Power cannulas, local anesthesia keys to safer liposuction

Power cannulas basically use a reciprocating back-and-forth movement to make small tunnels in the adipose tissue, which, when compressed, cause the fat layer to thin out.

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

Results can additionally be improved when dermatologists have patients stand at the end of the procedure.

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

Complications and associated factors

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

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

The facility where liposuction is performed also plays a role in the occurrence of side effects, as fewer problems are seen in office-based liposuction than hospital-based surgeries. One study showed that 71 percent of malpractice suits originated in hospital-based procedures, whereas only 21 percent originated in office-based settings (Derm Surg. 1999;25(5):343-347).

Other factors linked with side effects include removal of large amounts of fat at one time and liposuction performed with multiple procedures over prolonged periods of time.

Unforeseen side effect

One unexpected side effect that Dr. Katz reports among power liposuction patients at his Juva Skin & Laser Center is the chance of a breast size increase. In a study of 73 patients, 34 percent reported a significant increase in breast size (Dermatol Surg. 2003;29:165-167).

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

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

"There are more androgenic receptors in the areas of the abdomen, hips and thighs, and when you remove them, you have a relative increase in the estrogenic receptors in the breast," Dr. Katz says.

For women who welcome the breast size increase, the side effect represents an additional perk from the procedure.

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

Disclosures: Dr. Katz reports no financial disclosures.