Liposuction by Melvin A. Shiffman & Alberto Di Giuseppe

Author:Melvin A. Shiffman & Alberto Di Giuseppe
Language: eng
Format: epub
Publisher: Springer Berlin Heidelberg, Berlin, Heidelberg

Fig. 42.2(a, b) Late result of 16 months after operation. A near-normal appearance has been achieved by means of a good facial balance. Cheek contour has been regained

42.2 Surgical Technique

The facial liposuction can be performed under local tumescent anesthesia or general anesthesia depending on the patient and surgeon preferences. Prior to the procedure, tumescent technique is proposed to reduce the complication rates of bleeding and fat embolism and to make easier aspiration of the fat by hardening the subcutaneous tissue. Almost 50 mL of modified Klein solution, which consists of 250 mg lidocaine (a concentration of 1/4000) and 1 mg of epinephrine (a concentration of 1/1,000,000) in 1 L of lactated Ringer’s solution, is used before the suction. Straight and short cannulas 2–3 mm in size with three holes and round tips are preferred. To avoid a cutaneous scar, the cannula is inserted from the buccal mucosa next to the ipsilateral oral commissura. Suction vectors should be designed radially and parallel to the courses of the facial nerve branches to prevent facial nerve injury. A suction plane is created so as to remain just in the subcutaneous fat tissue, and the cannula should never be introduced into the dermis and under the superficial musculoaponeurotic system (SMAS). At the end of the procedure, a lipoaspirate (supernatant fat) of 50–100 mL can be approximately obtained depending on the size of the hypertrophy. To prevent hematoma and excessive edema formation, compression should be obtained with an adhesive bandage for 5 days postoperatively. The main potential complications of the facial liposuction are hematoma, skin slough or necrosis, facial paralysis, contour irregularity, and skin discoloration. An adequate facial contour and symmetry can be achieved with this technique, and thus the patient is satisfied from the facial aspect in the postoperative course (Fig. 42.2). Recurrence is not expected normally, if an effective suction is performed. When it develops, facial lipoaspiration can be safely repeated.

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