Liposuction is the second most commonly performed cosmetic surgery in the United States.

It is the most common surgical procedure in patients between the ages of 35 and 64.


The most common sites for fat removal:  the abdomen, flanks, trochanteric region, lumbar region, and gluteal region.



Additional areas of fat removal include the breasts, thighs, and calves.



Liposuction increasingly used as an other aesthetic procedures such as breast augmentation, cervicoplasty, abdominoplasty, gluteal fat transfer, and body contouring after bariatric surgery.



Gluteal fat transfer: large volumes of fat are transferred from an undesirable area, such as the abdomen or inner thighs, to the buttocks.



Noncosmetic indications include: treatment of lipomas, lipedema, and lipodystrophy syndromes.



An outpatient procedure.



It removes adipose tissue from the subcutaneous space with the goal of achieving a more desirable body contour. 



Liposuction removes deposition of fat in those areas.



Liposuction’s most common complication is contour deformity.



The procedure redistributes adipose volume with lower complication, morbidity, and mortality rates than other surgical procedures.



Liposuction is an  adjunct in reconstructive surgery, when harvested fat is autologously reinjected into the breast and face, cervicoplasty, abdominoplasty, gluteal fat transfer, and body contouring for postsurgical bariatric patients.



Superficial subcutaneous tissues adhere to underlying deep fascia of muscle in 5 zones in the body: the lateral gluteal depression, gluteal crease, distal posterior thigh, midmedial thigh, and inferolateral iliotibial tract. 



There  zones define the natural shape of the body.



The procedure suctioning from these areas increases the risk of contour deformities.



Liposuction patients should have adequate skin elasticity and be within 20% to 30% of their ideal body weight to achieve desired aesthetic outcomes.



Liposuction promote gender-specific features: In women promotes shapely contours of the breasts, waist, hip, and buttocks; In men, liposuction removes excess flank adipose tissue.



High-volume fat transfer, is defined as a volume greater than 1,000 mL.



High-volume fat transfer is 


associated with a higher risk of infection at the graft site and seroma formation at a  harvested site. 



Gluteal fat transfer is rapidly increasing due to shifting beauty standards.



Fatal pulmonary fat embolisms following injury to gluteal veins and an estimated mortality rate of 1 in 3,000 has been reported.



Liposuction is also being used for reconstructive purposes:



Lipomas and angiolipomas









Lipodystrophy syndromes



Cervicodorsal lipodystrophy associated with Cushing syndrome and use of HIV medications.



Gynecomastia in men and macromastia in women



Liposuction can be used to:


Reduce excess fat deposits at surgical sites in obese patients who are undergoing tracheostomy, colostomy, or urostomy procedures. 



Reduce the amount of subcutaneous fat in flaps created for reconstructive procedures.



Collect harvested fat to fill in breast reconstruction, burns, and scars.



Anticoagulants and medications that interfere with lidocaine metabolism should be stopped before liposuction.



Poor skin firmness and elasticity in elderly patients would lead to poor skin aestheics postoperatively and potentially increase patient dissatisfaction.



Patients with body dysmorphic disorder may require a psychiatric consultation before surgery. 



Patients with diabetes mellitus, cardiac disease, and liver disease may need medical clearance before surgery.



Poorly controlled diabetes increases the risk of infection.



Suction-assisted lipectomy is the standard procedure.



Small-volume liposuction with a maximum of 1,000 cc of fat to be removed can be performed under local anesthesia. 



The risk for seroma and fluid imbalance increases as the volume of fat that is removed increases.



Megaliposuction, refers to a procedure in which an amount greater than 10% of body weight is removed.



Such large-volume liposuction procedures are performed with general anesthesia.



Liposuction typically has a short surgery time of under 3 hours, depending on the extent of fat removal.



Patients undergoing liposuction have a short recovery period, unobtrusive scars, permanent results, low complication rates, and low morbidity and mortality rates relative to other surgical procedures. 



When adipocytes are removed, further storage of fat in those areas is limited.



Risks: patients with cardiovascular disease, pulmonary disease, diabetes, and vascular disease, tobacco use have higher risk for surgical complications.



Ongoing infections, particularly, near the area of the liposuction site requires treatment with antibiotics and resolution of infection before surgery. 



Previous venous thromboembolism, may increase the risk of surgical complications.



Complications are relatively uncommon:  2.4%.



The complication rate is higher, 3.5%, when liposuction is  combined with other procedures.



Complications include ecchymosis, edema, surgical site infection, seroma, hematoma, and venous thromboembolism.



The most common complication of liposuction relates to contour deformities: 9% of patients may report soft-tissue depressions or elevations, skin panniculus, folds, or wrinkles.


Most common complications are contour irregularities (0.17%), unplanned hospitalization (0.11%) and prolonged edema (0.9%).


Major and minor complications 0.1% to 2%.

Reoperative rates of 5-15%.

Fatal complications 0.02% to 0.3%.

Mortality attributed mainly to pulmonary embolus, abdominal viscus perforation, anesthesia complications and fat embolus.



By utilizing smaller diameter cannulas, avoiding suctioning at superficial layers, and correcting for postoperative fat lysis, contour deformities can be minimized.



Seroma frequency formation can be reduced by using progressive tension sutures to address dead space formation: decreasing 9% to 2%.



Wound infections is reported in fewer than 1-3% of liposuction cases.



Low infection rates attributed: surgeon expertise, proper prophylactic antibiotics, and sterile technique.



Cellulitis, fasciitis and sepsis can occur, rarely.



Fat embolization is a rare complication.



Fat embolization has a mortality rate of 10% to 15%, so management requires careful postoperative monitoring for rapid detection and treatment.



Fat embolization occurs within 12 to 72 hours after surgery.



Gluteal fat transfer has the highest mortality rate of any aesthetic procedure: higher risk of fatal fat embolism,



Venous thromboembolism incidence after liposuction is low at 0.03%: 


pulmonary embolism is the most common cause of death after this procedure, which carries an overall mortality rate of 0.01%.



Liposuction causes a transient elevation of acute inflammatory markers such as interleukin 6, and C-reactive protein



Complications arising  weeks to months after surgery: edema, lymphedema, wound dehiscence, hypertrophic scar formation, ecchymosis, and skin laxity. 



Cannula placement injury can lead to abdominal wall injury, bowel perforation, or vessel injury. 



Skin necrosis can occur if the surgeon suctions too superficially, close to the skin.



Autologous fat transfer to the breast may lead to fat necrosis that mimics microcalcifications suspicious for breast cancer on mammography.



Additional noninvasive body contouring includes: cryolipolysis, deoxycholic acid subcutaneous injection, and radiofrequency skin-tightening.






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