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Power tools: Moving from manual cannulas and general anesthesia can mean safer liposuction — even in an office setting

Article-Power tools: Moving from manual cannulas and general anesthesia can mean safer liposuction — even in an office setting

Dr. Katz
National report The advent of power cannulas has brought tremendous advances to liposuction, allowing for procedures that are not only safer and more efficient, but which offer better results than traditional manual cannula devices, according to Bruce Katz, M.D. Power cannulas employ a reciprocating back-and-forth movement to make small tunnels in the adipose tissue that, when compressed, cause the fat layer to thin out.

"The devices can make about 3,000 strokes per minute, allowing for a faster procedure time and reduced surgeon strain," explains Dr. Katz, a clinical professor at the Mount Sinai School of Medicine in New York.

In a study comparing traditional cannula use on one thigh and the power cannula on the other thigh, Dr. Katz found that bruising, swelling and pain were significantly reduced on the side in which the power cannula was used. (Katz et al, 20011 ). According to Dr. Katz, results can be further improved when patients are brought to their feet at the end of the procedure.

"I'll have patients stand, with the nurse's help, in order to see what the results will look like when gravity is working," he says. "This way you can really see how the body's contours look upright, rather than lying on the table when the contours are flattened."

GENERAL COMPLICATIONS In addition to bruising and swelling, complications from liposuction can include infection, skin irregularities, fluid collections, perforation of internal organs, pulmonary embolism and even death. But one of the key factors associated with the more severe complications is general anesthesia.

"General anesthesia can cause dilation of blood vessels and increased bleeding, so there is a much higher mortality rate from liposuction performed under general anesthesia rather than local tumescent anesthesia," Dr. Katz relates. "[Doctors] started with general anesthesia, and a lot of people still prefer to use that, but most have realized that local tumescent anesthesia really is the safest and most effective way to do liposuction," he adds.

The facility where liposuction is performed also plays a role in the occurrence of side effects, as fewer problems are seen in office-based liposuction than hospital-based surgeries. One study showed that 71 percent of malpractice suits originated in hospital-based procedures, whereas only 21 percent originated in office-based settings (Coleman et al, 19992 ). Other factors linked with side effects include removal of large amounts of fat at one time, and liposuction performed with multiple procedures over prolonged periods of time.

BREAST BENEFITS One unexpected side effect that Dr. Katz reports among power liposuction patients at his Juva Skin & Laser Center is the chance of a breast size increase. In a study of 73 liposuction patients, 34 percent reported a significant increase in breast size (Yun et al, 20033).

"Patients were generally pleased with the outcome," Dr. Katz says. "Their breasts were firmer and fuller and there was sometimes even an increase in cup size."

The change typically occurred several months after liposuction in the abdomen, hips or thighs, and it was associated with the extraction of a large volume of fat. One theory on why the breast size would increase relates to the relative change in the balance of androgenic versus estrogenic fat cell receptors.

"There are more androgenic receptors in the areas of the abdomen, hips and thighs, and when you remove them, you have a relative increase in the estrogenic receptors in the breast," Dr. Katz explains. For women who welcome the breast size increase, the side effect represents an additional perk from the procedure.

"The possible increase in breast size in 30 to 40 percent of women means you can have two cosmetic benefits from one procedure," he says.

Dr. Katz reports no disclosures related to this article.

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