NEW YORK Tumescent liposuction is one of the safest office-based cosmetic procedures, and probably the most effective way to manage localized adipose deposits, said Naomi Lawrence, M.D., chief of procedural dermatology, Cooper University Hospital, Marlton, N.J.
Speaking at an update sponsored by the American Academy of Dermatology, Dr. Lawrence noted that tumescent liposuction now ranks as the most popular cosmetic procedure in the United States, and it has rendered traditional liposuction under general anesthesia virtually obsolete.
One of the major trends over the years has been a progressive reduction in the size of the cannulas. Today's cannulas give surgeons far greater precision and control, which lead to better cosmetic results with far less tissue injury than was possible in 1985 when the technique first went public.
Dr. Lawrence was part of a research team that in 2001 surveyed 517 members of the American Society for Dermatologic Surgery who had listed liposuction as a part of their practices regarding their experience with performing office-based tumescent liposuction. A total of 267 surgeons answered the survey, and provided complete data on 66,570 liposuction procedures.
Within this cohort, there were no deaths, and the overall serious adverse event rate was only 0.68 per 1,000 cases, a finding that underscores the overall safety of this procedure when performed by well-trained dermatologic surgeons. Adverse event rates were higher for hospitals and ambulatory surgery centers than for nonaccredited office settings. Serious adverse event rates also rose when tumescent liposuction was combined with intravenous or intramuscular sedation, compared with oral sedation or no sedation at all (Dermatol. Surg. 2002;28:971-8).
Elimination of localized adipose deposits is the most common indication for tumescent liposuction.
Although it is important to encourage patients to continue with diet and lifestyle changes to control weight, it is equally important to foster realistic expectations. "Contrary to what a lot of people believe, 'spot' exercise does not reduce localized fat deposits. For example, abdominal crunches will not necessarily get rid of abdominal fatty deposits. The best way to deal localized adiposity is by liposuction," she said.
Many women develop fat deposits on the posterior aspects of their waists and hips after menopause, and Dr. Lawrence has found liposuction to be effective. "This 'back fat' causes obvious and unattractive bumps and ripples underneath clothing, and many women have a hard time with this. We can successfully smooth them out with liposuction."
She says she believes that many women who seek abdominoplasties ("tummy tucks") would be better off with liposuction. Even if they have stretch marks and poor elasticity, most women with abdominal rolls can get good cosmetic results with liposuction, obviating the need for a more invasive surgical procedure.
"Liposuction can also cause the skin to retract, reducing the prominence of the stomach. Overall, it is a safer alternative," she said.
It is also a safer than open surgery for breast reduction, an area that Dr. Lawrence sees as one of the procedure's fastest-growing indications. "In the past, the only solution for a woman who wanted to reduce her breast size was to undergo a breast reduction procedure under general anesthesia, which usually caused a lot of discomfort and limited her activity for several weeks. Liposuction is much less invasive than traditional breast reduction surgery, and requires a lot less recovery time."
The technique works best when the patient is seeking a reduction of one to two cup sizes. Women with fattier, less fibrous breasts tend to have the best outcomes. As a general rule, Dr. Lawrence said, make sure the patient has had a recent mammogram before undertaking a liposuction procedure for breast reduction.