Liposuction : Principles and Practice

This superbly illustrated book covers all aspects of liposuction: anatomy, pathology, biochemistry, preoperative care, equipment, the full range of procedures, complications, postoperative care, outcomes, lipedema, and medical legal aspects. Compared with the successful first edition, the text has been extensively updated and many additional chapters included, with particular attention to recently introduced techniques. While new technology helps to improve results, experience, care, and skill on the part of the cosmetic surgeon are essential if optimal results satisfactory to the patient are to be achieved. The contributors to this book have expended much time and effort to present the cosmetic and plastic surgeon with as much information as possible on the techniques and uses of liposuction for the purposes of cosmetic and non-cosmetic surgery. __Liposuction: Principles and Practice__ will be of value for residents and fellows and for practicing and highly experienced surgeons in plastic surgery, cosmetic surgery, general surgery, and other subspecialties. Foreword to the Second Edition......Page 8 Preface to the Second Edition......Page 10 Contents......Page 12 Contributors......Page 22 Part I: Anesthesia......Page 33 1: Anesthesia for Liposuction......Page 34 1.2 The Surgical Facility......Page 35 1.2.1 Personnel......Page 36 1.3 Preoperative Evaluation......Page 37 1.3.1 Preoperative Risk Assessment......Page 38 1.4.1 Cardiac Disease......Page 39 1.4.2 Obesity......Page 40 1.4.3 Hypertension......Page 41 1.4.5 Pulmonary Disease......Page 42 1.4.6 Sleep Apnea Syndrome......Page 43 1.5 Anesthesia for Liposuction......Page 44 1.5.1 Local Anesthesia......Page 45 1.5.2 Sedative–Analgesic Medications (SAM)......Page 48 1.5.3 General Anesthesia......Page 54 1.5.4 Preoperative Preparation......Page 57 1.5.5 Airway Management......Page 62 1.5.6 Perioperative Monitoring......Page 63 1.5.7 Perioperative Fluid Management......Page 64 1.6 Recovery and Discharge......Page 67 References......Page 69 Additional Recommended Reading......Page 80 2.1 Introduction......Page 81 2.3 Tumescent Technique......Page 82 References......Page 83 3.1 Background and History......Page 85 3.2.2 Pharmacology of Tumescent Anesthesia......Page 86 3.2.3 Tumescent Anesthesia Formulation......Page 87 3.3 Lidocaine Metabolism and Toxicity......Page 88 3.5 Ancillary Pharmacology......Page 90 3.6.1 Tumescent Fluid Infiltration......Page 91 3.6.2 Microcannulas and Lipoaspiration......Page 93 3.8 Complications......Page 94 3.9 Safety of Tumescent Liposuction......Page 96 3.10 Guidelines for Maximum Volumes of Lipoaspiration......Page 97 References......Page 98 4.1 Introduction......Page 100 4.3 Articaine Study......Page 101 References......Page 103 5.1 Introduction......Page 104 5.2 Background......Page 105 5.3.1.2 Lidocaine Dosing and Toxicity......Page 106 5.3.1.3 Epinephrine Dosing and Toxicity......Page 107 5.3.1.5 Effect of Sodium Bicarbonate in Tumescent Lidocaine Anesthesia......Page 108 5.3.2.2 Pharmacokinetics......Page 109 5.3.2.4 Relative Potency, Tolerability, and Toxicity......Page 110 Efficacy of Combined Caine Formula......Page 111 Safety of Combined Caine Formula......Page 112 References......Page 113 6.1 Introduction......Page 116 6.3 Surgical Technique......Page 117 6.4.1 Efficacy......Page 118 6.5 Discussion......Page 119 References......Page 122 Part II: Histology, Pathology, Biochemistry, and Physiology......Page 124 7.1 Introduction......Page 125 7.2 Experimental and Preclinical Background......Page 126 7.3 Clinical Studies......Page 127 References......Page 129 Part III: Preoperative......Page 131 8.2 Physical Examination......Page 132 8.5 Preoperative Instructions......Page 133 9.2.1 Introduction......Page 136 9.2.2 Discussion......Page 137 9.4 Dangers of Herbals in Surgery......Page 138 9.5 Toradol for Postoperative Analgesia......Page 139 9.6.3.1 Effects (Pharmacology)......Page 141 9.6.3.5 Food and Drug Administration Warnings......Page 142 References......Page 143 Part IV: Cannulas, Equipment......Page 146 10.2 Cannula Types......Page 147 10.3 Decontamination and Sterilization Techniques......Page 148 10.4 Infections Secondary to Surgery......Page 151 References......Page 152 11.1 Introduction......Page 154 11.2 Technique......Page 155 11.3 Discussion......Page 156 References......Page 157 12.1 Introduction......Page 158 12.3 Discussion......Page 159 References......Page 161 13.1 Introduction......Page 163 13.3 Discussion......Page 164 References......Page 165 Part V: Techniques......Page 166 14.2 New Principles of Liposuction......Page 167 References......Page 169 15.1 Introduction......Page 170 15.3 History......Page 171 15.4.1 Adipose Anatomy-Physiology......Page 173 15.5.2 Ultrasound-Assisted Liposuction (UAL)......Page 174 15.5.4 Power-Assisted Liposuction......Page 175 15.5.6 Radiofrequency-Assisted Liposuction (RFAL)......Page 176 15.7 Subdermal Liposuction......Page 177 Conclusions......Page 178 References......Page 179 16: Nonaesthetic or Functional Indications of Liposuction......Page 182 16.2.1 Knees......Page 183 16.2.2 Legs......Page 184 16.2.3 Thighs......Page 185 16.2.4 Hips......Page 187 16.2.5 Upper Extremities......Page 188 16.2.7 Abdomen......Page 189 16.3.1 Multiple Symmetric Lipomatosis (MSL) (Madelung or Launois-Bensaude Disease)......Page 190 Conclusions......Page 191 References......Page 192 17.1 Introduction......Page 195 17.2.2 Volume......Page 196 Conclusions......Page 197 References......Page 198 18.1 Dry Liposuction Procedure......Page 199 18.3 Anatomy of Lymphatics in the Lower Limb......Page 200 18.4 Lymphatics of the Upper Limb......Page 201 18.6 Lymph Liposuction......Page 202 References......Page 203 19.1 Introduction......Page 204 19.2 Standards of Liposuction Today......Page 205 19.3 The Role of Tissue Stabilization......Page 206 19.4 Side Comparison Study to Demonstrate the Effects of the MASST......Page 207 References......Page 208 20.1 History of Syringe Liposculpturing......Page 209 20.2.1.2 Syringes......Page 212 20.2.2 Cautions......Page 213 20.3.2 Pre-estimation of the Quantity to Be Resected......Page 214 20.3.5 Anesthesia......Page 215 20.3.8 Positioning the Patient......Page 216 20.3.9 Surgical Technique......Page 217 20.3.10 Dressing......Page 218 20.3.12 Technical Considerations......Page 219 20.6 Results......Page 220 References......Page 222 21.1 Introduction......Page 223 21.2 Modifications in Syringe-­Assisted Liposuction......Page 224 21.3 Modifications in the Tumescent Solution Infiltration......Page 225 21.4 Modifications in the Cannula Port Side......Page 226 References......Page 227 22.1 Introduction......Page 229 22.4 Material......Page 230 22.6 Discussion......Page 231 References......Page 235 23.1 Introduction......Page 236 23.2 Technique......Page 237 23.3 Discussion......Page 238 References......Page 240 24.1 Introduction and General Concepts......Page 241 24.3.1 Development and Structure......Page 242 24.3.2 Fat Biochemistry and Adipose Tissue Metabolism......Page 243 24.4.1 Regional Fat Distribution by Gender and Race......Page 244 24.5 Impact of Liposuction on General Health Risks......Page 245 24.6.1 Preoperative Preparation......Page 246 24.6.3 Total Injected Volume......Page 247 24.6.4 Transoperative and Postoperative Facts......Page 250 24.8 Final Considerations......Page 251 References......Page 252 25.1 Introduction......Page 254 25.3 Indications......Page 255 25.4.2 Technique of Subcutaneous Infiltration......Page 256 25.4.3 Operative Technique......Page 257 25.4.3.1 Follow-Up and Postoperative Care (Figs. 25.4 and 25.5)......Page 259 25.5 Results......Page 260 25.6.1 Local complications......Page 279 25.6.2 General Complications......Page 280 25.7 Discussion......Page 283 References......Page 284 26.1 Introduction......Page 285 26.2 Technique......Page 289 References......Page 302 27.1 Introduction......Page 303 27.2.2 Case 2 (Fig. 27.2)......Page 306 27.3 Discussion......Page 312 References......Page 316 28.2.1 Patient Selection......Page 317 28.4 Preoperative Planning......Page 318 28.5.2 Skin Incisions......Page 319 28.5.3 Probes......Page 320 28.5.4.1 Fat Emulsification......Page 321 28.6 Clinical Results......Page 323 28.7 Mastopexy......Page 324 28.9 The Passot Technique......Page 326 28.9.2 Procedure......Page 329 28.11 Selectivity and Specificity of Ultrasound......Page 338 28.12 Calcifications......Page 339 Conclusions......Page 340 References......Page 341 29: The Clinical Applications of Multifrequency Ultrasound Technology in Body Reshaping......Page 342 29.1 Introduction......Page 343 29.3 US and Adipose Tissue Interaction......Page 344 29.4 What about Multifrequency Technology......Page 346 29.6 Surgical Application......Page 347 29.8.2 Cavitation Effect and Infiltration......Page 348 29.8.3 Surgical Time......Page 349 29.13 Transcutaneous Ultrasound Treatment......Page 350 29.13.2 Preoperative Planning and Choice of Probe......Page 354 29.13.5 Posttreatment Advice and Session Scheduling......Page 355 29.17 Combined Treatments......Page 356 Conclusions......Page 357 References......Page 359 30.1 Introduction......Page 360 30.2 Study Results......Page 361 30.3 Discussion......Page 362 References......Page 364 31.1 Introduction......Page 366 31.3 Current Instrumentation......Page 367 31.4 Advantages and Disadvantages of Powered Instruments......Page 369 References......Page 370 32.2 Material and Methods......Page 371 32.3 Technique......Page 372 32.3.2 Nutational Infrasonic Liposculpture......Page 373 32.4 Results......Page 374 References......Page 376 33.1 Introduction......Page 377 33.3 Consultation and Patient Selection......Page 378 33.4 Operative Techniques......Page 379 33.6 Results......Page 380 33.7 Discussion......Page 382 References......Page 386 34.2 Nd:YAG Laser......Page 388 34.3 Histological Studies......Page 389 34.4 Surgical Technique......Page 390 34.5 Results......Page 392 Conclusions......Page 393 References......Page 394 35: Combination Laser-Assisted Liposuction and Minimally Invasive Skin Tightening with Temperature Feedback for Treatment of the Submentum and Neck......Page 395 35.1 Introduction......Page 396 35.2.3 LAL Step......Page 397 35.2.5 ST Step......Page 398 35.3.4 Safety and Recovery......Page 399 35.4 Discussion......Page 400 References......Page 403 36.1 Introduction......Page 405 36.2 Review of Treatment Series......Page 406 36.3.1 Case 1......Page 407 36.3.3 Case 3......Page 408 36.3.5 Case 5......Page 409 36.4 Technique Evolution......Page 410 36.6 Discussion......Page 411 References......Page 413 37.1 Introduction......Page 415 37.2.3 Case 3......Page 416 37.3 Discussion......Page 418 References......Page 421 38.1 Introduction......Page 422 38.2 Patient Selection......Page 424 38.2.1 The Ideal Patient......Page 425 38.2.2 Common Pitfalls......Page 426 38.4.2 Anesthesia......Page 427 38.4.3 Surgery......Page 428 38.5 Recovery Phase......Page 431 38.6 Complications......Page 432 References......Page 433 39.1 Introduction......Page 434 39.2 Asian Anatomy and Aesthetics......Page 435 39.3 Adipose Anatomy, Histology, and Physiology......Page 436 39.4.1 Facial Liposuction......Page 437 39.4.2 Autologous Facial Fat Transplantation......Page 438 Reference......Page 440 40.1 Introduction......Page 441 40.1.1 Patient Selection......Page 442 40.2 Technique......Page 443 40.4 Complications......Page 446 References......Page 448 41.1 Introduction......Page 449 41.3 Results......Page 450 41.4 Discussion......Page 451 References......Page 454 42.1 Introduction......Page 456 42.2 Surgical Technique......Page 457 42.3 Discussion......Page 458 References......Page 459 43.1 Introduction......Page 460 43.3.3 Submental Neck Skin......Page 461 43.4 Evaluation......Page 462 43.5 Patient Selection Process......Page 463 References......Page 465 44.1 Patient Consultation......Page 466 44.2 Technique......Page 467 44.3 Postoperative Care......Page 468 44.4 Discussion......Page 469 References......Page 470 45.1 Introduction......Page 471 45.3 Principles of Operation......Page 472 45.4 Operative Technique......Page 473 45.6 Discussion......Page 474 References......Page 478 46.2 Classification......Page 479 46.4 Mechanisms of Axillary Odor......Page 480 46.5.3 Botulinum Toxin......Page 481 46.5.5 Surgical Treatments......Page 482 46.6.2 Technique......Page 483 Conclusions......Page 484 References......Page 485 47: Liposuction for Axillary Hyperhidrosis: Reconciling Trial Results and Expert Opinion......Page 487 47.3 Discussion......Page 488 Conclusions......Page 490 References......Page 491 48.1 Introduction......Page 492 48.3 Method......Page 493 48.5 Laser Treatment and Suction or Laser Treatment Alone? Which Approach Is Superior?......Page 495 48.6 Safety Measures......Page 497 48.7 Ectopic Sweat Glands......Page 498 48.8 Epilation......Page 499 48.11 Observed Side Effects and Complications......Page 500 48.12 Safety Guidelines......Page 504 49.2 Upward Rotation of the Breast......Page 505 49.3 Subdermal Skin Stimulation......Page 506 49.4 Subcutaneous UAL Undermining......Page 507 49.5 Discussion......Page 509 References......Page 514 50.1 Introduction......Page 515 50.2.2 Conventional Liposuction or Suction-Assisted Lipectomy (SAL)......Page 517 50.2.3 Ultrasound-Assisted Liposuction (UAL)......Page 518 50.2.4 Open Excision ± Skin Reduction......Page 519 50.4 Discussion......Page 520 References......Page 525 51.1 Introduction......Page 528 51.3 Clinical Features......Page 529 51.5.1 Anesthesia......Page 530 51.5.2 Technique......Page 531 References......Page 532 52.1 Introduction......Page 534 52.2.1 Instruments......Page 535 52.2.2 Anesthesia......Page 536 52.2.3 Regularity......Page 537 52.2.5 Internal Ultrasound......Page 538 52.2.6 External Ultrasound......Page 539 52.3 Discussion......Page 541 Conclusions......Page 542 References......Page 543 53.2 Complications of Silicone Injections......Page 545 53.4.1 Stage I......Page 546 53.4.4 Stage III......Page 547 53.5.1 History......Page 548 53.6.3 Fat Preparation......Page 549 53.6.6 Postoperative Care......Page 550 53.7.1 Case Example......Page 551 References......Page 552 54.3 History......Page 553 54.4 Anatomy......Page 554 54.6 Physiopathology of the Heavy Legs Syndrome and Lipoedema......Page 555 54.7 Surgical Technique......Page 556 54.7.2 Operation Tactics......Page 557 54.8 Postoperative Period......Page 558 54.9 Complications......Page 559 54.10 Discussion......Page 560 References......Page 562 55.1 Introduction......Page 563 55.2 Case Presentation......Page 564 55.3 Discussion......Page 565 References......Page 568 56.1 Introduction......Page 569 56.2.2 Blood Supply......Page 571 56.3.3 Technique......Page 572 56.6.1 Case 1: Right Foot Dorsum Degloving Injury with Groin Flap Coverage......Page 574 56.6.3 Case 3: Left Ankle Crush Injury with ALT Flap Coverage......Page 575 References......Page 577 57.2 Technique......Page 578 57.2.2 Liposuction......Page 579 57.2.3.1 Trochanteric Dermolipectomy for Correction of Drooping Buttocks and Interfemoral Flaccidity......Page 581 57.2.3.2 The Upper Limbs......Page 582 57.2.3.3 The Abdomen......Page 583 References......Page 586 58.1 Introduction......Page 588 58.6 Proposed Surgery and Its Objectives......Page 589 58.7 Technical Sequence......Page 590 58.8 Postoperative Care......Page 592 58.9 Clinical Cases......Page 594 Conclusions......Page 616 References......Page 617 59.2 History......Page 618 59.3 Clinical Anatomy......Page 619 59.4 Patient Evaluation......Page 620 59.5.1 Preoperative Treatment......Page 621 59.5.2 Suction Lipectomy......Page 622 59.5.3 Dermolipectomy......Page 623 59.6 Postoperative Care......Page 624 References......Page 625 60.1 Introduction......Page 627 60.4 Differential Diagnosis......Page 628 60.6 Diagnosis......Page 629 Conclusion......Page 630 References......Page 631 61.1 Introduction......Page 632 61.6 Assessing Body Composition......Page 633 61.8 Materials and Methods......Page 634 61.9 Operative Technique......Page 635 61.10 Clinical Results......Page 637 61.11 Surgical Risk......Page 639 References......Page 643 62.1 Introduction......Page 644 62.2 Case Reports......Page 645 References......Page 647 63.1 Introduction......Page 649 63.2.1 Case 1......Page 651 63.3 Summary......Page 652 References......Page 653 64.1 Introduction......Page 655 64.2 Diagnosis......Page 656 64.5 Results......Page 657 References......Page 658 65.1 Introduction......Page 659 65.2.2 Technique......Page 660 65.3 Postsurgical Hematomas......Page 661 References......Page 662 66.1 Fox–Fordyce Disease......Page 664 66.2 Therapies......Page 665 66.3 Description of Procedure: Axillary Liposuction-Assisted Curettage......Page 666 References......Page 667 67.1 Introduction......Page 668 67.2 Technique......Page 669 Conclusions......Page 672 References......Page 673 68.1 Introduction......Page 674 68.2 Technique......Page 675 68.3 Results......Page 676 References......Page 678 69: Reverse Tissue Expansion by Liposuction Deflation Adopted for Harvest of Large Sheet of Full-­Thickness Skin Graft......Page 680 69.3 Discussion......Page 681 References......Page 682 70.2 Cellulite......Page 683 70.4 Lymphedema......Page 684 References......Page 685 71.1 Introduction......Page 687 71.3 Discussion......Page 688 References......Page 690 72.1 Neurofibromatosis Type 1 and Plexiform Neurofibromas......Page 691 72.3 Use of Liposuction for Treatment of Plexiform Neurofibromas......Page 692 72.4 Risks of Procedure......Page 693 Conclusions......Page 694 References......Page 695 73.1 Introduction......Page 696 73.2.1 Technical Aspects......Page 697 73.3 Discussion......Page 698 73.4 Timing of Liposuction......Page 699 73.7 SAL in Irradiated Flaps......Page 700 References......Page 701 74.2 Side Effects Associated with Filler Materials......Page 703 74.3 Liposuction Technique for Extraction of Permanent Fillers......Page 705 References......Page 706 Part VI: Lipedema (Lipoedema) and Lymphedema......Page 707 75.2 Anatomy and Pathophysiology......Page 708 75.3 Clinical Categories of Lipedema......Page 711 75.8 Surgical Therapy......Page 712 References......Page 713 76.1 Introduction......Page 714 76.2 Diagnosis......Page 716 76.4 Technique......Page 719 76.5.1 Controlled Compression Therapy (CCT)......Page 721 76.7 Patient Selection......Page 722 References......Page 724 77.2.1 Clinical Aspects......Page 727 77.2.5.1 Conservative Treatment......Page 728 77.3.1 Patients and Methods......Page 730 77.4 Discussion......Page 731 References......Page 735 78.3 Lipolymphosuction......Page 736 78.5 Endermologie® and LPG Technique......Page 737 78.8 Results......Page 738 78.9 Discussion......Page 739 References......Page 742 79.1 Introduction......Page 743 79.2 Clinical Picture......Page 744 79.4 Extragenital Impact of Sex Hormones......Page 746 79.6 Lymphological Liposculpture......Page 747 79.7 Cologne Lipoedema Study 2012......Page 748 References......Page 752 Part VII: Complications......Page 754 80.1 Introduction......Page 755 80.3.1.1 Fat Embolism Syndrome (FES)......Page 756 80.3.1.4 Hypovolemia/Anemia......Page 757 80.3.1.5 Lidocaine Toxicity......Page 758 80.4.1 Contour Irregularities......Page 759 80.4.2 Skin Necrosis......Page 760 80.4.4 Hyperpigmentation......Page 761 Conclusion......Page 762 References......Page 763 81.2.1 Asymmetry......Page 764 81.2.4 Depressions (Grooves, Waviness)......Page 765 81.2.7 Fibrosis......Page 766 81.2.9 Hyperpigmentation......Page 767 81.2.12 Lidocaine Toxicity......Page 768 81.2.16 Neurologic Problems......Page 769 81.2.19 Scars......Page 770 81.2.21 Thromboembolism......Page 771 81.2.22 Toxic Shock Syndrome......Page 772 References......Page 773 82.2 Local Anesthetic Toxicities......Page 775 82.3.1 Animal Research......Page 776 82.3.2 Local Anesthetic System Toxicity (LAST)......Page 777 82.5.1 Animal Studies Showing Drug Toxicity Response to Lipid Rescue......Page 778 82.5.2 Specific Toxic Effects of a Variety of Drugs Were Treated in Humans Successfully......Page 779 82.6 Guidelines and Advisories......Page 780 82.7 Proposed Mechanisms by Which Lipid Rescue Works......Page 781 References......Page 783 83: Correction of Liposuction Sequelae by Autologous Fat Transplantation......Page 787 83.2 Patients and Methods......Page 788 83.4 Results......Page 789 83.4.1 Case 1......Page 790 83.5 Discussion......Page 792 References......Page 797 84.2 Technique......Page 800 84.4 Discussion......Page 803 References......Page 805 85.2 Risks of Mortality with General Anesthesia......Page 806 85.5 Cosmetic Surgical Procedures and Mortality......Page 807 References......Page 808 86.1 Introduction......Page 809 86.2 Causes of Death after Liposuction and Risk Factors Related to Fatal Complications......Page 810 86.3 Medicolegal Consequences, Autopsy, and Analysis of Physician Technique......Page 812 References......Page 814 87: Harmful Effects of Liposuction and Lipolysis Procedures Questionable Safety and Scientific Validity: A Medico-Legal Perspective and Advantages of “Light” Hypo-osmolar Liposuction......Page 817 87.2.1.1 Case 1......Page 818 87.2.1.2 Case 2......Page 820 87.2.2.2 Case 4......Page 821 87.2.2.3 Case 5......Page 823 87.3 Lipolysis and Lipotomy......Page 824 87.3.2 Physical Mechanism of Lipotomy......Page 825 87.4 Merits of Light Hypo-­osmolar Liposuction......Page 829 Conclusion......Page 830 References......Page 831 88.1 Introduction......Page 832 88.2 Technique......Page 833 88.3 Discussion......Page 834 References......Page 836 89.2 Necrotizing Fasciitis (NF)......Page 838 89.3 Visual Loss and Blindness......Page 841 Conclusions......Page 844 References......Page 845 90.1 Introduction......Page 846 90.4.1 Timing of Onset and Symptoms......Page 847 Conclusions......Page 848 References......Page 849 91.1 Introduction......Page 850 91.3 Operative Technique......Page 851 91.4 Postoperative Course......Page 852 91.5 Discussion......Page 853 References......Page 855 92.1 Introduction......Page 857 References......Page 858 Part VIII: Postoperative......Page 860 93.1 Introduction......Page 861 93.2.1 Cholesterol......Page 862 93.2.3 Subcutaneous to Visceral Fat Ratio, Waist Circumference......Page 863 93.2.4 Blood Glucose Levels and Insulin Resistance......Page 864 93.4 Inflammatory Markers......Page 865 References......Page 866 94: Liposuction and Visfatin......Page 868 94.2 Visfatin......Page 869 References......Page 870 Part IX: Outcomes and Patient Satisfaction......Page 872 95.1 Introduction......Page 873 95.3 Diagnosis and Classification......Page 874 95.5 Technique......Page 876 95.6.1 Effect on Pain......Page 877 95.7 Complications......Page 878 95.8 Selection of Patients......Page 879 References......Page 882 96.1 Introduction......Page 884 96.3 Sociodemographic and Quality of Life Aspects......Page 885 96.4 Body Dysmorphia......Page 886 References......Page 887 Part X: Medical Legal, Commentary......Page 888 97.1 Introduction......Page 889 97.4 Other Dangers......Page 890 97.6 Medical Board of California vs. Matory, Tustin District, CA; Medical Board of California vs. Hoo, Tustin District, CA......Page 891 97.8 Herron vs. Stewart, Forsyth County (NC), Superior Court. In Medical Malpractice Verdicts, Settlements & Experts 1995;11(10)47......Page 892 97.11 Medical Board of California vs. O’Neill......Page 893 97.13 Medical Board of California vs. Chavis, Los Angeles District, CA......Page 894 97.15 Estate of Caswell vs. Daniel, Commonwealth of Kentucky Fayette Circuit Court (Eighth Division), Case No. 99-CI-1947......Page 895 97.17 Donnell-Behringer vs. McCann, Los Angeles County (CA) Superior Court, Case No. VC26507. In Medical Malpractice Verdicts, Settlements & Experts 2000;16(8):50......Page 896 97.20.2 Legal Definition......Page 897 97.20.3 Suggestions for Office......Page 898 97.21 Discussion......Page 899 References......Page 900 98.2 Terminology......Page 902 98.5 New Technologies......Page 903 98.8 Ultrasound-Assisted Liposuction......Page 904 References......Page 905 Index......Page 906 Liposuction began as a contouring procedure but has evolved into the treatment of obese patients, gynecomastia, ptosis, macromastia, and even patients who have complications from heart disease or diabetes. Other disorders such as axillary sweat hypersecretion, lipomas, and angiomas are also potential disorders that may be treated with liposuction.Physicians performing liposuction must be adequately trained and experienced in the potential and actual complications before attempting to perform liposuction. Patient safety is the most important aspect of all surgeries, but especially of cosmetic surgery, which is an elective procedure.New technology helps improve results but experience, care, and skill of the cosmetic surgeon is necessary to obtain optimal results that satisfy the patient.The contributors to this book have spent time and effort presenting the cosmetic and plastic surgeon as much information as possible on the techniques and uses of liposuction for cosmetic and non-cosmetic surgery purposes. "This superbly illustrated book covers all aspects of liposuction: anatomy, pathology, biochemistry, preoperative care, equipment, the full range of procedures, complications, postoperative care, outcomes, lipedema, and medical legal aspects. Compared with the successful first edition, the text has been extensively updated and many additional chapters included, with particular attention to recently introduced techniques. While new technology helps to improve results, experience, care, and skill on the part of the cosmetic surgeon are essential if optimal results satisfactory to the patient are to be achieved. The contributors to this book have expended much time and effort to present the cosmetic and plastic surgeon with as much information as possible on the techniques and uses of liposuction for the purposes of cosmetic and non-cosmetic surgery"--Publisher's description