LIPOSUCTION TEXTBOOK
The Tumescent Technique By Jeffrey A. Klein MD
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.