1,000 Consecutive Cases of Laser-Assisted Liposuction - Medical Fibers

Keywords:surgical fibers, medical fibers,  Time:30-01-2016

The tumescent technique uses subcutaneous injection of isotonic fluid containing vasoconstrictive and analgesic agents and is proved to be safe, with low morbidity and mortality rates. Laser-assisted liposuction (LAL) using local infiltration of an anesthetic and no general anesthesia or sedation has been developed, with claims of fat destruction and skin tightening. This study aimed to review 1,000 consecutive cases of LAL and SAL performed with the patient under local anesthesia and to determine whether this represents a safe technique with few complications. Methods During a period of 22 months, 581 consecutive patients (486 females and 95 males) underwent 1,000 LAL/ SAL operations, 545 of whom had multiple procedures performed. None of the patients had a body mass index (BMI) higher than 30 kg/m2. The patients ranged in age from 18 to 62 years. The fat aspirate ranged from 50 to 1,400 ml. Patients were given an oral sedative, an antibiotic, and an analgesic. Ringer’s lactate solution containing lidocaine and epinephrine was injected into the subcutaneous space.

The treated areas included the neck, triceps, male breast, midback, flanks, axilla, abdomen, mons pubis, thighs, presacrum, and knees. No patient was administered intravenous sedation or general anesthesia. Results The average number of areas treated was 1.8, and no major complications or mortalities were observed. There were three burns, two infections, one hematoma, and one seroma. A total of 73 secondary procedures were performed (7.3%). No tertiary procedures were required. Conclusion For appropriately selected patients, comparable results can be obtained with an excellent safety profile and short recovery period using LAL and SAL with the patient under local anesthesia. The awake patient is able to participate in body positioning and to provide physiologic monitoring. No major complications occurred in this series. The burn and hematoma complications occurred in the first 25 cases and may have been related to a learning curve. One case of cellulitis occurred in the triceps region, and a second infection occurred in the abdomen. Both responded to antibiotics. Altogether, 73 touch-up procedures (7.3%) were performed. The amounts of fat removal were comparable with the volumes obtained using traditional liposuction. In conclusion, this series demonstrated that LAL/ SAL using local anesthesia is a safe procedure for selected patients, with acceptably low morbidity and revision rates. 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 at medfibers.com provide the high quality medical fibers.

Advances in the evolution of suction-assisted lipectomy (SAL) include improved instrumentation, a better understanding of fluid dynamics, reduced anesthesia requirements, and an improved concept of appropriate indications. In most cases, the procedure is performed using the superwet and tumescent techniques with the patient under general anesthesia, which has many advantages but may carry a small but significant risk to the patient [1–3]. Alternatively, the procedure may be performed using local anesthesia [4]. Use of the tumescent technique in laser fibers liposuction has proved to be safe, with very low morbidity and mortality rates [5–7]. Various methods such as ultrasound-assisted liposuction (UAL), power-assisted liposuction (PAL), and laser-assisted liposuction (LAL) aim to decrease the postoperative recuperation period, reduce operator fatigue, or assist with the removal of fibrous fatty deposits.

Recently, LAL using local infiltration of anesthetic and no general anesthesia or sedation has been developed [8], with claims of fat destruction and skin tightening [9]. Less postoperative pain has been reported by the treated patients, but these results have not been proved clinically in blinded studies [10, 11]. This study reviewed 1,000 consecutive cases of LAL and SAL performed with the patient under local anesthesia to determine the complication and revision rates.

Materials and Methods

Over a 22-month period, 581 patients underwent 1,000 consecutive LAL with SAL operations with local anesthesia. All the procedures were performed in an American Association for Accreditation of Ambulatory Surgery (AAAASF)-accredited, office-based operating room. Of the 581 patients, 545 underwent two or more procedures. All the patients were evaluated and screened preoperatively by the two operating surgeons. History, physical exam, laboratory values, photographs, and medical clearance when indicated were obtained for all the patients. The patients all provided informed consent, and none had a body mass index (BMI) greater than 30 kg/m2. The patient skin types ranged from Fitzpatrick 1 through 6. The 581 patients comprised 486 females (83.6%) and 95 males (16.4%) ranging in age from 18 to 62 years (average, 33 years). The age group with the largest number of patients and the highest percentage was the 25- to 35-year-old segment (267 patients, 46%). The SmartLipo neodymium:yttrium-aluminum-garnet (Nd:YAG) laser-assisted liposuction device (Cynosure Corp., Westford, MA) was used for all the patients. The first 500 patients underwent the procedure with the single-platform, 1,064-nm-wavelength device, and the second group of 500 patients had procedures using the Multiplex (MPX) 1,064/1,320-nm dual-wavelength platform. Except for the different wavelengths noted earlier, all the patients underwent identical procedures. The exclusion criteria ruled out medical contraindications to liposuction or the medicines used, BMI exceeding 30 kg/m2, severe skin laxity, patient objection to an awake procedure, and unrealistic patient expectations. The same criteria used for traditional SAL were applied to determine the adequacy of skin for LAL including the pinch test, presence or absence of dermal striae, and subjective determination of elasticity. On the day of surgery, the areas to be treated were marked with the patients in the standing upright position, and the patients were given one dose of oral antibiotic with the option of 10 mg oral diazepam and one tablet of hydrocodone with acetaminophen.