence rates after lipectomy and liposuction. Fewer complications occurred after liposuction compared with lipectomy, but relapse was more common after liposuction. CONCLUSION: Madelung disease consists of specific epidemiological and clinical characteristics, knowledge of which can be helpful for diagnosis and cognition. Lipectomy and liposuction are considered to be the most effective treatment methods for Madelung disease; however, choice of surgery should be based on comprehensive consideration of the disease, such as severity, mass location, and patient expectations. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
Assuntos
Abdominoplastia , Lipectomia , Lipomatose Simétrica Múltipla , Idoso , Humanos , Pessoa de Meia-Idade , Lipomatose Simétrica Múltipla/diagnóstico , Lipomatose Simétrica Múltipla/epidemiologia , Lipomatose Simétrica Múltipla/cirurgia , Pescoço , Resultado do TratamentoRESUMO
BACKGROUND: Despite the proven efficacy of liposuction, there is a population of patients who prefer non-surgical alternatives. Laser hyperthermia-induced lipolysis has emerged as one non-invasive alternative to liposuction. OBJECTIVES: The authors sought to evaluate the safety and efficacy of a 1060-nm (±10 nm) diode laser for non-invasive fat reduction of the abdomen. METHODS: This single-arm, 2-center study enrolled 30 patients. Patients received a 25-minute 1060-nm diode laser treatment on their abdomen. Ultrasound adipose measurements, body weight, and circumference were taken at baseline and at 6- and 12-week follow-up visits. Blinded evaluators identified "before" and "after" photos of each patient. A patient satisfaction questionnaire was completed by each patient at study exit. RESULTS: A total 29 patients completed all treatment and follow-up visits. Ultrasound images showed an adipose reduction of 8.55% at 12 weeks post-treatment (Pâ <â 0.0001). Blinded evaluators correctly identified 67% of the pre- and post-treatment images at site 01 (Sacramento, CA) and 56% at site 02 (Dallas, TX). Satisfaction was high, with 72% of patients reporting being either "satisfied" or "very satisfied" with their results on a 5-point Likert scale. Pain was rated as mild by 62% of patients, moderate by 38%, and severe by none on the Wong-Baker Scale. CONCLUSIONS: These results indicate that a single treatment with a 1060-nm (±10 nm) diode laser, per the treatment protocol, is safe and effective in reducing unwanted fat in the abdomen as objectively measured employing ultrasound. The treatment was well-tolerated among all patients, with minimal discomfort reported and high patient satisfaction.
Assuntos
Lasers Semicondutores , Lipectomia , Abdome , Tecido Adiposo/cirurgia , Humanos , Lasers Semicondutores/efeitos adversos , Lipectomia/efeitos adversos , Satisfação do Paciente , Resultado do Tratamento , UltrassonografiaRESUMO
BACKGROUND: In continued interest to develop and refine minimally invasive procedures, recent publications reported a scarless approach in breast lifting. OBJECTIVES: The authors sought to describe a power-assisted lipomodeling technique combined with surgical loops to achieve breast reduction and reshaping with minimal scars. METHODS: Between 2014 and 2018, 94 patients underwent breast reduction by combined liposuction and loops. Following infiltration of the breasts, liposuction of the outer quadrants and the lower pole was achieved to reduce the breast footprint and the lateral and inferior heaviness of the breast. After multiaxial multiplanar tunnelization, 3 types of loops were taken around the breast to suspend and elevate the breast skin envelope and parenchyma. Each loop was guided through a 3-mm, 3-hole cannula passed through skin stab incisions. The first loop was designed to reduce the breast footprint and enhance the breast projection, whereas the second loop was designed to achieve breast conus remodeling. The third loop was passed circumferentially around the areola and then cephalad along the breast axis and pulled until the desired nipple-areola complex elevation was reached. Each loop was pulled to achieve the desired breast projection and shape. RESULTS: The authors achieved breast reduction with a mean nipple elevation of 7.3 cm, and 88% of patients were satisfied with their breast shape. The total complication rate was 1%, including mild cellulitis in 1 breast, treated efficiently with oral antibiotics. CONCLUSIONS: The proposed technique is a novel, simple, and safe alternative to achieve breast reduction and reshaping without a scar.
Assuntos
Lipectomia , Mamoplastia , Cicatriz/etiologia , Cicatriz/prevenção & controle , Procedimentos Cirúrgicos Dermatológicos , Feminino , Humanos , Lipectomia/efeitos adversos , Mamoplastia/efeitos adversos , Mamilos/cirurgiaRESUMO
BACKGROUND: Lipedema is a chronic, progressive disorder of subcutaneous adipose tissue that usually affects the lower extremities of women. Also known as "two-body syndrome," the fat accumulations in lipedema are unsightly and painful. The disorder is well-known in Europe but is largely unrecognized and underdiagnosed in the United States. OBJECTIVE: To hold the First International Consensus Conference on Lipedema with the purpose of reviewing current European guidelines and the literature regarding the long-term benefits that have been reported to occur after lymph-sparing liposuction for lipedema using tumescent local anesthesia. METHODS: International experts on liposuction for lipedema were convened as part of the First International Congress on Lipedema in Vienna, Austria, June 9 to 10, 2017. RESULTS: Multiple studies from Germany have reported long-term benefits for as long as 8 years after liposuction for lipedema using tumescent local anesthesia. CONCLUSION: Lymph-sparing liposuction using tumescent local anesthesia is currently the only effective treatment for lipedema.
Assuntos
Anestesia Local/métodos , Lipectomia/normas , Lipedema/cirurgia , Dor Processual/prevenção & controle , Guias de Prática Clínica como Assunto , Anestésicos Locais/administração & dosagem , Conferências de Consenso como Assunto , Progressão da Doença , Feminino , Humanos , Lidocaína/administração & dosagem , Lipectomia/efeitos adversos , Lipectomia/métodos , Lipedema/diagnóstico , Lipedema/etiologia , Pessoa de Meia-Idade , Dor Processual/etiologia , Planejamento de Assistência ao Paciente/normas , Cuidados Pós-Operatórios/métodos , Cuidados Pós-Operatórios/normas , Gordura Subcutânea , Resultado do TratamentoRESUMO
BACKGROUND: Weight loss is traditionally viewed as straightforward counting of calories in and calories out, with little regard to the role of the adipocytes tasked with storing said calories. However, the body executes a complex compensatory response to any intervention that depletes its energy stores. Here, the authors discuss the methods used to attain weight loss, the body's response to this weight loss, and the difficulties in maintaining weight loss. Furthermore, the authors provide an overview of the literature on the physiological effects of liposuction. OBJECTIVE: To describe the role of adipose tissue in energy homeostasis, methods of weight loss, weight regain, and the effect of liposuction on endocrine signaling. METHODS: The authors conducted a narrative review of representative studies. CONCLUSION: A variety of strategies for weight loss exist, and optimizing one's weight status may in turn optimize the aesthetic outcomes of liposuction. This is most apparent in the preferential reaccumulation of fat in certain areas after liposuction and the ability to avoid this with a negative energy balance.
Assuntos
Lipectomia , Obesidade/terapia , Gordura Subcutânea/metabolismo , Aumento de Peso/fisiologia , Redução de Peso/fisiologia , Terapia Combinada , Dieta Saudável , Terapia por Exercício , Humanos , Leptina/metabolismo , Metabolismo dos Lipídeos/fisiologia , Obesidade/metabolismo , Recidiva , Gordura Subcutânea/cirurgia , Resultado do TratamentoRESUMO
BACKGROUND: Osmidrosis is a troublesome disease characterized by excessive bodily malodor. Invasive surgical treatments have proven effective and permanent in treating this disease. This study sets out to evaluate the effect of tumescent liposuction with power-assisted dermal curettage for the treatment of axillary osmidrosis. METHODS: Twenty-eight patients with axillary osmidrosis (56 axillae) were treated with tumescent liposuction and power-assisted dermal curettage between January 2016 and May 2019. Patients were followed up and evaluated using survey questionnaire at least 3 months after the procedure. RESULTS: Twenty-four (85.7%) patients responded excellent for malodor elimination, 4 (14.3%) patients evaluated it as good and no patients evaluated it as fair or poor. One patient reported mild pigmentation in the axilla after the procedure. No recurrence and no serious side effects were reported. CONCLUSION: Tumescent liposuction with power-assisted dermal curettage is a safe and effective surgical treatment of axillary osmidrosis with high patient satisfaction, rapid recovery time and minimal complications or recurrences. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.
Assuntos
Hiperidrose , Lipectomia , Glândulas Apócrinas/cirurgia , Axila/cirurgia , Curetagem , Humanos , Hiperidrose/cirurgia , Odorantes , Resultado do TratamentoRESUMO
Lipedema is a painful disease of subcutaneous adipose tissue leading to bilateral increase of leg and/or arm volume, but sparing hands and feet. Although conservative treatment with complex decongestive therapy has been considered as the fundamental treatment, micro-cannular liposuction in tumescent anesthesia has become a surgical option. We report on 111 patients mostly with advanced lipedema treated by this technique in our center between 2007 and 2018. The median age of the patients was 44 years. Eighty percent of patients had at least one comorbidity. There was an association of longstanding and advanced disease to obesity and diseases of the metabolic syndrome-spectrum. The median total amount of lipoaspirate was 4,700 ml, with a range of 950-14,250 ml. The median reduction of limb circumference was 6 cm. The median pain level before treatment was 7.8 and 2.2 at the end of the treatment. An improvement of mobility could be achieved in all patients. Bruising was also reduced. Serious adverse events were observed in 1.2% of procedures, the infection rate was 0% and the bleeding rate was 0.3%. Liposuction is an effective treatment for painful lipedema. The procedure should be performed in specialized centers.
Assuntos
Anestesia/métodos , Lipectomia/métodos , Lipedema/terapia , Dor/etiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Lipectomia/efeitos adversos , Síndrome Metabólica/epidemiologia , Pessoa de Meia-Idade , Obesidade/epidemiologia , Resultado do Tratamento , Adulto JovemRESUMO
Since its advent in the early 1980s, liposuction has made tremendous advancements, making it the most popular aesthetic surgery performed today. The goal of this Continuing Medical Education (CME) article is to provide a foundation of knowledge of the relevant anatomy, preoperative evaluation, intraoperative technique, and postoperative management for surgeons performing liposuction. Finally, the prevention and management of potential complications will be reviewed along with measures to optimize patient safety and outcomes.