skip to Main Content
949-248-1632 x1204 Email Michele

LIPOSUCTION TEXTBOOK
The Tumescent Technique By Jeffrey A. Klein MD

lipo-class

LIPOSUCTION TEXTBOOK

Index

A

α1-Acid glycoprotein, 127

Abdomen

postliposuction edema and, 84

tumescent liposuction of, 297-324

abdominoplasty and, 307-308, 309, 310, 311, 312, 313, 314, 315-316, 317

anatomic considerations for, 297-305, 298, 299, 300, 301, 302, 303-304, 305, 306

anesthetic infiltration and, 308, 318

end point for, 319

intraoperative positioning and, 308, 317

pitfalls and special considerations of, 323-324, 324

postoperative care of, 320-323, 321-322

preoperative evaluation of, 307

surgical technique of, 318, 318-320

upper, tumescent liposuction of, 298, 319

Abdominal binders, 321

Abdominal blood vessels, 305, 306

Abdominal perforation, 89-90, 323

Abdominal scars, 258-259

Abdominoplasty, 299, 307-308, 309, 310, 311, 312, 313, 314, 315-316, 317

Abecedarian, 43

Abrupt cardiac decompensation, 65

Absorption

of lidocaine, 145-155, 160, 164, 177

simultaneous, elimination and, 160

Absorption rate constant, 154

Absorption rate paradox, lidocaine and, 149-150

Absorptive compression pads, tumescent liposuction of abdomen and, 320-321

Absorptive sponges, 282

Abuse, drug, 204-205

Accelerated healing, microcannulas and, 240

Accuracy, microcannulas and, 239

Acetaminophen, 33, 52, 92, 182

Acetylsalicylic acid; see Aspirin

Acid-fast bacteria (AFB), 96, 97

Acidosis, lactated Ringer’s solution and, 192

Acidotic vasoconstriction, 65

ACL antibodies; see Anticardiolipin antibodies

ACLS; see Advanced Cardiac Life Support

Acoustic energy, ultrasonic-assisted liposuction and, 272

Acquired immunodeficiency syndrome (AIDS), 72

Activated protein C (APC), 71

Activated protein C resistance, 72

Acute heart failure, 65

Adipocytes, 213, 214-215, 217

Adipose tissue, 213-214, 214, 215, 242

Adits, 156, 239, 240, 251-252, 262, 286, 287-288, 289

Adjustable breast compression, 421

Adrenaline, 189, 198

Adrenergic medications, 197, 197-202

Adrenocorticotropic hormone, 215

Adult respiratory distress syndrome (ARDS), 64, 167

Adult-onset, non–insulin-dependent diabetes mellitus, 54, 264, 305

Adult-onset insulin-dependent diabetes mellitus, 58

Advanced Cardiac Life Support (ACLS), 17, 168

Adverse drug interactions, 166, 167; see also Drug interactions

Advertising, unethical, 14

Advil; see Ibuprofen

Aesthetic goals

microcannular tumescent liposuction and, 248

tumescent liposuction of arms and, 427-439, 428, 429, 430-431, 432

AFB; see Acid-fast bacteria

Age, microcannular tumescent liposuction and, 265

Aggressive approach to liposuction, 10

β Agonists, 197

AIDS; see Acquired immunodeficiency syndrome

Air pump, 267

Albuterol, 198

Alcohol dehydrogenase, 137

Alcohol-induced intoxication, 114

ALE syndrome; see Amplified liposuction edema syndrome

Alert patients, 222-223

Aleve; see Naproxen

Alfentanil, 33, 39-40, 134, 135, 182, 201, 206

Alkalinization of anesthetics, 125

Alkalosis, lactated Ringer’s solution and, 192

Allergic contact dermatitis, 46-47

Allergic reaction, 166-167

Allergic rhinitis, 204

Allicin, 112

Alpha2 adrenergic receptors, 200-201

Alpha dichotomy, 197-198

Alprazolam, 134-135, 136

Alveolar pulmonary edema, 64

American Academy

of Cosmetic Surgery, 4

of Dermatology, 13

American Heart Association, 17, 180

American Journal of Cosmetic Surgery, 4

American Medical Association (AMA), 14

American Society

of Anesthesiologists (ASA), 29, 39, 188, 263

for Liposuction Surgery, 4

Amikacin, 97

Aminoglycoside antibiotics, 97-98

Amiodarone, 137, 167

Amitriptyline, 136

Ammonia, 50

Ampicillin-sulbactam, 93

Amplified liposuction edema (ALE) syndrome, 84-86

Anabolic steroids, 404

Anacin; see Aspirin

Analgesics, oral, 33

Ancillary pharmacology, 196-209

Anesthesia, 205

choice of, 12-13

complete, 225

death caused by, 38

formulations of, 5-8

general; see Systemic anesthesia

local; see Local anesthesia

as precipitating cause of death, 38

regional, 33

segmental, 33

systemic; see Systemic anesthesia

true tumescent, 122-123

tumescent facelift and, 388-389

Anesthesia-related mortality risks, 38-40

Anesthetic formulations, 5-8

Anesthetic infiltration

tumescent liposuction of abdomen and, 308, 318

tumescent liposuction of arms and, 434-435

tumescent liposuction of buttocks and, 397

tumescent liposuction of chin, cheeks, and jowls and, 379

tumescent liposuction of female breasts and, 419-421, 420

tumescent liposuction of female legs and ankles and, 440-443

tumescent liposuction of male breasts and, 407, 407-408

tumescent liposuction of male flanks and, 355

tumescent liposuction of medial knee and, 368

tumescent liposuction of medial thigh and, 363

Anesthetic mixtures, 181

Anesthetics, bulk flow of, 228

Animal data, prilocaine and, 182

Ankles

edema of, 52

female; see Female legs and ankles

Annexins, 73

Anterior axillary fat pad, 438, 438-439, 439

Anterior thighs, tumescent liposuction of, 370, 370-371

Anterosuperior epigastric veins, 305

Antiarthritis medications, 111

Antibacterial effects of lidocaine, 128-129

Antibiotics, 51, 88, 93, 261

aminoglycoside, 97-98

necrotizing fasciitis and, 93

Antibodies, antiphospholipid, 73

Anticancer drugs, 90, 114-115

Anticardiolipin (ACL) antibodies, 73

Anticardiolipin antibody syndrome, 70

Anticoagulants, blood-thinning, 111

Antidepressants, 134, 265

tricyclic, 199, 265

Antiepileptic drugs, 137

Antiinflammatory drugs, 92, 206, 261

Antiinflammatory effects of lidocaine, 128

Antiinflammatory steroids, 206

Antimalarials, 182

Antiphospholipid antibody syndrome, 73

Antiphospholipid syndrome, 70

Antiretroviral medications, 137

Antiseizure medications, 168

Antithrombin III deficiency, 71

α1-Antitrypsin deficiency, 58

Antitypy, 220

Anxiety

patient, 230-231

surgeon, 231

Anxiolytic drugs, oral, 230

APC; see Activated protein C

Aperture area of microcannulas, 244-245, 245

Aperture edges of microcannulas, 245

Aperture translocation, microcannulas and, 245

Apertures, inspissated fat in, microcannulas and, 241

Apical fat, 215, 300

Apical layer of subcutaneous fat, 215-216

Apraxia, facial nerve, 232-233

Arachidonic acid, 112

ARDS; see Adult respiratory distress syndrome

Area under the curve (AUC), 146, 146, 147-148, 176

Arg506Gln, 71, 72

Arms, tumescent liposuction of, 427-439

aesthetic goals of, 427, 428, 429, 430-431, 432

anatomic considerations of, 427-433

anesthetic infiltration in, 434-435

intraoperative positioning for, 433-434, 435

pitfalls and special considerations of, 437-439, 438, 439

postoperative care of, 436, 436-437, 437

preoperative evaluation of, 433, 433-434

surgical technique for, 435-436

ASA; see American Society of Anesthesiologists

Ascending venography, 67

Aseptic technique, dermatologic, 98

l-Asparaginase, 71

Aspirate volume, maximum safe dose of liposuction and, 116-117

Aspiration, systemic anesthesia and, 32-33

Aspirator, liposuction, physics of, 266-270

Aspirator tubing, 270

Aspirin, 44, 54, 73, 110, 112, 206

baby, 305

hemostasis and, 111

Astemizole, 135

Atenolol, 198

Ativan; see Lorazepam

Atmospheric pressure, liposuction aspirator and, 267

Atracurium, 182

Atropine, 49-50, 197, 204, 233

AUC; see Area under the curve

Autonomic failure, 49

Avogadro’s number, 126

Axilla, 437-438

Axillary fat pad, anterior, 438-439

Azithromycin, 93, 135

B

Baby aspirin, 305

Bacitracin, 46-47

Back

female, tumescent liposuction of, 348, 348-352, 349-350, 351, 352

infrascapular, tumescent liposuction of, 349, 349-350

ultrasonic-assisted liposuction of, 350

Banana-form folds, tumescent liposuction of buttocks and, 397-399, 400, 400, 401, 402

Barbiturate, ultrashort-acting, 168

Barraquer-Simons syndrome, 58

Basal energy expenditure (BEE), 221

Battery, informed consent and, 250

BEE; see Basal energy expenditure

Belly, tumescent liposuction of abdomen and, 297

“Belt line,” 353

Bentham, Jeremy, 12

Benzodiazepines, 9, 33, 131, 136, 163, 165, 196, 202-204, 203, 231

“Bermuda Triangle” of buttocks, 397

Beta blockers, 132, 167, 199-200, 264

Beta dichotomy, 197-198

Beta-adrenergic agonists, 63

Biaxin; see Clarithromycin

Bier’s block, 164

Bimodal compression, 79

postliposuction care and, 281-293

tumescent liposuction of abdomen and, 320

Bioavailability, drug, 155-156

Biophysics of ultrasound, 271-272

Biostatistics, clinical, of safety, 27-31

Bisulfite, 198

“Black hole,” third spacing and, 61

Bleeding, 232, 235-236, 236, 305, 306, 306

Bleeding disorders, perioperative; see Perioperative bleeding disorders

Blindness, 233

Blood pressure, bupivacaine and, 179

Blood-thinning anticoagulants, 111

Bordetella pertussis toxin, 200

Bradycardia, alpha2 adrenergic receptors and, 201-202

Breast augmentation, lidocaine and, 176-177

Breast compression

adjustable, tumescent liposuction of female breasts and, 421

trimodal, 291

Breast lumps after liposuction, 423

Breasts

female; see Female breasts

male; see Male breasts

Brethine; see Terbutaline

Bretylium, 163

Bruising, 53, 288, 290

Buck’s fasciae, 304

Buffered solution, 192-193

Bufferin; see Aspirin

Bulk flow

of anesthetic solution, 228

tumescent, through fat, 144

Bupivacaine, 29, 64, 125, 126, 129, 167, 179-181, 183, 184

ropivacaine versus, 183-184, 184

sodium bicarbonate and, 190

Burns

external ultrasonic-assisted liposuction and, 276, 276-277

internal ultrasonic-assisted liposuction and, 274, 274-275, 275

intravenous fluids and, 194

Buttocks, tumescent liposuction of, 392-403

anatomic considerations of, 392-395, 393, 394

anesthetic infiltration in, 397

intraoperative positioning for, 395, 397

pitfalls and special considerations for, 399-403, 400, 401, 402, 403

postoperative care of, 399, 399

preoperative evaluation of, 395, 396

surgical technique for, 397-399, 398, 399

Butyrophenones, 199

C

Cadaveric appearance as complication of liposuction, 43

Calcium channel blockers, 136, 264

California Medical Association, 22

California Society of Anesthesiologists (CSA), 38

cAMP; see Cyclic adenosine monophosphate

Camper’s fascia, 300

Cannula; see also Microcannulas

infiltration, 223

large, tumescent liposuction of chin, cheeks, and jowls and, 379

size of, tumescent liposuction of chin, cheeks, and jowls and, 379

Cannula insertion, pain during infiltration and, 224

Capillary filtration, excessive, 79-80

Capistrano cannulas, 350, 351

Capistrano microcannulas, 236-239, 237, 242, 261

Carbamazepine, 134

Cardiac decompensation, abrupt, 65

Cardiac effects of hypothermia, 102

Cardiogenic pulmonary edema, 64

Cardiotoxicity, bupivacaine and, 179-181

Cardiovascular disease, microcannular tumescent liposuction and, 265

Cardiovascular effects of lidocaine, 163

Catapres; see Clonidine

Catecholamines, 197

C4b binding protein (C4bBP), 72

CCJ; see Chin, cheeks, and jowls

CDC; see Centers for Disease Control and Prevention

Cefadroxil, 88

Cefoxitin, 97

Cefuroxime, 93

Cellular distribution of body water, 193-194

Cellulite, 218-219

Cellulitis, 218

Centers for Disease Control and Prevention (CDC), 22

Central compartment, lidocaine and, 143

Central nervous system effects

of lidocaine, 128, 162-163

of ropivacaine, 183

Central registry, reporting of liposuction deaths and, 21

Cephalexin, 88

Cephalosporin, 93

Cervicofacial rhytidectomy, 388-390, 389

Cervicothoracic dorsal hump, tumescent liposuction of, 351-352, 352

Cheeks, tumescent liposuction of; see Chin, cheeks, and jowls, tumescent liposuction of

Chemotherapy, 90, 114-115

Children, dose of lidocaine in, 121-122

Chin, cheeks, and jowls (CCJ), tumescent liposuction of, 372-391

anesthetic infiltration for, 379, 380-381

ethical considerations of, 390-391, 391

intraoperative positioning for, 378, 378

postoperative care of, 388, 388

surgical technique of, 381, 381-388, 382, 383, 384, 385, 386-387

tumescent facelift, 388-390, 389

two-stage tumescent facelift, 372-391

Chloride load, 193

Cholinergics, 197

Chronotropy, bupivacaine and, 179

Chrysanthemum, 112

Cimetidine, 133, 206

Ciprofloxacin, 97

Circumferential thigh liposuction, 69, 341, 341, 371

Cisapride, 135

Clarithromycin, 93, 97, 135

Clearance

drug, 141-142

of lidocaine, 155

Clindamycin, 93

Clinical biostatistics of safety, 27-31

dose-response phenomenon and, 27-29, 28, 29t

lidocaine dose limits and, 30

liposuction volume limits and, 29-30

Clinical pharmacology, liposuction and, 119-209

Clinical qualifications for liposuction, 16-19

Clinical significance, 177

Clinical toxicology, 27-28

Clomiphene, 404

Clonazepam, 136

Clonidine, 33, 54, 189, 196, 197, 200-202, 203, 223, 229, 230, 388

Clostridium difficile–associated pseudomembranous enterocolitis, 88

Clozapine, 136

Clozaril, 136

CME; see Continuing medical education

CO2 laser, ultrasonic-assisted liposuction and, 274

Coagulation, impaired, hypothermia and, 103

Cocaine, 167, 199, 204

Cocaine psychosis, 204

Codeine, 196

Cold compresses, 104

Cold sterilization of liposuction equipment, 94

Colles’ fasciae, 304

Colloid, definition of, 80

Coma, alcohol abuse and, 114

Comfort, patient, 225, 250

Communication, surgeon-anesthesiologist, 167

Competition, liposuction and, 9, 10, 14

Complications of liposuction, 25-118

common unwanted, 50-54, 51, 52, 53, 54, 55, 56

excessive liposuction, 43-45, 44, 45, 46

external ultrasonic-assisted liposuction and, 277-279

iatrogenic, 20

from local anesthesia, 232-233

pseudocomplications, 56-60, 57, 58, 59

surgical, 69-70

surgical site, 46-48, 47, 48

vasovagal syncope, 48-50

Compresses, cold, 104

Compression

bimodal; see Bimodal compression

excess, tumescent liposuction of abdomen and, 323

postliposuction, 290-292

postliposuction edema and, 82, 83

trimodal, tumescent liposuction of female breasts and, 421-423, 422, 424, 425

trimodal breast, 291

Compression garments

elastic, tumescent liposuction of abdomen and, 321-322, 321-323

physics of, 292-293

Compression pads, 282, 320-321

Compression sponges, 282, 283, 286, 288, 289, 290, 292

Concentration

drug, 142

neural blockade as function of, 128

Concentration solution, 126

Concentration-versus-time graph, 173

Concomitant gynecologic surgery, 263

Conflict of interest, 13

deaths from liposuction and, 38

financial, 13, 118

potential, external ultrasonic-assisted liposuction and, 278-279

Connective tissue panniculitis, 58

Conscious sedation, 205; see also Systemic anesthesia

Consensus gentium fallacy, 30, 34

Consent, informed, 118, 249-250, 266

Contact dermatitis, allergic, 46-47, 47

Continuing medical education (CME), liposuction and, 17

Contraceptives, oral, 69-70, 73

Convenience, liposuction and, 9-10

Cordarone; see Amiodarone

Cordilleras, 348

Corgard; see Nadolol

Corticosteroids, 7, 51, 54, 90, 92, 261

Cortisol, 215

Cosmetic surgical techniques, 9

Coumadin; see Warfarin

Council of Medical Specialty Societies, 14

Crixivan; see Indinavir

Cryoanesthesia, 102-105

Cryoglobulinemia, 104

Cryoglobulins, 104

Cryoimmunoglobulins, 104

Crystalloids, 61

definition of, 80

intravenous, and lungs, 62

CSA; see California Society of Anesthesiologists

Cushing syndrome, 80

Cyclic adenosine monophosphate (cAMP), 179

Cyclooxygenase, hemostasis and, 111

Cyclosporine, 136

Cytochrome P450 3A4 (CYP3A4), 30, 37, 98, 122, 131-140, 154, 165, 174, 187, 196, 199, 203, 206, 264

Cytokines, 215

D

Dalmane; see Flurazepam

Dapsone, 182

DDAVP; see 1-Desamino-8-D-arginine vasopressin

Death certificate data, reporting of liposuction deaths and, 22

Deaths from liposuction, 40, 103

alcohol abuse and, 114

anesthesia-related mortality risks of, 38-40

attributable to general anesthesia, 39

in healthy patients, 38-39

immediate and precipitant, 37-38

lidocaine-associated, 172

problems in reporting, 20-23

systemic anesthesia and, 32-33

underreporting of, 38-39

Debilitation, 114

Deceptive promises of local anesthesia, 39, 40

Decompression orthostatic hypotension, 50

Decremental liposuction, 258

Deep compartment layer of subcutaneous fat, 217

Deep fascia, 302

Deep liposuction, 256, 256-257

Deep venous thrombosis (DVT), 36, 67-68, 75, 92, 261, 291

Deformation, compression garments and, 292

Delayed diagnosis, systemic anesthesia and, 36

Delayed fluid overload, systemic anesthesia and, 36

Demerol; see Meperidine

Dental data, local versus systemic anesthesia and, 40

Depressed incision site, 259

Dermal dystrophy, voluntary, 56, 57

Dermal necrosis, 45, 46, 104

Dermal trauma, tumescent liposuction of chin, cheeks, and jowls and, 390-391

Dermatologic aseptic technique, 98

Dermatologic origins of tumescent technique, 4

Dermatology, local anesthesia and, 144

Dermatomyositis, 58

Dermolipectomy, 299

1-Desamino-8-d-arginine vasopressin (DDAVP), 109

Desmopressin, 109

Detumescence, 226, 381

before liposuction, 251

Diabetes mellitus, 54, 58, 198, 264, 305

Diagnosis, delayed, systemic anesthesia and, 36

Diastasis recti abdominis, 298

Diazepam, 3, 5, 126, 131, 136, 163, 168, 177, 188, 196, 202, 204, 230, 404

lidocaine and, 203

postoperative, 163

DIC; see Disseminated intravascular coagulation

Dietary supplements, hemostasis and, 112

Diffusion of lidocaine, 228

Diflucan; see Fluconazole

Digitalis, 404

Dihydropyridine calcium channel blockers, 136

Dilute solution, 126

Dilutions, 126-127, 150-151, 151

Dimples and muscles, 56, 56, 57

Diprivan; see Propofol

Direct tissue effects of lidocaine, 163-164

Dirithromycin, 135

Discomfort, local anesthesia and, 259-260

Disincentives to report liposuction deaths, 21

Disseminated intravascular coagulation (DIC), 103, 106-108, 167

Distal adit, tumescent liposuction of lateral thighs and, 338

Distal fat pad, tumescent liposuction of arms and, 438

Distal lipoatrophy, 58, 59

Distribution, 142

of lidocaine, 145-155, 152

volume of, 123

Distribution phase, lidocaine and, 152

Do no harm, ethical considerations and, 12-13

Documentation versus experimentation, 7-8

Dolichopygia, 395

Dolophine; see Methadone

Dorsal hump, cervicothoracic, 351-352, 352

Dosage, 123, 187

Dose, 123, 187

Dose-response function

clinical biostatistics of safety and, 27-29

maximum safe dose of liposuction and, 114-115

Dose-toxicity relationship, 170

Double infragluteal crease, tumescent liposuction of lateral thighs and, 328-329

Downs, Hugh, 13

Doxycycline, 88, 97

Drainage

open; see Open drainage

patient misperceptions of, 60

persistent, microcannular tumescent liposuction and, 262

Drainage phase, bimodal compression and, 291

Droperidol, 199

Drowsiness, mild, lidocaine toxicity and, 162

Drug abuse, 204-205

Drug bioavailability, 155-156

Drug clearance, 141-142

Drug concentration, 142

Drug elimination, 141

Drug interactions, 37, 165

adverse, 167

cytochrome P450 3A4 and, 135-137

lidocaine toxicity and, 162-169

systemic anesthesia and, 36-37

Drunkenness, 114

Dry technique, 3, 273

Dunnigan syndrome, 58

Duplex ultrasonography, 67

DVT; see Deep venous thrombosis

Dynabac; see Dirithromycin

Dyschromia, 241, 262

Dysfibrinogenemia, 70

E

Ecchymosis, 52-53, 323

ECF: see Extracellular fluid

ECFV; see Extracellular fluid volume

Edema, 52-53, 82, 83, 85

genital, tumescent liposuction of abdomen and, 323

interstitial, 62-63

pitting versus nonpitting, 81

postliposuction; see Postliposuction edema

posttraumatic, postliposuction care and, 284-286, 285

pulmonary; see Pulmonary edema

tumescent liposuction of abdomen and, 304

Editorial conflict of interest, 13

EDTA; see Ethylenediaminetetraacetic acid

Educational qualifications for liposuction, 16-19

Efficiency of microcannulas, 240-241, 242-245, 245

Elastic compression, 292-293

Elastic compression garments, 321-322, 321-323

Elastic compression vector, compression garments and, 292

Elastic force, compression garments and, 292

Elbow trauma, microcannulas and, 240

Elimination

drug, 141

of lidocaine, 145-155, 155, 159

simultaneous absorption and, 160

Embolism, 67-78

fat, 73-75

prevention of, 75

pulmonary; see Pulmonary embolism

surgical complications and, 69-70

systemic anesthesia and, 36, 68

thrombophilia and, 70-73

Embolon, 67

Embolus syndrome, 73-75

Empiricism, radical, maximum safe dose of liposuction and, 115

Energy

ultrasonic-assisted liposuction and, 272

vacuum pumps and, 268-269

Enflurane, 65

Enzymes, microsomal, 131

Ephedra; see Ephedrine

Ephedrine, 166

Epidemiologic data, lack of, reporting of liposuction deaths and, 20-22

Epidemiologic death certificate questionnaire, 22

Epigastric fat pads, tumescent liposuction of abdomen and, 298

Epigastrium, tumescent liposuction of abdomen and, 297

Epinephrine, 3, 5, 53-54, 61, 63, 144, 151, 165, 167, 174-175, 180, 184, 188, 189, 197-200, 229, 233, 265

adverse reactions to, 198-199

allergy to, 199

lidocaine and, 188-190, 188t

minimum effective concentration of, 6

Equipment, liposuction, 94-95

Erythema ab igne, 44, 216, 259

Erythema ab liporaspiration, 44, 44, 45, 216, 259, 356, 368, 390

Erythromycin, 93, 135, 206

Essential mixed cryoglobulinemia, 104

Estradiol, 137

Estrogens, 69-70, 71, 404

Ethanol, 137

Ethical considerations, 12-15

competition and, 14

external ultrasonic-assisted liposuction and, 275-277, 279

maximum recommended dose of tumescent lidocaine and, 171

microcannular tumescent liposuction and, 248, 263

Ethylenediaminetetraacetic acid (EDTA), 182

Excessive capillary filtration, 79-80

Excessive liposuction; see Liposuction, excessive

Excessive superficial liposuction, 43-45

Experimental linear regression, 28

Experimental toxicology, clinical biostatistics of safety and, 27-28, 28

Experimentation versus documentation, 7-8

External ultrasonic-assisted liposuction, 271, 275-277

Extracellular fluid (ECF), 193

Extracellular fluid volume (ECFV), 61, 62

Extreme superwet technique, 29

Extremely large-volume liposuction, 30

F

Facelift

tumescent, 388-390, 389

two-stage tumescent, 372-391

Facial flushing, 51, 51

Facial nerve complications, 232-233

Facial resurfacing, technique for, 229-230

Factor V Leiden, 71, 72

Fallacies exposed, systemic anesthesia and, 34

Fanlike pattern, microcannular tumescent liposuction and, 255

Fascia, 54, 218

Buck’s, 304

Camper’s, 300

Colles’, 304

deep, 302

muscle, 302

Scarpa’s, 300, 301-305, 303-304, 318

subcutaneous, 302

tumescent liposuction of abdomen and, 301-302, 303-304

Fasciitis, necrotizing, 88, 90-93

Fastin; see Phentermine

Fat, 213

anatomy of, microcannulas and, 242

apical, 215, 300

deep compartment of, 300

fibrousness of, 220

hierarchical architecture of, 217-218

hip, 343

infranatant, 117, 260

inspissated, in apertures, microcannulas and, 241

mantle, 300

physiology of, 221

subcutaneous; see Subcutaneous fat

sub-Scarpa’s, 301

supranatant, 117, 260

tumescent bulk spread through, 144

vacuum applied to, liposuction aspirator and, 268

vascularity of, 215

volume of, microcannulas and, 243-244, 244

Fat atrophy, 57

Fat cells, 213, 214-215, 217

Fat compartments, 213, 217, 350

Fat distribution, tumescent liposuction of abdomen and, 324, 324

Fat embolism syndrome, 73-75

Fat lobules, 213, 217

Fat pad

anterior axillary, 438-439

distal, 438

subplatysmal, 385

Fat pearls, 213, 215, 217, 242

Fat sections, 213, 217

Fat transplantation, tumescent liposuction of female breasts and, 426

FDA; see Food and Drug Administration

Feathering periphery, microcannular tumescent liposuction and, 258

Felodipine, 136

Female ankles; see Female legs and ankles

Female back, tumescent liposuction of, 348, 348-352, 349-350, 351, 352

Female breasts

hypertrophy and reduction of, 413-414, 414, 415, 416

tumescent liposuction of, 413-426

anatomic considerations of, 417, 417

anesthetic infiltration in, 419-421, 420

breast hypertrophy and reduction, 413-414, 414, 415, 416

pitfalls and special considerations of, 423-426

postoperative care of, 421-422, 422, 424, 425

preoperative evaluation of, 417-419, 418

surgical technique for, 421

Female flank, tumescent liposuction of, 353

Female hips, tumescent liposuction of, 342-348, 343, 344, 345, 346-347

Female legs and ankles, tumescent liposuction of, 440-443

anatomic considerations of, 440

anesthetic infiltration in, 440-443

intraoperative positioning for, 440, 443

pitfalls and special considerations of, 443

postoperative care in, 443

preoperative evaluation of, 440, 441, 442

surgical technique for, 443

Femoral nerve block, 233

Fenno, Gary, 4

Fentanyl, 9, 33, 39, 177, 196, 197, 202, 205-206, 264

Fetal glucose-6-phosphatase deficiency, 182

Feverfew, 112

Fibroblasts, 214-215

Fibrofacients, 220

Fibrosis, 220

Fibrous bands, tumescent liposuction of chin, cheeks, and jowls and, 384

Fibrous content of fat compartment, 350

Fibrous tissue

pain during infiltration and, 223

tumescent liposuction of female breasts and, 419, 420

Fibrousness of fat, 220

Field, Larry, 4

Financial conflict of interest, 13, 118

Finesse, microcannulas and, 239, 241

Finesse cannulas, 365

Finesse microcannulas, 236, 236, 242, 261

First-order absorption process, lidocaine and, 137, 145, 154, 159

Flank

female, tumescent liposuction of, 353

male, tumescent liposuction of, 352-356, 353, 354, 355

Flow sheets, 167-168

Fluconazole, 136

Fluid homeostasis, tumescent solvents and, 190-194

Fluid incubation, postliposuction edema and, 84

Fluid leak, amplified liposuction edema syndrome and, 85

Fluid osmolality, postliposuction edema and, 83-84

Fluid overload, delayed, systemic anesthesia and, 36

Fluid volume and overload, superwet liposuction and, 61-63

Flumazenil, 202

Fluoxetine, 134-135, 136

Flurazepam, 122, 131, 136

Flushing, facial, 51, 51

Fluvoxamine, 134, 135

Foam, Reston; see Reston foam

Food and Drug Administration (FDA), 4, 21, 70

external ultrasonic-assisted liposuction and, 277

safe dosages of local anesthetics and, 177-178

Fournier, Pierre, 43

Fragility, microcannulas and, 241

Free radicals, ultrasonic-assisted liposuction and, 274

“Frog-leg” position, tumescent liposuction of medial thighs and, 363

Frostbite, 104

Fulcrum of rotation, microcannular tumescent liposuction and, 255

Full-thickness dermal necrosis, 45, 46

Furosemide, 183

G

G proteins, 200

GABA; see Gamma-aminobutyric acid

Gabion, 216

Gamma-aminobutyric acid (GABA), 202

Garlic, 53, 54, 112

Garments, compression; see Compression garments

Gastrointestinal effects of lidocaine, 162

10-Gauge Capistrano microcannula, 239

12-Gauge Capistrano microcannula, 239

14-Gauge Capistrano microcannula, 238

16-Gauge Capistrano microcannula, 238

18-Gauge Capistrano microcannula, 237-238

20-Gauge Capistrano microcannula, 237

14-Gauge female breast microcannulas, 239

16-Gauge female breast microcannulas, 239

Gauze sponges, sterile absorbent, 250-251, 251, 254

Gel, interstitial colloidal, 144

General anesthesia; see Systemic anesthesia

Generalized lipoatrophy, 58

Genitals, edema of, 52, 52-53, 323

Gibbosity of inferolateral buttock, 392

Ginkgo Biloba, 112

Glucogen, 215

Gluconeogenesis, lactate metabolism and, 192

Glucose-6-phosphatase deficiency, 182

Glucuronide, 136

Gluteofemoral dell, lateral, 342, 343

Glycine xylidine (GX), 133

Government reporting, reporting of liposuction deaths and, 21

Graduated versus bimodal compression, 291

Granulomatous lipoatrophy, 58

Grapefruit juice, 136

Group A streptococci, necrotizing fasciitis and, 90-91

GX; see Glycine xylidine

Gynecologic surgery, contomitant, microcannular tumescent liposuction and, 263

Gynecomastia, 404

H

Halcion; see Triazolam

Half-life, 141, 155

Halothane, 9, 33, 36-37, 65, 167

Handle of microcannula, 246, 246, 252, 253

Harris-Benedict equation, 221

Hartmann, Alexis Frank, 191

Hartmann’s solution, 191-193

HCV; see Hepatitis C virus

HDL; see High-density lipoprotein

Healing, accelerated, microcannulas and, 240

Health food supplements, 189

Healthy patients, deaths in, 38-39

Heart failure, acute, 65

Heat, ultrasonic-assisted liposuction and, 272

Heat stroke, ultrasonic-assisted liposuction and, 273

Heavy IV sedation; see Systemic anesthesia

Hematocrit, microcannular tumescent liposuction and, 260

Hematomas, 232

tumescent liposuction of abdomen and, 305, 306

tumescent liposuction of male breasts and, 411-412

Hemodilution

amplified liposuction edema syndrome and, 85

disseminated intravascular coagulation and, 107

excessive liposuction and, 194

thrombosis and, 69

tumescent fluid and, 62

Hemophilia, 106, 109

Hemophilia A, 109

Hemophilia B, 109

Hemorrhage, occult, 108-109

Hemostasis, 110-112

impaired, 110-112

internal ultrasonic-assisted liposuction and, 273

tumescent, 11, 235-236

tumescent vasoconstriction and, 63

Henderson-Hasselbalch equation, 124

Heparin, 71, 75

Hepatic metabolism of lidocaine, 132-133

Hepatitis C virus (HCV), 98, 264

Hertz, H.R., 271

Hertz (Hz), 271

Heteroscedasticity, linear regression analysis and, 176

Heterozygous hyperhomocystinemia, 72-73

High–capillary pressure pulmonary edema, 64

High-density lipoprotein (HDL), 72

High-to-low extrapolation, maximum safe dose of liposuction and, 116

Hip fat, 343

Hips, female, tumescent liposuction of, 342-348, 343, 344, 345, 346-347

Hismanal; see Astemizole

HIV; see Human immunodeficiency virus

HK Breast-Torso Garment, 422, 424

HK Pads, tumescent liposuction of abdomen and, 320-321

Homeostasis, fluid, tumescent solvents and, 190-194

Homocystine, 73

Horizontal infragluteal crease, 392

Hormones, adipocytes and, 215

Hospital practices, reporting of liposuction deaths and, 21-22

Hospital surgical privileges, liposuction and, 18-19

Hub of microcannula, 246, 246

Human error

prevention of, 164-165

systemic anesthesia and, 34-35

Human immunodeficiency virus (HIV), 90, 137, 264

Human toxicology, clinical biostatistics of safety and, 28-29, 29t

Hyaluronidase, 127

Hydrocodone, 165

Hydrocortisone, 88, 155

Hydrodynamics, liporaspiration and, 242

Hydrostatic vasocompression, 63

Hyperhidrosis, tumescent liposuction of arms and, 437-438

Hyperhomocystinemia, 72-73, 73

Hyperpigmentation, 47, 47-48, 48, 262

Hypertension, microcannular tumescent liposuction and, 264

Hyperthermia, malignant, microcannular tumescent liposuction and, 265

Hyperthyroidism, microcannular tumescent liposuction and, 265

Hypertrophic scars, microcannular tumescent liposuction and, 259

Hyperventilation syndrome, 165

Hypopigmentation, 47, 47-48, 48, 262

Hypotension

alpha2 adrenergic receptors and, 201-202

decompression orthostatic, 50

Hypothermia, 102-103

and cryoanesthesia, 102-105

disseminated intravascular coagulation and, 107

thrombosis and, 69

Hypothyroidism, microcannular tumescent liposuction and, 265

Hypoxic vasoconstriction, 65

Hysterectomy and liposuction, 323

Hz; see Hertz

I

Iatrogenic complications, 20

Iatrogenic pulmonary edema, 62

Ibuprofen, 44, 51, 111, 206

Ice packs, 104

ICF; see Intracellular fluid

Idiopathic lipoatrophy, 57-60, 58, 59

Imidazole, 201

Immediate causes of death, systemic anesthesia and, 37-38

Immobility, thrombosis and, 70

Immunocomplexes, 104

Immunocompromised patients, 264

Immunosuppressive drugs, 90, 92

Impaired coagulation, hypothermia and, 103

Impaired lymphatic drainage, postliposuction edema and, 79

Improbability fallacy, systemic anesthesia and, 34

Inapsine, 199

Incision site, depressed, microcannular tumescent liposuction and, 259

Incisions, microcannulas and, 241

IND; see Investigational New Drug

Indented scars, 47

Index finger, microcannular tumescent liposuction and, 254, 254

Indinavir, 137

Inebriation, 114

Infections, 88-101, 128

dermatologic aseptic technique and, 98

microcannular tumescent liposuction and, 261

necrotizing fasciitis and, 90-93, 93

predisposing conditions and, 89-90

prophylactic antibiotics and, 88

rapidly growing mycobacteria and, 94-98, 95, 96, 97

viruses and, 98

Infiltration

deep, 225

excess

avoidance of, 229

tumescent liposuction of abdomen and, 323

initiation of, 225-227

intraoperative, 227

pain during, 223-224

patterns of, 225, 227

rate of, 224-225

volume of, 227-229

volume of, 227-229

Infiltration cannulas, 223

Infiltration hematomas, 232

Infiltration rate, lidocaine and, 150, 150

Infiltration technique, tumescent; see Tumescent infiltration technique

Inflammation

fibrosis and, 220

microcannular tumescent liposuction and, 261

prostaglandin-mediated, 261

Inflammation-mediated pulmonary edema, 64

Inflammatory mediators, amplified liposuction edema syndrome and, 85

Informed consent, 118, 249-250, 266

Infragluteal crease

double, tumescent liposuction of lateral thighs and, 328-329

horizontal, 392

horizontal, tumescent liposuction of buttocks and, 400-403, 402, 403

Infranatant fat, 117, 260

Infrascapular back, tumescent liposuction of, 349, 349-350

Injection of anesthetic, 233

Injury of facial nerve, 232-233

Inotropy, bupivacaine and, 179

Insertion and injection pain, 233

Inspissated fat in apertures, microcannulas and, 241

Insulin lipoatrophy, 58

Insurance practices, reporting of liposuction deaths and, 21-22

Intellectual conflict of interest, 13

Intensity, ultrasonic-assisted liposuction and, 272

Intention, ethics and, 12

Intergluteal crease, 392

Internal ultrasonic-assisted liposuction, 260, 271, 272-275

Interpersonal skills, 231-232

Interstitial edema, 62-63

Interstitial fluid pressure, postliposuction edema and, 83

Interstitial pulmonary edema, 64

Intracellular fluid (ICF), 193

Intradermal blebs, 225

Intravenous crystalloids and lungs, 62

Intravenous fluid overload, tumescent vasoconstriction and, 63

Intravenous fluids, 194

“Inverted-smile” appearance, tumescent liposuction of abdomen and, 324

Investigational New Drug (IND), 8

Investigational review board (IRB), 6

Invirase; see Saquinavir

IRB; see Investigational review board

Isoflurane, 9, 65

Isomorphism, topologic, 248

Isoproterenol, 197

Itraconazole, 135, 136

IV sedation, heavy; see Systemic anesthesia

J

Journal

of Dermatologic Surgery and Oncology, 172

of Plastic and Reconstructive Surgery, 7

Jowls, tumescent liposuction of; see Chin, cheeks, and jowls, tumescent liposuction of

Juvenile rheumatoid arthritis, 58

K

Kant, Emmanuel, 12

Keloid scar, microcannular tumescent liposuction and, 259

Kenalog; see Triamcinolone

Ketalar; see Ketamine

Ketamine, 9, 33

Ketoconazole, 135, 136, 154

Kinetic energy

ultrasonic-assisted liposuction and, 272

vacuum pumps and, 268-269

Kinetic studies, 142-145, 143t

“Kleenex sign, positive,” cocaine abuse and, 204

Klonopin; see Clonazepam

Knee, medial, tumescent liposuction of, 367-368, 368, 369

L

LA; see Lupus anticoagulant

Labetalol, 197, 200, 202

Lacerations, vascular, 54, 54

Lactated Ringer’s solution, 69, 191-193

Lactic acid, 192

Large cannulas, tumescent liposuction of chin, cheeks, and jowls and, 379

Large-volume liposuction, 30

Larynx, tumescent liposuction of chin, cheeks, and jowls and, 378

Laser, CO2, ultrasonic-assisted liposuction and, 274

Lasix; see Furosemide

Lateral circumflex veins, tumescent liposuction of abdomen and, 305

Lateral gluteofemoral dell, 342, 343

Lateral thigh aggregate, 325

Lateral thighs, tumescent liposuction of, 325-341

anatomic considerations of, 325-332, 327, 328, 329, 330, 331, 332, 333

intraoperative positioning and, 333-334, 334

pitfalls and special considerations of, 341, 341

postoperative care of, 338, 339-340

preoperative evaluation of, 333

surgical technique of, 334-338, 335, 336, 337, 338

Lawrence-Seip syndrome, 58

Leanness, fibrosis and, 220

Legs

edema of, 52

female; see Female legs and ankles

Leptopygian, tumescent liposuction of buttocks and, 395

Leptosomatic, tumescent liposuction of buttocks and, 395

Lesions, microcannular tumescent liposuction and, 261

Lethal dose of liposuction, 115-116

Levobupivacaine, 129

Levo-thyroxine, 204

Lichen sclerosus, 58

Lidocaine, 3, 4, 5, 7, 10, 27, 29, 37, 89, 97, 128, 132, 134, 136, 137, 138, 143-144, 145, 151, 187, 188, 189, 196, 199, 200, 206, 229, 233

adverse drug interactions and, 162-169

bupivacaine versus, 180-181

characteristics of, 124-127, 125

concentration of, rate of infiltration and, 224

diazepam and, 203

diffusion of, 144

dose limits of, 30

dose recommendations for, 121-122

double dose of, 165

effects of, 127-129

epinephrine and, 188-190, 188t

estimating time for clearance of, 158

hepatic metabolism of, 132-133

local anesthetic allergic reactions and, 166-167

maximum recommended dosage of, 170-178

early reports and recent studies of, 172-177, 173, 174

FDA and, 177-178, 177t

pragmatic estimate of, 170-172

maximum safe dose of, 6-7

metabolism of, 174

cytochrome P450 3A4 and, 131-140

drug interactions and, 135-137

Michaelis-Menten enzyme kinetics and, 137-138

metabolites of, 133, 134

minimum effective concentration of, 6

misconceptions about, 4-5

overdose of, treatment of, 168

pharmacology of, 124-130

versus prilocaine, 181-182, 183

rate of absorption of, 142-143

versus ropivacaine, 184

surgical orders and flow sheets and, 167-168

toxicity of, 162-169

Ligaments

of Jacque, 392

of Luschka, 392

Lightheadedness, lidocaine toxicity and, 162

Lignocaine, 175

Limen, 6

Linear energy balance equation, 221

Linear regression

experimental, 28

maximum recommended dose of tumescent lidocaine and, 175

observational, 27-28

Lipoatrophia semicircularis, 58

Lipoatrophic diabetes mellitus, 58

Lipoatrophy, 57-60, 58, 59

Lipoblast, 218

Lipodystrophy, 57

Liponots, 50, 250, 261, 329, 331, 332, 332, 333

Lipophilia, 124-125, 125

Liporaspiration, physics of, 242-245, 243

Liposuction; see also Tumescent liposuction

ancillary pharmacology of, 196-209

bimodal compression and, 281-293

bupivacaine and, 179-186

clinical biostatistics of safety and, 27-31

clinical phamarcology and, 119-209

complications of; see Complications of liposuction

cryoanesthesia and, 102-105

cytochrome P450 3A4 and lidocaine metabolism and, 131-140

deaths from; see Deaths from liposuction

decremental, 258

early, 3-4

educational and clinical qualifications and, 16-19

embolism and, 67-78

ethical considerations and, 12-15

ethical considerations of, 12-15

excessive, 43-45, 116-117

hemodilution and, 194

versus limited liposuction, 10-11

progressive edema and, 85

thrombosis and, 69

tumescent liposuction of abdomen and, 324

extremely large-volume, 30

foundations and issues in, 1-23

hypothermia and, 102-105

infections and, 88-101

large-volume, 30

lidocaine toxicity and drug interactions and, 162-169

liposuction privileges and, 19

maximum safe dose of, 114-118

excessive liposuction and, 116-117

liposuction trauma and, 114-116

megaliposuction and, 117-118

mechanical versus thermal trauma in, 274-275

median-volume, 30

open drainage and, 281-293

pathophysiology and complications of, 25-118

peer review and, 18-19

perioperative bleeding disorders and, 106-113

pharmacology of lidocaine and, 124-130

postliposuction care and, 281-293

postliposuction edema and, 79-87

prerequisite training and, 16

prilocaine and, 179-186

problems in reporting deaths from, 20-23

pseudocomplications of, 56-60

residency training and, 16-17

risks of, 32-42

ropivacaine and, 179-186

safety issues in, 9-10

sequential, 118

small-volume, 29-30

standards of care for, 9-11

superficial; see Superficial liposuction

superwet; see Superwet liposuction

surgical training and, 17-18

thrombosis and, 67-68

tumescent; see Tumescent liposuction

ultrasonic-assisted; see Ultrasonic-assisted liposuction

Liposuction aspirator, physics of, 266-270

Liposuction equipment, 94-95

Liposuction syncope, 49

Liposuction volume limits, 29-30

Lipotrops, 50, 250, 260-261, 329, 331, 332, 332, 333

Lipowarps, 251, 325-328, 328, 329

Litigation, external ultrasonic-assisted liposuction and, 277-278

LIVAS; see Local anesthesia plus intravenous analgesia-sedation

Livedo reticularis, 216

Lobular structure of fat pearl, 217

Local anesthesia

allergic reactions to, 166-167

deceptive promises of, 39, 40

definition of, 33

dermatology and, 144

fallacious assumptions about, 4

inadequate, 259-260

insufficient, 227

plus intravenous analgesia-sedation (LIVAS), 33

relative potency of, 125, 126

safety of, 40

solubility of, 125, 126

versus systemic anesthesia, microcannulas and, 241

tumescent, definition of, 33

Localized involutional lipoatrophy, 57

Logic, sophistic, 18

Lopressor; see Metoprolol

Lorazepam, 33, 136, 163, 196, 197, 202-203, 223, 229, 230, 388

“Love handles,” 352

Lumbosacral fat pads, tumescent liposuction of, 351

Lumpiness, temporary, 50-51

Lungs, intravenous crystalloids and, 62

Lupus anticoagulant (LA), 73

Lupus anticoagulant syndrome, 70

Lupus erythematosus, 58

Luvox; see Fluvoxamine

Lymphatic function, postliposuction edema and, 79-84

Lymphatic impairment, amplified liposuction edema syndrome and, 84-85

Lymphatic pump mechanism, postliposuction edema and, 83

Lymphatics, circumferential thigh liposuction and, 371

Lymphedema, postliposuction edema and, 79-84

Lymphotasis, circumferential thigh liposuction and, 371

M

MAC; see Monitored anesthesia care

Male breasts, tumescent liposuction of, 404-412

anatomic considerations of, 404-405

anesthetic infiltration of, 407, 407-408

intraoperative positioning for, 405-407, 407

pitfalls and special considerations for, 412

postoperative care of, 408-412, 410, 411

preoperative evaluation of, 405, 406-407

surgical technique for, 408, 409

Male flanks, tumescent liposuction of, 352-356, 353, 354, 355

Males, dose of lidocaine in, 121

Malignant hyperthermia, microcannular tumescent liposuction and, 265

Malpractice insurance, 21-22

Mammograms, 423

Mammoplasty, reduction, complications of, 423

Mantle fat, 300

Mantle layer of subcutaneous fat, 216

MAOIs; see Monoamine oxidase inhibitors

Margin of safety, maximum recommended dose of tumescent lidocaine and, 171

Marijuana, 404

Mathematics

pharmacokinetics of tumescent liposuction and, 141, 157-160

tumescent lidocaine kinetics and, 158-160

Maximum recommended dosage of tumescent lidocaine, 33, 170-178

Maximum safe dose

of lidocaine, 156

of liposuction, 114-118

MBC; see Medical Board of California

MEC; see Minimal effective concentration

Medial condyle, 367

Medial knee, tumescent liposuction of, 367-368, 368, 369

Medial thigh furrow, tumescent liposuction of, 357-358, 358, 359

Medial thigh lift, 361-363

Medial thighs, tumescent liposuction of, 357-366, 358, 359, 360, 361, 362-363, 364, 365, 366, 367

Median epileptogenic dose, 122

Median lethal dose, 5, 28, 122, 182

Median-volume liposuction, 30

Medical Board of California (MBC), 21

Medications

causing perioperative bleeding, 110

pain during infiltration and, 223

Megadoses, maximum recommended dose of tumescent lidocaine and, 171-172

Megaliposuction, 29, 30, 35, 115, 117-118

MEGX; see Monoethyl glycine xylidide

Melanophages, 262

Menadione, 109

Menaquinone, 109

Menstrual irregularity, 54

Meperidine, 5, 9, 126, 136, 196, 205

Mephyton, 110

Metabolic activities, simultaneous, lidocaine and, 152-153, 153

Metabolic alkalosis, 192

Methadone, 134, 135

Methemoglobin, 182

Methemoglobinemia, 181, 182-183

Methohexital, 264

Methylene blue, methemoglobinemia and, 183

Metoprolol, 198

Michaelis-Menten enzyme kinetics, 137-138

Michaelis-Menten kinetics, 137, 138

Microcannula tips, 236

Microcannular liposuction, internal ultrasonic-assisted liposuction and, 273

Microcannular tumescent liposuction, 248-253

operative considerations for, 253, 253-260, 254, 256, 257

patient selection for, 262-266

physics of liposuction aspirator, 266-270, 269

postoperative considerations for, 260-262

preoperative considerations for, 248-253, 249, 251, 253

surgical technique for, 248-270

surgical technique of, 248-270

Microcannulas, 232, 235-247, 252

advantages of, 239-240, 252

care of, 247

designs and terminology of, 236, 236-241, 237, 238t

disadvantages of, 240-241

liposuction application and, 235-236, 236

manufacture and fabrication of, 245-246, 246

physics of liporaspiration and, 242-245, 243, 244, 245

progressively larger, 256

tumescent liposuction of chin, cheeks, and jowls and, 379

tumescent perspective on, 246-247, 246t

Microincisions

location of, tumescent liposuction of chin, cheeks, and jowls and, 379, 380-381

microcannulas and, 240

Microseroma, 51

Microsomal enzymes, 131

Microsomes, 131

Microtunnels, 240

Microvascular thrombosis, internal ultrasonic-assisted liposuction and, 273

Midabdomen, tumescent liposuction of, 297

Midazolam, 9, 33, 131, 136, 163, 168, 197, 202, 203, 204, 205, 223, 229, 230

Mild drowsiness, lidocaine toxicity and, 162

Mill, John Stuart, 12

Milligrams, 142, 187

Milliliters of lidocaine, 142

Minimal effective concentration (MEC), 5, 6

Minor superficial irregularities, 50

Mitral stenosis, 65

Mitral valve disease, 65-66

Mitral valve prolapse (MVP), 88, 265

Mitral valve regurgitation, 65

Mixed immunoglobulin complexes, 104

Modesty, 230, 250

Modified tumescent technique, 34

Moguls, tumescent liposuction of buttocks and, 392-394

mol; see Mole

Molality, 80

Molar mass, 126

Molarity, 80, 126, 193

Mole (mol), 80, 126, 193

Molecular weight, 126

Monitored anesthesia care (MAC), 39; see also Systemic anesthesia

Monitoring

cryoanesthesia and, 103

overreliance on, systemic anesthesia and, 35

Monoamine oxidase inhibitors (MAOIs), 136, 199, 205

Monoclonal proteins, 104

Monoethyl glycine xylidide (MEGX), 133

Mons pubis, tumescent liposuction of abdomen and, 324

Morbid obesity, microcannular tumescent liposuction and, 263

Morbidity risks, local versus systemic anesthesia and, 40

“Morning-after-liposuction syncope,” 50

Morphine, 201, 264

Motor hand, microcannular tumescent liposuction and, 253, 254

Motrin; see Ibuprofen

Multilocular adipocytes, 215

Multiple procedures, 74

maximum safe dose of liposuction and, 116

systemic anesthesia and, 36

thrombosis and, 69

Murphy’s Law, 34

Muscle fascia, 302

Muscle paralysis, 233

Muscle strength, microcannulas and, 240

Muscles, dimples and, 56, 56, 57

Mutagenicity, potential, internal ultrasonic-assisted liposuction and, 274

MVP; see Mitral valve prolapse

Mycobacteria, rapidly growing, 94-98, 95, 96, 97

Myocardial depression, bupivacaine and, 179

N

Nadolol, 197

Naproxen, 111

Narcotic analgesics, 9, 33, 196

Narcotics, 196-197, 201, 205, 230-231, 264

National Center for Injury Prevention and Control (NCIPC), 22

Near-syncope, 233

operating room, 49-50

vasovagal, 204

Necrosis, internal ultrasonic-assisted liposuction and, 274, 274-275, 275

Necrotizing fasciitis, 88, 90-93

Needle breaks, 232

Needle insertion, painful, 233

Needles

microcannulas and, 238

tumescent liposuction of female breasts and, 419, 420

Nefazodone, 134, 136

Nelfinavir, 137

Neomycin, 46-47

Neosporin, 46-47

Neo-Synephrine; see Phenylephrine

Nerve compression, lactated Ringer’s solution and, 192

Nerve fiber effects of lidocaine, 128

Neural blockade, 128

Neurally mediated syncope, 48

Neurocardiogenic syncope, 48

Neurogenic syncope, 48

Neurotoxicity of lidocaine, 129

Nevus lipomatosus, 215-216

NIDDM; see Non-insulin-dependent diabetes mellitus

Nifedipine, 134, 135, 136

Nisoldipine, 136

Nitrendipine, 136

Nitrites, 182

Nitrofurantoin, 182

Nitrous oxide, 33, 36-37, 167

Nizoral; see Ketoconazole

Non-insulin-dependent diabetes mellitus (NIDDM), 198

Nonpitting edema, 81

Nonpunitive policy, reporting of liposuction deaths and, 22

Nonsteroidal antiinflammatory drugs (NSAIDs), 51, 90, 92, 110-111, 112, 206, 261

Norepinephrine, 197-198

Normal saline (NS), 69, 188, 191, 191t

Normalized entitiy, 123

Norvir; see Ritonavir

Novacain; see Procainamide

Novocain; see Procaine

NS; see Normal saline

NSAIDs; see Nonsteroidal antiinflammatory drugs

Nursing, microcannular tumescent liposuction and, 250

O

Obesity, 122, 263-264

Oblique septa, 218

Observational linear regression, 27-28

Occult hemorrhage, 108-109

OCs; see Oral contraceptives

Octanol, 124

Office efficiency, 232

OHIA syndrome; see Operative hysteroscopy intravascular absorption syndrome

Olanzapine, 136

Oncotic pressure, 80

One-compartment model, lidocaine and, 145

Open drainage, 79

postliposuction care and, 281-293

versus sutures, 284, 289

tumescent liposuction of abdomen and, 320

Operating room near-syncope, 49-50

Operating room (OR) skills, 16

Operative hysteroscopy intravascular absorption (OHIA) syndrome, 36, 194

OR skills; see Operating room skills

Oral analgesics, 33

Oral anxiolytic drugs, 230

Oral contraceptives (OCs), 69-70, 73

Osmolality, 80, 193

Osmolarity, 80, 193

Osmosis, 80

Osmotic pressure, 80

Outer thigh, tumescent liposuction of, 325

Over-the-counter drugs, bleeding problems and, 106

Oxazepam, 136

Oxidation, lactate metabolism and, 192

Oxygen, methemoglobinemia and, 183

Oxyhemoglobin, 182

Oxytocin, 199

P

PAF; see Platelet activating factor

Pain

during infiltration, 223

injection, 233

local anesthesia and, 259-260

microcannulas and, 239

threshold of, 6

true, 260

Panniculitis

connective tissue, 58

postliposuction, 7, 51, 51

postoperative, 98

Panniculus adiposus, tumescent liposuction of abdomen and, 298-299

Pannus, tumescent liposuction of abdomen and, 298-299

Paralogism, 34

Paralysis of facial nerve, 232

Paramedian neurovascular bundles, tumescent liposuction of abdomen and, 305

Paroxetine, 134

Partial lipoatrophy, 58

Partial vacuum, 267

Pathophysiology and complications of liposuction 25-118

Patient

alert, 222-223

evaluation of, 261

expectations of, 231

immunocompromised, 264

misperception of, of drainage, 60

pediatric, dose of lidocaine in, 121-122

physical comfort of, 231

“red flag,” 266

selection of, 262-266

Patient anxiety, 230-231

Patient comfort, 225, 250

Paxil; see Paroxetine

PDR; see Physician’s Desk Reference

PE; see Pulmonary embolism

Peak concentration of lidocaine, 146-148, 149

Peak plasma concentrations, 181

Peau d’orange appearance, 228-229

Pediatric patients, dose of lidocaine in, 121-122

Peer review, liposuction and, 18-19

Penetration

easier, microcannulas and, 240

tumescent liposuction of abdomen and, 304

Perforation, abdominal, 89-90, 323

Perioperative bleeding disorders, 106-113

disseminated intravascular coagulation, 106-108

normal and impaired hemostasis and, 110-112

occult hemorrhage, 108-109

predisposing disorders, 109-110

Perioperative tachycardia, 53-54

Peripheral compartment, lidocaine and, 143

Peripheral nerve toxicity, lidocaine toxicity and, 163-164

Peristaltic infiltrating pump, 7

Peritoneoscopy, tumescent liposuction of abdomen and, 323

Peritonitis, 36, 89-90

Permissiveness, systemic anesthesia and, 35

Petite seromas, 261

Pfannenstiel’s incision, 305, 305

pH, 124-126

pH partition hypothesis, 124

Pharmacokinetic compartment, 144-145

Pharmacokinetics

mathematics of, 157-160

science of, 141-142

of tumescent liposuction, 141-161

Pharmacology

adrenergic medications, 197, 197-202

ancillary, 196-209

antiinflammatory drugs, 206

atropine, 204

benzodiazepine sedatives, 202-204

clinical, liposuction and, 119-209

conscious sedation and systemic anesthesia, 205-206

drug abuse and liposuction, 204-205

of lidocaine, 124-130

lidocaine toxicity and, 162

tumescent guidelines for, 196-197

of tumescent technique, 121-123

Phenobarbital, 182

Phenothiazines, 199

Phenoxybenzamine, 197

Phentermine, 167

Phenylephrine, 198

Phenytoin, 167, 182, 404

Phlebitis, popliteal, 74

Phylloquinone, 109

Physician’s Desk Reference (PDR), 4

Physiologic saline, 188

Phytonadione, 109, 110

Pindolol, 198

Pitch, microcannular tumescent liposuction and, 255

Pitting edema, 81

pKa, 124-125

Placebo effect, external ultrasonic-assisted liposuction and, 275-277

Plasma concentration, 181

Plasma concentration thresholds for toxicity, 181

Plasma protein binding, lidocaine and, 127

Plastic and Reconstructive Surgery, 174

Platelet activating factor (PAF), 112

Platelet thromboembolism, ultrasonic-assisted liposuction and, 273

Platysma muscle plication, 382, 382-384, 383

Platysmal bands, 375

Pneumothorax

systemic anesthesia and, 36

tumescent liposuction of female breasts and, 421

Polymyxin B, 46-47

Polyphenols, 111-112

Popliteal phlebitis, 74

“Positive Kleenex sign,” cocaine abuse and, 204

Postdrainage phase, bimodal compression and, 291

Postinflammatory dyschromia, 262

Postliposuction care, 281-293

bimodal compression and, 281-293

open drainage and, 281-293

physics of compression garments and, 292-293

postliposuction compression and, 290-292

posttrauma edema and, 284-286, 285, 287-288, 289, 290

preventive approach to, 281-284, 282, 283

traditional approach to, 281

Postliposuction compression, 290-292

Postliposuction edema, 79-87

amplified liposuction edema syndrome and, 84-86

lymphatic function and, 79-84, 82, 83

lymphedema and, 79-84, 82, 83

Postliposuction lymphedema, 80, 81

Postliposuction panniculitis, 7, 51, 51

Postoperative panniculitis, 98

Postoperative seromas, 44, 45

Postoperative soreness, 52, 53, 53

Posttraumatic edema, 284-286, 285

Posttraumatic lipoatrophy, 60

Posttraumatic pseudolipomas, 219

Potassium, Ringer’s solution and, 191

Potential energy, vacuum pumps and, 268-269

Powder, superabsorbent, 282

Power

ultrasonic-assisted liposuction and, 272

vacuum pumps and, 268

Precipitant causes of death, systemic anesthesia and, 37-38

Prednisone, 7, 51, 98, 206

Pregnancy

methemoglobinemia and, 182-183

proteins C and S and, 71-72

ropivacaine and, 183

thrombosis and, 69

tumescent liposuction of abdomen and, 298

Prerequisite training, liposuction and, 16

Press fitting, microcannulas and, 245-246

Pressure sensations, intolerance to, 260

Presyncope, vasovagal, 48

Prilocaine, 181-183

Primary lymphedema, 80

Prior obesity, microcannular tumescent liposuction and, 263-264

Procainamide, 4, 143, 165

Procaine, 165

Procardia; see Nifedipine

Prophylactic antibiotics, infections and, 88

Propofol, 9, 33, 37, 39-40, 65, 128, 168, 190, 205, 206, 264

Propranolol, 133, 137, 167, 197, 199

Propulsid; see Cisapride

Prostaglandin-mediated inflammation, 261

Prostaglandins, 54

Protease inhibitor drugs, 98, 137, 264

Protein C, 71-72

Protein S, 71-72

Proteolysis, amplified liposuction edema syndrome and, 85

Prothrombin, 72

Proventil; see Albuterol

Prozac; see Fluoxetine

Pseudobulges, 251, 329, 329, 330

Pseudocomplications of liposuction, 56-60

Pseudogynecomastia, 404, 405

Pseudolipoma, 219, 219, 304, 305

“Pseudopower” of liposuction aspirator, 268

“Pseudotoxicity,” benzodiazepine sedatives and, 202

Psychiatric disease, microcannular tumescent liposuction and, 265

Pulmonary edema, 63-66, 67, 167

causes of, 64

conditions associated with, 65-66

iatrogenic, 62

lethal cycle of, 66

prevention of, 64-65

pulmonary lymphatic system and, 65

superwet liposuction and, 61-66

types and causes of, 6

Pulmonary embolism (PE), 36, 73

prevention of, 75

systemic anesthesia and, 37-38

Pulmonary embolus, 67

Pulmonary lymphatic system, 65

Pulmonary thromboembolism, 67-78

Pulse oximetry, 33-34, 182

Q

Qualifications, educational and clinical, for liposuction, 16-19

Quality control, surgeons and, 20

Quinine, 182

R

Radical empiricism, maximum safe dose of liposuction and, 115

Radiolabeled fibrinogen uptake testing, 67

Rapid absorption toxicity of lidocaine, 164

Rapid rate of infiltration, 224-225

Rapidly growing mycobacteria (RGM), 94-98, 95, 96, 97

“Reasonable informed consent,” microcannular tumescent liposuction and, 248

Recurrent respiratory depression (RRD), 39-40

“Red flag” patients, microcannular tumescent liposuction and, 266

Red wine, 53, 54, 111-112

Reduction mammoplasty, complications of, 423

Redundant skin, tumescent liposuction of chin, cheeks, and jowls and, 375, 385-388, 386-387

Reflexogenic syncope, 48

Regional anesthesia, 33

Relative pressure, 267

Reporting bias, external ultrasonic-assisted liposuction and, 278

Reputation, external ultrasonic-assisted liposuction and, 277

Residency training, liposuction and, 16-17

Respiratory depression, recurrent, 39-40

Respiratory effects of lidocaine, 163

Reston foam, 46, 320

Restraints, tumescent liposuction of abdomen and, 308

Resurfacing, facial, technique for, 229-230

Retracted scars, 47

RGM; see Rapidly growing mycobacteria

Rheumatoid arthritis, juvenile, 58

Rhinitis, allergic, 204

Rhytidectomy, cervicofacial, 388-390, 389

Rib belts, tumescent liposuction of abdomen and, 321

Rifampicin; see Rifampin

Rifampin, 134, 135

Ringer, Sidney, 191

Ringer’s solution

lactated, 191-193

without lactate, 191

Risk-benefit analysis, 27

Ritonavir, 137

Ropivacaine, 183-184

Rotation, fulcrum of, 255

RRD; see Recurrent respiratory depression

Rugosity

tumescent liposuction of abdomen and, 298

tumescent liposuction of medial thigh and, 361

S

“Sad-face” result, tumescent liposuction of abdomen and, 324

Safe/toxic threshold, maximum safe dose of liposuction and, 115, 115-116

Safety

clinical biostatistics of, 27-31

dose of liposuction and, 114-118

lidocaine and, 143-144, 188-190

liposuction and, 9-10

of local versus systemic anesthesia, 40

maximum recommended dose of tumescent lidocaine and, 171, 174

microcannular tumescent liposuction and, 248

pharmacokinetics of tumescent liposuction, 142

prilocaine and, 181-182

ultrasonic-assisted liposuction and, 271

Salesperson versus scientist, external ultrasonic-assisted liposuction and, 278-279

Salicylates, 110

Saline

lactate and, 193-194

normal, 69, 188, 191, 191t

SAP; see Superabsorbent powder

Saquinavir, 137

Scarpa’s fascia, 300, 301-305, 303-304, 318

Scars

abdominal, 258-259

hypertrophic, 259

indented, 47

keloid, 259

retracted, 47

Scheduling, 232

Scientist, salesperson versus, external ultrasonic-assisted liposuction and, 278-279

Scleroderma, 58

Second World Congress of Liposuction Surgery, 4

Secondary lymphedema, 80

Sedation

conscious, 205; see also Systemic anesthesia

heavy IV; see Systemic anesthesia

narcotics and, 230-231

tumescent facelift and, 388

Sedatives, 196-197, 202-204, 203, 205

Segmental anesthesia, 33

Seizures, 167

Seldane; see Terfenadine

Selective serotonin reuptake inhibitors (SSRIs), 131, 134-135, 136, 165, 265

Semicircular lipoatrophy, 58, 58

Semitumescent technique for liposuction, 34

Sensory hand, microcannular tumescent liposuction and, 253-254, 254

Sentinel event, 20

Sequential liposuction, 118

Sequestered lidocaine reservoir, 156-157

Serax; see Oxazepam

Seromas

internal ultrasonic-assisted liposuction and, 275

petite, 261

postoperative, 44, 45

Sertraline, 30, 122, 131, 132, 134, 136, 137, 154, 165, 171

Serzone; see Nefazodone

Sibi-placebo, 12

SIDS; see Sudden infant death syndrome

Sinus bradycardia, 167

Skaphepygia, tumescent liposuction of buttocks and, 395

Skin, irregularities in, microcannular tumescent liposuction and, 260-261

Skin excisions, 54, 55, 56, 389

Slow absorption toxicity of lidocaine, 164

Slow rate of infiltration, 224-225

Slow-release oral tablet, lidocaine and, 146

Small-volume liposuction, 29-30

SMAS; see Subcutaneous musculoaponeurotic system; superficial musculoaponeurotic system

Smelling salts, 50

Smoking

microcannular tumescent liposuction and, 265

thrombosis and, 70

Smoothness, microcannular tumescent liposuction and, 248

Snakebite, 104

Sodium bicarbonate, 7, 125-126, 128, 188, 189, 190, 191, 192, 230-231, 233

Sodium bisulfite, 167

Sodium channel blocking, lidocaine and, 127

Sodium chloride, 61, 188, 193

Sodium load, 193

Solute, 126

Solution composition, 126

Solutions, physiology of, 80

Solvents, 126, 190-194

Somnolence, lidocaine toxicity and, 165

Sophism, 18

Soreness

microcannular tumescent liposuction and, 261

postoperative, 52, 53, 53

Sound waves, ultrasonic-assisted liposuction and, 272

Spironolactone, 404

Spoke wheel deformity, microcannular tumescent liposuction and, 259

Sponges

absorptive, 282

compression, 282, 283, 286, 288, 289, 290, 292

sterile absorbent gauze, 250-251, 251, 254

Sporanox; see Itraconazole

Sputum traps, 243, 244

Squeeze, tactile, microcannular tumescent liposuction and, 258

SSRIs; see Selective serotonin reuptake inhibitors

Standard deviation, 27-28

Standards of care

for liposuction, 9-11

megaliposuction and, 117-118

Staphylococcal abscess, 98, 128

Starling’s law, 65

Static energy balance equation, 221

Statistical outlier, lidocaine and, 177

Statistical significance, 177

Steatopygia, tumescent liposuction of buttocks and, 395

Sterile absorbent gauze sponges, 250-251, 251

Sterilization of liposuction equipment, 94

Steroids, 92, 206, 404

Streptococcal necrotizing fasciitis, 93

Streptococcal toxic shock–like syndrome, 90, 93

Streptococci, group A, necrotizing fasciitis and, 90-91

Stretch, compression garments and, 292

Stroke of cannula, 243

Subcutaneous fascia, 218, 302

Subcutaneous fat

adipose tissue, 213-214, 214, 215

anatomy and histology of, 213-221

cellulite, 218-219, 219

effects of, on tumescent anesthesia, 220-221

fibrosis, 220

hierarchical architecture of, 214, 217-218, 218

histology of adipocyte, 214-215

layers of, 215-217, 216

tumescent liposuction of abdomen and, 300-302, 302, 303-304

tumescent liposuction of arms and, 427-431

tumescent liposuction of buttocks and, 392, 393

tumescent liposuction of chin, cheeks, and jowls and, 375-378

tumescent liposuction of lateral thighs and, 325, 327

tumescent liposuction of male breasts and, 404

tumescent liposuction of male flanks and, 352

tumescent liposuction of medial knee and, 367

tumescent liposuction of medial thighs and, 357

vascularity of fat, 215

Subcutaneous musculoaponeurotic system (SMAS), 375

Sublimaze; see Fentanyl

Subplatysmal fat pad, tumescent liposuction of chin, cheeks, and jowls and, 385

Sub-Scarpa’s fat, 301

Sudden infant death syndrome (SIDS), 48

Sulfonamides, 182

Superabsorbent compression pads, 320-321

Superabsorbent powder (SAP), 282, 320-321

Superficial irregularities, minor, 50

Superficial liposuction, 216

excessive, 43-45, 257, 257-258

microcannulas and, 239

Superficial musculoaponeurotic system (SMAS), 389

Superwet disseminated intravascular coagulation, 61

Superwet liposuction, 29, 34, 61-66, 103, 108

fluid volume and overload and, 61-63

and pulmonary edema, 61-66

third space and, 61

versus ultrasonic-assisted liposuction, 273

Supracostal abdominal fat pads, tumescent liposuction of abdomen and, 298

Supranatant fat, 117, 260

Surface area, pharmacokinetics and, 157-158

Surgeon, quality control and, 20

Surgeon anxiety, 231

Surgeon-anesthesiologist communication, 167

Surgeons’ lemma, 34

Surgical complications of liposuction, 69-70

Surgical defects, prevention of, microcannular tumescent liposuction and, 259

Surgical orders, 167-168

Surgical site complications, 46-48

Surgical technique of microcannular tumescent liposuction, 248-270

Surgical training, liposuction and, 17-18

Suspensory ligaments of Jacque, 325

Sutures

amplified liposuction edema syndrome and, 85

elimination of, 7

microcannulas and, 240

versus open drainage, 284, 289

postliposuction care and, 286, 289

tumescent liposuction of chin, cheeks, and jowls and, 384, 385

Swan-Ganz studies, 66

Syllogism, 19

Symmetry, assessment of, microcannular tumescent liposuction and, 258

Syncope, 233

at home, 50

liposuction, 49

vasovagal, 48-50

Synergistic hands, microcannular tumescent liposuction and, 253, 253-254

Synthroid; see Levo-thyroxine

Systemic anesthesia, 9, 39, 167, 205

anesthesia-related mortality risks and, 38-40

deaths attributable to, 39

definition of, 33

hypothermia and, 103

immediate and precipitant causes of death and, 37-38

inherent risks in, 34-36

and liposuction deaths, 32-33

versus local anesthesia, 33-34

methemoglobinemia and, 182

risks of, 32-42

safety of, 40

thrombosis and, 68

unique risks of, 36-37

T

T4; see Thyroxine

Tachycardia

epinephrine and, 189

perioperative, 53-54

thyroxine and, 204

Tactile squeeze, microcannular tumescent liposuction and, 258

Tanacetum parthenium, 112

Tangential septa, 218

Teamwork, 232

Tegretol; see Carbamazepine

Telephone calls as threshold, maximum safe dose of liposuction and, 117

Temperature elevation, 52

Temporary lumpiness, 50-51

Tenormin; see Atenolol

Tension pneumothorax, 36

Terbutaline, 198

Terfenadine, 135

Testing of microcannulas, 243-244

Testosterone, fibrosis and, 220

Theophylline, 137

Therapeutic surgical techniques, 9

Thermal relaxation time, internal ultrasonic-assisted liposuction and, 274

Thermal trauma

internal ultrasonic-assisted liposuction and, 273-275

thrombosis and, 69

tumescent liposuction of chin, cheeks, and jowls and, 384, 384

Thigh Aside, 333-334, 334, 363, 368

Thigh liposuction, circumferential, 69, 341, 341, 371

Thigh Midline, 329, 333-334, 334

Thighs

lateral; see Lateral thighs

medial; see Medial thighs

outer, tumescent liposuction of, 325

postliposuction edema and, 84

tumescent liposuction of, 322-323

Thin patients, 122

Thiopental, 136, 168, 182, 264

Third spacing

amplified liposuction edema syndrome and, 86

posttraumatic edema and, 284

superwet liposuction and, 61

Threshold of pain, 6

Thrombocytopenia, 109

Thromboembolic disease, microcannular tumescent liposuction and, 265

Thromboembolism, 67-78

platelet, ultrasonic-assisted liposuction and, 273

pulmonary, 67-78

Thrombomodulin, 71

Thrombophilia, 70-73

Thrombophlebitis, case studies of, 73, 74

Thrombosis, 67-78

deep venous, 36, 67-68, 75, 92, 261, 291

microvascular, internal ultrasonic-assisted liposuction and, 273

prevention of, 75

surgical complications and, 69-70

systemic anesthesia and, 36, 68

thrombophilia and, 70-73

Thromboxane, 111, 112

Thyroid hormones, 404

Thyroid medications, 204, 205, 265

Thyroxine (T4), 204, 205, 215

Ticarcillin-clavulanate, 93

Time efficiency, 232

Tissue immobilization, pain during infiltration and, 224

TIVA; see Total intravenous anesthesia

Tobramycin, 97

Tocopherols, 111

Toluidine, 181, 182

Topographic markings

microcannular tumescent liposuction and, 248-249, 249

tumescent liposuction of buttocks and, 395, 396

Topologic isomorphism, microcannular tumescent liposuction and, 248

Torricellian vacuum, 267

Total body clearance, 141-142

Total intravenous anesthesia (TIVA), 33

Total lipoatrophy, 58

Toxic shock syndrome (TSS), 89

Toxicity, lidocaine, 148-149, 149, 162-166

Toxicologic methodology, 122

Toxicology

clinical, 27-28

experimental, 27-28, 28

human, 28-29, 29t

Training

prerequisite, 16

residency, 16-17

surgical, 17-18

TRAM flap; see Transverse rectus abdominis myocutaneous flap

Trandate; see Labetalol

Transurethral resection of the prostate (TURP), 36, 194

Transverse rectus abdominis myocutaneous (TRAM) flap, 305

Trauma

dermal, tumescent liposuction of chin, cheeks, and jowls and, 390-391

liposuction, 114-116

thermal

thrombosis and, 69

tumescent liposuction of chin, cheeks, and jowls and, 384, 384

thrombosis and, 69

Triamcinolone, 7, 47, 190

Triazolam, 134, 136

Tricyclic antidepressants, 199, 265

Triiodothyronine, 205

Trimodal compression

breast, 291

tumescent liposuction of female breasts and, 421-423, 422, 424, 425

Triphasil, 70, 73

Trochanteric area, tumescent liposuction of, 325

Trochanteric pseudobulge, 251, 329, 329, 330

Troleandomycin, 135

True pain, 260

True tumescent anesthesia, 122-123

TSS; see Toxic shock syndrome

Tumescence, 226

Tumescent, definition of, 222

Tumescent anesthesia, true, 122-123

Tumescent facelift, 388-390, 389

two-stage, 372-391

Tumescent fluid and hemodilution, 62

Tumescent formulations, 187-195

caveats of, 187-188

fluid homeostasis and, 190-194

intravenous fluids, 194

lidocaine and epinephrine concentrations, 188-190, 188t

tumescent solvents and, 190-194

Tumescent hemostasis, 11, 235-236

Tumescent infiltration technique, 222-234

initiation of infiltration and, 225-227, 227

interpersonal skills and recommendations for, 231-232

local complications of, 232-233

preliminary considerations for, 222-224

rate of infiltration and, 224-225

technique for facial resurfacing, 229-231

volume of infiltration and, 227-229, 228, 228t

Tumescent liposuction, 3-8, 295-443; see also Liposuction

of abdomen, 297-324

anatomy and physiology of subcutaneous fat and, 213-221

of anterior thighs, 357-371

by area, 295-443

of arms, 427-439

of buttocks, 392-403

of cheeks, 372-391

of chin, 372-391

of female ankles, 440-443

of female back, 342-356

of female breasts, 413-426

of female hips, 342-356

of female legs, 440-443

formulations of, 187-195

fundamental aspects of, 211-293

history of, 3-8

infiltration technique of, 222-234

of jowls, 372-391

kinetic studies and models and, 142-145, 143t

of knees, 357-371

of lateral thighs, 325-341

lidocaine dose recommendations for, 121-122

of male breasts, 404-412

of male flanks, 342-356

of medial thighs, 357-371

microcannular; see Microcannular tumescent liposuction

microcannulas and, 235-247

pharmacokinetics of, 141-161

absorption, distribution, and elimination of lidocaine and, 145-155, 146, 147-148, 149, 150, 151, 152, 153, 155

drug bioavailability and, 155-156

mathematics of, 157-160

sequestered lidocaine reservoir and, 156-157

pharmacology of, 121-123

toxicologic methodology and, 122

true tumescent anesthesia and, 122-123

Tumescent local anesthesia, definition of, 33

Tumescent solvents, 190-194

Tumescent vasoconstriction, 63

Tummy tuck, tumescent liposuction of abdomen and, 299

“Turkey gobbler” appearance, liposuction of chin, cheeks, and jowls and, 381

TURP; see Transurethral resection of the prostate

Two-compartment model, lidocaine and, 143

Two-stage tumescent facelift, 372-391

Tyrosine, 198

U

UAL; see Ultrasonic-assisted liposuction

Ultrashort-acting barbiturate, 168

Ultrasonic-assisted liposuction (UAL), 271-280

of back, 350

biophysics of ultrasound and, 271-272

complications and conflicts of, 277-279

critique of, 271-280

external, 275-277, 276

internal, 272-275, 274, 275

safety and, 271

Ultrasonography, duplex, 67

Ultrasound, biophysics of, 271-272

Ultrasound liposuction; see Ultrasonic-assisted liposuction

Unconsciousness, 114

Undermining, tumescent facelift and, 389

Underreporting

of deaths, 38-39

reasons for, external ultrasonic-assisted liposuction and, 277-278

Unethical advertising, 14

United States Pharmacopeia (USP), 191

Upper abdomen, tumescent liposuction of, 298, 319

U.S. Food and Drug Administration; see Food and Drug Administration

User-dependent toxicity, bupivacaine and, 180

USP; see United States Pharmacopeia

V

Vaccine Adverse Event Reporting System, 49

Vacuum

applied to fat, liposuction aspirator and, 268

definition of, 267

Vacuum canister, liposuction aspirator and, 268

Vacuum pumps, 267, 268

Vacuum source, liposuction aspirator and, 266, 267

Vacuum-pump paradox, liposuction aspirator and, 267

Valium; see Diazepam

Vancomycin, 93

Varicella, 90

Vascular lacerations, 54, 54

Vascular structures, vulnerable, microcannular tumescent liposuction and, 259

Vascularity, lidocaine and, 151

Vasocompression, hydrostatic, 63

Vasoconstriction

acidotic, 65

hypoxic, 65

lidocaine and, 151, 151

ropivacaine and, 184

tumescent, 63

tumescent, 63

Vasodepressor syncope, 48

Vasovagal near-syncope, 49, 204

Vasovagal presyncope, 48

Vasovagal stimulation, 204

Vasovagal syncope, 48-50, 233

Velcro

tumescent liposuction of abdomen and, 321

tumescent liposuction of male breasts and, 411

Velocity of aperture translocation, 245

Venography, ascending, 67

Versed; see Midazolam

Vibratory sensations, intolerance to, 260

Viracept; see Nelfinavir

Viruses, 98

Vision problems, 233

Visken; see Pindolol

Vitamin E, 53, 54, 111

Vitamin K1, 109, 110

Vitamin K2, 109

Vitamin K deficiency, 109-110

Volume

of distribution, 123

pharmacokinetics and, 157-158

Voluntary dermal dystrophy, 56, 57

von Willebrand factor (vWF), 109

von Willebrand’s disease (vWD), 106, 109

vWF; see von Willebrand factor

W

W; see Watts

Waist, tumescent liposuction of, 342, 353

Waistline, tumescent liposuction of abdomen and, 297-298, 298, 299, 300, 301

Waistline fibrosis, tumescent liposuction of abdomen and, 298, 300

Waistline sulcus, tumescent liposuction of abdomen and, 297-298, 299, 301

Warfarin, 109-110, 136

Water reservoir, liposuction aspirator and, 268-269

Water-displacement method of measuring volume of breast, 418

Watts (W), ultrasonic-assisted liposuction and, 272

Weight reduction, liposuction and, 221

Wet technique, 3, 273

Willow bark, 112

Wine, red, 53, 54, 111-112

Withholding of knowledge, 13

Work

ultrasonic-assisted liposuction and, 272

vacuum pumps and, 268

Wrinkles, tumescent liposuction of chin, cheeks, and jowls and, 372-375

Written orders, 187

X

Xanax; see Alprazolam

Xylocaine; see Lidocaine

Y

Yaw, microcannular tumescent liposuction and, 255

Yield strength, compression garments and, 292

Youthfulness, fibrosis and, 220

Z

Zero-order absorption process, lidocaine and, 137, 145, 154

Zithromax; see Azithromycin

Zoloft; see Sertraline

Zyprexa; see Olanzapine

Page numbers in italics refer to illustrations; page numbers followed by t refer to tables.

Back To Top