Prevention of Progression of Lipedema With Liposuction Using Tumescent Local Anesthesia: Results of an International Consensus Conference.

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.

Safety Studies in the Field of Liposuction: A Systematic Review.

BACKGROUND: There is an increasing demand for safety standards for cosmetic treatments. With regard to liposuction, interdisciplinary consensus is lacking, especially regarding treatment setting and physician specialty. OBJECTIVE: A solid, independent interpretation of scientific data on safety requires a systematic approach, which is the aim of this study. METHODS: A systematic literature search was conducted for safety studies about liposuction through April 2017. Fatalities and/or reported serious adverse events served as outcome measures for safety. RESULTS: Twenty-four studies were included. Factors that contributed to increased serious complication and mortality risk were: use of the (super)wet technique; use of systemic anesthetics, especially general anesthesia and intravenous sedation; execution by a plastic surgeon; execution in an operating room; and combination with other procedures. CONCLUSION: Liposuction using tumescent local anesthesia has been shown to be the safest method of fat removal, especially if no or only minimal systemic anesthesia is used. Performance of this technique in an office-based setting has been proven to be safe beyond doubt. When systemic anesthesia is used, an outpatient or ambulatory surgery facility seems also safe. Regardless of the physician specialty, knowledge and training on the execution of the tumescent procedure are vital to ensure optimal safety.

Risks of unregulated use of alpha-melanocyte-stimulating hormone analogues: a review.

Recently, the unregulated use of untested synthetic alpha-melanocyte-stimulating hormone (α-MSH) analogues, commonly known as melanotan I and II, appears to have increased. These analogues are primarily used for their tan-stimulating effects. Dermatologists see many patients in their clinic who tan. This review provides an overview of the risks of the unregulated use of these substances. Other topics discussed here include the history and safety of afamelanotide, which is the only α-MSH analogue that is approved for use in a limited number of medical indications. Although afamelanotide has been thoroughly tested and deemed safe, illegal melanotans are likely risky for several reasons. There are questions regarding the preparation, administration, and dosage of these substances. In addition to these general risks, increasing numbers of case reports indicate that the unregulated use of both melanotan I and II is associated with cutaneous complications, particularly melanocytic changes in existing moles and newly emerging (dysplastic) nevi. Four case reports have described melanomas emerging from existing moles either during or shortly after the use of melanotan. Although conclusive evidence linking these phenomena is lacking, publications have stressed the importance of awareness that melanotan is a part of a 'tanning culture' in certain subpopulations. Multiple national health organizations have issued safety warnings regarding the use of melanotan I and II.

Efficacy of minimally invasive nonthermal laser-induced optical breakdown technology for skin rejuvenation.

We demonstrate the efficacy of a novel minimally invasive nonthermal skin rejuvenation technique for wrinkle and fine-line reduction based on laser-induced optical breakdown. The optical breakdown caused by tightly focused near-infrared laser pulses creates a grid of intradermal lesions without affecting the epidermis, leading to skin rejuvenation. The pilot in vivo efficacy test performed on five subjects successfully demonstrates wrinkle and fine-line reduction, and improvement of other skin features without pain or any other unpleasant sensations or any social downtime associated with the treatment. The efficacy is evaluated objectively and subjectively by assessing the improvement of wrinkles and/or fine lines or skin texture after the treatment. The treatment is safe without side effects or social downtime, and all test subjects reported that the treatment is "perceptible but not painful." Four out of the five subjects who participated in this pilot study were assessed to have "minor" to "significant" improvements of wrinkles and fine lines by the professional panels. The results of this clinical study are expected to bring a paradigm shift in the present laser- and light-based skin rejuvenation methods by introducing a safe treatment procedure without damaging the epidermis, with no or little social downtime and with an efficacy that might be comparable to ablative techniques.

Minimally invasive non-thermal laser technology using laser-induced optical breakdown for skin rejuvenation.

We describe a novel, minimally invasive laser technology for skin rejuvenation by creating isolated microscopic lesions within tissue below the epidermis using laser induced optical breakdown. Using an in-house built prototype device, tightly focused near-infrared laser pulses are used to create optical breakdown in the dermis while leaving the epidermis intact, resulting in lesions due to cavitation and plasma explosion. This stimulates a healing response and consequently skin remodelling, resulting in skin rejuvenation effects. Analysis of ex-vivo and in-vivo treated human skin samples successfully demonstrated the safety and effectiveness of the microscopic lesion creation inside the dermis. Treatments led to mild side effects that can be controlled by small optimizations of the optical skin contact and treatment depth within the skin. The histological results from a limited panel test performed on five test volunteers show evidence of microscopic lesion creation and new collagen formation at the sites of the optical breakdown. This potentially introduces a safe, breakthrough treatment procedure for skin rejuvenation without damaging the epidermis with no or little social down-time and with efficacy comparable to conventional fractional ablative techniques.

Liposuction of the female breast: a histologic study of the aspirate.

BACKGROUND: Liposuction for female breast reduction is a new treatment modality that has many advantages over the generally accepted procedure of excision, which can damage glandular tissue and impair breastfeeding capacity. OBJECTIVE: To assess any potential damage to glandular tissue caused by liposuction of the female breast. METHODS: Specimens of the aspirate from 61 consecutive female patients who underwent liposuction of the breast using tumescent local anesthesia (TLA) and powered cannulae (PCs) were sent for histologic evaluation. RESULTS: In all cases, fat tissue was the main component observed in the breast aspirate specimens. In 58 cases, fragments of fibrotic tissue were found. In nine cases, minor fragments of the smallest glandular tissue ductuli were detected. In no case was there any sign of larger glandular structures. CONCLUSIONS: Histologic evaluation of 61 specimens of the aspirate obtained from breast liposuctions using TLA and PCs showed only minor signs of damage to glandular tissue in a small minority of patients. There was no indication that lactation might be impaired using this procedure. The authors have indicated no significant interest with commercial supporters.

Efficacy of tumescent local anesthesia with variable lidocaine concentration in 3430 consecutive cases of liposuction.

BACKGROUND: Lidocaine toxicity is a potential complication related to using tumescent local anesthesia (TLA) as the exclusive form of pain management in surgical procedures. OBJECTIVE: We sought to determine the minimum concentration of lidocaine in the tumescent solution required to provide adequate anesthesia in patients undergoing liposuction using TLA exclusively. METHODS: Liposuction using TLA exclusively was performed in 3430 procedures by the same surgeon. The initial concentration of 1000 mg/L lidocaine in the tumescent solution was gradually reduced to find the minimum required for adequate anesthesia. RESULTS: Adequate anesthesia was achieved using a lidocaine concentration of 500 mg/L saline in all areas treated and 400 mg/L saline for most of the areas treated. LIMITATIONS: Data are based on the specific TLA technique used by the same surgeon. Lidocaine serum levels were not analyzed. CONCLUSION: For patients undergoing liposuction using TLA exclusively, the concentration of lidocaine in the normal saline solution required for adequate anesthesia is 400 mg/L for most body areas and 500 mg/L for some sensitive areas.

Safety of liposuction using exclusively tumescent local anesthesia in 3,240 consecutive cases.

BACKGROUND: Many surgeons consider liposuction using tumescent local anesthesia (TLA) to be a safe technique, but when TLA has been combined with other techniques, such as general anesthesia or intravenous medication, or when the guidelines associated with TLA have been violated, serious complications and deaths have occurred. This has resulted in uncertainty concerning the safety of liposuction using TLA, which this article seeks to resolve. OBJECTIVE: To investigate whether liposuction using TLA is a safe procedure. METHODS: The same surgeon performed liposuction using exclusively TLA in 3,240 procedures. Detailed records were kept of the complications that occurred. RESULTS: In a series of 3,240 procedures, no deaths occurred, and no complications requiring hospitalization were experienced. In nine cases, complications developed that needed further action. CONCLUSIONS: Liposuction using exclusively TLA is a proven safe procedure provided that the existing guidelines are meticulously followed.

Breast reduction using liposuction with tumescent local anesthesia and powered cannulas.

BACKGROUND: Having large, heavy breasts can be a problem for women. The widely accepted method of breast reduction is excision, but this procedure often leads to a large number of unwanted side effects and complications. There is, therefore, a need for an effective technique that produces fewer of these undesirable features. OBJECTIVE: A study was conducted to evaluate the safety and efficacy of liposuction using tumescent local anesthesia (TLA) and powered cannulas. METHODS: One hundred fifty-one women were treated. Exact measurements of volume and ptosis were performed before the procedure and at intervals of 6 weeks and 4 months after the procedure. RESULTS: The average volume of the breast removed was 53%. Fat was abundant in elderly women and more easily removed because of the progressive fatty involution of the breast. Ptosis reduction was sufficient in women of all ages, with an average of 3.0 cm achieved after 4 months. Patient satisfaction was high, no serious complications were seen, and down-time was minimal. Pre- and postoperative mammograms were taken 1 year after the procedure and showed no new calcifications. CONCLUSION: Liposuction using TLA and powered cannulas is a safe and effective treatment modality for breast reduction.