- Good tumescent anesthesia, attention to detail and adequate experience are key to minimizing poor liposuction results
- Early detection and intervention help address infection concerns and prevent progression to serious complications
Avoidance is the best method for addressing complications after liposuction, and that is usually possible by practicing careful patient selection and using proper technique based on appropriate training and adequate experience, says E. Antonio Mangubat, M.D., who spoke at the 27th annual scientific meeting of the American Academy of Cosmetic Surgery in January.
"Fortunately, serious or severe complications after liposuction are very rare, and the most common complications are cosmetic in nature. Although the latter can often be treated to achieve a satisfactory outcome, they are also mostly preventable in the hands of a well-trained surgeon," says Dr. Mangubat, a board-certified cosmetic surgeon in private practice in Seattle.
Patients who underwent liposuction alone when they really needed abdominoplasty to remove excess skin account for many of the poor cosmetic outcomes, whereas the presence of contour irregularities (lumps, bumps, divots, ridges) is the most common cosmetic complication seen after liposuction procedures, Dr. Mangubat says. In all cases, good tumescent anesthesia, attention to detail and adequate experience are critical to minimize poor results. In addition, surgeons who are early in their liposuction experience should focus on treating only smaller anatomic areas and removing smaller volumes of fat using microcannulas.
MASTERING FAT DISRUPTION Dr. Mangubat suggests that more experienced surgeons — as well as beginners — consider a fat-disruption technique he introduced several years ago that is effective for enabling the evacuation of larger volumes of adipose tissue without leaving divots. The fat disruption technique uses a special cannula (Mangubat Fast-Lipo Cannula, IMI Beauty and Sound Surgical Technologies) that mechanically disrupts the fat infrastructure and allows large volumes to be removed faster using larger cannulas with reproducibly smooth results.
A 37-year-old female patient who had undergone liposuction of the thighs (left) and subsequently presented to Dr. Mangubat with significant cosmetic defects. Repair results are shown (right) six months post-revision liposuction using a fat disruptor in the scarred areas and fat transfer using a closed-syringe technique adding platelet-rich plasma to the fat grafts. (Photos credit: E. Antonio Mangubat, M.D.)
"I have found the fat-disruption technique to be a valuable adjunct for training young surgeons in our fellowship program, because it shortens the learning curve to achieving good outcomes, and I have received very positive feedback from other surgeons who have used it around the world," Dr. Mangubat says.
COMBATING IRREGULARITIES When contour irregularities occur, their appearance can be improved, although they usually cannot be totally eliminated to achieve a perfectly smooth surface. Intervention involves a multiple-step process.
After marking the depressed areas and injecting tumescent anesthetic, the surgeon can use the fat-disrupter cannula to break up the fat and fibrosis. This will result in an almost-immediate improvement of the defects, but not full correction. Further smoothing is accomplished with fat-shifting and fat-transfer techniques.
For fat shifting, after disrupting the fat in both the elevated and depressed areas, the surgeon can try to relocate the fat by applying mechanical pressure on elevated areas, forcing the freed-up fat to ooze into the depressed regions. However, fat transfer offers greater control for contouring and therefore is a more reliable method for achieving good results, Dr. Mangubat says.
To perform fat transfer, after disrupting the fat and fibrosis into an emulsified layer, the surgeon uses a small fat-harvesting cannula to remove excess fat from the elevated areas. The fat is harvested into a syringe, processed for transfer and injected into the depressed areas.
"If the fat and fibrosis was adequately disrupted, the depressions will rise up nicely in response to the fat injection. Otherwise, it may be necessary to reintroduce the fat disrupter to release more of the scarring, or in some cases to free it by cutting with scissors," Dr. Mangubat says.
He says any intervention to address irregularities should not be attempted for at least three months in order to allow for some healing and scar-tissue maturation. If the patient is willing, he says, waiting six months is even better.