Chapter 31: Liposuction Sameer Ahmed

Chapter 31: Liposuction Sameer Ahmed Chapter 31: Liposuction Sameer Ahmed - Start

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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: 716130 Download Presentation

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Chapter 31: Liposuction Sameer Ahmed




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Presentations text content in Chapter 31: Liposuction Sameer Ahmed

Slide1

Chapter 31:Liposuction

Sameer Ahmed

11/14/2012

Slide2

Background

Adipocyte physiology

Hyperplasia occurs after a critical mass has been reached

Liposuction 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 naturee.g.: double chin since childhoodAnatomical sites:Submental, melolabial, submandibular, and buccal areasYounger 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

cannulaNo cutting surface, Fat avulsed “atraumatically”LiposhavingSoft tissue shaver w/ gentle suctioningAfter 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 incision

Identify subQ plane w/ Metz

Increasing size cannulas to bluntly dissect, “spokelike”, without suctionSuction aspiration of fatSequence:Submental, jaw & posterior cervical, melolabial1 atm of negative pressureCannula tips 3-6mm in size

Smaller size for melolabial

region

Post-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 avoidedPalpate cannula tip and preserve some fat on the flap’s undersurfaceAvoid

repeated passes in the immediate

submental

area

Can result

in a cobra

neck deformity

.

Release

vacuum

when withdrawing/repositioning

the

cannulaTo 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 face 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 hematomasContour irregularitiesFrom asymmetric liposuctioningMotor or sensory nerve injuriesRare but if they occur, are usually temporaryCardiovascular 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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