Chapter 31:

Chapter 31: Chapter 31: - Start

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Liposuction. Sameer Ahmed. 11/14/2012. Background. Adipocyte physiology. Hyperplasia occurs after a critical mass has been reached. Liposuction reduces # of adipocytes, regardless of their size. Should provide long lasting results. ID: 175779 Download Presentation

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Chapter 31:




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Presentations text content in Chapter 31:

Slide1

Chapter 31:Liposuction

Sameer Ahmed

11/14/2012

Slide2

Background

Adipocyte physiologyHyperplasia occurs after a critical mass has been reachedLiposuction reduces # of adipocytes, regardless of their sizeShould provide long lasting resultsLipocontouring happens in the subQ plane Healthy skin flap (don’t get too superficial)Avoid damaging deeper structures (nerves, muscles)

Slide3

Ideal Candidate

Ideal for liposuction:

Diet-resistant

fat pockets, congenital in nature

e.g.: double chin since childhood

Anatomical sites:

Submental

, melolabial, submandibular, and buccal

areas

Younger

patients

Greater skin elasticity, skin contracts better on new subQ contour

Pt. is not obese/overweight. These pts have excess adipose in multiple layers and do not respond to lipocontouring

Lipocontouring does

not replace weight control

Slide4

Types of Lipocontouring

Liposuction

Involves negative pressure through a hollow

cannula

No cutting surface, Fat avulsed “atraumatically”

Liposhaving

Soft tissue shaver w/ gentle suctioning

After the blade is activated,

care

should be taken at the

incision site

to avoid damage to the skin margins

Ultrasonic Liposuction

Mechanical agitation of cannula

 microcavities within adipocytes implode  liquefaction of fat

Slide5

Liposuction Technique

5-10mm incisionIdentify subQ plane w/ MetzIncreasing size cannulas to bluntly dissect, “spokelike”, without suctionSuction aspiration of fatSequence:Submental, jaw & posterior cervical, melolabial1 atm of negative pressureCannula tips 3-6mm in sizeSmaller size for melolabial regionPost-operative dressing

Slide6

Incision Sites and Access

Melolabial

Submental

Post-auricular

Slide7

Liposuction Technique

“Open” Liposuction combined with face lift

Completely

cross-hatch each area,

reduce

the risk of banding.

Hollowing

and inconsistent flap elevation can be avoided

Palpate cannula tip and preserve some fat on the flap’s

undersurface

Avoid

repeated passes in the immediate

submental

area

Can result

in a cobra

neck deformity

.

Release

vacuum

when withdrawing/repositioning

the

cannula

To

avoid

creating grooves over posterior

face

& parotid

A

criss

-crossed pattern of passes helps create a smoother, more natural

contour

Slide8

Integrating Liposuction

Slide9

Pitfalls

1. Significant

ptosis of facial skin may appear accentuated after lipocontouring, thereby creating a more aged

appearance;

 Perform

f

ace lift.

Skeletal

insufficiency may reduce structural definition and give the illusion of excess fullness of a certain area

Chin implant

or

genioplasty

may improve

blunted

cervicomental

angle

3.

Ptotic submandibular glands and hypertrophy of parotid glands can mimic areas of excess adipose collection and should be appreciated and not traumatized.

Slide10

Complications

Hematoma

Can get infected and cause skin flap necrosis

Pigment changes from undiagnosed hematomas

Contour irregularities

From asymmetric

liposuctioning

Motor or sensory nerve injuries

Rare but if they occur, are usually temporary

Cardiovascular instability does not happen w/ only H&N liposuctioning

Can happen with total body suctioning 2/2 massive fluid shifts

Slide11

Preoperative

(A)

and postoperative

(B)

photographs show the illusion of enhanced chin projection after

submental

and submandibular liposuction, as well as the enhancement of the mandibular margin with improvement of the

cervicomental

angle. 


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