The five new evidence-based principles for successful liposuction include:

1) Preoperative Evaluation and Planning.

Patients should be generally healthy and demonstrate a commitment to long-term lifestyle changes and exhibit “appropriate and realistic” expectations. Key elements of surgical planning should be discussed during the consultation, including the choice of suction-, ultrasound-, and power-assisted techniques, write Geo Nicolas Tabbal, MD from the University of Texas Southwestern Medical Center in Dallas, and colleagues in Plastic and Reconstructive Surgery-Global OpenĀ®.

2) Intraoperative Monitoring and Safety

According to the authors, several key principles exist to guide the appropriate choice of anesthetic. “Small-volume liposuction (?1000 mL) can be safely performed with local anesthetic, a proper wetting solution, and additional sedation as needed. However, general anesthesia may be more preferable and comfortable in more complex, large volume, or combination procedures with an emphasis on endotracheal intubation if the patient is to be in the prone position,” they write. Both epidural and spinal anesthesia should be avoided because of their potential for vasodilation and hypotension, with resultant risk of fluid overload due to aggressive fluid resuscitation. As far as position goes, body contour surgeons are able to safely perform liposuction from the prone and/or the supine and lateral decubitus positions. As much as 75% of the body can be accessed from the prone position.

3) Wetting Solutions and Fluid Status

Techniques using various “wetting solutions” have been developed to allow larger-volume liposuction to be performed safely and with good result, but close monitoring of the patient’s fluid status is essential.

4) Body Contouring and Prevention of Complications

Specific sequencing of techniques is key when performing liposuction. Each step should complement the next.

5) Postoperative Care and Outcomes Measurement

Patients should wear compression garments for the first 2 weeks after liposuction, and at night for a few weeks afterward. Contour irregularities that are evident during the operation should be immediately addressed by fat grafting. Postoperatively, contour irregularities should be treated conservatively for at least 6 months. “Depending on the severity of the irregularity, methods of correction include liposuction of areas of prominence or adjacent to areas of depression, fat grafting, or even dermolipectomy,” the authors write.

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