Fixing Mistakes Nov 1, 2003 By: Andrew Bowse Liposuction mistakes are correctable, but avoiding them in the first place is the best route to a successful outcome. New Orleans - Several effective methods for fixing liposuction defects are available, but surgeons doing primary liposuction procedures should try to avoid the risk of overcorrection in the first place by removing fat conservatively, according to Lisa M. Donofrio, M.D.
"It's best to not be overzealous," said Dr. Saylan, who in October gave a presentation on liposuction corrections here at the combined annual meeting of the American Society for Dermatologic Surgery(ASDS). When liposuction has to be corrected with a liposhifting procedure or free fat transfer, "you are pushing fat blindly, or expecting free fat grafts to take, and they don't, always," said Dr. Donofrio, assistant clinical professor of dermatology at Yale University School of Medicine. "You may need to do it again and again." Dr. Donofrio said she defines a correction as the improvement of an actual liposuction defect caused by a surgeon. Second procedures, by contrast, include additional liposuction procedures for areas that may not be completely corrected on the first try. "Some areas turn out more irregular, and it takes education so the patient knows what to expect," she said. Liposuction defects, according to Dr. Donofrio, usually take the form of divots, or valley-like areas. They can be caused when liposuction is performed where it shouldn't be, for example, the procedure could violate the gluteal cleft (the groove between the buttocks), requiring that proper shape be restored to the area. Defects can also result when the gluteal area is oversuctioned and, hence, flat. Many liposuction corrections are done on the thighs and buttocks of young women, some of whom probably should not have had liposuction in the first place, according to Dr. Donofrio. This is particularly true for thin women, since any small divot will become more pronounced should weight gain occur. Correction Methods Dr. Donofrio described three different ways to correct liposuction defects. One method is to perform additional liposuction on high points surrounding the divot ("hills" around the valley). This blends in the defect so the slope is more gradual. n addition, free fat grafts can be used to bolster the area. Dr. Donofrio said she will usually extract fresh fat with a cannula from different body parts, centrifuges it, and injects it back into the defect gradually, "weaving" the cannula backward in the area where fat should be. A third method, known as liposhifting , involves loosening and pushing fat into the divot from the area superior to it. This is particularly suited to cases where a considerable amount of fat remains next to the defect. Dr. Donofrio said that for a liposhifting procedure, she will first apply standard Klein formula tumescent anesthesia, which loosens the fat while providing anesthesia. She then uses a tissue dissector to undermine the bulge of superficial fat, separating it from connective tissue. Then, a round-tipped blunt cannula can be used to make a series of tunnels through the fat. To push fat into the divot, the cannula is placed on the outside surface of skin, and pressure is applied at a right angle to the push tracks previously made. "I roll it down over the skin, like a rolling pin, pushing fat into the divot," Dr. Donofrio said. Some experts recommend overcorrecting the defect by up to 30 percent to account for subsequent absorption of tumescent solution. The next step is fixation using an elastic tape, compressing any of the "hills" taken down during the procedure. This is left in place for two to three days. A compression garment might be used after extensive undermining or correction of multiple areas nearby each other. "If it's just a small divot up to 5 cm, I would just tape it," Dr. Donofrio said. Patient Satisfaction Results of the procedure may depend on the severity of the defect and the experience of the surgeon. Ziya Saylan, M.D ., cosmetic surgeon in Dusseldorf , Germany , reported in 1999 in the International Journal of Cosmetic Surgery a satisfaction rate of 88 percent, or 15 of 17 female patients (median age 34) treated over the course of one year. Liposhifting doesn't always work the first time. Of the 17 patients reported, five (24 percent) required more than one liposhifting procedure, with a time of three to four months required between the treatments. Dr. Saylan reported that patients were alerted to the fact that multiple procedures may be required: "If they know that they need two or three sessions, they are more cooperative and satisfied with the result." Since liposuction correction doesn't always work the first time, surgeons who perform primary liposuction procedures may want to err on the side of undercorrection. "It's a lot more work to correct a liposuction defect," Dr. Donofrio said. "I tell my patients that. If I get to the point where I am uncertain, I leave it in." In Dr. Donofrio's practice, patients are charged for touchups, but not divot correction. "I prepare my patients for the fact that undercorrection in my hands is the norm, and preferable," she said. "They will more than likely need a touchup to get an area as thin as they want." ORİJİNAL YAZI için tıklayın: http://www.findarticles.com/p/articles/mi_hb077/is_200311/ai_n5977167 |
Dr. Lisa Donofrio