Thyroid supplements have a reputation for promoting weight loss. Some patients intentionally ingest excessive doses of levo-thyroxine (Synthroid) to accelerate their weight loss. One such patient showed the difference in clinical response to the slow absorption of epinephrine in a dilute solution compared with its rapid absorption in concentrated commercial preparations (Case Report 24-3).
Emergency Care
Ten hours after completion of the tumescent infiltration of lidocaine, the patient awoke, experiencing nausea, vomiting, unsteady gate, mild confusion, and dysarthria. Physical examination in a local emergency room revealed anxiety, short-term memory impairment, and slight pallor; otherwise, the neurologic and cardiovascular findings, the ECG, and routine laboratory studies were unremarkable. Blood drawn at 23:48 p.m. had a plasma lidocaine concentration of 6.3 mg/L by immunoassay (IA), and confirmed by gas chromatography (GC) to be 6.1 mg/L. Lidocaine plasma levels greater than 6 mg/L are associated with an increased risk of toxicity. Admitted to the hospital for overnight observation, she was discharged the next morning after a 06:45 a.m. lidocaine level was 2.9 mg/L by IA, and confirmed at 3.0 mg/L by GC.
Colonoscopy
The risk of complications is greatly increased by combining liposuction with multiple unrelated surgical procedures such as facelift, breast surgery, nose surgery, or laser surgery. The combination of an intra-abdominal gynecologic surgery and abdominal liposuction is also very dangerous. This risk of complications when a patient has multiple unrelated surgical procedures explains why non-cosmetic surgeries are rarely combined. Because of the fear of complications, surgeons do not expose patients to the risks of simultaneous but unrelated therapeutic surgeries such as gallbladder surgery, hip surgery, and colonoscopy. The risks associated with having multiple cosmetic procedures including liposuction on the same day may often out weigh the benefits of having only one convalescent period. Liposuction is probably the safest of all cosmetic surgery procedures provided that it is not combined with other unrelated surgical procedures.
Pneumonia
Other potentially catastrophic complications, although extremely rare, include: Allergic drug reactions, aspiration pneumonia (most likely under general anesthesia), cardiac arrest and potentially fatal cardiac arrhythmias, permanent nerve damage, brain damage due to lack of oxygen under general anesthesia, and seizures.
On the morning after childbirth a woman has an increased risk of fainting if she stands up too fast immediately after urinating. This is known as post-micturation syncope. A similar situation occurs the morning after liposuction. A liposuction patient should stand up slowly after urinating. In order to avoid a serious injury from a fall, if dizziness does occur, the patient should sit or lie down on the floor immediately. It is recommended that patients not lock their bathroom door so that someone can come to assist if necessary.
The tumescent technique was invented by Jeffrey A. Klein, M.D., a dermatologist who now practices in San Juan Capistrano, California. Dr. Klein attended medical school at University of California San Francisco. After medical school, he obtained training and board certification in Internal Medicine at UCLA and Dermatology at UC Irvine. Additional studies included a masters degree in biostatistics at UC Berkeley, and a National Institutes of Health (NIH) research fellowship in clinical pharmacology. Dr. Klein started his private practice of dermatology in November of 1984.
Testicular Cancer
This is defined as enlargement of male breast(s) caused by excessive glandular breast tissue. A true excess glandular breast tissue in men is not common. There are a number of distinct causes of gynecomastia including alcoholism, failure of the testicles to produce sufficient testosterone hormone, and many medications. Bilateral gynecomastia can also be associated with human immunodeficiency virus (HIV) infection, renal failure treated with hemodialysis, certain cancers such as testicular cancer, and adrenal corticosteroid secreting tumors. If a male has a single enlarged breast then one must consider the possibility of a true breast tumor. Any significant asymmetry of the male breasts, especially if there is a history of recent onset of asymmetric growth, should prompt the surgeon to consider a mammogram.
Shavit I, Brenner B, Lanir N, et al: Coexistence of acquired protein S and protein C deficiency and the Arg 506Gln mutation in factor Va in a child with severe thromboembolic disease...
Safety of UAL is controversial. One study of 250 consecutive UAL patients concluded that internal UAL is “both safe and effective” despite three cases of dermal necrosis (1.2 percent), 28 postoperative seromas (11.2 percent), and 35 patients with Reston foam blisters. (Maxwell GP. Ultrasound-assisted lipoplasty: a clinical study of 250 consecutive patients. Plast Reconstr Surg 101:189-202,1998). Based on this report, most experienced liposuction surgeons have concluded that UAL is less safe than Tumescent Liposuction with microcannulas.
X-Rays
Chemotherapy
Our patient was a 39-year-old female weighing 80 kg, on whom we performed two tumescent liposuction surgeries. Five years earlier, a breast cancer was treated by chemotherapy, radiation, and bone marrow transplantation. She had a long history of treatment with sertraline (Zoloft) 200 mg daily for anxiety disorder, panic attacks, and mild depression. Sertraline was not discontinued prior to either surgery.
Radiation Therapy
Other risk factors that may affect the relative safety and ultimate cosmetic results of abdominal liposuction include: prior abdominal surgery, laparoscopic procedures, and radiation therapy in the abdominal area.
Keep incisions clean. Shower once or twice daily. First wash your hands, then wash incisions gently with soap and water; afterwards gently pat incisions dry with a clean towel. Apply new absorbent pads. When an incision has ceased draining for more than 24 hours, it no longer needs to covered by pads.
Orthopedic Surgery
17,18 Blood hypercoagulability is significantly greater with general anesthesia than with epidural anesthesia in orthopedic surgery that uses tourniquets.
Neurosurgery
Injury to peripheral nerves is possible with UAL. Patients who have had internal UAL appear to have an increased incidence of prolonged numbness consistent with injury to sensory nerves. The neurosurgery literature has documented the injurious effects of ultrasound on peripheral nerves. The potential for ultrasonic energy causing damage to peripheral nerves suggests that the risks of using UAL in arms, legs, neck and face may outweigh any potential benefits.
Vascular Surgery
During a tumescence local anaesthesia (TLA) procedure, an anaesthetic strongly diluted within a salt solution is pumped directly into the patient’s tissue. The Definition Lipo method has principal advantages with any treatment that requires local anaesthesia, such as liposuction (fat removal) or many applications of vascular surgery.
Hysterectomy
The Pfannenstiel incision is the name for the incision across the lower abdomen that is typically made for Cesarian sections, or a hysterectomy. A common but undesirable consequence of a Pfannenstiel incision is a persistent bulge of subcutaneous fat just above the incision. Liposuction can easily repair this annoying deformity.
Hip Replacement
Within the past 15 years, clinicians have begun considering the possible association of systemic anesthesia with DVT, PE, and fatal PE. Because of the relatively high incidence of DVT and PE associated with surgery for hip fractures and elective hip replacement surgery, some of the most revealing studies appear in the orthopedic literature.
Knee Replacement
A revealing study of total knee replacement found that the incidence of DVT diagnosed by venography was 59% for general anesthesia and 19% for regional anesthesia.
Reconstructive Surgery
We have treated 108 patients who had over 1500 ml of material removed. All patients were treated in the hospital; 44 percent were admitted after surgery. A total of 227 units of autologous and 2 units of homologous blood were transfused. As measured by a computerized monitor, the average amount of blood in the material removed from thighs was 30 percent; from abdomens, the blood loss was 45 percent. No complications were encountered. A few patients developed undesirable sequelae, the most common of which was seroma formation, which occurred in 19 percent of those who had suction of abdominal-wall fat. (Plastic and Reconstructive Surgery, volume 89, pages 1068-1079,1992).
In a report of six cases, lidocaine with epinephrine was injected subcutaneously for vasoconstriction before blepharoplasty (eyelid surgery) and resulted in a rapid onset of malignant hypertension and severe bradycardia.9 Another patient taking propranolol was given 0.3 mg of concentrated epinephrine (1:1000) subcutaneously to treat a suspected allergic reaction and rapidly developed hypertension and bradycardia.10
Liposuction
Liposuction Information Liposuction Defined Liposuction is defined as the removal of fat from deposits beneath the skin using a hollow stainless steel tube (called a cannula) with the assistance of a powerful vacuum. Liposuction can be accomplished either with the use of general anesthesia, or with heavy IV sedation, or totally by local anesthesia.
Breast Augmentation
Patients occasionally ask if it is possible to take fat from one area of a woman’s body and inject it into her breasts. This procedure, known as autologous fat transplantation, has been associated with severe complications. Breast augmentation by autologous fat transplantation is an experimental procedure. It should only be done under the guidance of formal human studies research protocols for patient protection. Among the complications that have been reported are life threatening infections, fat necrosis, and lipo-necrotic cysts.
Breast Reduction
Older techniques for breast reduction, known as surgical-excision breast reduction, involved cutting the breast with a scalpel to excise or remove large amounts of breast tissue. Problems associated with surgical-excision breast reduction include the risk of keloids or excessively large scars, uneven sized breasts, abnormal appearance of the skin near the nipple, impaired nipple sensation, and possible nipple damage. Other risks include bleeding, blood clots or hematoma in the breast, seromas (fluid collection in the breast), fat necrosis with cyst formation in the breast, and scarring of the deep breast tissue that can produce mammogram abnormalities. Besides requiring general anesthesia, breast reduction by excision is also associated with significant pain and prolonged recovery.
Breast Lift
Breasts, Female Tumescent Liposuction of the Female Breast Breast liposuction using Tumescent liposuction of the female breast totally by local anesthesia can produce both a significant breast reduction and a moderate but gratifying breast lift. The use of microcannulas permits breast reduction with minimal postoperative pain, rapid postoperative recovery, quick return to normal activities, and
Plastic Surgery
€¢ Large-Volume Suction Lipectomy: An Analysis of 108 Patients (by Eugene H. Courtiss, M.D., et al., Division of Plastic Surgery, Department of Surgery, Harvard Medical School, Boston, MA).
Thigh Lift
For a woman who cannot tolerate her extensive wrinkling of the inner thigh, there is the option of a surgical thigh lift. Most women are often disappointed by the aesthetic results of an inner thigh lift. They find the scaring associated with a medial thigh lift to be worse than the wrinkling. For patients with marked wrinkling, and only a minimal amount of medial thigh fat, the most reasonable option might simply be no surgical treatment.
Face Lift
Face and Neck Tumescent liposuction is the safest and usually the most effective technique for removing fat from the chin, cheeks and jowls. Liposuction involves fewer complications, fewer scars, avoids the dangers of general anesthesia, has a more rapid recovery, lower costs, and typically gives a more natural appearance compared to a facelift. Women Women
Neck Lift
Laser liposuction offers the same contouring and visual improvement of traditional liposuction and is actually being used more often in small areas of treatment. Specifically, many liposuction surgeons opt to use laser liposuction on the chin, jowls or face of a patient because of the precision of the procedure and the great success. The excess pockets of fat that can develop in this area can be melted with precision and the tightening of the skin operates almost as a face or neck lift.
Blepharoplasty
2. A moderate epinephrine concentration (1:100,000) is injected into highly vascular tissue, such as buccal mucosa for local anesthesia in dentistry, ocular mucosa with blepharoplasty, or for a regional nerve block.
Abdominoplasty
A previous pregnancy tends to stretch the abdominal muscles, and cause the lower abdomen to bulge to a certain degree. This curvature of the abdominal wall muscles determines the flatness or the shape of the abdominal silhouette after liposuction. Nevertheless, the vast majority of women who have been pregnant are ultimately very happy with results obtained by liposuction alone, and do not require an abdominoplasty (tummy tuck).
Nose Surgery
Breast Surgery
Any significant breast mass must be evaluated with a mammogram and possibly a breast biopsy prior to breast reduction. Cosmetic breast surgery is not appropriate until the surgeon has established that there is a minimal likelihood of breast cancer. Breast surgery in any patient with a significant family history of breast cancer requires very careful consideration and detailed informed consent.
Body Contouring
Sometimes your healthy habits do not quite result in the body shape you were hoping to attain, luckily help is on the way. Body contouring procedures like liposuction help to reduce and smooth your figure to put the lasting touches on your profile. The staff at Senza Aesthetic Medicine has a few tips to help
Laser Resurfacing
This is a surgical technique that uses a diamond-coated disc to literally sand-off the superficial layer of the skin. True dermabrasion is associated with some bleeding, requires good anesthesia, and can provide dramatic cosmetic improvement of facial wrinkles. The term “micro-dermabrasion” refers to an ineffective technique that only provides temporary feeling of smoothness, and does not improve deep wrinkles. This old fashioned dermabrasion using tumescent local anesthesia is probably the most successful technique for eliminating deep wrinkles on the upper lip. The success of dermabrasion depends on a high degree of surgical skill. Some cosmetic surgeons do not have experience in doing dermabrasion. Lip wrinkles which are not too deep can also be treated by laser resurfacing.
Gynecomastia
Pseudo-gynecomastia is defined as an enlargement of male breast(s) caused by an excessive amount of fat tissue, but a normal amount of glandular breast tissue. Most male breasts that appear unusually large are the result of excessive fat. A slight but cosmetically undesirable degree of pseudo-gynecomastia probably occurs in a majority of men as they become older. Excessively fatty breasts are not uncommon in younger men who are relatively obese.
Cosmetic Surgery
Excessive amounts of surgical trauma can be regarded as toxic to patients. Increasing doses of liposuction-induced surgical trauma produce increasing risks of toxicity in the form of surgical complications. It is not possible to precisely identify the threshold for dangerous amounts of liposuction. However, one can be certain that removing 6 to 9 liters of fat on one day is many times more dangerous than removing 2 to 3 liters of fat on each of three separate surgeries spaced at least one month apart. Liposuction of 5% of the body's subcutaneous surface area is obviously safer than liposuction of 40% of the body surface area. Cosmetic surgery is not emergency surgery, liposuction patients should not be exposed unnecessary risks of excessive liposuction on a single day.
Dermabrasion
Liposuction does not eliminate facial wrinkles, but there are modern cosmetic facial resurfacing techniques that do. Facial wrinkles, blotchy pigmentation, and acne scars can all be treated by any one of several techniques including CO2 laser resurfacing, chemical peel, dermabrasion, or a combination of these techniques. A combination of liposuction plus wrinkle removal can often provide a better overall cosmetic improvement than a facelift.
Two recent reports have found that dilute lidocaine in a concentration of 500 mg per liter of solution (0.05%) does have in-vitro antibacterial activity. Another study found this lidocaine dilution to be bacteriostatic for Staphylococcus aureus. Another in-vitro study, using suspensions of bacteria containing approximately 105 bacteria per ml found that all gram-positive organisms tested, including S. aureus, had significantly lower colony counts in 0.05% or higher concentrations of lidocaine diluted by the IV anesthetic propofol. There is in-vitro evidence that lidocaine is not just bacteriostatic but actually bacteriocidal for organisms isolated from skin lesions. Recently it has been shown that when sodium bicarbonate is added to lidocaine, this in-vitro bacteriocidal activity is increased.
Chemical Peels
Chemical peels involve the application of a dilute chemical solution to the face producing an injury to the superficial layers of the skin. An experienced surgeon can use different chemicals and different concentrations of the chemical to achieve a desired result. Superficial chemical peels that remove only the most superficial layers of skin, heal quickly, and are used to remove blotchy pigmentation. Intermediate chemical peels can remove fine wrinkles as well as blotchy pigmentation. Deep peels can remove deep wrinkles and provide results that are comparable to the maximum effects of a CO2 laser.